ANTISEPIS AND ASEPSIS. 69 



infected by atmospheric germs he introduced an antiseptic spray, 

 the vapour of which covered the entire area of operation. All 

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

 were shortened, and the edges of the wound brought together with 

 catgut sutures. Rubber drain-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. 



Lister's method of dressing rapidly spread throughout all Conti- 

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

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

 the time demanded for its application, 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 founder of the method, surgeons set to 

 work to perfect and especially to simplify its application. Carbolic 

 acid was replaced by salicylic acid, thymol, zinc chloride, corrosive 

 sublimate, bismuth subnitrate, iodine, iodoform, and other anti- 

 septics. Ordinary tarlatan or muslin, soaked for a week in carbolic 

 solution, was substituted for carbolised gauze. The spray was dis- 

 continued as superfluous. Drainage tubes of decalcified bone were 

 suggested, because they became absorbed, irritated the tissues little, 

 and necessitated less frequent renewals of the dressing. The pro- 

 tective 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 

 disinfecting hands, instruments, and dressings, and his good results 

 were in a large measure due to the habit he had formed of thoroughly 

 washing the hands and cleansing the region of operation and its 

 neighbourhood with soap and camphorated alcohol before opera- 

 tion. In Lister's practice, the most important factor was the 

 rigorous cleanliness of the hands, of the instruments, and of the 



