Aprit 8, 1915] 
NATURE 
163 

I said it was unpleasant for all. There were some 
surgeons to whom it was positively poisonous. 
Amongst these was a friend of Lister’s, Thomas 
Keith, the ovariotomist, whose field of operation was, 
of course, the peritoneal cavity. In pre-antiseptic 
days he had obtained results that had astonished the 
world, by dint of great dexterity, devoted personal 
attention, and scrupulous regard to cleanliness. His 
success tried the faith of some, but not of Lister, who 
was aware of the specially high vitality of the peri- 
toneum, and of other anatomical and physiological 
peculiarities which diminish the chance of survival of 
germs, but which are too technical for discussion 
here. 
Keith’s success was so great that he hesitated to 
adopt rigorous antiseptic methods, and Lister at first 
dissuaded him from doing so, fearing that carbolic 
acid might dangerously interfere with the vitality of 
the peritoneum. Besides, at that time he did not fully 
trust the efficacy of the spray. Keith did, however, 
for a time use all Lister’s methods, including the 
spray; but this seriously interfered with his health, so 
he abandoned it, and yet, when he gave it up, 
his results continued to be as good as when he was 
using it. 
The germicidal powers of the peritoneum are 
great, but they are only in degree greater than those 
of muscle, fat, and other tissues. And when it was 
found that other surgeons, some of them keen dis- 
ciples, were absolutely forced to give up the spray, 
or give up surgery, and that, when they chose the 
former alternative, their results were no worse than 
before, Lister at last came to the conclusion that the 
spray was unnecessary, even if it had really made an 
antiseptic atmosphere, but, as I said before, he now 
saw that this was impossible. The spray was really 
only a convenient, unconscious, automatic irrigator. 
It killed germs on the wound, not in the air, and as 
such had been very useful during the time when the 
lesson was being gradually learned that every surgical 
operation, every surgical dressing, is, in fact, a com- 
plicated bacteriological experiment. 
The mitigation of the strength of the lotion and the 
abandonment of the spray seemed to some like lower- 
ing the standard. But it was not so. It was not so 
because the principle remained unshaken, namely, that 
as organisms are the cause of putrefaction they must 
be excluded from a wound, or if they had gained 
access to it they must be destroyed or prevented from 
growing. Two changes of method had indeed been 
introduced :—weaker antiseptics were employed be- 
cause greater respect was paid to the defensive powers 
of the body, and the spray was given up because 
opinion had altered with regard to the importance of 
aerial attacks. Aircraft came to be disregarded, 
while it was seen that what may be compared to 
land and water attacks were far more dangerous. 
The germs on the skin of the patient, the dirt on 
the hands of the surgeon, the unpurified sponge, 
the dried clot on a badly cleaned instrument; these 
were the dreadnoughts and submarines; these were 
the sappers and miners, the howitzers, and hand- 
grenades that really decided the fate of the campaign. 
Thus it became obvious that the precautions taken 
against such sources of danger, which, though they 
were adopted from the first, had been overshadowed 
by the attention devoted to the air-raids, were really 
of far more vital importance; and much ingenuity was 
thenceforward devoted to devising means for purifying 
the skin by mechanical or chemical means, to invent- 
ing gloves which would not impair the sense of touch, 
and also to proving that there was a radical difference 
between aseptic and antiseptic surgery. 
We now come to the question of what is meant by 
NOW2e70, VOL. 95] 
aseptic as opposed to antiseptic surgery. Aseptic is 
no new word. Lister employed it quite early in his 
writings, and, though it is plain to see why he called 
his system antiseptic, it is almost to be regretted that 
he did not call it aseptic. It would have prevented 
the confusing suggestion that, as Hunter and others 
had spoken of and used antiseptics, his system was 
nothing new, and perhaps it might have saved us 
from the still more confusing suggestion that there 
is some fundamental antagonism between aseptic and 
antiseptic treatment, though they are really the same. 
Those who call themselves aseptic surgeons main- 
tain that they do not employ chemical antiseptic 
agencies. The idea started amongst the gynaecologists 
who, as has been shown, were working under pecu- 
liarly favourable conditions as regards asepsis. They 
were supposed to use only mechanical means in striv- 
ing after cleanliness—washings and scrubbings and so 
forth, which do, of course, remove the deadliest form 
of danger, particulate dirt. But even these surgeons, 
or some of them, used to employ freely the most 
potent of all antiseptics, heat. They boiled their in- 
struments and boiled the water with which they 
washed out the peritoneal cavity, and some were in 
the habit of using a pretty powerful antiseptic, sulphur- 
ous acid for purifying those most dangerous things, 
sponges. 
Let us now watch an aseptic surgeon at work. 
Somewhere in the background there must be a very 
large steriliser for superheating overalls, caps, veils, 
towels, dressings, and bandages; also a boiler for 
' boiling instruments, and an unlimited supply of boiled 
(he calls it sterilised) water and normal salt solution. 
He spends a long time in scrubbing his hands in 
soap and water, and probably in spirit of wine, which 
is an antiseptic; he then puts on his sterilised overall, 
cap, veil, and india-rubber gloves. Thus, converted 
from a dangerous into a harmless character, he ought 
never to touch any contaminated object. But it is to 
be feared that he sometimes forgets the meaning of his 
vestures : that he wrongly looks upon them as armour, 
and, inspired by this confidence, he touches the unclean 
thing, and then puts his fingers into the wound. 
One may be forgiven a passing smile at the un- 
reasoning way in which these details are followed out. 
Surgeons dress themselves up like white-robed priests 
to examine the external ear, or to explore those parts 
of the body that no process on earth can render even 
approximately aseptic. 
But to return to our aseptic operation. The instru- 
ments, having been boiled, are commonly placed in a 
tray containing boiled water. Why I have never 
been able to discover. They would be equally safe 
if used dry. Probably it is only an imitation of 
Lister’s plan of sterilising his instruments in a tray 
of carbolic acid lotion. 
The patient’s skin is almost always purified by a 
chemical antiseptic, sometimes alcohol, but now 
usually tincture of iodine. The part to be operated 
on is then surrounded by superheated dry towels, and 
the operation proceeds. Superheated swabs have re- 
placed marine sponges. No antiseptic is applied to 
the wound. Plain boiled water or boiled saline solu- 
tion is used for washing away clots; preferably saline 
solution, because it does not interfere with the living 
cells by osmosis as plain water does. 
When the operation is over, a dressing of super- 
heated gauze and wool is fixed by a superheated 
bandage or by plaister. This, of course, only acts as 
a mechanical filter of dust, but it is now looked upon 
with reverence, as if it had some other special virtue, 
and you may see it applied with extraordinary pre- 
cautions to septic suppurating wounds and kept on 
| for twenty-four hours, regardless of the fact that it 

