Scientific worthies : [No.] 29, Sir Joseph Lister / [Hermann Tillmanns].
- Hermann Tillmanns
- Date:
- [1896]
Licence: Public Domain Mark
Credit: Scientific worthies : [No.] 29, Sir Joseph Lister / [Hermann Tillmanns]. Source: Wellcome Collection.
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![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. Lie 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 carbolisecl 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—1873 to 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 septicaemic 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 septicasmia, 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- j 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 different 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°-i3o° C. We employ exact and definite methods to free our hands from microbes, and the instruments are sterilised by boiling in 1 per cent, solution of sodium carbonate. All bandages and the outer garments we wear are made aseptic by prolonged exposure to steam at ioo°-i30° C. in a specially](https://iiif.wellcomecollection.org/image/b30592069_0002.jp2/full/800%2C/0/default.jpg)
