NATURE 



451 



THURSDAY, FEBRUARY 17, 1910. 



ASEFTIC SURGERY. 

 The Collected Papers of Joseph, Baron Lister. Two 

 vols. Vol. i., pp. xliv+429; vol. ii., pp. vii + sSg. 

 (Oxford : Clarendon Press, 1909.) Price 2I. 2S. net. 



ALTHOUGH the numerous papers collected in 

 these two volumes were for the most part 

 written thirty or forty years ago, their interest is in 

 no way diminished to-day. Had the work of Lister 

 failed to meet with due appreciation, his friends and 

 pupils could have found no surer way of obtaining 

 this than by the simple collection of his writings into 

 these two volumes, and when one has said " this was 

 his work," no further comment or eulogium is pos- 

 sible. In the records of most epoch-making dis- 

 coveries one can read between the lines the character 

 of the discoverer. At first sight it would seem as if 

 the papers dealt with many and diverse subjects, but 

 more careful study shows a remarkable unity, each 

 one constituting a step towards the great work with 

 which the name of Lister will always be associated. 



With the exception of one or two isolated physio- 

 logical papers, Lister's work was directed towards 

 the elucidation of the meaning of the phenomena, 

 which followed injuries to living organisms, com- 

 monly summed up under the term inflammation. 

 Lister carried out a long series of experiments on the 

 coagulation of blood, which must ever remain as a 

 pattern of carefully planned and skilfully worked out 

 investigation ; and it was the relationship between 

 inflammation and vascular thrombosis which deter- 

 mined the point from which he attacked this problem. 

 Lister's observations had for their object the study 

 of blood coagulation in the vessels themselves, and 

 he attempted to discover why blood which coagulated 

 so readily when shed into a basin remained fluid in 

 contact with living or surviving tissues. His experi- 

 ments upon inflamed blood-vessels, conducted largely 

 upon the web of a frog's foot, in spite of the large 

 amount of work which has been done on this sub- 

 ject, require but little revision ; his experiments on 

 the pigmentary corpuscles in the frog form one of 

 the most brilliant demonstrations of the effect of 

 injury on the tissue cells as distinguished from 

 changes in the blood-vessels. 



Naturally, however, the greatest interest of Lister's 

 work centres around the papers on the use of anti- 

 septics. Surgery was not merely revolutionised — a 

 new science was born. His article on "A New- 

 Method of Treating Compound Fracture, Abscess, 

 &c., with Observations on the Conditions of Sup- 

 puration," gave the result of two years' experience 

 in the new methods. This paper was published in 

 1867, and reading it to-day it is diflicult to conceive 

 why theories so ably argued and so conclusively 

 proved failed to obtain immediate acceptance ; but 

 for many years Lister shared the common fate of 

 I reformers, and had to cope with misunderstanding 

 and misrepresentation. It is appalling to think that 

 in the great war of 1870 and 1871 no real attempt was 

 NO. 2103, VOL. 82] 



made to use the methods which Lister had employed 

 for four vears. The opposition, however, to Lister's 

 methods was not unique, for in the article on 

 anaesthetics in these volumes, written in 1861, seven- 

 teen years after the discovery of ether, Lister re- 

 marks 



'■ that such being the great benefits conferred by this 

 agent it is melancholy to reflect that in many parts 

 of Europe and even 'of the United Kingdom it is 

 either withheld altogether or given so scantily as to 

 be nearly useless." 



The "sepsis" which Lister was attacking was not 

 the sepsis which is known to-day, but actual putre- 

 faction of the discharges from wounds, to which were 

 attributed the septicaemia, pyaemia, and hospital 

 gangrene which were so prevalent before the anti- 

 septic era. It is hard to-day to think of being 

 familiar with 



"the faint sicklv smell commonly perceptible in 

 surgical wards under ordinary treatment, and still 

 more with the stench which prevails at the tmie of 

 the daily dressing"; 



but at that time it was a matter of common experi- 

 ence. The value of the antiseptic method could not 

 have been more severely tested than in the original 

 men's accident ward in Glasgow Infirmary, in which 

 it was first put in practice. Separated from this ward 

 by a passage 12 feet wide was another similar ward, 

 in which the death-rate from pyEemia and hospital 

 gangrene was so high that it attracted the attention 

 of the authorities even at this time. An excavation 

 was made, and it was found that on a level with the 

 floors of these two wards, with only the basement 

 area, 4 feet wide, intervening, was the uppermost tier 

 of a vast number of coffins, placed there during the 

 cholera epidemic of 1849. In addition to this, one 

 end of the surgical hospital abutted on the cathedral 

 burial yard, in which the revolting practice of pit 

 burial was carried out; that is to say, bodies of 

 paupers enclosed in rough coffins were placed in 

 large pits, which were loosely covered up with boards, 

 and only filled in with earth when the pit was full. 

 In such circumstances as these. Lister was able 

 to state, at the British Medical Association meeting m 

 DubHn,' that for the nine months in which the anti- 

 septic system had been in proper working order not 

 a single case of pyasmia, erysipelas, or hospital 

 gangrene had occurred in his ward, although these 

 diseases were exceptionally rife in the other wards 

 of the hospital. 



In the first attempts at antiseptic surgerjs German 

 creosote, a crude form of carbolic acid, was introduced 

 into the wound on a strip of lint, which was in 

 some cases left in position ; some fresh antiseptic was 

 mixed with the blood exuding from the wound so as 

 to form a crust, the carbolic acid in which was then 

 prevented from evaporating by a piece of block tin; 

 this was removed once or twice a day, and fresh car- 

 bolic acid painted on the crust to supply the place of 

 that which had evaporated. Crude and irritating^ as 

 this method was, its results were an enormous im- 

 provement on any that had been previously obtained. 

 Of the first eleven cases of compound fracture and 



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