414  Standard  Suroical  Dressinos.        (Am  jour.  Pharm. 
\  September,  1911. 
STANDARD  SURGICAL  DRESSINGS.^ 
By  Frederick  B.  Kilmer. 
The  subject  of  standardization  of  surgical  dressings  was  a  pro- 
lific theme  of  discussion  during  a  period  beginning  in  1893.  A 
reference  to  the  journals  of  that  [ime  will  disclose  the  questions 
then  at  issue,  and  need  not  be  here  entered  into.  To  understand 
the  present  day  situation,  it  will  be  necessary  to  review  somewhat  the 
history  and  technic  of  surgical  practice. 
A  recent  writer,  Dr.  Robert  T.  Morris,  tersely  sums  up  the 
situation  as  follows : 
"  Surgery  is  now  in  the  dawn  of  the  fourth  era.  In  the  days 
of  Hippocrates  surgery  was  heroic.  That  represents  the  first  era. 
Then  came  Vesalius  and  the  anatomists,  and  we  had  the  second  or 
anatomic  era.  Pasteur  and  Lister  introduced  the  third,  or  the  patho- 
logic era.  While  this  third,  or  pathologic  era,  is  now  prevailing 
to  a  great  extent,  it  is  rapidly  passing  to  what  this  authority  named 
as  the  fourth  or  physiological  era." 
The  dominant  idea  of  this  fourth  era  is  to  prevent  the  develop- 
ment of  bacteria  in  wounds,  and  to  remove  the  products  of  infection 
by  means  of  the  art.  The  present  day  surgical  dressing  has  been 
evolved  out  of  the  Listerian  era.  Peculiar  to  the  Listerian  era, 
especially  in  its  opening  period,  was  the  use  of  antiseptics,  which 
were  applied  in  the  form  of  sprays,  irrigation,  washing  and  the  like. 
Lister  devised  a  series  of  dressings  made  by  combining  an  anti- 
septic, chiefly  carbolic  acid,  with  resins  and  parafiin,  somewhat 
resembling  a  cerate  or  plaster  mass ;  this  was  poured  while  hot  into 
meshes  of  lint,  afterwards  upon  gauze  cloth.  The  intention  of  this 
dressing  was  that  the  gauze  should  adhere  to  the  flesh  and  that 
the  vehicle  or  cloth  should  prevent  the  volatilization  of  the  carbolic 
acid.  Very  quickly  it  was  found  more  convenient  to  take  a  piece  of 
gauze  or  cotton  and  dip  it  into  antiseptic  solutions  such  as  were  then 
in  use. 
The  National  Formulary  of  this  period  contained  a  formula 
for  carbolized  gauze,  essentially  an  adhesive  mass  containing  carboHc 
acid.  The  Formulary  at  this  time  adopted  as  a  standard  of  fabric, 
a  market  gauze  known  as  Lehigh  E. 
It  is  perhaps  interesting  to  note  that  the  amount  and  strength 
^  Read  at  the  meeting  of  the  New  Jersey  Pharmaceutical  Association, 
June  14,  1911. 
