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HENRY 0. MARCY, A.M., M.D., 
BY 
BOSTON, U S. A., 
PRESIDENT AMERICAN ACADEMY OF MEDICINE; MEMBER OF THE INTERNATIONAL 
MEDICAL CONGRESS; MEMBER OF THE BRITISH MEDICAL ASSOCIATION; MEMBER 
OF THE AMERICAN MEDICAL ASSOCIATION; MEMBER OF THE MASSACHUSETTS 
MEDICAL SOCIETY; CORRESPONDING MEMBER OF THE MEDICO- 
CHIRURGICAL SOCIETY OF BOLOGNA, ITALY; FELLOW OF 
THE BOSTON GYNAECOLOGICAL SOCIETY; CAMBRIDGE 
MEDICAL IMPROVEMENT SOCIETY; LATE 
SURGEON U. S. A., ETC. 
before menican 0cademj of FRedicine 
Philadelphia, 0ct. 26, 1882, Tl| f Me[(j 0 ds 
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HENRY 0. MARCY, A.M., M.D., 
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president American academy of medicine; member of the 
MEDICAL CONGRESS; MEMBER OF THE BRITISH MEDICAL ASSOCIATION; MEM&fcfb 
OF THE AMERICAN MEDICAL ASSOCIATION; MEMBER OF THE MASSACHUSETTS 
MEDICAL SOCIETY; CORRESPONDING MEMBER OF THE MEDIOO-V 
CH1R URGICAL SOCIETY OF BOLOGNA, ITALY; FELLOW O 
THE BOSTON GYNAECOLOGICAL SOCIETY; CAMBRIDGE 
MEDICAL IMPROVEMENT SOCIETY; LATE 
SURGEON U. S. A., ETC. 
Pead before Q merican Qcadcmy of Fftedicine. 
Philadelphia, 0ct. 26, 1882, 
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hb THE BEST METHODS 
OF 
Treating Operative wounds* 
BY 
Henry O. Marcy, A. M., M. D., Boston. 
The problems of our Art are of difficult solution. The limited num- 
ber of well-known factors, out of which we would fain build a science, 
are ever so intimately and variously blended with the unknown, that 
each clinical history is of an interest intensely dramatic, the central 
and all absorbing thought no less than human life itself. 
Like the weavers of the wonderful old tapestries we follow with anx- 
ious gaze the outlines of the dimly traced pattern, selecting shades 
with doubtful short-sighted vision, and alas, like them, too often work- 
ing upon the wrong side of our canvas. 
Yet, with historic certainty, we sketch the progress of our art from 
the standpoint of the centuries, and record with proud content, the 
marvellous discoveries of our age. With prophetic sense, like a trav- 
eller in an unknown land, from some lofty point of vision, filled with 
inspiration at the view, we scan the outlying territories of the future, 
and, at least, in a general way, map out the vast stretches which loom 
up before us. 
A distinguished trans-Atlantic correspondent writing in this spirit, 
closes with this sentiment: “ The medicine of the twentieth century, 
Sanitary Science and Surgery! ” 
*Read before the American Academy of Medicine, Philadelphia, Oct. 26,1882. 2 
TREATING OPERATIVE WOUNDS. 
Iq the enthusiasm of our younger discipleship, we had thought our 
subject, “The Best Methods of Treating Operative Wounds,” settled 
at least in principle and outline. Invested with the new interest 
which the discussions of the last year have given, there is, perhaps, 
no topic of equal importance to which we could invite the attention of a 
professional assemblage. Indeed, no one subject has commanded a 
deeper interest since the days of Hippocrates to. our own time. One 
of the first objective lessons in surgery is, that both in danger and suf- 
fering, a sub-cutaneous differs from an open wound. The how and the 
ichy have occupied the attention of the profession these two thousand 
years, and have never been satisfactorily settled until the present. 
The question of operative wound treatment can be categorically an- 
swered by the statement that the best method is that which gives re- 
sults in recovery nearest like those following sub-cutaneous injury, in 
other expression, best adapted to secure primary union. 
Thanks to the revelations of the microscope and the remarkable 
series of investigations of Pasteur and others, this generation of the 
profession was early taught that fermentation and decomposition were 
due to the development of myriads of minute organisms; that these or- 
ganisms everywhere pervaded in greater or less extent the atmosphere, 
and that they multiplied rapidly under the conditions of heat and 
moisture, especially in albuminous or nitrogenous compounds. Pas- 
teur also showed that these fluids underwent no change when such 
germs were excluded therefrom, and that they could be excluded by 
littering the air to which they were exposed through layers of loose 
cotton fibres. 
Based upon these observations, simple and important as they may 
appear to the superficial observer, there has developed the entire sys- 
tem of modern wound treatment. In retrospection it seems very nat- 
ural that the acute mind of Mr. Lister should have defined the problem 
that herein lay the difference between subcutaneous and open wounds, 
and that the exclusion from the latter of the all-pervading germs 
would render them as amenable to nature’s easy cure as the former. 
Convinced of the truthfulness of this belief and dominated by it, as TREATING OPERATIVE WOUNDS. 
3 
the central thought of a life, this surgeon has devoted his great genius 
to its solution with untiring zeal. It was our good fortune to meet 
him in the hey-day of his youthful enthusiasm, and to record day by 
day his splendid triumphs won in the absence of all good hygiene 
in the wards of the old Infirmary of Edinburgh twelve years ago. 
Governed by the conservatism of older and often dogmatic teaching, 
our profession has ever been slow in adopting new methods and 
wisely demanded of their advocates, with rigorous severity, the rea- 
sons for their faith. 
The generations had witnessed the sickening horrors of hospitalism, 
the dangers therefrom multiplying in almost geometric ratio to the ag- 
gregate numbers of the sick and wounded. In our own late war we 
learned that the wounded became endangered almost in ratio to the abil- 
ity with which we adjudged ourselves able to surround them with the 
so-called comforts of life, while the supposed more unfortunate, upon 
the tented field, separated only by a canvas covering alike from the 
smiles and blasts of heaven, made by far the best recovery. In vain was 
the solution sought; the general opinion, however, was correct, a 
better sanitary and protective condition had been thus maintained, 
depending upon ventilation and cleanliness. 
The history of the last ten years shows, the world over, better re- 
sults following wounds, owing to improved general care and sanitary 
hygiene, independent of the precise mode of local treatment. The 
opponents of antiseptic methods claim, that to this, rather than any 
local care, the result should be attributed. It is, however, generally 
conceded that the great danger to be overcome in wound treatment 
lies in poisonous conditions which cause the failure of primary union, 
and that these conditions are in a large measure owing to changes of 
a putrefactive character taking place in the wound, produced by the 
presence of vital organisms. 
All are familiar with the rapidity and safety of repair which is secured 
in a properly adjusted simple fracture, and are alike conversant with 
the dangers arising both to limb and life in compound fractures. The 
difference consists not in the severity of the lesion, but in the something 4 
TREATING OPERATIVE WOUNDS. 
introduced from without, which something is none other than minute 
living particles which cause the changes of putrescence and dissemi- 
nate as a vital poison to infect the entire organism. 
A better knowledge of the widely distributed forms of micro-organ- 
isms is much needed; indeed their life histories are required in order 
to be at all certain of many conditions which now seem most impor- 
tant. There can be no doubt that morphological peculiarities pertain 
to the same organisms at different stages of their development, that 
much depends upon their surroundings, as temperature, character, 
of material with which they are mingled, etc. It is equally certain 
upon the other hand, that organisms undistinguishable from each 
other vary greatly in their active properties. The demonstration is 
generally accepted, that quite a number of acute diseases depend upon 
the development of certain species of germs, either as a variety peculiar 
to the disease or modified by certain conditions which so influence 
their development as to produce a given series of results. 
The recent studies of a very considerable number of independent 
investigators show a much more widely disseminated causa causans in 
the role which germs play in the development of disease than has 
been suspected hitherto even by the most ardent supporters of the 
germ theory. 
The dissemination of pathogenic bacteria now gives an easy and 
satisfactory explanation to the widespreading of contagious and infec- 
tive diseases; — that subtle something long recognized as an impor- 
tant clinical factor, but hitherto too intangible for demonstration. 
Pasteur’s culture experiments show that certain forms of very deadly 
bacteria may be so modified as to lose in very large share their viru- 
lence, although they are reproduced in a similar manner, and this 
alteration is effected only by a change of the temperature to which 
they are subjected. It is equally probable that the converse is true, 
and that the bacteria with which we are ordinarily harmlessly sur- 
rounded, under certain modifying circumstances become most de- 
structive agents. 
The study of climatology has for a long time occupied the best minds Tit EATING OPERATIVE WOUNDS. 
5 
of the medical profession, and this generation has seen the Goddess 
of Hygiea properly enshrined within our temples, but do we not And, 
behind climatology, hygiene, sanitary surroundings of hospital and 
home, in the myriads of invisible vital agencies, a new and significant 
meaning! 
Dr. Sternberg, Surgeon U. S. Army, in a paper upon bacteria in 
healthy individuals, read before the American Association for the 
Advancement of Science, Cincinnati, 1881, says, “The question is fre- 
quently asked, ‘If bacteria are such terrible things, how is it possible 
that we can exist upon the earth surrounded and infested as we are by 
them? ’ ” Certainly there would be an end to all animal life, or rather 
there never would have been a beginning, if living animals had no 
greater resisting power than dead animal matter to the attacks of 
these parasites, which by numbers and rapid development make up for 
their minute size. On the other hand, but for the power of these 
little giants to pull to pieces dead animal matter, we should have dead 
bodies piled up on all sides of us in as perfect a state of preservation 
as canned lobster or pickled tongue, and there being no return to the 
soil of the materials composing these bodies, finally all vegetation 
would disappear and the surface of the earth would be a barren and 
desolate wilderness, covered only with the inanimate forms of succes- 
sive generations of plants and animals.” 
In the ever-widening knowledge of our art, the relationship to and 
interblending of medicine and surgery become more intimate. The 
role which germs play in disease and injury ceases to be a theory, and 
has become a fact as assuredly demonstrated as any in our science. 
Putrefactive processes so evidently depend upon their development 
that it is generally admitted to be true even by the opponents of anti- 
septic surgery. The relation which germs sustain to wounds is the 
question of primary importance. It has been claimed that the inflamma- 
tory exudates do not depend upon the presence or influence of germs, 
but that they are met with in subcutaneous injuries: others as 
strongly maintain that septic organisms are primarily the sources of 
all the inflammatory and other troubles to which wounds are liable. 6 
TREATING OPERATIVE WOUNDS. 
There can be no doubt that the processes of putrefaction differ very 
greatly in wounds subject to similar exposures. Mr. Lawson Tait, 
who is one of the strongest opponents of the Listerian system, but is 
the very disciple of cleanliness, and shows most excellent results, 
draws a distinction between the effect of germs upon living and dead 
tissues, alleging that it is only the introduction of them into the sys- 
tem through the medium of dead tissue which causes serious con- 
sequences. To this Mr. Stokes makes answer, “that those who hold 
this view ignore the elementary fact that there never was a wound, 
and especially one in which vessels are tied or twisted, in which dead 
and living tissues are not at once brought into contact.” Again if 
dead matter is first necessary for the growth of germs, the abscesses 
infested with myriads of bacteria which are observed in pyaemia and 
after ulcerative endocarditis, would be of difficult explanation. 
There is much of truth, however, in Mr. Tait’s statement; for the 
bio-plastic exudation from a wound of healthy tissues has a vitality of 
its own often superior to the most active germs, and either fails to fur- 
nish them the necessary pabulum, or walls them in from further depre- 
dation, and finally eliminates them from the body, even after a consid- 
erable development, as for example, by a localized abscess. 
How different their active growths and disseminations in a devi- 
talized patient. 
A further discussion of this part of our subject would lead us 
beyond our present purpose. We would, however, earnestly invite the 
attention of all interested, to the exceedingly valuable experiments of 
Mr. Lister, from which he demonstrates the fact that blood clots and 
blood serum even have a very considerable resisting power to septic 
influence. These were reported at the International Medical Con- 
gress, and are reprinted in Braithwaite, for July, 1882. 
Only last year we held it in belief that no competent surgeon would 
refuse to grant to suffering humanity everywhere the benefits arising 
from antiseptic surgery. In opening the discussion upon Abdominal 
Surgery, in the International Medical Congress of 1881, we gave this 
as our opinion, and stated that least of all did we believe that anti- TREATING OPERATIVE WOUNDS. 
7 
septic surgery needed defence in London. We were familiar with the 
marvellous improvements in German surgery, wrought during the last 
decade under its usage. We had recently read the masterly work of 
Monsieur Championniere, and Mr. McCorraac’s address, with its 
interesting discussion, was fresh in memory. These statements and 
more were confirmed by our own experience which covered the period 
of antiseptic surgery in America from its very first introduction. It 
appeared that we were mistaken. 
Mr. Savory’s remarkable address upon surgery, before the British 
Medical Association in 1880, in which he claimed, from the statistics 
of St. Bartholomew Hospital, as good or better results without the use 
of antiseptic precautions, had had its influence. This author read 
before the Congress of 1881, above mentioned, a very valuable paper 
upon the causes of failure to obtain primary union in operative 
wounds. He closed with the following: ‘‘When is a wound to be 
considered septic or aseptic? Is pyrexia a sign? Is pus a sign of 
septicism, or the presence of bacteria, or any other of the lowest 
visible forms of life; or are we driven back upon the odor, and must 
we depend upon the sense of smell? But then, what relation is there 
between poison and bad odor? Who will define a septic from an 
aseptic state? Is it then, after all, so far as wounds are conceimed, 
merely a question of degree? For the present, at least, I am inclined 
to think so? ” His claim is that the remarkable improvement in the 
surgery of the present is due to better sanitary arrangements, and 
yet, in fact, how does Mr. Savory manage his wounds? Let Mr. 
Stokes, in his address upon surgery, read before the British Medical 
Association at its recent meeting at Worcester, give answer. “As 
regards Mr. Savory’s denunciation of Listerism, I would say that, 
after reading it, and also the able reply to it by my colleague, Mr. 
Thompson, one cannot but come to the conclusion that, when the 
address is stripped of all its brilliant eloquence and rhetorical decora- 
tion, two facts are, to our surprise, brought clearly to light. One is 
the admission of the germ theory of putrefaction, and the other, that 
the method of dressing employed by Mr. Savory is essentially antisep- 8 
TREATING OPERATIVE WOUNDS. 
tic, consisting, as it does, of many of the features that characterizes 
Listerian dressings; for example, carbolized cat-gut ligatures, car- 
bolized oil, drainage and washing the wound with a weak perman- 
ganate of potash lotion, or some other potent antiseptic. 
Now, as the author of the reply to which I have referred properly 
asks, “ Is this method fittingly characterized by its simplicity and the 
entire absence of all novelty?” No discussion of modern times has 
had a more weighty influence in moulding surgical opinion than this; 
especially has it been persistently misquoted and misinterpreted. Dr. 
Keith, than whom there could be no more competent witness, said: 
“ For some time I have not found the carbolic spray necessary, and 
have not used it in my last twenty-seven cases, all of whom have 
recovered easily. With every possible care, the spray has not, in my 
hands, prevented the mildest septicaemia, and its effects on the kidney 
were sometimes disastrous. I have frequently seen kidney hemor- 
rhage follow long operations, and two deaths in hospital patients were 
occasioned, I believe, by carbolic acid poisoning. Though I had at 
one time a series of eighty recoveries under the spray, I have 
reluctantly given it up, believing that on the whole it did more harm 
than good.” 
Mr. Lister, in his discussion of the question, “ Is the spray really 
necessary?” replies with equal candor, “ In other words, is there suffi- 
cient chance of the air of an operating theatre or private room 
containing septic matter which can prove effective in blood serum, to 
make it needful to regard the question of contamination from the 
atmosphere at all? If the answer must be given in the affirmative, 
and the choice must lie between the spray and antiseptic irrigation 
during the operation, at intervals varying according to the dis- 
cretion of the surgeon, with syringing the cavity of the wound,after 
stitching, and syringing, also, at every dressing, then I should give my 
voice decidedly in favor of the spray, as being more sure of attaining 
its object, and involving less irritation of the wound, and also (if car- 
bolic acid be the antiseptic used) much less risk of carbolic poison- 
ing. At the same time it must be distinctly borne in mind that the TREATING OPERATIVE WOUNDS. 
9 
spray is, beyond all question, the least important of our antiseptic 
means; and that the circumstance that a surgeon does not happen to 
have a spray producer at hand is no excuse whatever for his abandon- 
ing the attempt to obtain aseptic results. But if the apparatus is at 
ray disposal, I, for my part, do not dare to abandon it. By the careful 
use of our present means, the spray included, we have arrived, I think 
I may venture to say, at absolute security of attaining the great ob- 
ject in view, provided that we have the two essential conditions com- 
plied with, an unbroken skin to start with, and the seat of operation 
sufficiently distant from any source of putrefaction to admit of ade- 
quate overlapping of the surrounding integument by the requisite 
dressing. Such being the case, I should not feel justified, except on 
perfectly established grounds, in omitting any part of the machinery 
by which results so important to our fellow-creatures have been ar- 
rived at. Nevertheless, I am aware that, concomitantly with the per- 
fecting of the spray, there has been an improvement in other parts 
of our antiseptic arrangements; and I am not prepared to say that 
our increased uniformity of good results may not be due to the latter 
rather than to the former. And it may be, for aught I know, that, 
when the International Congress next meets, I shall be able to speak 
of results of a still higher order, obtained without using the spray at 
all. For, if further investigation should confirm the conclusion to 
which our recent facts seem to point, and should, indeed, be proved 
that all idea of atmospheric contamination of our wounds during 
operations, may be thrown to the winds, then no one will say with more 
joy than myself, ‘Fort mit dera spray.’ ” 
Notwithstanding the earnest advocacy of careful antiseptic surgery 
by Esmarch, Yolkmann, and Martin, of Germany, Sir Spencer Wells, 
Mr. Thornton, Mr. MacCormac, Mr. Gant, Prof. Humphry, of England, 
and Dr. J. Marion Sims, of New York, reports were written, as the 
verdict of the Congress, that antiseptic surgery had recived its doom, 
that Listerism was dead, etc. Tlie profession in New England, emi- 
nently conservative, received a prejudicial report, in a remarkable let- 
ter, by the late Dr. Green, of Portland, published in the Boston Medi- 10 
TREATING OPERATIVE WOUNDS. 
cal and Surgical Journal. Many Journals gave reviews more or less 
misleading, which remained uncorrected until the transactions them- 
selves appeared. Even in our late meeting of the American Medical 
Association at St. Paul, it was loudly proclaimed with attempted 
proof, that “ Listerisra was dead.” So strongly has the less impor- 
tant factor of the spray been mistaken for, or allowed to take the place 
of the great scientific system of antiseptic wound treatment. 
A wound per se is not benefited by carbolic or other medication. No 
student of Mr. Lister would for a moment claim that a wound is other 
than irritated thereby, and rendered less likely to quick repair, but, 
that it is treated in this manner as the less of two evils, for thus we 
exclude the contamination of putrefactive agencies, and secure an asep- 
tic wound, surgically clean in character, as nearly as possible like a 
sub-cutaneous injury. 
To our personal knowledge Dr. Keith, Mr. Tait, and Dr. Bantock, 
as well as Mr. Savory, make as much emphasis upon the obtaining 
such conditions as any others, and hence, in our Judgment, their re- 
markable results. Dr. Kieth, many years ago, before the adoption of 
spray by Mr. Lister, showed us the sponges which he had used in a 
very large number of ovariotomies and emphasized his personal care 
for their cleanly preservation. This included, not only washing and 
boiling, but their submission to a bath of potash solution; immersion 
in ether, a careful drying, and then their exclusion from dust until 
again required. 
A friend tells us Mr. Tait is equally careful in this and other re- 
spects, and Dr. Bantock pointed out to us only last year the thought- 
ful attention given to every detail in the Samaritan Hospital. How 
delightfully does this contrast with much of the so-called antiseptic sur- 
gery which we have seen, where, in a blind reliance upon the spray, 
pouring in thick clouds over the patient, in bad surroundings, dirty 
sponges, unprotected instruments and towels were used by unclean 
hands, and the failure to obtain good results charged to a system con- 
demned, because violated in all its fundamental factors! There are 
times and occasions, when it may be exclaimed, in the interests of sys- TREATING OPERATIVE WOUNDS. 
11 
tem and even science as well as individuals, “ Save us from our 
friends.” 
Do facts sustain the extraordinary claims of antiseptic surgery? 
It would seem that a verdict could be obtained from such a tribunal, 
from which there could be no appeal, and thus settle the question at 
issue. Yet in such a problem, it is very difficult to obtain reliable 
data, simple as it would at first appear. Facts seem to have an 
especial aversion to registration. Percentages of death-rate fall far 
short of a representation of the case. Amount of suffering and pain, 
depreciation by suppuration and exhaustion, the length of the period 
of retention under surgical observation, and detention from active 
employment; all these factors come within the scope of experience. 
The lesson to be taught from statistical research is the proud record 
of recent, sudden and marvellous improvement, and whether under 
antiseptic regime or not, by far the most important factor appears in 
the scrupulous attention to cleanliness, as a ‘‘virtue next to godli- 
ness,” and this, when perfectly attained, by whatever means, is no 
more or less than an aseptic wound, the theoretic as well as practical 
result sought and secured by the most careful devotion to antiseptic 
detail. Much statistical evidence has been adduced which needs no 
repetition here. 
It is scarcely more than a decade, when the mortality rates were so 
great in Boston and vicinity, after ovariotomy, that such leaders of 
the profession as Drs. Bigelow and Wyman, denounced the operation 
as unwarrantable, and decried the men who presumed to think differ- 
ently. Now how changed! 
Ovariotomy is not looked upon as a very dangerous operation, and 
this is due in very large measure to the observance of the great princi- 
ples of antiseptic surgery. Yet it is just here, in the field of abdom- 
inal surgery, Mr. Lister would regard his innovation as the least 
triumphant. 
Sir Spencer Wells’ marvellous experience stretches; over a wider 
range than any other ovariotomist, and he gives it as his unqualified 
opinion that the greatest gain both in safety and rapid recovery is due 12 
TREATING OPERATIVE WOUNDS. 
to these protective agencies. We have elsewhere referred to Dr. 
Keith, who in abandoning the spray for especial reasons, by no means 
ignores or fails to put them in practice. Indeed, Dr. Keith himself 
reports eighty successive recoveries while using the spray, a record 
without duplication in the history of surgery. 
Mr. Thornton believes that almost the only danger in abdominal 
surgery is septicism. He reported last September at the Boston 
Meeting of the American Gynaecological Society, that of his last 
ninety cases of ovariotomy he had only three deaths, and these three 
were maglignant cases. Under such protective influences, uterine 
tumors are removed, and the entire organ with the ovaries is ablated 
with fair results. 
Did the occasion permit, we would gladly review the entire realm 
of operative surgery. The broad clinical fact pertains to the entire 
field. Blood poisoning, arising from altered secretions in the wound 
which has hitherto been the ever present dread and danger is pre- 
vented. If this is owing to putrefaction which depends upon the ad- 
missions to the wound of the minute living particles, and if, by the 
careful application of certain precautions, these changes and their 
consequences may be with certainty prevented, then all these various 
forms of septic and pyannic processes may and should be eradicated. 
This broad antiseptic method gives scope to a great variety of de- 
tail. Prof. Esmarch has reported the following statistics of major 
operations as the result of the use of his modified iodoform 
permanent dressings:* “146 extirpations of large tumors, including 
40 amputations of the breast, with clearing out of the axilla, and 
14 castrations. Of these 3 died — viz.: 1 from pericarditis and invet- 
erate syphilis, 1 from apoplexy and 1 from fatty degeneration of the 
heart. (2.) 51 amputations, viz.: 18 of the femur, 27 of the leg, 5 of 
the upper arm, 1 of the forearm. Of these two 2 died—viz.; 1 from 
shock depending on weakness of the heart after amputation of the 
thigh, 1 from delirium tremens. (3.) 61 resections — viz.: 20 of the 
knee, 8 of the ankle-joint, 7 of the shoulder-joint, 14 of the elbow, 3 
* Transactions International Med. Cong. II., p. 364. TREATING OPERATIVE WOUNDS. 
of the wrist, 5 of the ribs, 1 of the sternum, 2 of the calcaneus, 1 of 
the patella. (4.) 11 exarticulatious — viz.: 3 of the hip, 5 of the 
ankle, 1 of the shoulder, 1 of the knee, which died of exhaustion, the 
patient suffering from inveterate syphilis. (5.) 26 removals of seques- 
tra, scooping out of carious bones, abscesses and fungoid growths. 
(6.) 13 nerve stretchings, of which 12 were cured, 1 died of tetanus. 
(7.) 8 herniotomy cases, all of which were cured. (8.) 21 cases of 
opening and clearing out of “cold abscesses.” All recovered. (9.) 
12 considerable wounds and lacerations of the soft parts. All re- 
covered. (10.) 40 complicated fractures and other large operative 
wounds. He sums up the advantages of the antiseptic permanent 
dressings: (1.) “ The absolute rest of the wound until cicatrization 
is effected. (2.) The healing of the majority of the cases per primans 
intentionem, even those which presents the most extensive wounds. 
(3.) The avoidance of the danger of infection, by removal of applica- 
tions and bandages. (4.) The diminished suffering of the patient. 
(5.) The diminished labor of the surgeon; and (6.) The diminished 
expense.” To which might be added the great shortening of the 
period of disability. 
The treatment of compound fractures and the open wounds of the 
larger articulations to our mind offer the most astounding proofs of 
the great value of antiseptic precautions. To those desirous of inves- 
tigating more carefully this subject, we would recommend the reading 
of Mr. MacCormac’s work. 
In the earlier treatment of compound fractures, with the very best 
of care, a very large percentage died, while by the prevention of germ 
development, Prof. Yolkraann reports seventy-five successive cases 
of compound fractures without a death, and he does not hesitate to 
claim that without infection there is no suppuration, and that to obtain 
primary union two factors are necessary, “complete disinfection and 
absolute apposition, so that the parts may have the chance of growing 
together.” 
While admitting that a depraved constitution and a devitalized con- 
dition would render the patient less able to resist the depredations of 14 
TREATING OPERATIVE WOUNDS. 
these vital poisons, he asserts as a demonstrated clinical fact, that 
such patients have a revivifying bio-plastic power, sufficient, under all 
circumstances, to afford immediate and complete repair if treated an- 
tiseptically. Drainage is even more important in antiseptic treatment 
than without. Under the irritation of the germicide used, there is an 
increased exudation from the divided portions, and unless this be re- 
moved there may be tensions and separations of the parts. Disinfec- 
tion, close approximation, drainage, rest and protection are the vital 
factors in modern operative wound treatment. 
The wide experience of the profession with carbolic acid as the 
germicide most relied upon, has given rise to a series of dangerous 
and fatal issues, and causes it to be held in fear or disuse by very 
many who recognize its antiseptic value. This has led to experimen- 
tation with other agents, a very considerable number of which are rec- 
ommended and sold for this purpose. Careful laboratory experiments 
have been undertaken by our assistant, Dr. Samuel Nelson, and myself 
in order to test the relative values of a number of antiseptics. For 
the destruction of organisms which cause putrefaction in wounds, the 
agent to be selected must act quickly. For this reason we have 
adopted, in the main, the method in testing employed by Dr. A. T. 
Cabot, of Boston, whose admirable article, “Experiments upon the 
Strength of Antiseptics,” was published in the Boston Medical and 
Surgical Journal, November 27, 1879. 
“Ten parts of the antiseptic to be tested are added to three 
parts of a foul solution. After a certain measured time, two drops 
of the resulting mixture are transferred to an aseptic solution which 
is carefully protected from the air, put aside, and watched for the first 
evidences of putrefaction. Supppose the putrefactive elements have 
preserved their vitality during this time of contact with the antiseptic; 
they are released from further antiseptic action when these two drops 
mix with, and are diluted in, the aseptic nutrient solution, and are 
then free to set up putrefactive changes in it. If, therefore, putrefac- 
tion appears in the test solution, we know that the antiseptic had not 
acted long enough upon the germs of putrefaction to destroy them. TREATING OPERATIVE WOUNDS. 
15 
We repeat the experiment with a longer time of exposure, and so pro- 
ceed till we reach the time that proves sufficient for the destruction of 
the putrefactive elements, and we then find that the aseptic solution 
continues clear and sweet. The sign of putrefaction, which was re- 
lied upon in these experiments was the appearance of cloudiness, due 
to the presence of micro-organisms, and their presence or absence 
was always verified by the microscope.” 
The aseptic solution is prepared by boiling several small pieces of 
meat with a large quantity of water in a glass flask purified by expos- 
ure to the flame of an alcohol lamp. This flask is stopped with a rubber 
cork, perforated by two glass tubes for the convenience of decanting. 
The tubes are bent downwards, and the ends are carefully protected 
with carbolized gauze. The cork and tubes are carefully cleansed be- 
forehand with carbolic acid. The resulting solution, if made, with 
lean meat, settles clear; if the meat is fat, the solution is rendered 
cloudy by fine oil drops, and must be prepared again. 
The mingled fluid is placed in a test tube purified by heat and this is 
covered by a bell glass similarly purified, which rests upon a car- 
bolized cushion. In this way it is subject to easy inspection and is 
protected from all external agencies. 
1. Acidi carbolic! 1-20 5 seconds. 
2. “ “ 1-40 2 minutes. 
3. Thymol 1-500 1 minute. 
4. “ 1-1000 exposed 2-4 minutes failed. 
5. Acidi salicylici 1-100 3 minutes. 
6. Listerine 4 minutes. 
7. Zinci chloridiT-12 5 minutes. 
8. Quinia sulphatis 1-10 exposed 5 minutes failed. 
9. Acidi boracici 1-10 “ 5 “ “ 
10. Calcic chloridi 1-10 “ 5 “ “ 
11. Potas, permang 1-50. “ 4 “ “ 
12. Boro glyceride 1-30 “ 3 “ “ 
13. Platt’s chlorides “ 4 “ “ 
14. Oil eucalyptus 1-100 “ 3 “ “ 16 
TREATING OPERATIVE WOUNDS. 
Dr. Cabot gives his results in the following table :— 
Acidi carbolic!. 1-20 5 seconds. 
Liquor sodse chlorinatae. 1-10 15: 30 seconds. 
Acidi salicylic! 1-240 3 minutes. 
Thymol 1-500 3 minutes. 
Thymol 1-1000 .4 minutes. 
Acidi carbolici 1-40 4 minutes. 
Potas. permang. 1-60 over 6 minutes. 
Zinci chloridi 1-12 over 6 minutes. 
*Alum acetatis .... - over 6 minutes. 
From these experiments, necessarily imperfect, although occupying a 
considerable period of time and attention, we may deduce that car- 
bolic acid still holds its place as the best agent for the rapid destruc- 
tion of micro-organisms, and that thymol, salicylic acid, and the fluid 
called Listerine, prepared by Lambert & Co., of St. Louis, are ger- 
micides of a trustworthy character. Any agent which is as safe as 
the latter, and as promptly active as the former, would be a valuable 
addition to the surgeon’s armamentarium. 
* Preparations recommended by Mr. Paul Burns in London Medical Record, 
April 15,1879, p. 168.