June 18, 1915] 



SCIENCE 



it is an incomplete and ever-lengthening 

 list ! As Mumford-" well says : 



Daring has become conservatism; rashness has 

 become common sense. 



Practically our ability to do all these life- 

 saving operations is the result of the re- 

 searches, the experiments, and the achieve- 

 ments of Lister aiid his followers. Had 

 antisepsis not made all operations, including 

 the opening of the head, the chest, the abdo- 

 men, and the pelvis, safe, we should still he 

 practising the very limited surgery of the 

 60' s. Every year thousands ivhom now we 

 restore to life and health would still be 

 dying. 



Wliat now are the prospects of Listerism 

 in the present horrible war ? I have so far 

 used the term "antisepsis." Asepsis is a 

 later and a natural development of anti- 

 sepsis and in civil life is of course prefer- 

 able. The underlying and enduring prin- 

 ciple of Listerism — the germ theory — is the 

 same in both. There is no fundamental 

 antagonism, but really a fundamental 

 agreement between the two methods. 



In the present war the surgeons whose 

 papers I have so far read are almost a unit 

 in favor of the antiseptic rather than the 

 aseptic treatment of the wounded. They 

 are right in my opinion, and the reason is 

 plain. Comparatively few of the wounded 

 reach hospitals with uninfected wounds. 

 MUd wounds, and even in some eases severe 

 ones, if they can be dressed soon after being 

 inflicted, heal readily. 



Sir Anthony Bowlby's^^ striking descrip- 

 tion of the conditions in the trenches shows 

 the difficulties very clearly : 



In this trench warfare, if a man is hit, he often 

 falls into filthy mud and water, which may be 

 three feet deep or more. The trench is only two 

 and a half feet wide. It is night, you can only 

 grope about in the dark and can do no dressing of 

 any kind, for you can't even get any clothes off 

 in the dark, and in so cramped a space, and you 



20 Keen 's ' ' Surgery, ' ' I., p. 76. 



21 Jour. Am. Med. Ass., April 10, 1915, p. 1257. 



must try to get the man away to a " dressing sta- 

 tion" half a mile distant, and thence to a field 

 ambulance. If it is daylight, you can't get the 

 man out of the trench at all, and he may have to 

 be kept there for many hours, because he would 

 certainly be killed if he were got out of the trench. 

 And the water in the trenches is hopelessly pol- 

 luted and soaks his clothes and his wound. Large 

 lacerated wounds, and especially bad bone 

 smashes, are so contaminated that it can never be 

 possible to render them aseptic. 



There is a noteworthy difference between 

 the results of the wounds in the case of the 

 trench-inhabiting soldiers and the wounds 

 of sailors. The latter escape the dangers of 

 the soil-infected trenches. 



Sailors with the most severe type of wound, 

 ragged, irregular, with uneven surface produced 

 by herniated muscle and retracted severed fibers, 

 usually have recovered promptly. Soldiers suffer- 

 ing from slight wounds have often had them con- 

 taminated with bacilli from the soil; particularly 

 the anaerobes. 



Hypertonic salt solutions like sea water 

 are actually remedial by promoting the 

 flow of lymph and serum in the wounded 

 tissues. 



But in a very large number of wounded 

 soldiers, possibly the majority, hours and 

 sometimes even days of delay ensure infec- 

 tion and then the surgeon is face to face 

 with the one overwhelming surgical prob- 

 lem which has so far bafBed all our efforts, 

 viz., how to transform a septic wound into 

 an aseptic wound and keep it so, and at the 

 satne time how to combat the toxins already 

 diffused throughout the body, but with- 

 out doing harm to the patient himself. 

 Cheyne,^^ Ehrlich, Wright and Carrel are 

 all at work and it may be that the happy 

 day when this, the most pressing and 

 urgent problem in surgery, shall be solved, 

 may come through this devastating war.-^ 



22Lan-eet, February 27, 1915, p. 419. 



23 In the British Medical Journal of April 10, 

 1915, a most important article by Sir Almoth E. 

 Wright on "Wound Infections" is begun. This 

 should be very carefully read. On pp. 735-38 of 



