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Antiseptic treatment and dressings

The essential part of Lister's operating treatment was not the application of strong carbolic acid to the wound, although that required careful management to ensure the wound was sterilised, but the design of the dressing in such a manner to stop the ingress of airborne infection. This was often misunderstood, even during the period when he was explaining the procedure to fellow doctors whilst at Glasgow who were celebrating him as humanaties benefactor and it caused him considerable irritation and unhappiness later in life. They were confused by the initial application of the acid and the whole treatment, that led to the claim that Lister was advocating for the use of carbolic acid to prevent suppuration.

The disadvantages of the first primitive dressing consisting of lint soaked in carbolic acid, were soon apparent. The German creosote was also far from ideal as it was irritating to the skin causing ulceration and then suppuration that occasionally resulted in tissue necrosis. It was also almost insoluble in water. Lister began to look for another source of phenol. Lister discovered that Frederick Crace Calvert, an honorary chemistry professor from the Royal Manchester Institution was manufacturing small quantities of phenol at a much finer purity and managed to obtain some. The phenol was in the form of small white crystals which liquified at 80 °F (27 °C) and was readily soluble in a ratio of 1:20 parts of water and to any extent soluble in oil. The watery solution could be used in a lotion of any strength and be used for disinfection of wounds while the solution in oil that served as a reservoir of antiseptic seemed likely to provide a suitable dressing. Lister began to experiment with the phenol and produced a new dressing made of a putty that consisted of carbonate of lime mixed with phenol mixed with boiled linseed oil in a ratio of 1:4 or 1:6.

After the two failures, Lister has no clear experimental design to test to efficacy of carbolic acid. At that point he decided to only experiment on patients that presented with compound fractures. These are defined as open wounds where the fractured bone breaks through the skin, leading to extensive loss of blood. In 1865, industrial accidents often led to the patient being thrown to the ground, leading to dirt entering the wound that risked deep infection. By the time the patient saw the surgeon several hours later, suppuration had invariably had set in. In 1865, amputation was the standard treatment for compound fractures. Lister reasoned that he could experiment on the patient and if the treatment failed, perform the amputation to remove the limb and save the patients life. He believed this experimental model was both ethically and medically ideal.