Antiseptic Surgery, or LISTERISM, is the system of treating surgical wounds introduced by Lord Lister (q.v.), based on his clear recognition of the fact that putrefactive processes (sepsis) are the chief danger which the surgeon has to combat in dealing with accidental and operation wounds. The system consists essentially in excluding, by the use of germicide substances, those microbes by which fermentative processes are induced, or in eradicating them from wounds to which they have gained access. In this way pyæmia, septicæmia, erysipelas, and gangrene, once the scourge of surgical hospitals, have in a short period of years become diseases of rare occurrence, and the reduction in hospital mortality has been very great. Carbolic acid dissolved in various menstrua, in the form of a steam spray, or impregnated in gauze or cotton-wool, was till recently the favourite antiseptic in surgical practice. Thymol, eucalyptus oil, boric and salicylic acids, and iodoform, are also in frequent use for the same purposes. In 1881 Professor Koch of Berlin drew attention to the much greater potency of perchloride of mercury (corrosive sublimate) as compared with other antiseptics, and his suggestion of its employment in a one pro mille aqueous solution has now been universally adopted with satisfactory results. Along with carbolic acid, which is still preferred for some parts of the method, this antiseptic is employed in destroying the infective particles or germs in the immediate neighbourhood of the wound. The wound itself is only treated with the germicide solution when the presence of germs within it is suspected, otherwise it is kept free from the irritative action of the lotion; but all objects approaching it must be rigorously purified if the danger of infection is to be safely avoided.
Method of Operating and of Dressing Operation-wounds.—The skin of the part, the hands of the operator and his assistants, and the instruments, are carefully purified with a watery solution (1 in 1000) of corrosive sublimate. Sponges, Ligatures, and Drainage-tubes (q.v.) are kept in carbolic acid solutions. The operation is conducted in an atmosphere impregnated with carbolic acid by means of a fine spray, usually produced by steam generated in a small boiler, or the wound and its neighbourhood are constantly irrigated by the corrosive sublimate solution during the continuance of the operation. When the operation is completed and the wound closed, it is covered with a layer of specially prepared oil-silk (protective), to prevent constant irritation by the antiseptic in the dressing. This consists of muslin impregnated with a mixture of carbolic acid, resin, and paraffin; it retains the carbolic acid at ordinary temperatures, but gives it off slowly at the temperature of the body, so that the dressing remains in an actively antiseptic condition for some days, till all its carbolic acid has evaporated. The first layer is wetted in carbolic acid solution (1 to 40) to destroy any germs adhering to its surface, and render it actively antiseptic at once. The remainder is applied dry, in order to soak up the discharge as it flows from the wound. This dressing may be in part or wholly replaced by fine cotton wadding impregnated with corrosive sublimite, or with salicylic acid, its elasticity rendering it a more comfortable application, and permitting its close adaptation to the contour of the body. The whole is fixed by bandages. The dressing is in general not changed till discharge becomes visible through it. When it is changed, similar precautions with regard to spray, purification of hands, &c. must be observed.
Treatment of Wounds not inflicted by the Surgeon.—They are washed out with a searching antiseptic solution, as watery solution of corrosive sublimate (1 in 500) or carbolic acid (1 in 20), and are thus at once thoroughly disinfected. They are then treated like operation-wounds. After 48 hours at furthest, it is not generally possible to eradicate the causes of putrefaction thoroughly.
Results.—If this treatment is thoroughly carried out: (1) no bacteria and no putrid smell are present in the discharge; (2) no pyæmia, septicæmia, hospital gangrene, or erysipelas results; and in general (3) no formation of pus takes place; (4) no pain is felt in the wound; (5) no fever follows.
Some of the most striking effects of this method on surgical practice are: (1) In many cases of injury, especially compound fractures and dislocations, a limb may now be preserved where amputation was formerly considered necessary. (2) Many operations are now fearlessly and safely performed, which formerly were either not attempted, or were frequently followed by disastrous results; especially operations on bones and joints, and opening of Chronic Abscesses, and Serous Membranes (q.v.). (3) Mortality from injuries and operations has been greatly diminished—e.g. the death-rate after major amputations (in 1864 and 1866) fell from 45 per cent. to 15 per cent. (1867–69) in Lister's wards in Glasgow after he introduced his method, and to about 12 per cent. (in 1871–77) in Edinburgh, when he had further developed it. Volkman of Halle was on the point of closing his wards in consequence of the prevalence of pyæmia and septicæmia. He tried Lister's method, and during the next five years the total mortality in his wards was less than 6 per cent. The tendency of late is, instead of antiseptic treatment, involving the disinfection of the wound with chemicals, to rely on Aseptic methods—sterilising instruments, cloths, hands, and skin to be operated on beforehand. See Cheyne's Antiseptic Surgery (1882), and Gerster's Rules (New York, 1888); also SURGERY, WOUNDS.