THE PRESENT POSITION OF ANTISEPTIC SURGERY 335 



the intervals between the fibres of a silk thread and destroy any microbes that 

 may have lodged there before they have had time to develop serious septic 

 mischief. But there must surely be a limit to the thickness of the threads. No 

 one, I imagine, would feel justified in leaving in the peritoneal cavit\' an unsteril- 

 ized cord as thick as a finger. Dr. Bantock, whose remarkable series of successful 

 ovariotomies may seem to justify his practice, does not, I believe, prepare his 

 ligatures antiseptically ; and I understand that he uses, for t^'ing the pedicle 

 of a tumour, silk twist of so strong a nature that it can be trusted to bear the 

 needful strain, with a diameter of only about i-3oth of an inch. But it would 

 surely be wiser to sterilize even so slender a cord. Who can say that septic 

 mischief may not occasionally lurk in the ligature in a form which may baftie 

 the phagocytes ? 



The success in abdominal surgery achieved by Bantock and Lawson Tait, 

 without, it is said, the use of antiseptic means, proves a stumbling-block to some 

 minds. But in truth the practice of these surgeons is by no means conducted 

 without antiseptic precautions, nor would they, I am persuaded, desire that 

 such an impression should prevail. Both are scrupulously careful in the purifi- 

 cation of their sponges, and if there is one thing more important than another in 

 the antiseptic management of wounds of the peritoneum it is the avoidance of 

 impure sponges. Both observe the strictest cleanliness — which is surely an 

 antiseptic precaution — for it owes its virtue to the fact that it presents the 

 septic organisms in the smallest possible numbers and thus reduces their power 

 for evil to the utmost that can be done by any measures that are not germicidal. 

 Both these surgeons also wash out the peritoneum with water so as to get rid 

 of coagula without injuring the peritoneal surface by rubbing it with sponges, 

 and this is done in order to avoid the risk of sepsis in residual clots. The drainage 

 of the peritoneum is another antiseptic measure, and Dr. Bantock, I am informed, 

 has the sponges which absorb the serum wrung out of sulphurous acid, and 

 changes them very frequently. 



This is a department of surgery in which I have had but little personal 

 experience. But I can see that while the measures to which I have referred are, 

 so far as they go, highly valuable, it must be in itself a very desirable thing to 

 avoid the direct application to the peritoneum of strong and irritating antiseptic 

 solutions. But now that we are all agreed that microbes are the evil with which 

 we have to contend, it is surely wiser to ensure by germicidal means tlieir entire 

 absence from our liands and instruments rather than trust to the most perfect 

 cleanliness in the ordinary sense of the term. And it" water is used tor washing 

 out tlie peritoneum, prudence seems to me to dictate that it ought to be freed 

 entirely from hving organisms, if this can be done witliout making it irritating. 



