Editing Joseph Lister (section)

===Antiseptic principle of the practice of surgery===
[[File:On the Antiseptic Principle of the Practice of Surgery.djvu|thumb|right|The widespread introduction of [[antiseptic|antiseptic surgical]] methods followed the publishing of Lister's ''[[Antiseptic Principle of the Practice of Surgery]]'' in 1867.]]
Within a few days of the publishing of the last part of the previous paper, Syme asked Lister to attend the British Medical Association meeting in Dublin on 9 August 1867.{{sfn|Godlee|1924|p=192}} Lister had some difficulty preparing a new paper, the seminal "On the Antiseptic Principle in the Practice of Surgery-*" Lister's second paper on antiseptic surgery.{{sfn|Godlee|1924|p=192}} It was later published in the [[British Medical Journal]] on 21 September 1867.{{sfn|Lister|1867a}}

Lister claimed that based on experiments on inflammation, the essential cause of suppuration in wounds was decomposition.{{sfn|Lawrence|Dixey|1992|p=166}} Several aspects of this claim need to be examined. Firstly, it was specific to wounds, as Lister had other views about suppuration elsewhere on the body. Secondly, he stipulated that decomposition was the "essential" cause of suppuration, i.e. not the only cause. Thirdly, decomposition was the cause of pus in wounds.{{sfn|Lawrence|Dixey|1992|p=166}} Lister's pronouncement is best described as that he had discovered that the only important cause of suppuration in inflamed wounds is decomposition. Lister was specifically referring to the pathology of pus formation in inflamed tissue, the essential cause of harm in the practice of surgery.{{sfn|Lawrence|Dixey|1992|p=166}} His appeal to the reader, in essence, to surgical consensus, was: "To prevent the occurrence of suppuration, with all its attendant risks, was an object manifestly desirable", and refers to the surgeon's dread of pus appearing in an inflamed wound.{{sfn|Lawrence|Dixey|1992|p=166}} Lister then made the wholly inaccurate statement that "...oxygen, which was universally regarded as the agent by which putrefaction was effected" compared to other sources.{{sfn|Lawrence|Dixey|1992|p=166}} Lister introduced the work of Pasteur, claiming that decomposition might be avoided by using a dressing that could destroy the minute organisms in the wound.{{sfn|Lawrence|Dixey|1992|p=167}} Lister decided to formulate his new surgical technique into a general principle.{{sfn|Lawrence|Dixey|1992|p=166}} He termed it the "antiseptic principle", thus linking its nomenclature to carbolic acid.{{sfn|Fisher|1977|p=149}} His principle was ''that all the local inflammatory mischief and general febrile disturbance which follow severe injuries are due to the irritation, and the reason for this was the carbolic acid induced suppuration but prevented decomposition, which was contrary to normal surgical treatment that saw suppuration as an indication that something was wrong, in Lister's case essentially that the antiseptic treatment had failed.[325] influence of decomposing blood or sloughs.''{{efn|Emphasis is present in the original}}{{sfn|Lawrence|Dixey|1992|p=167}}<!-- something is wrong with this sentence, please check it --> He stating a "great principle" – not that decomposition was the cause of disease in wounds, but that it was the only cause.{{sfn|Lawrence|Dixey|1992|p=167}}

The paper instructed surgeons to continue treatment even when suppuration appeared.{{sfn|Lawrence|Dixey|1992|p=167}} The reason for this was the carbolic acid-induced suppuration but prevented decomposition, which was contrary to normal surgical treatment, which saw suppuration as an indication that something was wrong, in Lister's case essentially that the antiseptic treatment had failed.{{sfn|Lawrence|Dixey|1992|p=167}} He noted that he felt it necessary to affirm on "pathological principles" that [[granulation tissue]] had no inherent tendency to form pus but only did so when "subjected to a preternatural tendency". He explained that carbolic acid and decomposing substances were similar, i.e., both caused suppuration by a chemical process but carbolic acid only acted on the surface of the tissue to which it was applied, but decomposition is a "self-propagating and self-aggravating poison". Decomposing tissue was a breeding ground for more decomposition that led to putrefaction in the tissue surrounding it.{{sfn|Lawrence|Dixey|1992|p=167}}

Lister argued that the pus formed by carbolic acid was acceptable as long as it was not accompanied by inflammation. In this respect, Lister's approach to normal or abnormal healing by granulation was the same as the average surgeon of the period: that healthy healing did not occur when inflammation was present.{{sfn|Lawrence|Dixey|1992|p=167}}

Lister paid particular attention to putrefaction. The last part of the paper stating that decomposing wounds were the cause of disease in hospitals, which was not an uncommon belief amongst the surgical community.{{sfn|Lawrence|Dixey|1992|p=168}} He described how the two large wards where he offered treatment were the unhealthiest in Glasgow and how since the application of antiseptics, "wounds and abscesses no longer poison the atmosphere with putrid exhalations" and the wards completely changed their character.{{sfn|Lawrence|Dixey|1992|p=168}} Not a single instance of pyaemia, hospital gangrene, or erysipelas had occurred in them since the new regime of antiseptics had begun.{{sfn|Lister|1867a|p=45}} However, Lister did not explain how the "putrid exhalations" led to fever.{{sfn|Lawrence|Dixey|1992|p=168}}