1915] on Back to Lister 391 



operation may reach the surface from the sweat and sebaceous glands 

 of the patient. 



These differences between the two systems, as thus stated, do not 

 appear to be great, but they are important. " The little more, and 

 how much it is I and the little less, and how far away ! " For in one 

 there is simplicity and safety, in the other complication and risk. 

 Thus in the first place sterilizing by a chemical antiseptic involves no 

 special apparatus. It can be carried out in the humblest cottage. 

 Secondly, the use of an antiseptic during the operation does away 

 with the necessity of the surgeon and his assistants, young dressers, 

 or busy country doctors, or nurses being constantly on the qui vive 

 lest their simply aseptic garments should touch some unpurified thing 

 and then convey defilement to the wound. Thirdly, security is 

 provided for against secondary infection from the skin ; or secondary 

 infection through dressing, if the discharges should soak through to 

 the surface and thus supply a neutral track for the germs to travel 

 along. 



When I come to speak of results I must necessarily be vague. I 

 have, however, formed the opinion, from much observation and long 

 experience, that the standard as regards suppuration amongst aseptic 

 surgeons is lower than Lister's used to be. If a case " goes wrong," 

 as the common but mischievous expression is, it is looked upon as an 

 unavoidable accident, not as a disgrace. In recent years the term 

 " stitch abscess" has sprung into use. Lister said he never had stitch 

 abscesses. Forgive me for dwelling on them for a moment. The 

 name is applied to suppurations occurring about stitches, and they arise 

 in this way. Our skin is full of small glands for supplying greasy 

 material to the hairs. Organisms are present in these glands, and 

 any weakening of the tissues gives them a chance of doing mischief, 

 the commonest illustration of which is the ordinary boil that starts 

 from the fretting of a cuff or a collar. A tight stitch, or a not very 

 tight one, may do the same. But the risk is very much diminished 

 by thorough purification of the skin, which is much more effectually 

 obtained by following Lister's than by " aseptic " methods. It may 

 be granted that stitch abscesses do not often lead to serious mischief, 

 but they often cause troublesome suppuration in the wound itself and 

 involve delay, and the removal of important deep stitches, which 

 were intended to be permanent. This risk is also lessened hj using 

 an antiseptic as opposed to an aseptic dressing. I confess I have 

 never been able to understand the objection to an antiseptic 

 gauze dressing. If the wound heals by first intention, the antiseptic 

 substance cannot possibly act upon the raw^ surface of the wound. 

 Antiseptic gauze has all the advantages of sterilized gauze except 

 that it is slightly more expensive and has none of its disadvantages ; 

 in fact, I am confident that it has only been discarded on purely 

 theoretical grounds. 



To what extent, then, should we return ? I would not urge the 



