53 



There still remain a considerable number of cases, 

 notably wounds of mucous membranes, in which ana- 

 tomical relations prevent the execution of either of these 

 aseptic methods : bacteria cannot be excluded, nor per- 

 fect cleanliness of the wound secured. In such cases 

 asepsis can be theoretically obtained very simply by the 

 presence of some substance in the wound which renders 

 vital activity of bacteria impossible. There is a great 

 variety of such agents alcohol, carbolic acid, etc. but 

 for these cases all such are, from their volatility or 

 solubility, practically useless ; and it was reluctantly ad- 

 mitted on all sides that operation wounds involving mu- 

 cous membranes could not, generally speaking, be ren- 

 dered aseptic with certainty. Between 1860 and 1880 

 Billroth performed the amputation or extirpation of the 

 tongue one hundred and nineteen times on one hundred 

 different individuals ; and notwithstanding the most care- 

 ful attention, including frequent syringing with solutions 

 of potassium permanganate, carbolic acid, or other anti- 

 septic, twenty-six of these patients died, nearly all from 

 septic infection, either directly from the wound or in- 

 directly through the inhalation of septic products 

 " schluckpneumonie." With the introduction of iodo- 

 form into surgery the long-sought substance was found 

 comparatively insoluble and non-volatile in whose 

 presence the ordinary bacteria do not multiply. Under 

 the proper use of iodoform wounds of mucous membranes 

 are as secure from decomposition and septic infection as 

 an amputated stump under a Lister dressing. This is 

 admitted even by the fiercest opponents of iodoform 

 those who, like Kocher of Bern, having ignorantly poi- 

 soned their patients with it, would transfer to the agent 

 *he odium which evidently belongs to themselves. In 

 1 880-8 1 Billroth made eighteen tongue extirpations, 

 packing the wound with iodoform gauze which was al- 

 lowed to remain undisturbed five to seven days, then 

 sometimes renewed. Not a single septic infection oc- 

 curred ; recovery followed in every instance. 



An operation which, though not per se formidable, 



