Lord Lister. 



in 



state of matters is quite different. Lister came to the conclusion that if only 

 he could prevent the putrefaction of the discharges in the wound, no suppura- 

 tion would occur and the wound would follow the same course as a sub- 

 cutaneous injury. 



Here, however, he came up against a dead wall ; what it was that led to 

 this putrefaction was unknown. It was evident that it had something to do 

 with the exposure of the wound to external agencies, and the general opinion 

 at that time was that it was due to the access of the air and especially of the 

 oxygen in the air. But he had long before satisfied himself that it could not 

 be the air itself, or any of the gases that composed it, because in certain 

 subcutaneous injuries, for example in some fractures of the ribs where the 

 lung was punctured, air might be present in the tissues in large quantity and 

 in contact with effused blood and serum, and nevertheless no inflammation or 

 suppuration or decomposition took place. Hence the conclusion he came to 

 was that it was not the air itself, but something which was conveyed by the 

 air, which caused the trouble, and in former times this something was spoken 

 of as a miasm. It will thus be seen that he had advanced a long way towards 

 the solution of the problem which was occupying his mind, and that all that 

 was wanting was the discovery of what it was that, carried by the air or 

 present in it, entered the wound from without and set up decomposition 

 and irritation and the various troubles which, in his opinion, resulted 

 therefrom. 



During these early years in Glasgow he tried in all sorts of ways to prevent 

 this decomposition of the fluids in the wounds. He paid attention more 

 especially to personal cleanliness, which he carried out to such an extent that 

 his scrupulousness in that direction led to very sarcastic remarks being made 

 about him. At that time surgeons very often did not even wash their 

 hands after handling a suppurating case and before dressing the next patient, 

 and they were equally careless as to the cleansing of the instruments used ; 

 indeed nothing but superficial wiping of a knife or other instrument was 

 done before it was used again. Xot only were the surgeons careless in 

 this respect, but also the nurses and dressers, so that infection was unwittingly 

 carried from one case to another. One of the early innovations which Lister 

 made on taking up his work in Glasgow was to institute scrupulous cleanliness, 

 and to insist that the hands and instruments should be thoroughly washed 

 before handling a fresh case. His wards were, therefore, provided with 

 basins, water, and piles of towels, a thing quite unusual at that time. 



Lister also carried this matter further and tried to diminish the putrefaction 

 in the wounds by washing them thoroughly. For example, in the case of an 

 amputation, the limb would be held up and kettle after kettle of warm water 

 would be poured over the wound to wash away the pus and decomposing 

 material ; he also employed various deodorising substances, more especially 

 Condy's fluid. None of these plans, however, led to any noticeable diminution 

 in the frequency of septic diseases, and it became evident that something 

 more was needed. The use of deodorising materials had also been tried by 



