ASEPSIS AND ANTISEPSIS IN PRACTICE. 
W. D. MILLER, M.D., D.D.S., BERLIN. 
(Reprinted from the Dental Cosmos for January, 1893.) 
In the Dental Cosmos for 1891, p. 514 et seq., I published the 
results of experiments on the sterilization of dental and surgical instru- 
ments, which showed that the methods commonly in use are totally 
inadequate to the purpose. Since that time I have been occasionally 
asked whether I carry out in practice the measures recommended in 
the article referred to, and if it does not entail a great sacrifice in time 
and labor to do so. 
It is the object of this communication to show that the methods 
suggested may be carried out in daily practice with perfect ease. I 
need not again point out here the desirability—in fact, the necessity— 
of the strictest aseptic and antiseptic precautions in operations upon 
the mouth. There may still be dental surgeons who know little and 
care less about asepsis and antisepsis, and who maintain that they can 
do just as good work with soiled hands and instruments as with clean 
ones ; the public, however, is becoming too well enlightened on this 
point to tolerate them. 
It is well known to be an exceedingly difficult matter to completely 
free the hands from living bacteria. Fiirbringer’s method,* which places 
particular stress upon the sterilization of the subungual space, re- 
quires ; (1) Dry cleansing of the nails from visible dirt; (2) brushing 
the hands, particularly the nails, for one minute with soap and warm 
water ; (3) washing for one minute in alcohol, not under eighty per 
cent. ; (4) thoroughly brushing for one minute in a 0.2 per cent, 
solution of sublimate, or three per cent, solution of carbolic acid. This 
operation requires about ten minutes, unless everything is placed in 
readiness by an assistant;, in this case it may be gone through with 
in somewhat less time. Kellyf scrubs the hands and forearms with 
sterile brushes for ten minutes with olein (common brown kitchen 
soap) and hot water, the nails with especial care. They are then 
The Cleansing of the Hands. 
* Fiirbringer, P., “ Untersuchungen und Varschriften iiber die Desinfection 
der Hande des Arztes, nebst Bemerkungen iiber den bacteriologischen 
Character des Nagelschmutzes.” Wiesbaden, 1888, Bergmann. 
t “ Gynecological Technique.” The New York Journal of Gynecology and 
Obstetrics. July, 1892. * immersed in a saturated solution of permanganate of potash, and 
transferred at once to a hot saturated solution of oxalic acid. Finally 
the hands are rinsed in sterilized water. This operation requires about 
fifteen minutes. 
The question has been asked, whether absolute sterility of the hands 
is necessary on the part of the dentist. It is reasoned that inasmuch 
as the human mouth, even when well cared for, contains enormous 
numbers of micro-organisms, the introduction of a comparatively 
insignificant number on the fingers would probably result in no differ- 
ence whatever in the general condition of the mouth. Furthermore, 
the fingers of the dentist do not come into contact with tissues which 
are very susceptible to infectious agents ; consequently hands that 
would be fatal to the success of a surgical operation may be intro- 
duced into the mouth without any ill results whatever. These con- 
clusions should be accepted only with considerable restrictions, and 
only with the understanding that the hands do not carry any specific 
germs, and do not introduce into the mouth any pathogenic micro- 
organisms not already there. 
I have adopted in practice the following mode of procedure ; 
Before beginning my work in the morning I cleanse my nails, which 
are not allowed to become over a mm. long, with a penknife, and 
then brush the hands, giving, of course, particular attention to the 
nails, for two minutes with a rather stiff brush, in a warm one to two 
per cent, solution of lysol. Lysol is quite equal, if not slightly 
superior, to carbolic acid as an antiseptic, and is far less escharotic. 
It makes a soapy solution, and cleanses the hands beautifully even 
without soap, though I usually add soap as a matter of habit as well 
as to make the cleansing doubly sure. The hands are then rinsed in 
hydrant water and thoroughly dried. The whole operation requires 
about four minutes. The hands are perfectly clean, but of course not 
absolutely free from germs. If the fingers are rough or cracked, or 
the nails long, double the time will be requisite to accomplish the same 
end; A slight odor of lysol clings to the fingers, but I have not found 
it disagreeable to the patients ; on the contrary, they are glad to be 
reminded of the fact that the dentist takes proper care of his hands. 
Between operations or consultations I wash the hands in soap-water, 
brushing the nails and fingers for half a minute to a minute. 
If, however, I have performed an operation upon a filthy mouth, I 
return to the lysol solution, even increasing its strength according to 
indication to two and one-half, three, and even four per cent. 
I do not knowingly, under any consideration, take on syphilitic 
patients during my regular hours of practice. If I am obliged to 
operate for such a patient I give an appointment at the close of the 
day, when there is ample time to disinfect hands, instruments, etc. 
If, however, the discovery is not made until the operation is begun, 
then it is as well to finish it at once ; but in this case an absolute steril- 
ization of the hands is called for, either by Fiirbringer’s or Kelly’s 
method, except that in the former I should recommend lysol instead 
of carbolic acid, and treat the hands at each step two minutes instead 
of one. 
It may be remarked in this connection that when the hands have 
been cleansed they should not be contaminated by contact with 
infected objects before or during the operation. It is not permissible to handle money or old teeth, or to dive down into the trousers 
pocket for a jack-knife, nor do I consider it quite proper to hold 
instruments back of the ear or between the teeth. 
In regard to instruments, particularly forceps and excavators, I 
hold that absolute sterilization should be demanded, inasmuch as 
inlectious matter is much more readily communicated by them through 
wounds than by the fingers, and further because the sterilization is 
so easily accomplished that there is no excuse whatever for our 
neglecting it. 
The method of sterilizing instruments now most commonly in use 
is by means of boiling water containing one to two per cent, of car- 
bonate of soda to prevent rusting. Three minutes for excavators and 
live for forceps will be sufficient, unless the instruments are covered 
with a thick, dry coat of infectious matter,—a condition of things not 
supposed to exist nowadays in a dental instrumentarium. 
Various apparatus have been devised for carrying out the boiling 
process, some of them, I think, unnecessarily complicated. I have 
devised a very simple boiling-pan, consisting of a metallic box three 
inches wide, six inches long, and one and one-quarter inches deep, 
with a partition wall in the middle parallel to its length, and a rim at 
the top one and one-half inches wide, making an angle of about one 
hundred and thirty degrees with the side of the vessel. In this appa- 
ratus the hot water does not come into contact with the handles of 
the instruments, which in many cases would be injured thereby. Fine- 
edged surgical instruments are said to suffer in the course of time 
from boiling (become blunt), but this objection can hardly apply to 
dental instruments. Personally, I have adopted another method of 
sterilizing instruments. My chief reason is the fact that even a very 
little boiling in a dental office is sufficient, in summer, to perceptibly 
raise the temperature of the room, and I have no room adjoining 
where the boiling might be done. I have found that a four to five 
per cent, solution of carbolic acid, lysol, or trichlorphenol suffices to 
completely sterilize mechanically clean instruments in thirty minutes. 
I keep two complete sets of instruments constantly in use, and as 
soon as I have finished operating for one patient the whole set of 
instruments used is removed from the operating-table and placed in 
the antiseptic solution, where it is allowed to remain while the other 
set is in use, or at least half an hour. 
Sterilization of Instruments. 
I do not only consider it necessary that every patient should have 
a fresh set of perfectly sterilized instruments, so that germs of disease 
may in no case be communicated from one person to another, but I 
hold that while operating for any one patient the instruments should 
be kept in a clean if not sterile, condition. I should, for example, con- 
sider it dangerous to wound the mucous membrane with an instrument 
just employed on infected tissue ; consequently instruments which 
become strongly infected (burs used in opening up putrid pulp-cham- 
bers, etc.) should at once be dropped into the antiseptic, and all 
instruments which become soiled with blood or mucus should be thor- 
oughly cleansed before being used again, even for the same patient. 
All this is done by the office-girl, who is indispensable for keeping the 
instruments in a proper condition. For about a year and a half I used a four to five per cent, solution 
of carbolic acid, to which one-half to three-quarter per cent, of car- 
bonate of soda was added to avoid rusting. I designate this small 
quantity because it is just sufficient, and a larger per cent. I have 
found by experiment to lower the antiseptic power of the carbolic acid. 
Since about four weeks I have substituted lysol for carbolic acid, 
since it is not necessary to add the soda to prevent rusting. It is also 
cheaper than carbolic acid. All instruments, including, of course, 
corundum disks, files, and clamps, are subjected to this treatment, 
whereas those instruments which do not come into contact with the 
mucous membrane, or do not become soiled in the mouth (gold- 
pluggers, etc.), are only occasionally sterilized. 
Mouth-mirrors require extra care, and must be carefully brushed 
before treating with the lysol solution, in order to remove small 
particles of infectious matter which may have inserted themselves 
between the glass and the fastening. I keep so many mirrors on hand 
that Ido not require to use any one twice on the same day. There 
is consequently no time lost between patients in cleansing mirrors. 
Drinking-Glasses. 
In order to be able to place before every patient a glass which at 
least does not carry any germs from the mouth of a previous patient, 
I have provided as many glasses as I have patients in a day. These 
are all placed in a three per cent, solution of lysol in the evening, and 
remain there for over twelve hours. They are then thoroughly rinsed 
in hydrant water. 
I never use a piece of rubber-dam more than once under any cir- 
cumstances. If I were to use the same piece repeatedly, I would 
sterilize it by boiling for ten minutes in the soda solution. 
In regard to the sterilization of napkins, teeth for transplantation 
and implantation, etc., I have nothing to add to what I have already 
said in the article before referred to.