342 ON THE PRINXIFLES OF ANTISEPTIC SURGERY 



have been shown by the most careful recent investigations to be deprived of 

 Hfe within a minute by a i to 20 watery solution of carbolic acid/ the agent 

 which we have always trusted for the purification of sponges and instruments, 

 the hands of the operator, and the integument of the patient at the seat 

 of operation. 



These are the points of greatest importance to attend to during the per- 

 formance of an operation, the once dreaded atmospheric dust being, as it would 

 seem, a matter that may be disregarded. We learn from various independent 

 inquiries that the effects of micro-organisms upon the living body are greatly 

 influenced by the dose, that is to say by the numbers in which they are present 

 at the point of introduction.^ And this seems to provide a clue to under- 

 standing how bacteria in the attenuated and minutely subdivided form in which 

 they are present in the atmosphere may be effectually disposed of by the natural 

 antiseptic action of the blood and the tissues. In pre-antiseptic days this natural 

 antisepsis often triumphed over enormous obstacles, preventing the layer of 

 lymph and coagulum between cut surfaces from putrefying, in spite of the use 

 of unclean sponges, instruments, and hands, and the presence, over the outlet 

 of the wound, of water dressing which, though cleanly when applied, was within 

 a few hours a stinking, putrid mass. But under the converse conditions in which 

 we now operate, this beneficent natural agency may, it seems, be implicly 

 trusted, if the microbes which enter the wound are only such as are deposited 

 from the atmosphere. That such is really the case has become apparent from 

 the uniform attainment of aseptic results by the use of means which could not, 

 as we now see, completely exclude living atmospheric organisms, whether spore- 

 producing or otherwise, during the performance of operations. The carbolic 

 spray, which was introduced for the purpose of destroying the microbes of the 

 air, could not, from its physical constitution, really effect that object,^ and owed 

 whatever good it did to its properties as an irrigator. But no system of irrigation 

 that can be devised can prevent, during the application of the sutures, the 

 occasional entrance of air into deep parts of the wound from which blood is 

 oozing on which the liquid of irrigation cannot act Yet under the use of the 

 spray or other forms of irrigation the results obtained may be fairly described 

 as uniformly aseptic, when opportunity for efficient antiseptic work was afforded 

 by unbroken skin of sufficient extent for the needful dressings. The complete 

 exclusion of living atmospheric organisms during operations is impossible ; 

 but no harm appears to arise from their introduction. 



' Vide Behring, 'Ueber Desinfection,' &c., Zeitschrift fiir Hygiene, Neunter Band, 1890, p. 417. 



" Vide W. Watson Cheyne, Suppuyation and Septic Diseases, Pentland, Edinburgh, 1889, pp. '^;i, £f. 



^ Vide Transactions of the Tenth International Medical Congress, vol. i, p. 32 (p. 336 of this volume). 



