DEVELOPMENT OF ANTISEPSIS. j^ 



as dressings should be rendered thoroughly aseptic. The wound 

 having been cleansed of organisms was covered with a material 

 saturated with an antiseptic, and precautions taken to prevent accumu- 

 lation within it of the serosity exuded by all injured tissues. Lister 

 long preferred carbolic acid in solutions of i in 20 to i in 40. With 

 the strong solution he disinfected the instruments, sponges, and seat of 

 incision, and once the operation was over, the wound throughout. The 

 weaker solution he used for disinfecting the hands of the surgeon and 

 his assistants, and for washing out sponges during operation. To 

 prevent the wound being infected by atmospheric germs he introduced 

 an antiseptic spray, the vapour of which covered the entire area of 

 operation. After operation and before the spray had ceased acting all 

 bleeding was checked, vessels were ligatured with catgut, the threads 

 were cut short, and the lips of the wound brought together with 

 catgut sutures. Drainage-tubes were inserted to permit serosity, etc., 

 to escape, and the dressing was then applied. 



The region of operation was first covered with a strip of protective 

 consisting of oiled silk, the object being to prevent prolonged action of 

 the carbolic solution on the wound, as this proved too irritant. Over 

 the protective was applied carbolised gauze, doubled six or eight times, 

 the last two layers being separated by a layer of mackintosh to prevent 

 the carbolic acid evaporating, and to force the wound discharges to 

 traverse the entire thickness of the dressing before escaping. All these 

 materials were fixed in place by bandages of carbolised gauze. 



The action of the carbolic acid on the tissues produced an abundant 

 discharge. At the end of twenty-four to twenty-eight hours, therefore, 

 it was necessary to remove the dressing, examine the wound, the 

 condition of the sutures and draining-tube, if necessary to remove 

 the latter and replace them after thoroughly washing in strong 

 carbolic solution, and to apply a new dressing, everything being done 

 under the spray. Whenever pain or any marked elevation of tempera- 

 ture appeared to demand it, the wound was re-dressed with the same 

 precautions. Such was the method for surgical wounds in tissues 

 primarily free from infection. 



For all recent accidental wounds with irregular margins the applica- 

 tion of a dressing was preceded by a careful cleansing with 10 per 

 cent, carbolic solution. Suppurating wounds received more complex 

 preparation, being curetted and scrupulously cleansed with 10 per 

 cent, chloride of zinc solution. As in them the irritant action of 

 carbolic acid was not to be feared the protective was suppressed. 



Lister's method of dressing rapidly spread throughout all Continental 

 countries. Though it at once displaced the old methods, it possessed 



