XX1V INTRODUCTION 
of the troubles after operations and injuries was in some way or other con- 
nected with the putrefaction of the blood and discharges in wounds. Putre- 
faction did not occur in subcutaneous injuries, or in wounds which healed by 
first intention, and in these there were no septic troubles, while conversely, as 
soon as putrefaction appeared, inflammation and other septic diseases followed. 
He concluded, therefore, that these complications were due to the formation of 
irritating materials in the discharges of the wounds as the result of putre- 
factive fermentation, and that the aim of treatment should be to get rid of the 
putrefactive process. 
In his Huxley Lecture? he refers to the treatment of hospital gangrene while 
he was house surgeon to Mr. Erichsen, and it is clear that even then he looked 
on the various diseases of wounds as essentially the result of putrefaction of the 
discharges. At that time the general teaching was that these putrefactive 
changes were the result of the action of the air, and more especially of the oxygen, 
on the organic fluids present in the wounds. He was never satisfied with this 
explanation ; like John Hunter, he was at an early period puzzled by a case of 
general surgical emphysema after fracture of the ribs with puncture of the lungs, 
for although air was present in the tissues and in contact with a large amount 
of blood, putrefaction and septic troubles nevertheless did not occur. This 
puzzle was constantly present in his mind until the solution was revealed by 
the researches of Pasteur. 
It is interesting to note in passing that even after the introduction of anti- 
septic surgery, some surgeons, unwilling to give up the oxygen theory, spoke of 
the antiseptic dressings as ‘occlusive’, their assumption being that the dressings 
excluded oxygen. Lister himself always recognised the hopelessness of any attempt 
to exclude oxygen, and never made any efforts in that direction. He had already, 
as has been pointed out, tried to mitigate the putrefactive process by scrupulous 
cleanliness, insisting on the washing of the hands between the dressings, a plenti- 
ful supply of towels in the wards, and the use of various substances which we 
now know to possess antiseptic properties. No appreciable improvement resulted, 
and it was perhaps fortunate for the development of antiseptic surgery that 
Lister’s wards were so insanitary that these attempts at cleanliness were of little 
avail. It is important to remember this fact, for the considerable improvement 
which in numerous instances followed on the recognition of the great importance 
of scrupulous cleanliness, led many surgeons to attribute the good results of 
antiseptic surgery entirely to simple cleanliness and not to the destruction of 
bacteria. 
At this time (the early ‘ sixties’ of the last century) Lister, then Professor 
** Vol. ti, p. 515. 
