388 Sir Rickman John Godlee [March 12, 



were absolutely forced to give up the spray, or give up surgery, and 

 that, when they chose the former alternative, their results were no 

 worse than before, Lister at last came to the conclusion that the 

 spray was unnecessary, even if it had really made an antiseptic 

 atmosphere ; but, as I said before, he now saw that this was impossible. 

 The spray was really only a convenient, nnconscious, automatic 

 irrigator. It killed germs on the wound, not in the air, and as such 

 had been very useful during the time when the lesson was being 

 gradually learned that every surgical operation, every surgical 

 dressing, is, in fact, a complicated bacteriological experiment. 



The mitigation of the strength of the lotion and the abandonment 

 of the spray seemed to some like lowering the standard. But it was 

 not so. It was not so because the principle remained unshaken, 

 namely, that as organisms are the cause of putrefaction they must he 

 excluded from a wound, or if they had gained access to it they must 

 be destroyed or prevented from growing. Two changes of method 

 had indeed been introduced : weaker antiseptics were employed 

 because greater respect was paid to the defensive powers of the body, 

 and the spray was given up because opinion had altered in regard to 

 the importance of aerial attacks. Aircraft came to be disregarded 

 while it was seen that what may be compared to land and water 

 attacks were far more dangerous. The germs on the skin of the 

 patient, the dirt on the hands of the surgeon, the unpurified sponge, 

 the dried clot on a badly cleaned instrument — these were the dread- 

 noughts and submarines ; these were the sappers and miners, the 

 howitzers and hand-grenades that really decided the fate of the 

 campaign. Thus it became obvious that the precautions taken against 

 such sources of danger, which, though they Avere adopted from the 

 first, liad been overshadowed by the attention devoted to the air-raids, 

 were really of far more vital importance ; and much ingenuity was 

 thenceforward devoted to devising means for purifying the skin by 

 mechanical or chemical means, to inventing gloves which would not 

 impair the sense of touch, and also to proving that there was a radical 

 difference between aseptic and antiseptic surgery. 



We now come to the question of what is meant by aseptic as 

 opposed to antiseptic surgery. Aseptic is no new word. Lister 

 employed it quite early in his writings, and, though it is plain to see 

 why he called his system antiseptic, it is almost to be regretted that 

 he did not call it aseptic. It would have prevented the confusing 

 suggestion that, as Hunter and others had spoken of and used 

 antiseptics, his system was nothing new, and perhaps it might have 

 saved us from the still more confusing suggestion that there is some 

 fundamental antagonism between aseptic and antiseptic treatment, 

 though they are really the same. 



Those who call themselves aseptic surgeons maintain that they 

 do not employ chemical antiseptic agencies. The idea started 

 amongst the gynecologists who, as has been shown, were working 



