THE PRESENT POSITION OF ANTISEPTIC SURGERY 337 



And these particles cannot have been in more than instantaneous contact with 

 much of the dust before it was drawn within the chest, and securely protected 

 by the pus or serum there from any further action of tlie antiseptic. It is 

 ]:)hysically impossible that the microbes in such dust can have been in any way 

 whatever affected by tlieir momentary presence in tlie spra}'. 



Yet we did not find our results in the treatment of empyema rendered worse 

 by this false confidence in the spray. There are few^ more beautiful things in 

 antiseptic surgery, as contrasted with the results of former practice, than to 

 see the abvmdant purulent contents of the pleural cavity give place at once 

 to a serous effusion, rapidly diminishing from day to day till, the opening being 

 allowed to close, the pleura, restored to its healthy condition, resumes its normal 

 function of absorbing gases ; and, as the natural vacuum within it becomes 

 re-established, the atmospheric pressure blows up the contracted lung, and 

 brings it again into contact with the chest wall unimpaired in its dimensions. 

 Such a case we had witnessed before the days of the spra\', and such we continued 

 to see during its use. 



If, then, no harm resulted from the admission day after day of abundant 

 atmospheric organisms to mingle unaltered with the serum in the pleural cavit\-, 

 it seems to follow logically that the floating particles of the air may be disregarded 

 in our surgical work ; and, if so, we may dispense with antiseptic washing 

 and irrigation, provided always that we can trust ourselves and our assistants 

 to avoid the introduction into the wound of septic defilement from other than 

 atmospheric sources. 



Since w'e abandoned the spray, three years ago, we have been careful to 

 compensate for its absence, not only by antiseptic washing and irrigation, but 

 ^by surrounding the seat of operation with widespread towels wrung out of an 

 antiseptic solution. For the spray, though useless for the object for which 

 it w'as originally designed, had its value as a diffuse and perpetual irrigator, 

 maintaining purity of the surgeon's hands and their vicinity as an unconscious 

 caretaker. But if besides the spray w^e give up all washing and irrigation of 

 the wound, our vigilance must be redoubled. Y^et I believe that, with assistants 

 duly impressed with the importance of their duties, the task would prove by 

 no means diflicult. 



I have not yet ventured to make the experiment on any large scale, although 

 I have long had it in contemplation. It is a serious thing to experiment upon 

 the lives of our fellow men, but I believe the time has now arrived wlien it mav 

 be tried. And if it should succeed, then perhaps may be fulhHed my early 

 dream. Judging from the analogy of subcutaneous injuries, I hoped that 

 a wound made under antiseptic jirecautions might be forthwith closed com- 



