502 



NATURE 



[January 2, 19 13 



both the aetiology of suppuration and its treatment 

 upon a scientific basis. Empiricism was in great 

 measure overthrown, and henceforward a rational 

 letiology for disease and its treatment was sought. 

 Microbiology, then in its infancy, received a great 

 impulse, and fresh fields were opened from which an 

 ever-increasing harvest has been reaped. From the 

 burning plains and pestilential swamps of the tropics, 

 10 our own slums, with their three great D's — dirt, 

 damp, and darkness, which we fondly harbour in our 

 midst — disease after disease has been traced to its 

 micro-organismal cause. Those diseases which re- 

 main will doubtless yield their secret to steady inves- 

 tigation, and would do so all the more readilv if 

 submitted to a properly constructed investigation de- 

 partment under scientific control. 



Tuberculosis, which for centuries was regarded as 

 an hereditary disease, was shown to be germ-borne, 

 common to man and to the lower animals, and to be 

 intercommunicable between them. Cancer and sar- 

 coma and the varieties included under these terms are 

 doubtless also germ diseases, the germs of which are 

 probably to be found near our everyday life, if our 

 eyes were open to perceive them. The need of a 

 scientific experimental investigation department under 

 scientific control is all the more apparent as the 

 Government has at last ventured to advance measures 

 intended to mitigate one of the communicable diseases 

 — tuberculosis. 



Yet what the governing bodies do with the one 

 hand they undo with the other. 



For instance, in the old days the light that entered 

 our houses was ta.xed, and the windows became 

 smaller ; to-day the powers that be tax the air con- 

 tained therein, and for every cubic foot of air enclosed 

 additional charge is made. In order to escape or to 

 lessen this burdensome assessment, manv huddle 

 themselves and their families into dwellings of the 

 smallest compass, where they inhale pre-breathed air, 

 with the resultant lowering of vitality, germ-dis- 

 semination, disease, and death. Then we appoint 

 commissions to find out the cause of the deterioration 

 of the race I 



Every man who is born has an inalienable right to 

 as much fresh air as he is able to consume ; but_ the 

 "powers that be" say, "God may give you that 

 right, but we shall tax you for using it." It is true 

 that they do not as yet tax us for the amount of air 

 we inhale out of doors, possibly because they do not 

 know how to estimate the individual consumption. 

 Yet the governing bodies are full of humanity and 

 have the best intentions. When the ravages of tuber- 

 culosis can no longer be hidden, as it stares them in 

 the face, they are moved to grasp at the first thing 

 that appeals to them, and they sav to the affected, 

 "Come, let us help you; we shall put you in sana- 

 toria." What happens there? The patient has his 

 birthright restored to him in being aljle to breathe 

 the fresh air which God has meted out so freelv, and 

 for the use of which he was previously taxed. 



Would it not be better to begin at the other end? — 

 better to stop producing tuberculosis than merely to 

 alleviate or to cure it once it has developed? 



Modifications in Antiseptic Treatment. 

 Antiseptic treatment underwent manv modifications. 

 What was essential in the early days of its introduction 

 became no longer necessary as the advance of know- 

 ledge brought clearer conceptions and paved the way 

 for radical changes in the form of treatment. It 

 became apparent that though strong antiseptics intro- 

 duced into wounds destroyed organisms, thev at the 

 same time exercised an irritating influence on the 

 living tissue, lowering its vitality, decreasing its re- 



XO. 2253, VOL. 90] 



sisting power, and increasing its secretions. To that 

 extent the free use of antiseptics in the interior of 

 wounds was detrimental. 



Besides being harmful, they were unnecessary, as 

 healthy living tissue of the interior of the body is 

 free from germs, and pure air is innocuous. 



Evolution of Aseptic Treatment. 



As microbiology yielded its secrets, the bearing of 

 germs and their products on the phenomena of disease 

 ever became the clearer. The primitive conception of 

 germs acting upon the human body just as thev 

 would in a laboratory test-tube was soon dispelled, 

 and the multiplicity of the defensive reactions estab- 

 lished by the living tissues for their own protection 

 was recognised. It was seen tliat the microbic pro- 

 ducts excited the tissues to anti-bacillary action, and 

 the elements of immunity, as we now understand it, 

 wore established. 



The anti-bacillary phagocytic action of the living 

 healthy tissue was demonstrated by the beautiful ex- 

 periments of Metclinikoff, when it was seen that a 

 certain number of organisms, brought into contact 

 with the living tissue, could be destroyed therein by 

 living cells. It also became obvious that the healthy 

 living tissue in the interior of the body was in- 

 herently free from germs, and when wounded was 

 capable of healing rapidly, and would do so if its 

 vitality were preserved, and if germs emanating either 

 from the abundant flora of the skin or from elsewhere 

 could be prevented from being brought into contact 

 with it. 



This was effected by sterilising the skin and the 

 instruments and all material brought into contact with 

 the wound, without allowing antiseptics to invade the 

 interior of the tissues. 



It is upon such lines that aseptic treatment was 

 introduced. Aseptic surgery was a natural evolution 

 of antiseptic surgery — the one paved the way for the 

 other. 



The surgery of the present day involves the per- 

 formance of painless, almost bloodless, operations, the 

 wounds healing, as a rule, under a single dressing 

 of the slightest description. Any material introduced 

 into a wound for the arrest of haemorrhage, or for 

 bringing the parts together, is of a kind which, after 

 its function has been performed, the living cells are 

 able to remove. When the patient recovers from the 

 effects of the anaesthetic his trouble is over. The film 

 which covers the wound drops off of itself as soon as 

 the phagocytes have completed their work of remov- 

 ing the deep part of the catgut stitches. 



The air of cheerfulness in a surgical ward is now 

 pronounced, the difficultv often being to persuade the 

 patients to remain quiet for a time sufficient to allow 

 the internal parts to heal. 



Advances consequent to the Introduction of Aseptic 

 Surgery. 



The introduction of aseptic surgery and the exten- 

 sion and more correct appreciation of bacteriological 

 knowledge have enabled surgical procedures upon the 

 human bodv to be greatly extended. The dangers 

 arising from risk of wound infection being averted, 

 many new devices have been practised for reaching the 

 internal organs and for removing therefrom the pro- 

 ducts of disease. 



Regions of the body hitherto considered too 

 dangerous to be operated upon have now been success- 

 fully entered, and it soon became apparent that wher- 

 ever diagnosis showed the presence of a serious 

 pathological lesion, there the surgeon could follow, 

 and where practicable eliminate it. 



Since the introduction of asepsis and the conse- 



