74 OPERATIVE TECHNIQUE. 



some drawbacks, such as the minuteness of detail required, the time 

 demanded for its appKcation, its high price, and the dangers resulting 

 from the poisonous nature of the antiseptic employed — carbolic acid. 

 While, therefore, respecting the great principles laid down by the 

 inventor, surgeons set to work to perfect and especially to simplify it. 

 Carbolic acid was replaced by salicylic and thymic acids, by chloride 

 of zinc, subnitrate of bismuth, corrosive sublimate, and iodoform. 

 For carbolised gauze was substituted ordinary tarlatan preserved in 

 dilute carbolic solution until the moment of use, or muslin kept for 

 a week in strong carbolic solution. For drainage purposes tubes 

 of decalcified bone were suggested, because they became absorbed, 

 irritated the tissues little, and necessitated less frequent renewals of 

 the dressing. The protective was shown to be useless, and drainage 

 was suppressed except when immediate union appeared uncertain. 

 The technique of dressing, the antiseptics, and the strength of solutions 

 have been varied infinitely. 



Believing that the principal point was to prevent atmospheric 

 germs gaining access to the wound, Guerin paid less attention to dis- 

 infecting hands, instruments, and dressings, and his good results were in 

 a large measure due to scrupulous observance of cleanliness, and to the 

 habit he had formed of thoroughly washing the hands and cleansing 

 the region of operation and its neighbourhood with soap and cam- 

 phorated alcohol before operation. 



Lister's method was more certain, but also had imperfections and 

 shortcomings. The success which attended the introduction of 

 antiseptics was certainly not due to carbolic acid alone. The anti- 

 septic was credited with greater bactericidal powers than it possessed. 

 The belief in its abilit}- to rapidly and completely disinfect instruments, 

 hands, and the region of operation was exaggerated. In Lister's, as in 

 Guerin's practice, the most important factor was the rigorous cleanli- 

 ness of the hands, of the instruments, and of the dressings. Antiseptic 

 treatment of wounds might never have survived had not observance 

 of cleanliness largely assisted it. 



To protect wounds from the action of atmospheric germs was the 

 chief preoccupation alike of Lister and of Guerin. Numerous 

 observers, however, have shown that infection is almost alwaj-s 

 produced by the hands of the operator or his assistant ; by the instru- 

 ments, dressings, or liquids employed ; not by atmospheric germs. 

 Contrary to the belief generally held when antisepsis was introduced, 

 entrance of air is little to be feared, and atmospheric germs, formerly 

 regarded as so formidable, can almost be left out of account. Those 

 which fall into a wound are generally destroyed by the phagoc}'tes. 



