ON THE PRINCIPLES OF ANTISEPTIC SURGERY 



{Virchow-Festschrift. Bd. iii (1891).] 



The fundamental truth on which Antiseptic Treatment in surgery is based 

 is now universally recognised. All are now agreed that the once formidable 

 complications of wounds are caused by living organisms derived from the external 

 world and incapable of originating de novo within the animal body. But the 

 practice which has resulted from a recognition of this truth varies greatly in 

 the hands of different surgeons ; and it is of great importance to endeavour to 

 ascertain, in accordance with the present state of our knowledge, what are the 

 points which it is essential to attend to, so that on the one hand we may be freed 

 from the encumbrance of needless precautions, and on the other hand may not 

 omit anything which is conducive to such constancy of aseptic results as can 

 alone justify many operations which are in themselves desirable but fraught 

 with grave dangers if septic complications arise. 



The original idea of the antiseptic system of treatment was the exclusion 

 of all microbes from wounds. It had long been obvious that the putrefaction 

 which at that period attended all wounds except the very small proportion which 

 united entirely by the first intention, was a grievous cause of mischief. Various 

 antiseptic substances were used to mitigate the evil, but entirely to prevent 

 its occurrence appeared hopeless so long as it was believed, in accordance with 

 the teaching of Gay Lussac, backed by the high authority of Liebig, that the 

 access of a minute quantity of free oxygen could start progressive fermentative 

 changes in organic substances. Where discharge escaped from a wound, oxygen 

 must be able to enter. But when Pasteur had shown that putrefaction and 

 other fermentative changes were caused by the growth of micro-organisms, and 

 had at the same time demolished the idea of spontaneous generation, the problem 

 of the prevention of putrefaction in wounds seemed no longer hopeless. The 

 fermentative microbes could not arise de novo in the blood or tissues, and the 

 experience of the absence of all danger in simple fracture seemed to indicate 

 that they could not gain access by any other channel than an open wound. 

 It therefore seemed possible that putrefaction might be entirely prevented in 

 wounds by treating them with some substance which might destroy the life 

 of the microbes, though not excluding the atmospheric gases. 



The first attempt to put this idea in practice was made with compound 

 fractures, in which the evils caused by putrefaction were especially manifest 



