Modern Surgical Dressings. 
By F. B. KILMER. 
Reprint from 
AMERICAN 
JOURNALOF PHARMACY. 
PUBLISHED BY AUTH0JUT7 OP THE 
PHILADELPHIA COLLEGE OP PHARMACY. 
HENRY TRIMBLE, PFi.M., Editor. 
Publishing Committee: 
HENBY N. BITTENH0B8E, 8AMUEL P.BADTLEB, -WALLACE PBOCJEB, J08EPH W. EHGLAND 
Vol. 69 
CONTENTS. 
The Murray Red Gum (Eucalyptus rostrata,*Schlecht) and it* Kino. By J. H. 
Maiden i 
Gelsemiutn. By L. E. Sayre .... 8 
The Commercial Sources of Licorice Root. By H. N. Rittenhosse ... ... 13 
Second Pan-American Medical Congress. By Joseph P. Remington 15 
Commercial Ferruginous Pills—Blaud’s Formula. By Wm. B. Thompson . . 17 
Adulterated Japan Wax. By Charles H. LaWall 18 
Petrolatum vs. Vaseline. By Louis Emanuel 31 
Modern Surgical Dressings. By F. B. Kilmer 24 
Chemical Analysis of the- Bark of Honey Locust, Gleditscbia triacanthos. By 
Louis P. Carstens, Ph.G. ' 40 
Alcohol as a Source of Error in the Titration of Alkaloids and Alkaloidal Resi- 
dues By Chas. Caspari, Jr 42 
A R6sum£ of Recurrent Topics. By William B. Thompson 44 
Cinchona Cultivation in Bengal . 47 
Recent Literature Relating to Pharmacy 48 
Editorial ' 5« 
Reviews and Bibliographical Notices 52 
Minutes of the Pharmaceutical Meeting . 53 
Classes of the Philadelphia College of Pharmacy 35 
JANUARY, 1897. 
No. 1 
Price, $3 per Annum, in advance. Issued In Monthly numbers of not less than 48 pages 
SINGLE NUMBERS, 25 CENTS. 
Address all papers for publication, etc., tc the Editor. 
All communications relating to subscriptions, advertisements, etc., to the Easiness MODERN SURGICAL DRESSINGS. 
F. B. Kilmer. 
The surgical dressings in use at the present time by such practi- 
tioners as keep pace with the advancement of the surgical art are 
the products of the practical application of scientific knowledge. 
They are the outcome of the modifications and amplification of pro- 
cedures that have been brought about in the evolution of surgical 
science. 
Dr. Wm. Pepper states that “ medicine and surgery have made 
more progress in the last twenty years than in the twenty centuries 
preceding.” This statement may also be applied to the surgical 
dressing. 
In the dawn of the present era of surgery, the teachings of Lister 
demanded that the dressings to be applied to a wound should be 
saturated with chemicals capable of killing germs “ within the 
wound or coming from without.” During this epoch antiseptics 
were empirically applied. A dressing that promised sure death to 
the microbe was in demand. In those days cloth was plastered 
with masses of pitch, paraffin fat and carbolic acid. The products 
were unclean—sticky, irritating and non-absorptive—directly the 
opposite to those in use at the present time. Crude as was this 
beginning, it contained the “ living spark of truth that illuminated 
the mysterious darkness which for centuries hovered over wound 
infection.” It brought blessings that “ have soothed and removed 
untold suffering and misery—have saved millions of lives. For this 
gift to surgery we are indebted to Sir Joseph Lister ”—Gerster. 
During the decades that have followed the time of which we 
speak, the forward progress of the principles of antisepsis has been 
continuous. 
The accurate scientific observations of bacteriology has determined 
the value of antiseptic substances, brought a knowledge of the na- 
ture of bacteria, their habits, their life, and shown their influence in 
the causation of wound infection. Such knowledge has given to 
the surgeon newer and better weapons than those first used in the 
combat against wound infection. The surgical dressing has always 
been to the front in the revolution and evolution of surgery. Caus- 
tic applications were early substituted for those which were mild, 
yet more patent. Many microbe-killers were found to be man- 2 
killers ; others were shown to be valueless. Power to absorb wound 
secretion and exclude infection was made an essential requirement 
for wound-dressing material. 
Prevention became both the watchword and the keystone of sur- 
gical technique. What is termed by Gerster “ the conscientious 
practice of thorough-going cleanliness,” was found possible of attain- 
ment by the use of antiseptics—“ angels of cleanliness.” Chemical 
sterilization has been combined with mechanical cleansing. Natural 
agents, as well as those instituted by the operator, have been called 
to the aid of the surgeon. In this transition, antisepsis has not 
been abandoned, but has developed into its higher form—asepsis. 
The antiseptic dressing has not been discarded, but has become 
aseptic. The terms antisepsis—asepsis, are not antagonistic; the 
one is not the antithesis of the other. “Asepsis is an exalted 
degree of cleanliness.” 
It is reached by the surgeon through the aid of antiseptics. The 
antiseptic agents employed to produce the condition of asepsis may 
be physical—heat, chemical—carbolic acid, etc., mechanical—wash- 
ing. These may be supplemented by measures which exclude all 
bacteria. The aim sought is a condition of freedom of septic 
material or micro-organisms—asepsis. 
The Fundamental Law.—In the transition of surgical practice, 
which we have noted, the great guiding principle first recognized by 
Lister has been strengthened, viz.: “ that the presence of certain 
kinds of bacteria is an essential condition of wound infection.” 
From this has been evolved the fundamental law that all materials 
which are to come in contact with the wound must be free from 
pathogenic organisms. To prepare a dressing which shall fulfil the 
requirements of this law would, at first glance, seem to be a simple 
undertaking. We find, however, that the task is not so easy of 
accomplishment when we note that over 150 species of bacteria are 
classed as pathogenic (6 pyogenic); in addition to this we have 
nearly 300 species of organisms classed as non-pathogenic for lack 
of information as to their disease producing power.1 
1 Buchner has shown that many of the common saprophytes classed as non- 
pathogenic, when injected under the skin, cause local abscess. I have recently 
witnessed serious results follow an experimental inoculation of a clean wound 
with mould spores supposed to be harmless. 3 
These bacteria are widely distributed. 
“ There is no well-defined dividing line between pathogenic and 
non-pathogenic bacteria.”—Sternberg. 
It would be impossible in the manipulation of dressing material 
to separate or remove harmless bacteria from those which may be 
virulent. Therefore, in its practical application the fulfillment of 
the law demands that surgical dressings shall be free from all forms 
of bacteria. 
All antiseptic agents do not possess the power to destroy or kill 
organisms. Therefore, dressings impregnated with antiseptics will 
not, of necessity, meet the demand. Hence, in the preparation 
of surgical dressings, the law must be construed to mean that, what- 
ever may be the material and whatever may be the methods by 
which it may be prepared, in order to meet the requirements of 
surgery, the fundamental principle governing its production must 
provide that it shall be free from all micro-organisms. 
The Infection of Dressings.—The materials which enter into sur- 
gical dressings, such as absorbent cotton, gauze, wool, are those 
which, in themselves, reach after, absorb and hold bacterial life. 
Every person and every object with which the dressing may come 
in contact in the course of its preparation, are liable to transfer to it 
infection. Infection through air is a possible factor. 
Micro-organisms are readily disseminated through the air by the 
medium of dust. The air of a crowded room is always laden with 
bacterial life. In hospitals, the air is infected through the dis- 
charges of patients. The air of a physician’s office cannot be kept 
free from infected dust. The dust on the drug-store counters, tables 
and shelves will always furnish a luxuriant bacterial garden. 
Wherever people move about, they must, of necessity, transfer soil 
and create dust. If they move from infected centres, as do the 
inmates and attendants at hospitals, the visitors to the doctor’s 
office or the patrons of a drug store, they spread infected dust. 
Dressings may also become infected through the water used in 
their preparation. The water used upon the dressings should 
always be that which is boiling or which has been thoroughly boiled. 
A greater source of infection arises from contact with the person 
who handles the dressing in the course of its preparation. Here 
the clothing of the operator is a possible germ carrier ; his body is 
swarming with bacteria numerous in species, in uncountable num- 4 
bers. Skin, hair and mucous membranes, even of persons who are 
healthy and of cleanly habits, furnish to bacteria a natural home for 
growth and multiplication. 
In catarrhal conditions, skin disease, or wherever there is an 
increase of secretions, the bacteria of the body increase both in kind 
and in number. These sources of infection require more than ordi- 
nary attention. 
Sterilization of the entire surface of the body is impossible. Yet 
we are confronted with the fact that the skin secretions, perspira- 
tion, dandruff from the hair, all mucous secretions, are a fruitful 
source of infectious particles, fatal to asepsis if by any chance they 
should be transferred to the dressing. To even touch an aseptic 
dressing with hands not disinfected, to touch with prepared hands 
the eyes, nose, mouth or clothing, and then touch a dressing, would 
mean that infection would surely follow. Such a procedure would 
be an unpardonable violation of surgical cleanliness, a crime against 
asepsis. We must further take into account that the objects within 
the room where dressings may be prepared, including the air, the 
walls, furniture, floors, the tables upon which the dressings are laid 
every piece of apparatus, every object of any nature that may come 
in contact with the dressing, may be the means of transference of 
germ life. If such objects happen to be of the nature of organic 
material or those which hold moisture, the more readily do they 
become carriers of infection. 
The maker of surgical dressings must have in mind, therefore? 
the materials of which the dressings are composed, that they are in 
their nature absorptive of infectious particles, that all objects con- 
nected with, all surrounding conditions, are sources through which 
infection may be carried to dressings during their handling and 
manipulation. 
The Disinfection of Dressings.—Whatever the term disinfection 
has been made to mean elsewhere, when applied to surgical dress- 
ings it can only mean one thing—destruction of all micro-organisms 
in or upon the material. This process presents many varying prob- 
lems. Bacteria show widely varying powers of resistance. Agents 
which destroy growing forms will not affect the vitality of their 
spores. The conditions of life and environment are all factors which 
must be taken into account in the disinfection of dressings. Thus, 
utensils and objects with smooth surfaces are readily disinfected, 5 
because any bacteria present will be found upon their outer surface ; 
but when bacteria are enclosed in a rock-like mass, as they are in 
dried dust particles, where we find them surrounded by an almost 
impenetrable fortress, in dried pus, sweat, in dried secretions or 
flesh tissue, these organisms are protected by a varnish-like coating. 
Bacteria, within the fibre of cotton or wool, are enclosed within a 
cellulose structure. Therefore, in the disinfection of cotton, wool, 
silk, sponge and catgut, we find that there is presented a varying 
problem with each material. Chemical reaction is also a factor in 
disinfection that has been long overlooked. In the disinfection of 
dressings the nature of the materials and their behavior toward the 
disinfecting agent must be taken into account. Thus cotton may 
be disinfected in a solution of soda, but wool thus treated would be 
destroyed. 
Wool may be disinfected in an acid solution, which, in turn, 
would destroy cotton. Catgut is affected by most chemicals; it is 
destroyed by moisture. Sponge tissue is affected by many chem- 
icals ; it is destroyed by moist heat. Oily substances are impene- 
trable by watery solutions. 
The sole universal disinfectant is fire. It destroys the infection 
and the infected material. It is applicable to the disinfection of 
asbestos dressings, which have recently been recommended for sur- 
gical purposes. There is no one method or agent which, under all 
circumstances, will meet all conditions. Generally, more than one 
agent and several methods of procedure must be used together or 
in succession. 
The writer has made a long series of investigations, having in 
view the possibility of disinfecting dressings with agents that would 
have no reaction with the material composing the dressing, that 
could be readily removed from the dressing, or, when allowed to re- 
main within the dressing material, would have no effect upon 
wound tissue. In these experiments, such agents as electricity, 
gases, vapors, friction and pressure were employed. 
The general method pursued was to infect fibres with a nutrient 
fluid containing bacteria, to then subject the infected fibres to the 
action of the disinfecting agent. The results may be briefly sum- 
marized. 
Electricity was not effective upon the organisms, except when 
electrolysis took place, as was the case when water or a solution 6 
of salts was the medium used in the transmission of electrical 
energy. 
Oxygen gas when under pressure had a germicidal effect, espe- 
cially so when the bacteria were in a moist state. Nascent oxygen 
was found to be a powerful germicide. Ozone gave similar results, 
as did oxygen. Carbon dioxide was found to be an inhibitant, 
but not a germicide. The gaseous oxides of nitrogen, except 
N20 were found to be powerful in their action upon bacteria, but 
destructive to dressing material and productive of great irritation 
upon inhalation. Sulphur dioxide was found to be germicidal in 
the presence of moisture, but inapplicable to many classes of the 
materials used in surgical dressings. Chlorine gas is a disinfectant, 
especially in its reactions which takes place in the bleaching pro- 
cess, namely, union with hydrogen, and consequent liberation of 
oxygen. 
The bleaching process, therefore, effectually destroys germ life. 
Iodine and bromine are energetic agents in the presence of mois- 
ture, but they react destructively with materials used in surgical 
dressings. Formaldehyde vapors possess a high power as a germi- 
cide. The vapors are highly irritating and destructive to flesh 
tissue. They are, however, applicable in the disinfection of some 
classes of material used in dressings, and are utilized in the pro- 
cesses hereinafter outlined. 
During the mechanical process of carding cotton and other 
fibres, the fibres are subjected to prolonged friction, with conse- 
quent heat and electrical action. The results upon infected fibre 
passed through the process were interesting, and the process was 
found to be one of sterilization. 
Experiments numbering many hundreds of series were made to 
ascertain the value of pressure as a sterilizing agent upon dress- 
ing materials. The results show that infected fibres may be steril- 
ized by a pressure of 50 to 100 tons to the square inch. This pro- 
cess has been utilized in the sterilization of certain forms of surgi- 
cal dressings. 
With the discovery of a new species of bacteria there is said to 
be a new chemical born for its destruction. 
But in the present day practice of surgery, only in a few 
instances, may we use chemical germicides for the disinfection of 
dressings and allow the chemical to remain in the finished pro- 7 
duct. The active chemical disinfectants are for the most part 
destructive to dressing fabrics as well as irritating to flesh tissue. 
Out of the many disinfectants lauded in days past for the impregna- 
tion of surgical dressings, but few remain. It has been found 
that dressings, even when impregnated with antiseptics, may still 
harbor germ life. In the presence of dry iodoform, dry corrosive 
sublimate, boric acid, germs will retain their vitality for a great 
length of time. 
Though seemingly a contradiction of terms, it is, nevertheless, a 
truth born of experience to state that antiseptic dressings may be 
the means of conveying infection to a wound. Hence, the require- 
ment that antiseptic dressings shall be free from micro-organisms. 
In the list of agents applicable to the disinfection of dressing 
materials, heat ranks first in germ-destroying power. Heated air is 
precluded for use with cotton and some of the other substances used, 
for the reason that the temperature required for efficiency is de- 
structive to the material. Heated air is quite inferior in disinfecting 
power to boiling water and steam. Boiling water almost instantly 
destroys most forms of germ-life ; resistant forms succumb to its 
action in a few minutes. 
Steam, then, holds the first place as a practical agent for the dis- 
infection of surgical dressings. To be effective, it must be saturated 
(unmixed with air). - Saturated or streaming steam circulating under 
moderate pressure reaches the efficiency and gives the results at- 
tained in boiling. 
Practical Application.—Having passed in review some of the prin- 
ciples which underlie the preparation of surgical dressings, fitted to 
fulfil the requirements of surgery, we can best gain an impression 
as to their practical application by a brief review of the methods 
instituted by the author, which are now in working operation in the 
laboratories of Johnson & Johnson, at New Brunswick, N. J. 
The buildings set apart for this work were built for this special 
purpose—made plain and tight to exclude dirt. They are admira- 
bly situated away from busy and dusty streets. For miles on either 
side stretches river and meadow-land, securing an almost dustless 
atmosphere. In fitting up the rooms in which the manipulations 
take place, the ideas kept in view were the exclusion of bacteria, 
easiness of keeping clean. 
The walls and ceilings are glass-smooth. The floors are filled and 8 
polished. There are no closets or shelving, no cracks or crevices to 
harbor dust or dirt. The furniture consists of glass-topped tables 
with iron frame, allowing effectual and easy cleansing. The princi- 
pal part of the work is done in the “aseptic room,” so called be- 
cause all things within it are at all times kept surgically clean. 
The following is an extract from the rules governing this room : 
“Everything- outside of this room, everybody and everything passing 
into this room from the outside are to be regarded as infected until subjected to 
special cleansing operations. 
“ Everything required for use in this room, or being brought in, must be ster- 
ilized according to the prescribed rules. 
“ All cleaning, sweeping and dusting must be done at the close of the day’s 
work. Tools, apparatus, towels, aprons, aseptible clothing, etc., are to be ster- 
ilized in the sterilizing chambers. The floor must be well moistened before 
sweeping ; dusting must be done with damp cloths. After sweeping and dust- 
ing, the covers upon the tables must remain for at least eight hours. 
“As often as may be necessary, the entire wood and iron work of the room 
must be washed with soap and water, then with antiseptic solutions ; the 
room closed and fumigated with sulphur and steam.” 
Everything, whatsoever may be its nature or history outside of 
this room, is considered as infected (though, in fact, it may be free 
from germ life); it is, therefore, disinfected before being taken into 
the room. The entrance to this room is through an ante-room, 
which is a disinfecting station of the highest type. Through this 
quarantine all persons and things pass before entering the aseptic 
room. The persons who operate in this room are under charge of 
graduate surgical nurses. 
The following extracts from the rules in force show the methods 
adopted for securing personal cleanliness : 
“ Every person before entering the aseptic room must put on the pre- 
scribed washable garments (flowers, ornaments, jewelry, etc., must be removed). 
They must thoroughly wash and scrub their hands, forearms and face according 
to the prescribed rules. 
“ Hand Disinfection.—(i) Scrub hands, face and forearms in a solution ot 
ammonia and soap with a disinfected brush. By the aid of a knife or nail- 
cleaner, scrape all particles under the nails and on the margins. 
“ (2) Wash again in ammonia and soap solution, then rinse in clean hot water 
and dry on a sterilized towel.” 
After this preliminary washing, operatives must pass at once into 
the aseptic room. Persons engaged in directly handling dressings 
must further put on sterilized over-dresses, caps, sleeves, etc., and 
again wash their hands with soap and ammonia, rinse them in clean 9 
water without drying, rinse in a solution of oxalic acid, finally in 
soda and alcohol without drying. After this washing, only such 
objects as have been cleansed and sterilized must be handled unless 
the hands are rewashed. If for any reason there is cause to leave 
the room, the sterilized garments must be taken off, and then, before 
re-entering, both the preliminary and final washing be again per- 
formed. Tracing the history of a yard of gauze on its way through 
these rooms, its course would be somewhat as follows : It is first ren- 
dered absorbent and bleached (in an adjoining department) and arrives 
at the ante-room to be made into dressings. The jars in which it will 
be packed, with their tops, fastenings, etc., are brought to the same 
point from a bath in hot soda solution. If the gauze is to be im- 
pregnated with antiseptics, it is done in this outer or ante-room. 
The gauze, the containers, labels and all things pertaining thereto 
next pass into the sterilizing chamber. This chamber forms a part 
of the dividing wall between the ante-room and the aseptic room. 
The chamber is rectangular in form, large enough to hold a wagon- 
load of goods. It is constructed with thick walls made of metal, 
asbestos and other non-conducting material. The interior is lined 
with steam-pipe radiators for producing heated air within the cham- 
ber. Doors to the chamber open at both ends, one into the ante- 
room and the other into the aseptic room. These doors are steam- 
tight and held in place by ratchet screws. 
The chambers are fitted with steam supply and escape connec- 
tions, gauges for pressure and vacuum, safety valves, exhaust valves, 
etc. Cars of iron with trays carry the articles to be treated. Sup- 
ply pipes controlled by valves admit live steam to the interior of the 
chamber. The actions involved in the operations within the cham- 
ber are: 
(a) Preliminary warming of the materials to prevent condensa- 
tion. 
(.b) Removal of air. 
(c) Circulation of saturated steam unmixed with air under press- 
ure through every fibre of the material, subjecting them to the 
highest possible action of this agent. 
(d) Subsequent exhaustion of steam and substitution of heated 
air. 
After the gauze passes into this chamber, the doors are closed 
and it then becomes a hot-air chamber. The air is then exhausted 10 
to a vacuum of io or 12 pounds; saturated streaming steam is then 
let in ; the temperature soon rises to possibly 240° F., and the press- 
ure gauge indicates 5 or 10 pounds. The steam pipes are now 
closed; the vacuum pump is again started until the proper vacuum 
is obtained. 
Again steam is turned on, and so on, in turn, currents of satur- 
ated steam follow each other through the vacuum for from one to 
two hours. Every part of the chamber is penetrated, every fibre is 
subjected to the action of this highest of bactericides. The most 
resistant form of germ life must be reached and destroyed. From 
the sterilizing chamber the gauze passes directly into the aseptic 
room. In this room, all persons, tables and apparatus having been 
previously prepared, the dressings are cut, folded and packed in the 
jars, the covers laid on loosely. 
(A large portion of this work is done by apparatus, to avoid 
touching with the hands.) 
This work is rapidly performed, and the filled jars returned to 
the sterilizing chambers for a re-sterilization. This final steriliza- 
tion effectually secures absolute safety against the remote possibility 
of infection by handling. After this final sterilization the jar seals 
are locked. For dressings packed in jars, this process is one of 
hermetic sealing, a partial vacuum having been formed within the 
jars during their heating and cooling. The finished dressings now 
pass on to be labelled, put in cartoons and made ready for shipment. 
These same chambers are utilized for disinfection with formalde- 
hyde vapors, the process being: first heating of the chambers, ex- 
haustion of the air, filling the chamber with formaldehyde vapors, 
which penetrate every portion of the material; finally, exhaustion of 
the formaldehyde vapors, which are in turn replaced with heated air. 
Sterilization Tests.—The effectiveness of sterilization procedures 
can be readily confirmed. 
In the writer’s laboratory the practice is substantially as follows : 
A portion of the dressing material (for example, a piece of gauze) 
is impregnated with an infected nutrient fluid. The thus infected 
material is then dried in air, that the organisms may, as far as pos- 
sible, be placed in a resistant condition. As a check experiment, a 
portion of this infected and dried material is placed in sterilized 
nutrient jelly in the culture chamber. This is done to ascertain 
whether the test material has surely been infected. The remaining 11 
portion of the infected material is then passed through the steriliza- 
tion process, care being taken that it passes through like conditions 
as would the sterilized dressings. 
In the case of gauze or cotton, the writer’s practice is to wrap 
the test material in the centre of the package. 
In testing catgut ligatures, the ligatures are moistened and 
untwisted; the infected material is then rolled up within the tissue 
and dried. After the infected material has passed through the 
sterilization processes, it is placed in nutrient media in a culture 
chamber. After a suitable time (at least three days) if a growth is 
found in the check experiment, we are certain that our test material 
was infected. If no growth has taken place in the infected material, 
that has passed through the sterilization processes, we are certain 
that sterilization has been complete in all the dressings. This con- 
clusion needs no verification. The dressings have been prepared 
and sterilized by methods which exclude contamination. If a cer- 
tain portion of material purposely infected, in passing through the 
sterilization process with them, is rendered sterile, it is conclusive 
proof that the whole of the dressings cannot fail to be sterile and 
aseptic. 
The above method of procedure applies particularly to dressings 
containing no chemical antiseptic. Where the dressings are so 
impregnated, the process is varied as follows : 
To avoid the restraining influence of the antiseptic upon the 
growth of the test organism, portions of the infected material, after 
passing through the sterilization processes, are placed in quite a 
large body of liquid nutrient media, which is shaken to dilute the 
antiseptic below its normal antiseptic potency; to carry this dilution 
still farther, a few drops from the first dilution are passed on to a 
second tube of culture media. 
It has been found in the use of antiseptics that enough may 
adhere to the organism (especially to spores) to restrain develop- 
ment, though not destroying their vitality. This is obviated even 
in the use of strong solutions of an antiseptic by the dilution above 
mentioned. 
In testing with antiseptics the test material is kept under a culti- 
vation for at least a week. Development is often so retarded by 
the antiseptic tending to make hasty conclusions erroneous. In 
these tests with antiseptics, liquefied flesh—peptone—gelatine of 
Koch is usually employed. 12 
Where no antiseptic has been employed, sterilized potatoes and 
other solid media have been found convenient. 
The required test is the presence or absence of a growth which 
will liquefy solid media or produce form, color or odor characteristic 
of bacterial colonies. 
This is verified when deemed necessary by a microscopical exami- 
nation. In surgical bacteriology, the bacillus of anthrax is used as the 
standard test organism ; whatever will destroy the vitality of this 
bacillus will destroy all the known organisms of wound infection. 
Who Should Make Surgical Dressings.—In the past, dressing 
materials were largely the product of domestic industry and convict 
labor. We could not now tolerate supplies from such disease- 
breeding sources. In recent discussions by surgical authorities, the 
question has been raised as to the relative fitness of the surgeon, 
the pharmacist and the manufacturer as makers and purveyors of 
surgical materials. 
The apostle of modern surgery manufactured “ Lister’s Gauze ” 
in his own kitchen. Sir Joseph’s kitchen is doubtless a more fitting 
place for such work than is the office of many of his followers. 
Doctors’ offices are not, as a rule, the most wholesome spots. Their 
upholstered furniture is in constant contact with the clothing and 
persons of patients carrying infections of every name and kind. 
Their tapestried carpets are filled with dust brought from pest-laden 
households. In the doctor’s office we will find that tables, shelves, 
books and apparatus are spattered with debris from urinal examina- 
tions, pus from foul sores, dried excretions from diseased skin, 
pathological tissue, clotted blood and dried discharges from innumer- 
able sources. 
Streams of infectious matter continually pour into the rooms of 
the busy doctor and find a lodging-place in its paraphernalia. The 
unfitness of such surroundings for the production of surgically clean 
dressings is evident. 
I claim for the American physician the highest of honors. I all 
but reverence the skill and genius of the American surgeon ; but 
before I would attempt to prepare aseptic dressings in their offices, 
I should, in most cases, require that they be first cleansed and disin- 
fected upon the lines adopted by health authorities for the purifica- 
tion of infected premises. 
A certain hospital claims that its operating room is “ the cleanest 13 
place in the world.” All hospitals have not earned such a title. 
Many of them are attached to medical colleges where students and 
professors gather fresh from the dispensary clinic, from visits to 
infected houses, from dissecting rooms, from hundreds of sources 
of contagion. 
Clinging to their persons and clothing may be found particles 
rich in pyogenic and pathogenic bacteria. In hospitals, the aggre- 
gation of infectious organisms cannot be avoided. Formerly, they 
were “ hot-beds of infection.” Now dangers are excluded only 
by the most rigorous procedures. 
When dressings are prepared by the pharmacist, the work is 
generally performed in the drug store back room. This place 
comes far short of the conditions known as surgical cleanliness. 
The chemically clean graduate is still unclean in the eye of the sur- 
geon. Counters covered with vegetable and animal drugs of all 
kinds are not suitable places upon which to lay absorbent gauze. 
Street and store dust, spatterings of syrups, extracts, oils, and all 
manner of decoctions, create a favorable lodging- and breeding-place 
for organic life. These are not wanted in surgical dressings. The 
pharmacist, though ordinarily clean in person and habits, familiar 
with soap and water in the pursuit of his calling, yet he is far from 
aseptic. Like the physician, he is constantly in contact with infec- 
tion through the person of his patrons. 
The hands that dispense beef tea at the soda counter, or that 
bring a jar from a mouldy cellar, should not touch sterilized mate- 
rial without cleansing. Thus there must be a radical change of 
environment before the pharmacist can attain success in aseptic 
technique, though he may, perhaps, rightfully claim conditions and 
facilities that are above those of the ordinary physician. 
The facilities of the manufacturer, whose whole organization is 
adapted to the production of surgical dressings, are certainly more 
perfect than those of the surgeon, to whom such work is incidental. 
The environment of a room from which pathogenic organisms and 
septic matters are entirely excluded is superior to that obtained in 
the hospital or in the doctor’s office. The room in which no work 
is undertaken except the handling of aseptic material will certainly 
be more nearly surgically clean than one to which infection has 
constant access. Persons whose only calling is that of preparing 
surgical material, who have been schooled in the principles under- 14 
lying the infection and disinfection of dressings, are probably more 
competent to handle dressings than the doctor’s student or his 
attendants, to whom such work is of necessity relegated. In this 
work, as in many other instances, properly constructed apparatus is 
more efficient, more cleanly, more perfect, than hand work. 
Further, an organization devoted exclusively to the manufacture 
of dressings, once having the details arranged to prepare a yard of 
dressing, can produce any number of yards more perfectly than if 
done as occasion may require, as is the rule in the hospital or in 
private practice. 
To the manufacturer and dispensing pharmacist is due the‘credit 
of having made possible the universal application of the principles 
of modern surgery. They have supplied to the practitioner in the 
most remote regions appliances as perfect as those used in the great 
hospital centres. They have placed in the hands of the practitioner 
appliances that fulfil every requirement of the advanced art of 
surgery. 
I hold that the preparation, selling and dispensing of medicinal 
and surgical supplies to the doctor, to the surgeon and to the pub 
lie belong to pharmacy. Their application is the province of the 
practitioner of medicine and surgery, and I maintain that it will be 
to the betterment of surgery to receive all dressing materials from 
the hands of a competent pharmacist. 
Training for the Work.—It is important that persons who are to 
handle surgical dressings in any capacity be familiar with the prin- 
ciples as well as the details of the work. They should also know 
why things are done as well as how to do them. The principles of 
surgical asepsis are applicable to the dispensing and sale of these 
materials. Therefore, the following epitome of a course in aseptic 
technique, devised for use in the writer’s laboratory, may be found 
useful to many pharmacists. 
In addition to the daily manual training under experienced per- 
sons, the operatives are required to attend stated instructions. 
These instructions are in the form of demonstrations of the processes, 
with an explanation of the principles involved. Those in attend- 
ance are given questions to be answered and experiments to per- 
form. Text and reference books are furnished. The scheme is 
modeled upon the plan of a college extension course. Among the 
subjects are the following : 15 
(1) The work of preparing surgical materials, its importance, its requirements. 
(2) Definition and meaning of terms. 
(3) Nature of the material used in dressings. (Fibres, cloth, ligatures, etc.) 
(4) Preparation of materials, bleaching, rendering absorbent, etc. 
(5) Kinds of dressings used in modern surgical practice. 
(6) Uses to which dressings are put in surgery. 
(7) Bacteria, their nature, conditions of growth, multiplication, products of 
their activity, with demonstrations of the means by which they may be trans- 
ferred to and from persons and things. 
(8) Wound infection. 
(9) Infection of dressings. 
(10) Disinfection—chemical agents and physical agents. 
(11) Exclusion of bacteria. 
(12) Sterilization. 
(13) Disinfection of persons and things. 
(14) Asepsis and aseptic technique in the preparation of dressings. 
The entire course in my practice occupies several months—in fact, 
becomes a continuous course, as additional methods are constantly 
brought into practice. 
Surgical Dressings in Commerce.—Dr. Gerster, in one of his ad- 
dresses, condemned the use of ready-made products as sold in the 
drug store, on the ground that the gauge of success is purely com- 
mercial, only directed solely to profit. 
Another writer affirms that the standard of such dressings is com- 
mercial in nature, the essential requisite being profit, and that they 
must be sold to meet competition. That in this the requirements 
of surgery are matters of indifference and generally matters of igno- 
rance. 
These statements were corroborated in a recent instance by a 
druggist in one of our large cities, who is commercially wise. He 
stated that to him quality, kind or make was no factor. Low prices 
were the sole criterion of value. Responsibility hovers over every 
field of the pharmacist’s activity in dispensing dressings ; we share 
the burden with the surgeon. Whoever has stood beside the sur- 
geon in his operating room and realized how much depended on 
not only the hand, the training and the skill of the operator, but the 
absolute cleanliness in every movement, must realize that there 
are some things that cannot be expressed in a money ratio. 
At such a time and in such a place the integrity of the dressing 
rises to supreme importance. Any neglect in its preparation, any 
misstep through the ignorance, cupidity and stupidity of any who 16 
have had to do in its history, is sure to be revealed. The issue of 
life or death in such a case should not be subject to the market rates 
per pound or yard. What results must follow the very common 
practice of dispensers who open packages of dressings, measure and 
weigh them over dusty counters with unclean hands, and send them 
on their mission ? It would be more humane, perhaps, to send a 
lethal dose of strychnine. In the light of asepsis, to dispense mor- 
phine for quinine becomes a virtue when compared with the wilful 
contamination of a surgical dressing. 
Poisons are put under lock and key, dispensed under rigid sys- 
tems of precaution and checking. 
The importance of the surgical dressing, the nature of its rei 
quirements, call for equal care. There is no article in the druggist’s 
stock which should receive greater care and judgment. Upon every 
yard of gauze, sponge or ligature he dispenses hangs, perhaps, the life 
and death of a patient and the reputation of a surgeon. They should 
be guarded from every channel of direct or indirect infection. 
A closet or a room, or a case should be provided for their recep- 
tion that is cleanable; it should be cleaned often and kept clean. 
They should be sold within the containers in which they are packed 
in their preparation. They should never be broken open for sale or 
for any other purpose. They should be delivered to the surgeon so 
perfect that there can be no question as to their integrity, placing 
all the responsibility for their subsequent care in his hands. In 
dispensing to the public, every purchaser should be cautioned 
as to their nature and instructed in their handling and use. The 
price should meet the cost of the dressing plus a profit which will 
cover this service of advice, trouble and care. 
Ninety-five per cent, of the 100,000 physicians in our land who 
apply these principles of surgery must look to the pharmacist for 
their dressing materials. In filling this demand, the pharmacist 
should supply such materials as will meet the highest surgical re- 
quirements. As far as the dressing is a factor, the surgeon at the 
country cross-roads, by the aid of the pharmacist, should be enabled 
to reach the advanced methods of the metropolitan clinic. 
To attain this end in the making, in the buying, in the sale and in 
the dispensing, even to the most minute detail, there is required 
knowledge, skill, ability and finally a faithful application of the same.