:392 Sir Rickman John Godlee [March 12, 



use of marine sponges, because they are difficult to clean and expen- 

 sive, and because cotton swabs are equally efficient. Nor would I 

 recommend the giving up of indiarubber gloves, although I know 

 that they have their dangers, and although I know that they may 

 safely be dispensed with by an antiseptic surgeon. Boiling instru- 

 ments, I think, should be continued. Otherwise I say that it is only 

 fair to students to tell them, and show them, that by carrying out 

 Lister's technique, it is more easy to obtain the very best results and 

 less likely to fail. 



I have only spoken of civil practice, but I would not have ventured 

 to offer you a surgical address, and I could not have hoped to attract 

 your attention if it had had no bearing upon the war which is now 

 raging. 



Lister's faithful followers had not only watched with regret what 

 they considered to be a retrograde step in civil practice, but they 

 feared that a war would bring out in relief its weak points. 



Wars have occurred of late in distant parts cf the world, but we 

 paid little heed to the details. It required a war in our midst, with 

 our own flesh and blood in the trenches exposed to the bullets of the 

 foe, and to the pestilence that walketh in darkness, to bring the 

 matter really home to Englishmen. And wlien it came, the reports 

 from the front of almost universal sepsis made us fear that our 

 prognostication had come true, and that the al^andonment of antiseptics 

 was, at least in part, accountable. It appears, however, that anti- 

 septics are being very largely used, though with most disappointing 

 results. 



The fact must not be overlooked that military surgery is excep- 

 tional, and that this particular war is being fought in most exceptional 

 circumstances — trenches dug and monster shells exploding in the 

 highly-cultivated soil of a noted tetanus area like the valley of the 

 Aisne. It is almost impossible for us at home to appreciate what is 

 going on. Listen, therefore, to this graphic extract from a letter I 

 received last week from Sir Anthony Bowlby : — " In this trench 

 warfare you must remember that, if a man is hit, he often falls into 

 filthy mud and water, which may be 3 ft. deep or more. Remember 

 also that the trench is only 2 J ft. wide. If it is night, you can only 

 grope about in the dark and can do no dressing of any kind, for you 

 can't even get any clothes off in the dark, and in so cramped a space, 

 and you must try to get the man away to a ' dressing station ' half a 

 mile distant, and thence to a field ambulance. //' it is dayUglit, you 

 can't get the man out of the trench at all, and he may have to be 

 kept there for many hours, because he would certainly be killed if he 

 was got out of the trench. And the water in the trenches is hope- 

 lessly polluted, and soaks his clothes and his wound. It is only too 

 evident that large lacerated wounds, and especially bad bone smashes, 

 are so contaminated that it can never be possible to render them 

 aseptic." 



