42 THE AMERICAN MONTHLY [February, 



forget that to Prof. Lister we owe the practical development of 

 the principles underlying what we know to be the true science of 

 aseptic surgery. 



The carbolic spray once universally applied has been almost 

 entirely abandoned, and during my recent visit to Europe I never 

 saw it once used. The many layers of protective gauze, mackin- 

 tosh, etc., are now replaced *by a simple layer of iodoform gauze, 

 with an abundant layer of pure aseptic cotton firmly retained by 

 bandages. 



Another remarkable change is in the growing disbelief in the 

 efficacy of the ordinary antiseptic solutions when used as germi- 

 cides. Solution of carbolic acid has been shown to be a very 

 weak germicide, and the same may be said of solution of boric acid 

 and of the other solutions commonly used for this purpose. Bichlo- 

 ride of mercury has been our sheet-anchor as a germicide until the 

 present time. As we lost our faith in one germicide after another, 

 we thought we could rely on that. Yet the iconoclasts are busy 

 in their work of tearing down all idols in medicine, and now 

 they have not left us that one. Recent investigations carried on 

 at Johns Hopkins- University and published in the Johns Hop- 

 kins Hospital Bulletin of April, 1891, p. 59, have shown that 

 solution of bichloride of mercury when used as a germicide is 

 often inert and still oftener actually injurious to the tissues when 

 applied during surgical operations. 



The great surgeon Lawson Tait believes in no germicide 

 except recently boiled water, and observation teaches me that the 

 consensus of opinion of the great masters of surgeiy is fast settling 

 upon the conviction that there are practically only two methods 

 of keeping wounds aseptic. One is to keep wounds made durmg 

 surgical operations as dry as possible, and the other is to use only 

 recently boiled water in contact with them. Every instrument 

 and surgical appliance must be sterilized, either by boiling in 

 water containing soda, or by being exposed to dry heat above the 

 temperatiu-e of boiling water for at least one-half hour. 



To this, of course, must be added microscopic cleanliness of the 

 operator, assistants, nurses, and all the appliances used in surgical 

 operations, and, of course, including the operating-room and all 

 the surroundings. The present paper will, however, be confined 

 to aseptic surgery as I saw it in three of the Paris hospitals, 

 namely. Hotel Dieu, Hospital Tenon, and the Hospital Bichat. 

 Hotel Dieu, the oldest hospital of Paris, was originally situated 

 on the south bank of the Seine, and the old building is said to have 

 been founded by Clovis H. in the year 660. The present build- 

 ing is located on the north side of the Place Notre Dame, and was 

 rebuilt in the years 1S6S-1S7S. 



It is like many of the European hospitals, quadrangular in shape, 

 with a courtyard in the centre, and accommodates about eight 

 hundred and fifty patients. 



The hospital is clean and well ventilated. Contagious diseases 



