On taking the chair, Professor LISTER said:GENTLEMEN :—

Although I am well aware that the time of this Section is exceedingly precious, I cannot refrain from expressing my deep sense of the honor I have received, an honor as great as it was entirely unexpected, in being called upon to preside over the Surgical Department of this great International Congress, sitting as it does in the chief centre of medical instruction on this vast continent. American surgeons are renowned throughout the world for their inventive genius, and boldness and skill in execution. It is to America that we owe anesthesia, the greatest boon ever conferred upon suffering humanity by human means; from America came the ligature of the common iliac artery for aneurism; the ligature of the internal iliac for the same disease; the "extension treatment" by the weight and pulley for fractures of the thigh, and other injuries and diseases; the reduction of dislocation of the hip-joint by manipulation; and that model of ingenuity, which I cannot mention without alluding to the name of its inventor, Sayre's splint for morbus coxarius. These are but samples of what surgery owes to this country, and it might, therefore, well have been that some American surgeon should have been called upon to preside over this Section of the Congress. Yet I assure you, gentlemen, that highly as I esteem this honor, it is the more gratifying to me, because I am persuaded that it has not been conferred on account of any special merit of my own, but in consequence of the interest felt by the profession in Antiseptic Surgery, with which my name happens to be connected. It was the circumstance of my observing in the programme of the business of the Congress that the subject of Antiseptic Surgery was to come on first for discussion, that led me to cross the Atlantic; and I should be pleased, indeed, if the discussion which is about to take place should have the effect of strengthening the belief of the profession in the truth, the value, and the practical application of the principles of Antiseptic Surgery.

ANTISEPTIC SURGERY.

BY

JOHN T. HODGEN, M.D.,

PROFESSOR OF SURGICAL ANATOMY AND OF FRACTURES AND DISLOCATIONS IN THE ST. LOUIS MEDICAL COLLEGE, ST. LOUIS, MO.

PUTREFACTION is a decomposition experienced by animal substances when deprived of life and placed under special circumstances. The products of putrefaction are the results of the retrograde metamorphosis of nitrogenized substances. The process bears a striking resemblance to similar retrograde changes that occur in vegetable matters, resulting in the production of carbonic acid, alcohol, acetic and butyric acids, etc., while the products of the decomposition of animal substances are represented by carbonic acid, ammonia, butyric acid, leucine, sulphuretted hydrogen, and many other matters whose chemical characters are not well established, and yet which cannot but be recognized as active agents in the production of septicemia. Pasteur has shown that neither in vegetable nor in animal substances can putrefaction occur rapidly without the presence of living germs.2

Tyudall has, by the aid of electric light, and by almost innumerable experiments in reference to the development of living organisms, shown that the germs, without which putrefaction cannot be induced, and without which living organisms cannot be made to appear in vegetable and animal infusions, are found in unnumbered multitudes in the atmosphere. The observations of Rindfleisch make it appear that these putrefactive and infusorial germs are abundant in water (terrestrial water), and less abundant, and perhaps not even present, under ordinary circumstances, a few hundred feet above the earth's surface. Tyndall has,

The Antiseptic System, by A. E. Sansom, p. 31. Nitrogen, hydrogen, ammonia; sulphuretted, carburetted, and phosphuretted hydrogen; carbonic acid; carbonic oxide; acetic, butyric, and valerianic acids, and various other phosphorus and nitrogen bases

2 Quarterly German Magazine, 1872; Mildew and Fermentation, by A. De Bary. Liv ing yeast cells capable of growing and budding are absolutely necessary to the introduction of fermentation. . . In dead substances in which we find bacteria, they are undoubtedly the vital promoters of decomposition.

3 British Medical Journal; abstract of paper read before the Royal Society, January 18, 1876, by Prof. Tyndall.

4 Virchow's Archiv, 1872, Bd. liv. S. 402. Examination of Lower Organisms, by Prof. Rindfleisch, of Bonn. Inaugural Thesis by Lothar Jasper, of Berlin, 1873. Treatment of Wounds by the Open Method and by Antiseptics. . . . Atmospheric air carries the organisms which produce suppuration. The air does not contain the organisms which produce decomposition, these are contained in terrestrial water and on all objects moistened by it.

5 See The Antiseptic System, by A. E. Sansom, in which Schroeder and Dusch (in 1854 and 1859) testify that air passed through cotton-wool, which acted as a filter, was free from organisms. (p. 36.) "In 1860 M. Pasteur . . . filtering the air through a quantity of guncotton, dissolved the latter in ether, and thus obtained in a small space a number of bodies whose appearance announced them to be organized.” (p. 35.) . . . He sowed the germs and produced organisms. "In some places the air was more fruitful than in others; especially its fertility diminished in proportion to the altitude from which it was obtained." (p. 36.) "In the air of sick rooms, hospitals, crowded halls, etc., many fungoid organisms have been noted by Trautman, Brittau, and Swayne, Dundas Thomson, Rainey, Lund, Lemaire, and

moreover, shown that, in the absence of currents of air, the germs do not reach infusions contained in vessels terminating in bent tubes, the ends of which are directed downwards, showing that germs must fall, or be carried by currents of air, into infusions, if they reach them at all, and establishing beyond a doubt that the specific gravity of the germs' is greater than that of the atmosphere.

Pasteur has determined that the ferments present different physical peculiarities, so that the one may be distinguished from the other, and that they feed upon albuminoid substances. Prof. Tyndall filled 100 tubes with infusions, and from the irregular manner in which the contents of the individual tubes were smitten, concludes that the germinal matter of bacterial life is not uniformly distributed in the air, and thus accounts for the difference in the behavior of different wounds similarly circumstanced.5

The atmosphere of hospitals seems to be pervaded by living germs, and the walls and ceilings seem to be encrusted with them. Chaivet" found putrescible matters in the atmosphere and on the curtains, the windows, the walls and the ceilings of the Hospital Saint Louis. He also states that the vapor of water condensed near a suppurating wound is charged with irregular corpuscles resembling dried pus. "The experiments of Chauveau and Burdon Sanderson demonstrate that if a septic fluid capable of producing toxæmia when injected into the veins of a living animal be strained through a porcelain filter, the liquor so filtered may be injected with impunity, whereas the solid residue remaining on the filter retains in full force all the septic properties of the original fluid matter.' Mr. Lund found bacteria in the air of the Manchester Royal Infirmary. Septicemia, in the surgical sense, expresses that condition of the blood which is induced by the presence of the products of putrefaction, a condition of the circulating fluid that unfits it for the proper performance of its function. Putrid matters may enter the circulation through any of the mucous, serous, or cutaneous surfaces, or from any part of the body in which they may be present."

997

In surgery, the meaning is limited to the presence of putrid matters

Ransome. More recently Dr. Maddox has carefully examined the particles derived from the atmosphere," . . . and found pollen grains, minute germs of fungi or protophytes, and excessively minute bodies, molecules,' 'globules,' etc." (p. 59.) "Dr. Percy found the dust of the British Museum to contain 50 per cent. of inorganic [Qu. organic?] matter. The latest investigations of this subject have been made by Mr. Tichborne, F.C.S. The following were the results of analyses: Street dust in Dublin contained organic matter 31 per cent. Dust from places of Public Concourse contained organic matter 32 to 53 per cent. Dust from Nelson's Pillar, 134 feet in height, contained organic matter 29 per cent." (p. 60.) See The Antiseptic System, by A. E. Sansom, p. 58. Pasteur and Lister find that putrefactive germs are arrested in bent tubes.

See Sansom, p. 36. "By further researches Pasteur concluded that the different kinds of organisms met with in putrefying solutions differed widely in the conditions of their nutrition and their vitality. Some absorb oxygen and excrete carbonic acid; others the converse."

Pasteur, Annales de Chimie et de Physique. Burdon Sanderson, Transactions of the Pathological Society of London, vol. xxiii., 1872. Cohn, Quarterly Journal of Microscopical Science, 1873, p. 156.

Sansom, p. 36; Pasteur's experiments.

5 Prof. Tyndall's recent researches; Abstract of paper read before the Royal Society, January 18, 1876. From the British Medical Journal.

Chalvet, Mémoires de l'Académie Impériale de Médecine; Paris, 1863, tome xxvi. See A Clinical Lecture on Septicemia, delivered January 26, 1876, by S. Messenger Bradley, F.R.C.S., Surgeon to the Manchester Royal Infirmary.

8 Ibid.

9 Pathology and Morbid Anatomy, by T. Henry Green, London, 1876.

derived from the decomposition of the solids and liquids of the body itself; and these putrid matters may be formed either in parts in direct contact with the air, or in those with which the air does not come directly in contact. Common observation indicates that absorption of these noxious matters takes place more rapidly in recent wounds, and in the early stages of inflammations, while the experiments of Billroth attest that after healthy granulation is fairly established, absorption of putrid matters goes on so slowly (if at all) that the phenomena of septicemia are not presented. He says, "Certain circumstances are necessary for putrid matters to be taken into the blood of man. Such substances are taken through the healthy skin and mucous membranes when the putrid substances have a destructive or cauterant action, or an active power of penetrating, like fungi and infusoria." "Diseased skin or wound-surfaces take up such putrid matters more readily, but even they only do so under certain circumstances; for instance, germs do not readily pass through well organized, uninjured granulations." "If we dress a nicely granulating wound on a dog with charpie dipped in the filthiest putrid matter, if the latter contains no cauterant substance that may destroy the granulating surface, the animal will not sicken; nothing will be absorbed. . . . If the septic poison be introduced into fresh tissue, it not only excites severe local inflammation, but quickly induces general fever."

Putrid pus is found in abscesses in many parts of the body; near the alimentary canal or respiratory passages, and in the soft tissues of the extremities, as well as in and about the bones, and, indeed, in every part of the body. A destructive inflammation may be set up about these collections, and the protecting walls may melt away and furnish more matter to undergo putrefaction, while the conditions left by their destruction will favor the absorption of septic matter. And it is probable that the septicemia that so frequently follows the discharge of large collections of putrid pus is due, not so much to the admission of air and fresh agents active in the production of putrefaction, as to the rekindling of a destructive inflammation in the walls of such abscesses. This renewing of inflammatory changes may be due to the increased flow of blood to their walls, permitted by suddenly removing the pressure that may have, for an indefinite period, acted as a barrier to its entrance. The renewal of inflammatory processes from any cause in tissues surrounding collections of putrid matters is apt to be followed by septicemia.

Certain conditions of the solids and liquids of the body are essential to the ready action of septic substances. In the physiological processes of the body, disintegrations and retrograde metamorphoses are constantly occurring as a consequence of vital actions, and the elements of the tissues assume a condition of fitness for putrefaction; all of the excretions. are examples of these products. Febrile states, inanition, over-exercise, all induce changes in the organism that favor putrefaction in the solids and liquids of the body.

The impregnation of the tissues with certain substances tends to prevent putrefaction. Prof. Polli, of Milan, found that the bodies of animals that had been fed on the sulphites resisted putrefaction longer than those of similar animals not so fed, and that urine passed after taking sulphites remained "fresh, acid, and clear, and did not undergo ammoniacal fermentation for eight days during the hottest Italian summer." According

Joseph Bell, M.D., Edinburgh Medical Journal, 1869, p. 982, et seq. 2 Billroth, Surgical Pathology, American Edition, 1871, p. 334.