748 



SURGERY. 



ing must be changed as soon as a little discharge 

 permeates it, lest a septic channel be established 

 for the ubiquitous and maleficent vibrios ; that 

 these will settle down, as a swarm from the 

 air, on a granulating sore, if the spray be not 

 kept in action while it is dressed are (I say 

 it with the sincerest respect) questionable 

 propositions." 



Irrespective of the theory upon which it 

 was based, the results of the practice of anti- 

 septic surgery were at once subjected to a 

 rigorous comparison with the results of sur- 

 gery without antiseptics, or with modified an- 

 tiseptic treatment, and the discussion assumed 

 considerable acrimony. For many months the 

 various medical journals abounded in statistics 

 of the treatment of wounds by the old and the 

 new method. Mr. MacOormac reported forty- 

 five operations for the division of various bones 

 for the removal of deformity, thirty of which 

 involved the knee-joint, and every one of which 

 "recovered in the speediest, easiest, and safest 

 manner possible." All his cases of compound 

 fracture (fracture combined with a wound of 

 the soft parts, allowing the entrance of air) 

 recovered, except one, and those of the leg 

 almost as though they had been simple ; and 

 so on through all the range of major surgical 

 operations. He says : 



Is there any other method even that with the " sim- 

 plest, safest, best of antiseptics," clean water which 

 will permit the surgeon to view a mass of dead blood 

 lying in an open wound being transformed day by 

 day oefore his eyes into living tissue ? If this be true, 

 and I suppose its truth will not be denied ; if the 

 great joints may be opened with absolute impunity 

 by the surgeon's knife; if such formerly fatal in- 

 juries as gunshot wounds of the knee may be saved 

 amid the difficulties of an army in the field ;, if ovari- 

 otomy be made more successful in the hands of ex- 

 perts, who operate on such cases by hundreds, and, 

 what is to my thinking more important, the operation 

 is rendered safer and more successful in the hands of 

 other surgeons ; if, in injuries of the head, in ordinary 

 amputations and excisions, and operations of various 

 kinds in compound fractures, not only is the risk of 

 life diminished, but the recovery of the patient marked 

 by a minimum of pain, fever, and suppuration then 

 a gain has been accomplished for surgery which it is 

 scarcely possible to characterize ; and I do not know 

 which to admire the more, the scientific mind that 

 has grasped a great principle and applied it, or the 

 character of the man who has unswervingly pursued 

 the object of his life, patiently perfecting, one oy one, 

 the means adapted to secure the end in view. 



This may be regarded as a glowing tribute 

 to Mr. Lister and to Pasteur by one who ac- 

 cepts entirely the practice of the former and 

 the theory of the latter, and there are many 

 surgeons who come within this class. There 

 are many others, however, who hold modified 

 views. For example, Mr. Holmes, arguing on 

 the basis of 162 compound fractures treated to 

 their conclusion, admits the great improve- 

 ment observed in the results of injuries and 

 operations since Mr. Lister began his attempts 

 to secure the healing of wounds without putre- 

 faction; but denies that this is due entirely 

 to the method itself, since it is noted in the 

 practice of those who repudiate Mr. Lister's 



teachings. He thinks that all wounds and 

 injuries are now much more carefully treated 

 than they were some years since; and the 

 effect of such increased care must show itself 

 in the practice of those who follow the old 

 methods of treatment, as well as of those who 

 have adopted the new system. The question 

 is, whether the results of the antiseptic system 

 are so decidedly superior to those of other 

 methods of treatment as to show that it is 

 the only system adapted for general use in 

 hospitals. The fractures occurring in St. 

 George's Hospital, on which Mr. Holmes's 

 statistics were based, were treated by no one 

 method to the exclusion of others, his idea 

 having been to give all methods a fair trial, 

 and thus form an unbiased judgment as to the 

 worth of the antiseptic method in particular. 

 The result was, that he formed a strong gen- 

 eral impression that the antiseptic method is 

 superior to the others, at any rate during the 

 dangerous period following the injury, in which 

 the occurrence of surgical fever is so common 

 under ordinary treatment, and during which 

 erysipelas, diffuse inflammation, sloughing, ex- 

 tensive suppuration, and general blood-poison- 

 ing are so common. 



The views are those of the greater number 

 of the surgeons of to-day. The best results 

 obtained by the strictest antiseptic treatment 

 may be matched in individual cases by as good 

 results obtained by almost no treatment, but 

 on the whole there has been a vast improve- 

 ment since Mi-. Lister began to teach the use 

 of the spray, though this improvement is not 

 entirely due to the spray. It is found equally 

 in hospitals where antiseptic surgery as taught 

 by Lister has never been practiced. True an- 

 tiseptic surgery is much older than Mr. Lister, 

 though this in no wise detracts from the debt 

 of gratitude the world owes to him for recall- 

 ing and insisting upon its real value. There 

 are also other antiseptics more powerful than 

 carbolic acid and impermeable dressings. In 

 the words of Mr. Gamgee, "Life and putre- 

 faction are not correlative, but antagonistic; 

 and, in proportion as the surgeon utilizes and 

 economizes the attributes of life, he will find 

 himself independent of those changes which 

 are inherent in decaying organic matter; 

 whether it be in bagging wounds or boggy 

 lands, Life is the great antiseptic. Preserve 

 it, restore healthy function, control by rest, 

 position, and pressure, nervous, vascular, and 

 muscular action, so as to minimize the material 

 for and the causes of discharge, carry this off 

 as it is produced, by drainage-tubes and absorb- 

 ent dressings, and the repair of injuries pro- 

 ceeds, like healthy nutrition, uninterruptedly 

 and painlessly." In addition* to these things, 

 the antiseptic properties of the balsamic prepa- 

 rations, of turpentine and resinous gums, of 

 alcohol, bark, and acids, have been utilized in 

 wound-treatment for generations. 



Thus, then, as a result of theory and practice, 

 the surgery of to-day has reached a stage in 



