September 17, 1896J 



NA TURE 



46/ 



part, but simply to the strenuous endeavour to carry out strictly 

 what seemed to me a principle of supreme importance. 



Kcjually striking changes were afterwards witnessed in other 

 institutions. Of these I may j;ive one ex.imple. In the great 

 Allgcmeines Krankenhaus of Munich, hospital gangrene had 

 become more and more rife from year to year, till at length the 

 frightful condition was reached that So per cent, of all wounds 

 became affected by it. It is only just to the memory of Prof. 

 von Nussbaum, then the head of that establishment, to say that 

 he had done his utmost to check this frightful scourge ; and that 

 the evil was not caused by anything peculiar in his management 

 was shown by the fact that in a private hospital under his care 

 there was no unusual unhealthiness. The larger institution 

 seemed to have become hopelessly infected, and the city authori- 

 ties were contemplating its demolition and reconstruction. 

 Under these circumstances, Prof, von Nussbaum despatched his 

 chief assistant. Dr. Lindpaintner, to Edinburgh, where I at 

 that time occupied the chair of Clinical Surgery, to learn the 

 details of the .antiseptic system as we then practised it. He 

 remained until he had entirely mastered them, and after his 

 return all the cases were on a certain day dressed on our plan. 

 F'rom that day forward not a single case of hospital gangrene 

 occurred in the Krankenhaus. The fearful disease pyaemia 

 likewise disappeared, and erysipelas soon followed its example. 



Hut it was by no means only in removing the unhealthiness of 

 hospitals that the antiseptic system showed its benefits. In- 

 flammation being suppressed, with attendant pain, fever, and 

 wasting discharge, the sufferings of the patient were, of course, 

 inunensely lessened ; rapid primary union being now the rule, 

 cimvalescence was correspondingly curtailed ; while as regards 

 safety and the essential nature of the mode of repair, it became 

 a matter of indifference whether the wound had clean-cut sur- 

 faces which could be closely approximated, or whether the injury 

 inflicted had been .such as to cause destruction of tissue. And 

 operations which had been regarded from time immemorial as 

 unjustifiable were adopted with complete safety. 



It pleases me to think that there is an ever-increasing number 

 of practitioners throughout the world to whom this will not 

 appear the language of exaggeration. There are cases in which, 

 from the .situation of the part concerned or other unusual 

 circumstances, it is impossible to carry out the antiseptic system 

 completely. These, however, are quite exceptional ; and even 

 in them much has been done to mitigate the evil which cannot 

 be altogether avoided. 



I ask your indulgence if I have seemed to dwell too long upon 

 matters in which I have been personally concerned. I now 

 gladly return to the labours of others. 



The striking results of the application of the germ theory to 

 surgery acted as a powerful stimulus to the investigation of the 

 nature of the micro-organisms concerned : and it soon appeared 

 that putrefaction was by no means the only evil of microbic 

 origin to which wounds were liable. I had myself very early 

 noticed that hospital gangrene was not necessarily attended by 

 any unplea-sant odour ; and I afterwards made a similar observ- 

 ation regarding the matter formed in a remarkable epidemic of 

 erysipelas in Edinburgh obviously of infective character. I h.ad 

 also seen a careless dressing followed by the occurrence of sup- 

 puration without putrefaction. And as these non-putrefactive 

 disoiders had the same self-propagating property as ferments, 

 and were suppressed by the same antiseptic agencies which were 

 used for combating the putrefactive microbes, I did not doubt 

 that they were of an analogous origin ; and I ventured to express 

 the view that, just as the various fermentations had each its 

 special microbe, so it might be with the various complications 

 of wounds. This surmise was afterwards amply verified. Prof. 

 Ogston, of Aberdeen, was an early worker in this field, and 

 showed that in acute abscesses, that is to say those which run a 

 rapid course, the matter, although often quite free from un- 

 pleasant odour, invariably contains micro-organisms belonging 

 to the group which, from the spherical form of their elements, 

 are termed micrococci ; and these he classed as streptococci 

 or staphylococci, according as they were arranged in chains 

 or disposed in irregular clusters like bunches of grapes. 

 The German pathologist, Fehleisen, followed with a beautiful 

 research, by which he clearly proved that erysipelas is 

 caused by a streptococcus. A host of earnest workers in 

 dift'erent countries have cultivated the new science of Bacteri- 

 ology, and, while opening up a wide fresh domain of 

 Biology, have demonstrated in so many cases the causal relation 

 between special micro-organisms and special diseases, not 



NO. 1403, VOL. 54] 



only in wounds but in the system generally, as to afford ample 

 confirmation of the induction which had been made by Pasteur 

 that all infective disorders are of microbic origin. 



Not that we can look forward with anything like confidence 

 to being able ever to see the iiiateries nwrbi of every 

 disease; of this nature. One of the latest of such discoveries 

 has been that by Pfeiffer of Berlin of the bacillus of influenza, 

 perhaps the most minute of all micro-organisms ever yet 

 detected. The bacillus of anthrax, the cause of a plague com- 

 mon among cattle in some parts of Europe, and often communi- 

 cated to sorters of foreign wool in this country, is a giant as- 

 compared with this tiny being ; and supposing the microbe of 

 any infectious fever to be as much smaller than the influenza 

 bacillus as this is less than that of anthrax, a by no means un 

 likely hypothesis, it is probable that it would never be visible to 

 man. The improvements of the microscope, based on the 

 principle established by my father in the earlier part of the 

 century, have apparently nearly reached the limits of what is 

 possible. But that such parasites are really the causes of all 

 this great class of diseases can no longer be doubted. 



The first rational step towards the prevention or cure of 

 disease is to know its cause ; and it is impossible to over- 

 estimate the practical value of researches such as those to which 

 I am now referring. Among their many achievements is what 

 may be fairly regarded as the most important discover)' ever 

 made in pathology, because it revealed the true nature of the 

 disease which causes more sickness and death in the human race 

 than any other. It was made by Robert Koch, who greatly 

 distinguished himself when a practitioner in an obscure town in 

 Germany, by the remarkable combination of experimental acute- 

 ness and skill, chemical and optical knowledge and successful 

 micro-photography which he brought to bear upon the illustration 

 of infective diseases of wounds in the lower animals ; in recog- 

 nition of which service the enlightened Prussian Government at 

 once appointed him to an official position of great importance 

 in Berlin. There he conducted various important researches ; 

 and at the London congress in 1881 he showed to us for the 

 first time the bacillus of tubercle. Wonderful light was thrown 

 by this discovery upon a great group of diseases which had 

 Ijeforebeen rather guessed than known to be of an allied nature ; 

 a precision and efficacy never before possible was introduced 

 into their surgical treatment, while the physician became guided 

 by new and sure light as regards their diagnosis and prevention. 



At that same London congress Koch demonstrated to us his 

 " plate culture " of bacteria, which was so important, that I 

 must devote a few words to its description. With a view to the 

 successful study of the habits and effects of any particular 

 microbe outside the living body, it is essential that it should be 

 present unmixed in the medium in which it is cultivated. It 

 can be readily understood how difficult it must have been to 

 isolate any particular micro-organism when it existed mixed, as 

 was often the case, with a multitude of other forms. In fact, 

 the various ingenious attempts made to effect this object had 

 often proved entire failures. Koch, however, by an ingenious 

 procedure converted what had been before impossible into a 

 matter of utmost facility. In the broth or other nutrient liquid 

 which was to serve as food for the growing microbe he dis- 

 solved, by the aid of heat, just enough gelatine to ensure that, 

 while it should become a solid mass when cold, it should 

 remain fluid though reduced in temperature so much as to be in- 

 capable of killing living germs. To the medium thus partially 

 cooled was added some liquid containing, among others, the 

 microbe to be investigated ; and the mixture was thoroughly 

 shaken so as to diffuse the bacteria and separate them from each 

 other. Some of the liquid was then poured out in a thin layer 

 upon a glass plate and allowed to cool so as to assume the solid 

 form. The various microbes, fixed in the gelatine and so pre- 

 vented from intermingling, proceeded to develop each its special 

 progeny, which in course of time showed itself as an opaque 

 speck in the transparent film. Any one of such specks could 

 now be removed and transferred to another vessel in which 

 the microbe composing it grew in perfect isolation. 



Pasteur was present at this demonstration, and expressed his 

 sense of the great progress effected by the new method. It was 

 soon introduced into his own institute and other laboratories 

 throughout the world ; and it has immensely facilitated bacterio- 

 logical study. 



One fruit of it in Koch's own hands was the discovery of the 

 microbe of cholera in India, whither he went to study the 

 disease. This organism was termed by Koch from its curved 



