390 Sir Rickman John Godlee [March 12, 



fact that it becomes a septic dressing immediately after application ; 

 that it is, in fact, nothing but a beautifully whitened sepulchre full, 

 if not of dead men's bones, at all events of all uncleanness. 



Some aseptic surgeons apply their principle to compound fractures 

 and rely solely on mechanical means for removing dirt from the 

 recesses of the wounds ; but most, I believe, continue to employ 

 powerful antiseptics for this purpose, and in this class of injury 

 follow Lister's instructions. 



I am not so ignorant or bigoted to suggest that so-called aseptic 

 surgery is a bad way of treating wounds. I know that first-rate 

 results are constantly obtained by means of it. But I maintain, and 

 here I am repeating what Lister has often said to me — 



1. That it is a troublesome and difficult process, involving for 

 successfully carrying it out an amount of parai^hernalia and an 

 amount of training that puts it almost beyond the reach of all except 

 hospital surgeons. 



2. That it is misleading to set it up in opposition to the antiseptic 

 system, because most of its advocates use chemical antiseptics for one 

 purpose or another, and all employ heat with great freedom. 



3. That infection of the skin and consequent later suppuration is 

 more likely to occur than if Lister's methods are followed. 



I will now describe one of Lister's operations in his last years at 

 King's College. He did not require a huge autoclave for sterilizing. 

 He did not wear gloves, but he purified his own hands and the skin 

 of the patient by a most potent antiseptic, which was called the strong 

 mixture. It consisted of 1 to 20 carbolic acid in 1 to 500 corrosive 

 sublimate. Lister, fortunately or unfortunately, had a very resisting 

 skin ; his hands, however, were usually rough, but he did not seem to 

 mind. This was not the case with many of his followers, who could 

 not, or would not, stand the discomfort strong lotions produced. 

 This has undoubtedly been one cause of secession. The instruments 

 and the sponges (he used marine sponges) had been long steeped in 

 strong carbolic acid lotion, but during the operation they were wrung 

 out of a very weak antiseptic solution. The towels placed round the 

 field of operation were also carbolized. No irrigation was carried out. 

 When the operation was complete, a dressing containing an antiseptic 

 substance was applied. 



His treatment of compound fractures was never modified after 

 the first few years. 



The differences you see are these : — 



1. Lister trusted to a potent chemical antiseptic, instead of to 

 mechanical cleansing and heat, for sterihzing the skin, instruments, 

 and the objects likely to be brought into contact with the wound. 



2. He applied a very weak antiseptic in small amount to the 

 wound itself, instead of boiled water or normal saline solution. 



3. Listead of plain gauze he used an antiseptic dressing, which 

 has the great advantage of acting upon any organisms that after the 



