ON THE PRINCIPLES OF ANTI:3EPTIC SURGERY 341 



and disastrous ; and the substance which I employed for the purpose was. 

 undiluted carbolic acid, a most potent germicide. The experiment answered 

 my most sanguine expectations ; the compound fractures following the same 

 safe and tranquil course as simple ones. 



The powerful caustic property of the agent employed was of trivial moment 

 in comparison with the greatness of the danger to be averted in compound 

 fracture, but made it quite unfit for application to incised wounds. But we soon 

 found that carbolic acid could be used with equally good effect under various 

 forms of dilution, so that the application of the j^rinciple could be extended to 

 wounds in general. The result was a complete revolution in the practice of 

 surgery. Hospitals which had previously been little short of pest-houses 

 became more healthy than private dwellings had been before ; and operations 

 which had been from time immemorial prohibited on account of their danger 

 were freely and successfully performed. 



Meanwhile it soon became apparent that putrefaction was b\' no means 

 the only evil that was avoided by treatment conducted on these lines. Hospital 

 gangrene, though in itself entirely free from unpleasant smell, disappeared as 

 if b}' magic, and the same was the case with erysipelas and odourless forms of 

 suppuration. This naturally suggested the idea that various diseases to which 

 wounds were liable, though not septic in the original sense of the word, were, 

 like putrefaction, caused by microbes, each disorder having, probably, its own 

 specific organism ; a view the truth of which has been amply demonstrated by 

 the study of bacteriology, to which the success of antiseptic treatment in surger\' 

 gave a powerful impetus. 



Thus the attempt to exclude microbes entirely from wounds was followed 

 by results which more than fulfilled the highest hopes entertained of it. Yet the 

 advance of knowledge has shown that to carry out such an idea in its entirety 

 is on the one hand impossible, and on the other hand unnecessary. 



It has been ascertained that many common bacteric forms produce spores 

 which resist for a long time the germicidal power of all known agents which could 

 be used in operations. Hence to exclude living microbes entirely from wounds 

 is an impossibility. 



It is, on the other hand, happily unnecessary; and that for more reasons than 

 one. In the lirst place, it appears that none of the bacteria which can cause 

 mischief in wounds are of the spore-bearing kinds, ^ while the sporeless bacteria, 

 such as the various stre}')tococci and staphylococci and the BcicHIks pyocvdiicus, 



' An exception was once met with by von X'olknumn who observed anthrax result from the use cf 

 the catgut Hgature, prepared, no doubt, from the intestine of a sheep that had died of that disease. But 

 this risk having been pointed t)ut, care is nt)w taken to treat the catyut in such a way as to make such 

 an occurrence impossible. 



