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odor decidedly offensive. Milk, when exposed to the air, becomes sour; and vegetable infusions of different kinds realize similar changes. When such liquids are examined microscopically, they are found to contain amazing numbers of living organisms, and which, according to Pasteur, arise spontaneously in consequence of these fermentative processes; that is, that all this array of life is marshalled into being, not from antecedent life, but by a creation of existences out of formless matter. Another theory, and that which, while it harmonizes with reason, has also a direct bearing upon the great question of healing, aflirms that these organisms are not the consequents or effects of fermentation, but the determining cause; and, in support of this statement, it is ascertained that when it is possible to exclude all sources which can serve to convey living forms to infusions, secretions, and other liquids, then putrefactive changes fail to occur for an indefinite time. Mr. Lister, reasoning from such facts, and recognizing the similarity of the processes of putrefaction and suppuration, reached the conclusion that, if it were possible to exclude or destroy these atmospheric germs-or bacteria, as they are termed—the rapid reparation of wounds would be greatly facilitated. Not only so, but if these putrefactive changes could be arrested or rendered harmless by disinfection, the healthfulness of hospital wards would be much improved.
As it was found that carbolic acid proves destructive to such organisms, this agent was employed, in various ways, to prevent their intrusion; and this brings me to what is called Antiseptic Surgery. What are its claims to professional confidence? As a rule, surgeons are cautious in adopting novelties, and many have been, and are, still incredulous as to the reality of the grand successes which have been claimed for the practice. Every year has served to furnish us with the results of independent observers, and the last has not been singular in this respect. For the past six months I have, for the most part, adopted the method, and although the time may be considered too short to warrant any reliable conclusions, yet the number and variety of cases which have been treated during that time, when compared with a similar number and variety treated after the ordinary plans, have yielded results so greatly superior, that I have no doubt in my own mind we are on the eve of an entire change in the surgical dressings of wounds. I do not misstate these results when I declare that, in a number of excisions of the female breast, the wounds healed without the formation of two ounces of pus; in two cases, I think, not over a single ounce was discharged; and in one, in which a number of the axillary glands were removed, the union occurred without any discharge
whatever of a purulent nature. In the extirpation of tumors of the neck, body, and face, an equally favorable result was obtained ; in compound fractures and amputations, though the number treated is too limited to admit of a dogmatic statement, yet the suppuration was certainly much less than I have usually witnessed under the ordinary modes of treatment. I am quite conscious that in adopting this method of dressing there were many omissions in details, almost inseparable from the employment of a new and untried practice, and which can only be corrected by a larger experience; and I may say that the faithful observance of the minutiæ is an absolute condition to success; and that any conclusions adverse to the antiseptic plan, where all the apparently trifling details of Mr. Lister are not enforced, are unreliable, and unjust to the method.
As the dust which floats in the air is loaded with infecting organisms, it follows that every object with which it comes in contact is similarly charged. To provide against such a wide-spread prevalence of bacteria the hands of the surgeon must be washed in carbolated water; the instruments and sponges with which he works must be kept in a bath of the same kind; the atmosphere for some distance over and around the wound, and the wound itself, must be constantly sprayed with this fluid; the strength of which may be stated as one part of carbolic acid, and from thirty to forty parts of water. Nor must this spray or mist be suspended until the wound is thoroughly closed, after which it is covered with a piece of coarse calico, perforated paper, or oakum, which has been coated with a mixture of carbolic acid, paraffine, and resin; and this in turn covered in with rubber tissue, or oiled silk, the whole made fast with the turns of a roller. When it is necessary to tie vessels, the antiseptic ligature made from carbolized catgut must be used, cutting off both ends, and leaving it to be absorbed. When the dressing is renewed the same attention to details is to be observed as in the original operation. In no instance where I have used the animal antiseptic ligature has it given rise to abscess or any noticeable irritation.
Let us now inquire what favorable testimony can be gleaned from abroad based upon the experience of the last year.
Mr. Lister says that by the antiseptic method the wards of the Glasgow and Edinburgh infirmaries, confessedly the most unhealthy in the kingdom, have become models of healthfulness. Professor Saxtorphe, of Copenhagen, who has under his care a large hospital, and which had become so infected with pyæmia, gangrene, and erysipelas that even amputation of the fingers was followed by death, now says " that pyæmia has vanished, gangrene almost dis
appeared, and erysipelas nearly unknown, unless brought into the hospital from without. Excisions of large joints, bone abscesses, compound fractures, and mashed limbs, are treated with singular success."
At Munich the large Allgemeinhes Krankenhaus had been increasing in unhealthfulness from pyæmia and gangrene until 1873, when these diseases reached the enormous prevalency of 80 per cent. of all wounds, whether accidental or inflicted by the knife of the surgeon. Professor Nussbaum having tried every plan in vain to banish these formidable scourges, at length resorted to the antiseptic method, and in a single year, 1875, there was not a single case of gangrene in the institution.
At Leipsic, Professor Thiersch, with three hundred surgical beds under his care, reports for 1874 only a single case of pyæmia. This hospital was the first to introduce the antiseptic plan of treatment in Germany.
Professor Volkmann, of Halle, with wards always over-crowded and badly constructed, having water-closets opening into them, and the great drain of the city lying underneath, after two years of trial, writes that not a single case of compound fracture died where conservative measures were adopted, and that the experiment was not limited to a few cases, I would state that thirty-nine of such injuries were treated, some with much laceration and bruising of the soft parts, together with the additional element of comminution, and, in two instances, the broken bone was the patell--aa compound fracture of which every surgeon knows to be an accident of the gravest nature-yet both recovered with good motion of the kneejoint. Professor Volkmann further states that for one year and a half previous to his writing not a case of pyæmia was seen in the hospital, though sixty major operations had been performed.
At the Berlin Charité-a hospital so very unhealthy that almost all the amputations of the inferior extremity perished from pyæmia, erysipelas, or gangrene-Professor Bardeleben, with one hundred beds under his care, and adopting the antiseptic practice, has absolutely banished these diseases from his wards.
At Magdeburg, a hospital with one hundred surgical beds, which has for 14 years been under the care of Dr. Hagedorn, had become exceedingly dangerous to its inmates in consequence of the great prevalence of pyæmia and septicæmia. The doctor introduced the antiseptic plan in 1872, and with such a favorable result, that he declares the presence of such diseases in a hospital must be the fault of the surgeon.'
i British Medical Journal, December, 1875.
In England there are men in charge of great hospitals who are becoming alive to such statements as have been volunteered in favor of antiseptic surgery, but they have not yet spoken, save in a partial manner.
The subject is entitled to the most serious consideration. The extraction of a calculus from the bladder; herniotomy; the excision of a joint; or the extirpation of a tumor from the deep structures of the neck, are all great triumphs of surgical skill; but the surgeon should have some higher motive, some nobler aspiration than merely the popular impression of a brilliant operation ; his great ambition should not terminate in self, but in the employment of every resource at command to make permanent the successes of the knife. With such testimony accumulating year after year, and given by able representative men in the profession, men trained to habits of careful observation and capable of forming a correct judgment, it is the duty of surgeons to test for themselves the verity of such statements, without which it is useless to deny their correctness.
About four years ago my attention was called by Dr. Studdiford, of Lambertville, New Jersey, to a paper fabric manufactured in that place, and which he had used with satisfaction in a case of amputation. Although defective in several important particulars, yet I was convinced that, with certain modifications, it could be made a most valuable and economical surgical dressing; but it has only been within the last few months, and that through the intelligence and skill of Dr. Huffnagle, of New Hope, Pennsylvania, that the different forms which I deemed necessary have been successfully produced. This lint is prepared from old rags decolorized with chloride of liine, and fashioned into sheets of varying thick
Some of these are thin, and designed merely as absorbents; some thick, and suited for a water dressing; others thick, soft, and coated with a thin film of rubber tissue, making its surface impermeable to moisture, and well adapted, when saturated with hot water, to fulfil the conditions of a poultice. Some of these sheets are prepared antiseptically, having been treated with a mixture of carbolic acid, paraffine, and resin, and others with salicylic acid. Having used it extensively both in private and hospital practice, I am certain it requires only to be known in order to its general adoption by the profession. As an absorbent, it receives rapidly the discharges which flow from wounds; with its water-tight coating it can take the place both of a poultice and the oiled silk; and in cheapness, as compared with patent lint, the difference in favor of the paper is very great.
Turning next to general surgery, I may notice a mode of attacking disease which has entered largely into the current literature of medical journals of the last year, and which has become popular in consequence of the facility with which certain medicinal agents can be deposited in the centre of growing tumors by means of the hypodermic syringe. In this manner, Bradly, of London, has been able to cure in a short time, by the use of iodine, enlargements of the lymphatic glands, such as ordinarily run a very protracteil course. I have in this way treated successfully lymphatic, fibroid, and vascular growths, and in one instance saw a very large thyroid gland reduced to its natural size in a few weeks. The hypodermic use of ergot, at first restricted to the treatment of certain uterine fibroids, is now employed in this manner for the cure of hemorrhoids, varix, varicocele, and other affections.
In the domain of operative surgery on a grander scale, we meet with both conservative and aggressive novelties. The experience of each succeeding year, through antiseptic plans of treatment and immobilization, gives a favorable aspect to the excisions, entire or partial, of joints like the ankle or knee, and which a few years ago were almost invariably doomed to amputation.
There is often much more involved in the announcement of a principle than may at first appear. Indeed it may be said that in the construction of all general laws no man, not even the authors of these laws, can foresee all the cases which they will govern. In the application of this statement I will recall to your minds the surgical maxim governing amputations, namely, the preservation of every possible inch of the limb, the mortality increasing in proportion as the trunk containing the great life organs is approached. In the lower extremity it has heretofore been customary to make two exceptions, that of applying the knife four or five inches above the ankle rather than nearer the articulation, though the condition of the soft parts might not contraindicate. The election in this case is determined from mechanical considerations, experience having shown that a stump made four inches above the joint is better adapted to the requirements of an artificial limb than when made lower down. The second exception was made in cases of injury when the choice of amputation was between the base of the condyles or the lower third of the femur, the latter being usually selected from two considerations, that of exposing less cancellated tissue, and the supposed risk of inflammation of the synovial membrane of the joint. Now, however, the law of preserving every inch asserts itself, in the success which has attended the supra-condyled amputations of Stokes, Wheelhouse, Jessop, and others, in which the