1915] on Back to Lister 389 



under peculiarly favourable conditions as regards asepsis. They were 

 supposed to use only mechanical means in striving after cleanliness — 

 washings and scrubbings and so forth, which do, of course, remove 

 the deadliest form of danger, particulate dirt. But even these 

 surgeons, or some of them, used to employ freely the most potent 

 of all antiseptics, heat. They boiled their instruments and boiled 

 the water with which they washed out the peritoneal cavity, and 

 some were in the habit of using a pretty powerful antiseptic, sul- 

 phurous acid, for purifying those most dangerous things, sponges. 



Let us now watch an aseptic surgeon at work. Somewhere in 

 the background there must be a very large sterilizer for superheating 

 overalls, caps, veils, towels, dressings, and bandages ; also a boiler 

 for boiling instruments, and an unlimited supply of boiled (he calls 

 it sterilized) water and normal salt solution. 



He spends a long time in scrubbing his hands in soap and water, 

 and probably in spirit of wine, which is an antiseptic ; he then puts 

 on his sterilized overall, cap, veil, and indiarubber gloves. Thus, 

 converted from a dangerous into a harmless character, he ought 

 never to touch any contaminated object. But it is to be feared that 

 he sometimes forgets the meaning of his vestures : that he \^Tongly 

 looks upon them as armour, and, inspired by this confidence, he 

 touches the unclean thing, and then puts his fingers into the 

 wound. 



One may be forgiven a passing smile at the unreasoning way in 

 which these details are followed out. Surgeons dress themselves up 

 like white-robed priests to examine the external ear, or to explore 

 those parts of the body that no process on earth can render even 

 approximately aseptic. 



But to return to our aseptic operation. The instruments, having 

 been boiled, are commonly placed in a tray containing boiled water. 

 Why I have never been able to discover. They would be equally 

 safe if used dry. Probably it is only an imitation of Lister's plan of 

 sterilizing his instruments in a tray of carbolic-acid lotion. 



The patient's skin is almost always purified by a chemical anti- 

 septic, sometimes alcohol, but now usually tincture of iodine. The 

 part to be operated on is then surrounded by superheated dry towels, 

 and the operation proceeds. Superheated swabs have replaced 

 marine sponges. No antiseptic is applied to the wound. Plain 

 boiled water or boiled saline solution is used for washing away clots ; 

 preferably saline solution, because it does not interfere with the 

 living cells by osmosis as plain water does. 



When the operation is over, a dressing of superheated gauze and 

 wool is fixed l)y a superheated bandage or by plaster. This, of 

 course, only acts as a mechanical filter of dust, but it is now looked 

 upon with reverence, as if it had some other special virtue, and you 

 may see it applied with extraordinary precautions to septic suppu- 

 rating wounds and kept on for twenty-four hours, regardless of the 



