ANTISEPSIS AND ASEPSIS 773 



In medical practice, while antiseptics can be applied locally 

 with success and, to some extent, for disinfecting the alimentary 

 tract, 1 no substance has yet been discovered which can be ad- 

 ministered with safety to such a degree as to saturate the body, 

 and so exert a general germicidal action in bacterial infective 

 diseases. Salvarsan, perhaps, to some extent possesses this 

 power and has been used with success in certain general infections, 

 e.g. anthrax. Protozoa are attacked selectively by many sub- 

 stances, e.g. the malaria parasite by quinine, spirochaetes by 

 salvarsan, trypanosomes by atoxyl, trypan red, etc., Piroplasma 

 canis by methylene-blue, etc. 



In surgical practice no unbiased observer can doubt the efficacy 

 of antiseptic treatment, but many so-called " antiseptic opera- 

 tions " are marred by faults of omission and commission which 

 render them far from being perfectly antiseptic. There has 

 been some controversy between the advocates of " antiseptic " 

 and of " aseptic " surgery. Undoubtedly antiseptics do diminish 

 the vitality and therefore the reparative power of the tissues, and 

 aseptic methods should so far as possible replace antiseptic ones. 

 The skin of the patient and the hands of the operator having been 

 disinfected as far as possible, no antiseptic should be permitted 

 to come into contact with the wound, which may be irrigated 

 with warm sterile physiological salt solution. A dry wound is an 

 important element to success, and a dry, sterile, unirritating 

 dressing should be employed. Instruments, sponges, etc., may 

 be kept in sterile salt solution after the preliminary disinfection 

 by heat (not sponges) or chemicals. But the aseptic system 

 requires more care to ensure success than the antiseptic one, and 

 unless the assistants can be trusted and the details rigorously 

 carried out, the latter seems preferable. 



With regard to septic wounds Wright maintains that no anti- 

 septic can be applied to a wound in sufficient concentration to 

 destroy micro-organisms without causing inhibition of phagocy- 

 tosis and other natural defensive mechanisms, and that antiseptics 

 therefore do more harm than good. To increase the flow of 

 germicidal lymph he recommends salt packs and hypertonic salt 

 solution. On the other hand Carrel flushes out the wound 



1 See F. E. Taylor, " Intestinal Disinfection in Alimentary Toxemia," 

 Medical Press, January 14, 1914. 



