NA TURE 



[May 7, 1896 



and bandaging. Like many a new invention, Lister's 

 was also at first incomplete, and was attacked from many 

 sides, partly as to the principles on which it was based, 

 and partly on the grounds of the somewhat complicated 

 manipulations it involved. But, firmly persuaded of the 

 correctness of his theoretical views, he went on steadily 

 developing the details of his antiseptic methods, at first 

 in Glasgow, and later in Edinburgh and London. He 

 endeavoured to prevent the entrance of bacteria by 

 careful disinfection of every object which comes into 

 direct or indirect contact with the wound, more especially 

 of the operational area on the patient, of the hands of 

 the surgeon and his assistants, of the instruments, 

 sponges and absorbents. To the same end he intro- 

 duced the use of carbolic " spray " during the operation 

 itself and each subsequent change of dressings, and by 

 his ingeniously devised carbolised gauze protected the 

 wounds from further infection. Injuries or wounds 

 already infected were methodically disinfected by 2-5 to 5'o 

 per cent, solution of carbolic acid. Lister's typical dress- 

 ing, as it first came into more general use, was applied as 

 follows. A layer of waterproof silk, the "protective," 

 was placed over the wound to shield it from the direct 

 action of the irritant substances (carbolic acid, paraffin) 

 in the antiseptic dressing materials ; over this came some 

 eight or more layers of carbolised gauze or muslin, and 

 between the outer two of these a sheet of gutta-percha 

 tissue. The whole was then securely bound round with 

 carbolised gauze so as to effect as far as possible an air- 

 tight enclosure of the wound. This Listerian bandage, 

 as it soon came to be called, was both applied and 

 changed under a continuous carbolic spray. 



The results which followed the application of Lister's 

 methods, as used not only for operational but accidental 

 injuries, were at that time — 187310 1875— simply astound- 

 ing. We read with the deepest satisfaction the surgical 

 reports of those early days of the more general employ- 

 ment of Lister's antiseptic devices, and find them inspired 

 with proud feelings as of a mighty victory finally won 

 after prolonged and grievous defeats. No such curative 

 results had ever been attained up to that time. In the 

 self-same hospitals in which till then septicaemia in- 

 fection had kept the upper hand, the best results were 

 henceforth obtained, and the once-dreaded wound-fevers 

 became more and more a rarity. Operations were 

 now successful which had previously been nearly 

 always fatal. The ever-advancing scientific investiga- 

 tions of traumatic septicaemia, more particularly as 

 carried on by Koch and his pupils, and dealing with 

 its origin and nature from the point of view of the 

 deleterious action of bacteria, gave more and more a 

 sound scientific basis for Lister's antiseptic method and 

 removed all doubts as to the correctness of his views. 

 Most convincing proof of the part played by the bacteria 

 was provided by the inoculation of animals with pure 

 cultures of these various organisms ; and it was exactly 

 and solely these experiments that proved the all-important 

 fact that in reality all the troubles and dangers which 

 threaten a wound, and hence the life of a patient, are 

 determined by the deadly action of bacteria. This is the 

 fact on which modern surgical methods are based. And 

 in the face of this, people are still found who contest the 

 utility of experiments on animals ! It would be well if 

 NO. 1384, VOL. 54] 



the opponents of vivisection could correctly picture to 

 themselves the blessings for which the human race has 

 to thank Lister's antiseptic method, and their relation 

 to animal experiment. Did they but realise how many 

 human lives are now saved in comparison with the past, 

 surely they would be compelled to admit the use of vivi- 

 section. And, in the future also, scientific medicine 

 imperatively demands experiments on animals for its 

 investigations in the interest of mankind. 



When once surgeons had learnt complete mastery of 

 Listerian method, the results they obtained were pro- 

 gressively better. With the help of antiseptic precautions 

 they succeeded in operations on which they would pre- 

 viously have never dared to venture. With these splendid 

 results before their eyes, even those scattered opponents 

 of the system who had at its inception raised their voice 

 against it became silent, for they could no longer blind 

 themselves to the conviction that a new and brilliant era 

 was opening up for surgery. 



After Lister's antiseptic method had become the 

 common property of all surgeons, it was progressively 

 improved and simplified, more especially in Germany. 

 One of the most important facts for its further develop- 

 ment was the proof that wound infections are chiefly due 

 solely to actual contact with already infected objects, and 

 that any infection by the entry of microbes from the 

 neighbouring air rarely, if ever, occurs. Moreover, it 

 was shown with increasing certainty of proof that under 

 normal conditions the blood, lymph and tissues of 

 healthy animals are free from bacteria. Upon these 

 important facts the conclusion was based that it is 

 unnecessary to disinfect a fresh and uninfected wound, 

 such as a surgical incision, so long as every object which 

 comes into direct or indirect contact with the wound is 

 truly and perfectly sterilised or aseptic in accordance 

 with Listerian requirements. Hence nowadays operations 

 are performed with almost painfully precise sterilisation 

 of every object or instrument employed, as Lister first 

 taught us to do, while at the same time we limit as far as 

 possible the action of irritant antiseptics, such as carbolic 

 acid, and even advantageously use none at all, operating 

 with as little fluid as possible. So far as it may be 

 necessary the fluid now employed is a sterilised solution 

 of common salt, or else sterilised water. In the place, 

 then, of carrying out our operations under the former 

 strictly antiseptic precautions, we now operate aseptically. 

 But the fundamental idea on which Lister's antiseptic 

 method was based has remained unchanged, and will 

 always be the same. We deal with it in internal opera- 

 tions merely in a slightly diflferent way, in so far as we 

 omit the disinfection of wounds with such substances as 

 carbolic acid or corrosive sublimate, regarding their 

 action as unnecessary or even injurious. But all our 

 precautions against traumatic infection are taken with 

 the most minute care. The operational area on the 

 patient is carefully disinfected in accordance with Lister's 

 instructions, and is surrounded with aseptic linen com- 

 presses sterilised in steam at ioo^-l30' C. We employ 

 exact and definite methods to free our hands from 

 miciobes, and the instruments are sterilised by boiling in 

 I per cent, solution of sodium carbonate. All bandages 

 and the outer garments we wear are made aseptic by 

 prolonged exposure to steam at 100°- 130° C. in a specially 



