Lord Lister. 



XL 



disturbance disappeared and very soon the abscess cavity was obliterated and 

 complete healing secured. This was the first occasion on which he ever made 

 use of a rubber drainage tube. On returning to Edinburgh, he repeated the 

 experiment in a case of amputation of the thigh, with the best possible 

 results. He immediately had rubber drainage tubes made by the manu- 

 facturers and ever afterwards used them constantly. Similar tubes had been 

 devised and used by Chassaignac early in the century for carrying off 

 accumulations of putrid pus from deep-seated situations ; but it is my 

 impression that the idea occurred to Lister quite independently. Whether 

 this be so or not, the use of them, when rendered aseptic, proved a valuable 

 addition to antiseptic treatment." 



Attention was also directed to the best methods of approximating the 

 edges of the skin so as to obtain primary union. Previously, when wounds 

 were stitched up, it was done in a very perfunctory manner, and the stitches 

 were generally pulled too tight and caused much irritation. Lister took 

 the greatest care to bring the edges together accurately without pinching 

 the skin under the stitches ; these stitches were termed " stitches of 

 co-aptation." When there was a moderate degree of tension two or three 

 stitches of fairly thick silver wire were first inserted so as to relieve the 

 tension (stitches of relaxation) and then the stitches of co-aptation were 

 introduced. When much skin was removed' he had a further arrangement 

 of " button stitches," pieces of lead placed on each side of the wound 

 connected by a piece of silver wire passing through the wound from one 

 side to the other and fastened to the lead plates. The silver wire was 

 pulled tight and caused marked approximation of the edges ; in these cases 

 the other two forms of stitches were also employed. The materials used 

 for stitches were silk, catgut, horse-hair, silkworm gut, and silver wire, 

 according to the circumstances of the case. 



In many operations on the extremities he also took steps to render the 

 limb bloodless before the operation. This was done by elevation of the 

 limb for three or four minutes so as to empty it of blood, and then a 

 tourniquet was applied at the upper part of the limb. At a later period 

 than that of which we are speaking, Esmarch introduced a method of obtaining 

 a bloodless limb by first bandaging it firmly from below upwards with an 

 elastic bandage, and then applying an elastic band just above the termination 

 of the bandage and removing the latter. There are various objections to the 

 use of the bandage, and Lister performed a number of experiments on animals 

 which showed that his method of elevating the limb was quite as satisfactory 

 as the bandage (see Lister's ' Collected Papers,' vol. I, p. 176) and free from 

 objection ; he, however, adopted Esmarch's elastic band in place of the 

 tourniquet. 



This was the state of matters when the author first began work as dresser 

 in Lister's wards in 1873. We had carbolic lotions, carbolic spray, and carbolic 

 dressings, protective and jaconet ; the vessels were tied with catgut, which was 

 cut short, the deeper parts of the wound were in some cases approximated with 



