Antisepsis

Antisepsis is the use of chemicals to kill or inhibit microorganisms in a wound, on the skin, or on instruments and dressings, so that infection does not take hold. It is different from asepsis, which aims to keep germs out of an operation in the first place, with heat-sterilised instruments, gowns and gloves. Modern surgery uses both.

Ancient physicians washed wounds with wine or vinegar and dressed them with honey or pitch. They had no concept of germs. Any explanation of why some of this helped is modern, not theirs.

In 1847 Ignaz Semmelweis, in Vienna, had doctors wash their hands in a chlorinated lime solution, and deaths from childbed fever on his ward fell. In 1867 Joseph Lister, in Glasgow, published an antiseptic method built on Louis Pasteur's work on microorganisms, using carbolic acid on wounds, dressings and instruments. By the end of the century, sterilising by heat was replacing much of the chemical approach.

1. Before the operation. Instruments, the surgeon's hands and the patient's skin were washed in antiseptic solution.
2. During it. Lister applied carbolic acid to the wound and, for a time, used a carbolic spray in the air of the operating room. He later gave up the spray.
3. Afterwards. Dressings soaked in antiseptic covered the wound and were changed with the same care.

The First World War tested the method hard. Shell fragments drove soil, cloth and manure into the body. Surgeons cut away dead tissue and irrigated wounds; the Carrel-Dakin method, introduced in 1915, flushed them repeatedly with a dilute hypochlorite solution.

• Halifax, December 1917. Capt. Frederick Tooke, a Montreal eye surgeon, wrote that nearly every face wound he saw was already septic. Among his own patients he credited ordinary laundry soap and argyrol, a silver-based antiseptic then common in eye care, for having only one infection.