xhi INTRODUCTION 
dry, and of indicating that the dressing had been uniformly charged. The use 
of this insoluble and non-volatile antiseptic allowed the macintosh covering to 
be dispensed with, and thus the discharges could dry up and the gauze became 
a dry dressing. In place of macintosh, a mass of antiseptic wool (double cyanide 
or salicylic) was applied outside, so as to add to the thickness of the antiseptic 
material through which the discharge had to pass. 
Lister, as Cameron has pointed out,’ was probably the first to use a dressing 
sterilized by heat, and not containing any antiseptic substance. This he did while 
still Professor in Edinburgh, and the material used for the purpose was absorbent 
cotton-wool. He did not, however, persevere in the practice, because he felt 
that it could only be safely adopted in such cases as furnished a comparatively 
small amount of discharge, for if the discharge came through the dressing without 
having acquired any antiseptic material in its passage, there was nothing to 
prevent putrefaction spreading into the wound. Hence in cases in which there 
was a considerable amount of discharge, it was necessary to change the dressings 
very frequently ; and further, the successful employment of sterilized materials 
not containing antiseptics was a much more difficult and complicated matter 
than the use of antiseptic dressings, and implied considerable practical experience 
in bacteriological work. He therefore preferred to retain the use of antiseptics 
judiciously chosen and carefully used, so that, while their germicidal influence 
was retained, an irritating effect was avoided. 
By the time he ceased active work as a surgeon, he had arrived at a method 
of wound treatment in which the maximum amount of protection against 
bacterial invasion was secured with a minimum amount of irritation to the wound. 
The result was that the frequent dressings formerly employed were given up, 
and usually one dressing, or at most two, sufficed for a clean case. At the same 
time also the irritation of the wound had been so much reduced that, in a great 
majority of cases, there was no necessity for drainage; in fact, his ideal of 
a subcutaneous injury had been more or less attained. 
GENERAL SURGICAL, ACTIVITY 
Apart from the surgical improvements directly resulting from the preven- 
tion of sepsis, Lister published various articles on other surgical subjects. 
Attention may especially be directed to the article on excision of the wrist, 
and to the essays on amputation and anaesthetics * written for Holmes’s System 
of Surgery. The article on amputation differs from other articles on the same 
subject written at that date, in that it presents the reader with the principles 
* loc. cit, Vols is sp. At, * Vok 4i;, px 375% Vole 15. ps 0356 
