Despite outward appearances, it was actually not until the latter decades of the 19th century that the surgeon truly emerged as a specialist within the whole of medicine to become a recognized and respected clinical practitioner

He would eventually make numerous modifications in the technique of dressings, the manner of applying and retaining them, and the choice of antiseptic solutions of varying concentrations. Although the carbolic acid spray remains the best remembered of his many contributions, it was eventually abandoned in favor of other germicidal substances.

• He would eventually make numerous modifications in the technique of dressings, the manner of applying and retaining them, and the choice of antiseptic solutions of varying concentrations. Although the carbolic acid spray remains the best remembered of his many contributions, it was eventually abandoned in favor of other germicidal substances.

Lister not only used carbolic acid in the wound and on dressings but also went so far as to spray it in the atmosphere around the operative field and table. He did not emphasize hand scrubbing but merely dipped his fingers into a solution of phenol and corrosive sublimate. Lister was incorrectly convinced that scrubbing created crevices in the palms of the hands where bacteria would proliferate.

• Lister not only used carbolic acid in the wound and on dressings but also went so far as to spray it in the atmosphere around the operative field and table. He did not emphasize hand scrubbing but merely dipped his fingers into a solution of phenol and corrosive sublimate. Lister was incorrectly convinced that scrubbing created crevices in the palms of the hands where bacteria would proliferate.

A second important advance by Lister was the development of sterile absorbable sutures. He believed that much of the deep suppuration found in wounds was created by previously contaminated silk ligatures. Lister evolved a carbolized catgut suture that was better than any previously produced.

• A second important advance by Lister was the development of sterile absorbable sutures. He believed that much of the deep suppuration found in wounds was created by previously contaminated silk ligatures. Lister evolved a carbolized catgut suture that was better than any previously produced.

He was able to cut the ends of the ligature short, thereby closing the wound tightly, and eliminate the necessity of bringing the ends of the suture out through the incision, a surgical practice that had persisted since the days of Paré.

• He was able to cut the ends of the ligature short, thereby closing the wound tightly, and eliminate the necessity of bringing the ends of the suture out through the incision, a surgical practice that had persisted since the days of Paré.

The acceptance of listerism was an uneven and distinctly slow process, for many reasons. First, the various procedural changes that Lister made during the evolution of his methodology created confusion. Second, listerism, as a technical exercise, was complicated with the use of carbolic acid, an unpleasant and time-consuming nuisance.

• The acceptance of listerism was an uneven and distinctly slow process, for many reasons. First, the various procedural changes that Lister made during the evolution of his methodology created confusion. Second, listerism, as a technical exercise, was complicated with the use of carbolic acid, an unpleasant and time-consuming nuisance.

Third, various early attempts to use antisepsis in surgery had proved abject failures, with many lead-ing surgeons unable to replicate Lister's generally good results. Finally and most important, acceptance of listerism depended entirely on an understanding and ultimate recognition of the veracity of the germ theory, a hypothesis that many practical-minded surgeons were loath to accept.

• Third, various early attempts to use antisepsis in surgery had proved abject failures, with many lead-ing surgeons unable to replicate Lister's generally good results. Finally and most important, acceptance of listerism depended entirely on an understanding and ultimate recognition of the veracity of the germ theory, a hypothesis that many practical-minded surgeons were loath to accept.

As a professional group, German-speaking surgeons would be the first to grasp the importance of bacteriology and the germ theory. Consequently, they were among the earliest to expand on Lister's message of antisepsis, with his spray being discarded in favor of boiling and use of the autoclave.

• As a professional group, German-speaking surgeons would be the first to grasp the importance of bacteriology and the germ theory. Consequently, they were among the earliest to expand on Lister's message of antisepsis, with his spray being discarded in favor of boiling and use of the autoclave.

The availability of heat steriliza-tion engendered sterile aprons, drapes, instruments, and sutures. Similarly, the use of facemasks, gloves, hats, and operating gowns also naturally evolved. By the mid-1890s, less clumsy aseptic techniques had found their way into most European surgical amphitheaters and were approaching total acceptance by American surgeons.

• The availability of heat steriliza-tion engendered sterile aprons, drapes, instruments, and sutures. Similarly, the use of facemasks, gloves, hats, and operating gowns also naturally evolved. By the mid-1890s, less clumsy aseptic techniques had found their way into most European surgical amphitheaters and were approaching total acceptance by American surgeons.