PRACTICAL IDEAS ON ANTISEPTIC AND ASEPTIC 
METHODS IN THE TREATMENT OF WOUNDS. 
WITH A REPORT OE FORTY-SEVEN CON- 
SECUTIVE OPERATIONS FOR NON-SUP- 
PURATIVE CONDITIONS, IN THE 
AUGUSTANA HOSPITAL DURING 
THE PAST YEAR. 
BY 
Dr. A. J. OCHSNER, 8.5., F.R.M.S. 
SURGEON-IN-CHIEF OF AUGUSTANA HOSPITAL; CONSULTING SURGEON OF HOSPITAL FOR WOMEN AND 
CHILDREN, CHICAGO, ETC. 
Read before the Chicago Medical Society, May 16th, 1892. 
Reprinted from The Chicago Medical Recorder, June, 1892. 
IR. IR. tfDcCabe <5l Co, 
press of 
YlDonroe Street, Chicago PRACTICAL IDEAS ON ANTISEPTIC AND ASEPTIC 
METHODS IN THE TREATMENT OF WOUNDS. 
With a Report of Forty-seven Consecutive Operations for Non- 
Suppurative Conditions, in the Augustana Hospital 
During the Past Year. 
De. A. J. OCHSNER, 8.5., F.R.M.S. 
SURGEON-IN-CHIEF OF AUGUSTANA HOSPITAL; CONSULTING SURGEON OF HOSPITAL FOR WOMEN AND 
CHILDREN, CHICAGO, ETC. 
Antiseptic and aseptic surgery have been discussed so frequently 
and by so many men who are great in their profession, that I cannot 
venture to speak upon these subjects before this Society without giving 
the reasons which justify my action. 
My observations, upon which the following methods are based, 
have extended over a period of more than seven years. 
At the beginning of this time my interest in this subject was aroused 
by the most conscientious and enthusiastic work Prof. Chr. Fenger was 
doing in this direction in the Cook County Hospital. The following 
year, while Interne in the Presbyterian Hospital, Prof. Moses Gunn 
kindly permitted me to apply my ideas in all of his operations and 
dressings, with the remarkable result of only two instances of suppura- 
tion in cases of wounds for non-suppurative conditions throughout my 
entire service under this brilliant surgeon. 
While studying in Europe during the following two years I care- 
fully observed the methods employed, particularly in the clinics of 
Profs. Billroth, Albert and Braun in Vienna, Kronlein in Zurich, v. 
Bergmann, Hahn, Bardeleben, Olshausen and Martin in Berlin, and 
Schede in Hamburg. 
Upon returning to Chicago, Prof. Chas. T. Parkes, with whom I 
had visited the above and other clinics in Europe, kindly gave me the 
management of antiseptic methods in connection with all of his opera- 
tions and dressings in his clinical and hospital as well as in his private 
practice. I have preserved accurate notes concerning the progress of 
Read before the Chicago Medical Society, May 16th, 1892. 2 
each one of the hundreds of wounds in the management of which I 
had the good fortune to assist this great surgeon. 
Unfortunately, the time allotted to each paper is too short to 
permit the use of abstracts from these notes, as I had intended. I 
will, however, state that primary union was the rule and suppuration 
the rare exception. 
For the past year I have had the privilege of assisting Prof. N. 
Senn in the care of all of his cases during and after his operations in 
the Surgical Clinic at Rush Medical College and at the Presbyterian 
Hospital, thus adding many valuable observations in this most im- 
portant subject. 
Such favorable opportunities for studying methods and results 
would, I think, justify me in describing the methods which I have 
chosen, not only from the study of theory, but from their value in 
practice, and which I apply in my surgical work, notwithstanding the 
fact that there is nothing new in these methods. 
Antiseptic surgery has experienced three distinct epochs, the 
first consisting in the discovery of the principle by Sir Joseph Lister, 
and the time following, during which various antiseptic substances 
were employed empirically; the second beginning with the accurate 
scientific observations introduced by Prof. R. Koch, determining the 
power of various antiseptic substances when applied in culture media, 
demonstrating the strength of solutions necessary to retard or obstruct 
the growth of the different bacteria; and the third epoch comprising 
the present time when antiseptic methods are used by most operators 
only to the extent of securing aseptic conditions. 
This plan has been advocated for some time by many of those most 
experienced in the practice of surgery, but it was almost as difficult to 
change from antiseptic to aseptic methods as it had been to change 
from septic to antiseptic methods. 
The studies of Geppert, which showed that all previous observations 
with the most powerful one of the antiseptic substances,—corrosive 
sublimate—had contained a fatal error, impressed observers more thor- 
oughly with the idea that studies made in the test-tube cannot safely 
be applied to surgical operations, and this has had much to do with 
bringing about the present tendency toward aseptic surgery. 
It would be useless to attempt a review of all of the important 
papers which have appeared since 1867, dealing directly with this 
subject. My own reading has covered more than one hundred of these, 
and I know of nearly twice as many others which I have not had an 
opportunity to read. 3 
I will therefore not occupy your time with these reviews, but will 
limit myself to a description of the methods which I follow in my own 
practice, and as an illustration of these methods and their results, I 
have tabulated abstracts of histories of all cases operated upon by my- 
self for non-suppurative conditions during the past twelve months in 
the Augustana Hospital of this city, in which I have had the entire 
control of the surgical work. I do not include orthopaedic operations 
in which no wounds were produced, or in which the wounds were 
made subcutaneously, nor cases which were treated by hypodermic 
injections. Neither do I include operations in the mouth, in the nasal 
cavity, in the vagina, or bladder, or rectum, because it has been 
repeatedly proven that there is neither a possibility nor a necessity for 
destroying all of the micro-organisms in these locations previous to 
operations. In order to give a clearer idea of the plan followed I will 
describe the different steps taken; 
Preparation oe Hands. My own hands and those of my assistant 
and the nurse who handles the sponges are washed thoroughly with 
ordinary good white soap in warm, running water, with a scrubbing 
brush. The finger-nails are cleaned with a pen-knife, and then the 
hands are washed once more in the same manner. They are then 
dried on a clean towel and then washed with one-half to one ounce of 
strong alcohol. 
After the hands are washed in this manner, they never touch any- 
thing except the instruments or ligatures, the sponges or the wound, 
and to this simple fact I attribute the complete absence of suppuration 
or sepsis in a large number of successive cases. 
My observations have taught me that it is a very simple matter to 
get everything surgically clean before an operation, but an exceed- 
ingly difficult matter to prevent the operator or his assistants, or the 
nurse, from handling something during the operation which directly 
or indirectly brings septic matter in contact with the wound. 
As a rule my own hands alone come in contact with the wound, in 
order to fix the responsibility. The assistant aids by means of retract- 
ors or other instruments. A basin of warm water is placed on a stand 
conveniently near for washing my hands. This water is changed fre- 
quently by a nurse who does not handle anything which is used 
directly in the operation. 
In order to eliminate a frequent cause of infection, I never touch 
a suppurating wound, or a soiled dressing, or pus from any source, if 
I can possibly avoid it, either in operations or in dressing wounds; 
and when there are several operations on the same day, I always 4 
arrange them so as to do those for non-suppurative conditions first. 
It is a rule with me, never to dress any case immediately before oper- 
ating. I have often observed, that if a surgeon is in the habit of con- 
stantly getting his fingers into pus, his assistants are sure to imitate 
him in this particular, but they are slow to learn the necessity of fol- 
lowing this bad practice by a thorough process of disinfection. 
Caee of Instruments. The instruments are placed in a clean 
platter, either dry or in hot water, or hot two per cent, carbolic acid 
solution, simply to keep them clean, not with any idea of disinfection. 
During the operation they are never placed upon anything which is 
not covered with a clean towel. 
After the operation the instruments are washed carefully in 
several changes of soap and hot water. They are always dried out of 
water at or near the boiling point in order to thoroughly dry the 
joints. They are then preserved in clean canvas cases. 
If the instruments have come in contact with pus they are boiled 
in a closed vessel for twenty minutes in water, with the addition of a 
tablespoonful of baking soda to the quart of water, the soda preventing 
the formation of rust. 
An instrument which has become rusty is at once replated. This 
incurs but a slight expense, and it is easier to see dirt on a plated than 
on a rusty instrument. 
Sponges. The sponges used consist of absorbent cotton rolled 
between the hands into convenient bunches, wrung out of boiled water 
immediately before the operation. These sponges are always applied 
dry, there being simply enough moisture to prevent the adhesion of 
cotton fibres to the wound. 
In abdominal sections we use sea-sponges which have been thor- 
oughly cleaned by repeated washings in pure warm water and then 
preserved in five per cent, solution of carbolic acid. If any of these 
sponges come in contact with pus they are permanently discarded. 
Sutures. Both silk and cat-gut sutures are employed; the former 
are boiled in water for an hour and then preserved in a five per cent, 
watery solution of carbolic acid. 
The cat-gut is de-fatted for several days in ether, then placed in 
five per cent, carbolic acid in water for forty-eight hours and preserved 
in 1-1000 corrosive sublimate in strong alcohol. 
Cat-gut sutures and ligatures are kept in strong alcohol during 
the operation to prevent them from swelling. Silk sutures are im- 
mersed in boiled water. Preparation of the Operating Boom. Owing to a lack of space 
in the present building I operate in any one of the twelve rooms and 
wards of the hospital, not considering it necessary to remove the furni- 
ture, nor especially to cleanse floors and walls. 
An operating table is placed near a window, a small table to one 
side for the instruments, ligatures and sutures, another one upon the 
other side for the sponges. All are covered with freshly laundried 
sheets or towels. The patient is placed upon the table, preferably 
before the administration of the anaesthetic. Everything is in readi- 
ness., and from this time until the wound is dressed nothing is dis- 
turbed in the room, and any instrument, sponge or suture which has 
touched anything not jwotected by clean towels is discarded for the 
entire operation. 
The patient receives a full bath with soap and water and a 
cathartic the day before the operation; he is also limited to a light diet 
during this day. This practically disposes of causes of infection from 
the skin and the alimentary canal. The patient receives no breakfast 
on the morning of the operation, which takes place at 8 a. m. in this 
hospital. 
Immediately before the operation the surface is washed thoroughly 
with soap and warm water, then shaved, then washed again with 
water, and then with strong alcohol. 
This disposes of the dirt, the loose epidermis, the hair and the 
fat, and leaves the skin clean and dry, and not irritated. A piece of 
gauze saturated with strong alcohol is left in contact with the surface 
for a minute or two before an incision is made. The field of operation 
is surrounded by dry, freshly-laundried towels. The operation is 
always performed with the greatest amount of speed compatible with 
the greatest care. The tissues are manipulated gently, in order to 
prevent tearing, crushing, or bruising. The wound is held open with 
retractors for the same reason. Hemorrhage is controlled thoroughly, 
by means of catgut ligatures or by pressure. 
In suturing, care is taken to bring the surfaces accurately together 
in order to avoid spaces and raw surfaces. Whenever a considerable 
amount of wound secretion is anticipated, the wound is either packed 
with iodoform gauze, or a rubber drainage tube is applied. This, 
however, is seldom necessary because wounds treated in this way 
rarely secrete much. 
Three or four days after the operation the packing or the drainage 
tube is removed, and the surfaces are held in contact by the applica- 
tion of pads of gauze or cotton. 6 
The dressing consists of ten per cent, of iodoform gauze, carbolated 
gauze, and absorbent cotton held in place by roller bandages. In 
wounds in which no drainage is expected, strips of iodoform gauze are 
applied and held in position by flexible collodion painted along their 
edges. No irrigation is employed, except in the presence of pus, and 
no antiseptic substance is applied to the wound. 
When aseptic wounds are redressed, either for the purpose of 
removing drainage-tubes or sutures, or for the purpose of removing 
iodoform gauze packing and- tying secondary sutures, the surface is 
simply sponged off with strong alcohol, and no irrigation is employed. 
I have seen many aseptic wounds infected by irrigation and other 
unnecessary manipulations at the first dressing. The dressing used is 
ordinarily the same as the original dressing. If there is any redness, 
or a slight amount of infection, a moist dressing of a sat. sol. of 
acetate of aluminium or a three per cent, carbolic acid dressing will 
usually relieve the condition at once. 
The following are the histories mentioned: 7 
Name and resi- 
dence. 
© 
be 
< 
Diagnosis. 
Duration 
of 
disease. 
Treatment. 
Kesult. 
Date of 
admission. 
Date of 
discharge. 
Matilda C., 
Attica, Ind. 
45 
Epithelioma upper eyelid. 
6 mos. 
Removal of half the eyelid; advised 
a secondary plastic operation 
after six months. 
Progress aseptic 
throughout. 
Oct. 30, 
1891. 
Nov. 20, 
1891. 
Mrs. M., 
Chicago. 
65 
Epithelioma lower lid of 
right eye. 
6 years. 
Y shaped excision with three- 
quarter inch base; closure of 
wound with silk sutures. 
Primary union. 
July 8, 
1891. 
July 13, 
1891. 
Chas. P., 
Ironton, Wis. 
56 
Seventeen years ago patient 
had face badly crushed 
in a runaway, leaving a 
fistula in right eyelid and 
the eye destroyed. Several 
attempts at closing fistula 
had failed. 
17 yrs. 
Evisceration of eye to form stump 
for artificial eye and closure of 
fistula by splitting the tissues 
and uniting with three rows of 
sutures. 
Primary union; no 
pus. 
April 15, 
1891. 
May 2, 
1891. 
Oscar 0., 
Chicago. 
8 
Suppurating dermoid cyst 
of left lower eyelid. 
2 years. 
Excision of entire cyst; closure of 
wound with silk sutures. 
Primary union. 
Jan. 22, 
1892. 
Feb. 5, 
1892. 
Bessie M. R., 
Waukesha, 
Wis. 
11 
Congenital double nose. 
Patient also has second 
toes double. 
11 yrs. 
Longitudinal incision through 
nose, splitting cartilage and re- 
moval of wedge-shaped portion. 
Deep quilled sutures, silk sutures 
for skin. 
Deformity corrected; 
primary union. 
June 29, 
1891. 
July 14, 
1891. 
John G., 
Kim b all, S. 
Dak. 
11 
Cicatricial contraction of 
face, causing ectropion 
and carrying the lower lip 
beneath the chin. Four 
years ago patient was 
burned in a prairie fire. 
4 years. 
Semilunar incision beneath each 
eyelid. Implantation of skin 
grafts inch. Semilunar 
incision beneath the chin, dissec- 
tion of cicatricial tissue. Cover- 
ing of raw surface with Thiersch’s 
skin grafts 4x6 inches. 
Healing throughout; 
patient closes 
mouth and eyes 
normally. 
Jan. 27, 
1892. 
April 27, 
1892. 
Christ M., 
Rockford, 111. 
26 
Varicocele, severe pain and 
nervous symptoms. 
2 years. 
Excision of enlarged veins. 
Primary union. 
July 15, 
1891. 
Aug. 1, 
1891. 8 
Name and resi- 
dence. 
Age. 
Diagnosis. 
Duration 
of 
disease. 
Treatment. 
Result. 
Date of 
admission. 
Date of 
discharge. 
E. A. G., 
Curry, Wis. 
24 
Varicocele; symptoms as 
above. 
8 years. 
Excision of enlarged veins. 
Primary union. 
June 24, 
1891. 
July 4, 
1891. 
James W., 
St. Louis, Mo. 
36 
Varicocele; caused by heavy 
lifting. 
8 years. 
Excision of enlarged veins. Some 
irritation occurred on fourth day 
which subsided upon application 
of sat. sol. of boric acid at once. 
Primary union; no 
rise of temperature. 
June 29, 
1891. 
July 7, 
1891. 
C. E. B., 
Iron Moun- 
tain, Mich. 
32 
Hydrocele of right side; 
caused by traumatism six- 
teen years ago. Was tap- 
ped and injected seven 
years ago. 
16 yrs. 
Incision; attachment of tunica 
vag. to skin. The sac was found 
to be covered with small tuber- 
cles. Cauterization with strong 
carbolic acid. Packing with 
iodoform gauze. This was re- 
moved on fifth day and re- 
packed. 
Healing from the 
bottom by granula- 
tion. Wound be- 
came infected two 
weeks after opera- 
tion. 
Jan, 18, 
1892. 
Feb. 24, 
1892. 
Mrs. C. A. A., 
Ga 1 es b u rg, 
111. 
35 
Lipoma of neck as large as 
a child’s hand. 
2 years. 
Enucleation; closure of wound with 
catgut. 
One dressing; prim- 
ary union. 
April 25, 
1891. 
May 3, 
1891. 
Emma J., 
Chicago. 
25 
Lipoma of labium maj. as 
large as two fists. 
30 mos. 
Enucleation; closure of wound 
throughout with cat-gut sutures. 
Primary union; one 
dressing. 
Aug. 10, 
1891. 
Aug. 19, 
1891, 
Charlotte E., 
Geneseo, 111. 
40 
Angiolipoma as large as a 
hand over seventh rib in 
lumbar region. 
1 year. 
Removal; closed with deep and 
superficial silk sutures. 
Primary union; one 
dressing. 
May 31, 
1891. 
Sept. 12, 
1891. 
Molly L., 
Laporte, Ind. 
10 
Congenital lipomata of 
right axilla and left side, 
each as large as a hand. 
10 yrs. 
Removal; applied iodoform gauze 
packing to overcome oozing, 
permitting it to project through 
an opening in the skin. Closed 
wound throughout; removed 
packing third day and applied 
pad to coapt surfaces. 
Primary union; two 
dressings. 
Nov. 16, 
1891. 
Dec. 2, 
1892. 9 
Augusta A,, 
Chicago, 
20 
Adenoma of left breast as 
large as a walnut. 
Noticed 
4 weeks 
ago. 
Enucleation; closure of wound 
with catgut sutures. 
Primary union; one 
dressing. 
Aug. 25, 
1891. 
Aug. 28, 
1891. 
Returned 
for dress- 
ing Sept. i. 
Mrs. F. Sp., 
Chicago. 
29 
Fibro adenoma of left breast 
as large as a small hand. 
6 years. 
Removal of breast; closure of wound 
with silk suture; rubber drain. 
Primary union; two 
dressings. 
Feb. 16, 
1892. 
Feb. 28, 
1892. 
Miss M. E. L., 
Aurora, 111. 
40 
Carcinoma of right breast. 
8 years. 
Removal of entire breast together 
with axillary glands and fat on 
fascia of pectoralis major 
muscle. 
Primary union. This 
patient developed 
typhoid fever after 
two weeks, from 
which she- recover- 
ed. The wound re- 
mained normal. 
April 19, 
1891. 
May 28, 
1892. 
Mrs. E. A. N., 
Hennepin, 111. 
62 
Carcinoma of right breast; 
the tumor being adherent 
to pectoralis major, m. 
8 mos. 
Operation the same as in previous 
case. Removal of a portion of 
pectoralis major muscle; axilla 
packed with gauze, which was 
removed on fifth day. 
Primary union. 
i 
May 3, 
1891. 
May 24, 
1891. 
Mrs. C. S., 
Altona, 111. 
56 
Carcinoma of right breast, 
involving axillary glands. 
7 mos. 
Operation the same as above without 
the removal of a part of the muscle. 
Primary union. 
Sept. 22, 
1891. 
Oct. 16, 
1891. 
Mrs. A. S. H., 
Evanston, 111. 
56 
Carcinoma right breast, in- 
volving axillary glands; 
ulcerated since eight 
months. 
2 years. 
Operation the same as above, but 
the amount of skin removed was 
• much greater. 
Wound healed prim- 
arily except where 
tension sutures cut; 
at these points it 
healed by granula- 
tion, remaining 
aseptic throughout. 
Oct. 5, 
1891. 
Oct. 27, 
1891. 
Mrs. W. E. H., 
Woodstock,111. 
44: 
Carcinoma right breast. 
• 1 year. 
Same operation. 
Primary union. 
Nov. 3, 
1891. 
Nov. 22, 
1891. 
Geo. J., 
South Bend, 
Ind. 
6 
Right inguinal hernia. 
2 years. 
Bassinis’ operation for radical 
cure, collodion dressing. 
Two dressings; prim- 
ary union; opening 
closed firmly. 
Nov. 17, 
1891. 
Dec. 16, 
1891. 
Andrew L., 
Rockford, 111. 
50 
Right inguinal hernia. 
3 years. 
The same operation. 
Primary union; one 
dressing. 
Jan, 28, 
1892, 
Feb. 20, 
1892, 10 
Name and resi- 
dence. 
tUD 
Diagnosis. 
Duration 
of 
disease. 
Treatment. 
Result. 
Date of 
admission. 
Date of 
discharge. 
Mrs. M. A. B., 
Chicago. 
30 
Right femoral hernia. 
5 years. 
Incision into sac; omentum 
adherent to sac and femoral 
ring. Loosening of omentum 
and resection of large piece. 
Closure of wound with four rows 
of catgut sutures. 
Primary union; one 
dressing. 
Mar. 20, 
1892. 
April 7, 
1892, 
Carl L. P., 
Cable, 111. 
69 
Tuberculosis of knee. Pa- 
tient’s general condition 
much reduced from long 
continued severe pain. 
2 years. 
Amputation of thigh at lower 
third long anterior; short pos- 
terior flap; catgut sutures; no 
drainage. 
Primary union; two 
dressings. 
Aug. 17, 
1891. 
Sept. 15, 
1891. 
Abner M., 
Chicago. 
77 
Chronic inflammation of 
tendons of left hand, 
anchylosis of wrist and all 
of the joints of hand and 
fingers. A sinus extends 
through center of hand. 
Constant severe pain; has 
undergone several opera- 
tions. 
2 years. 
Amputation at lower third; modi- 
fied circular flap; no drainage; 
catgut sutures. 
Primary union; two 
dressings. 
March 4, 
1892, 
Mar. 13, 
1892. 
Peter E., 
Monmouth, 
111. 
43 
Deformity after compound 
Pott’s fracture of left leg; 
faulty union; marked de- 
formity; patient has not 
been able to walk. 
14 mos. 
Curetting of ulcer; longitudinal 
incision over surface of inner 
maleolus; osteotomy excision of 
wedgeshaped piece of bone with 
one and a half inch base; closure 
of wound with catgut sutures; 
no drainage; application of 
plaster-of-paris cast. 
Primary union 
throughout; leg and 
heel was covered 
with blisters at first 
dressing, possibly 
the result of vigor- 
ous scrubbing; posi- 
tion perfect. 
Nov. 30, 
1891. 
Feb. 23, 
1892. 
Clem R. S., 
Chicago. 
23 
Faulty union of tibia and 
fibula at lower third after 
compound fracture. Pa- 
tient feels pain at point of 
fracture and in hollow of 
foot. 
2/ij yrs. 
Operation the same as above. 
Primary union; per- 
fect position; pa- 
tient is to remain 
under observation 
for ten weeks. 
April 7, 
1892. 
April 28, 
1892. 11 
Ida M., 
G a 1 e sb u rg, 
111. 
20 
Tubercular glands of the 
left side of neck, super- 
ficial and deep, extending 
from angle of jaw to 
clavicle. 
3 years. 
Free incision; removal of glands; 
irrigation with iodine water; 
packing with iodoform gauze; 
secondary sutures; removed 
packing on fifth day and tied 
sutures. 
Wound healed 
throughout without 
suppuration. 
July 21, 
1891. 
Aug. 5 
1891. 
Mrs. J. L., 
Chicago. 
30 
Tuberculosis of superficial 
and deep cervical glands 
left side. 
6 mos. 
Removal of all glands through a 
large incision from angle of jaw 
to clavicle, including krjver half 
of parotid gland; iodoform 
gauze packing, etc., as above. 
Wound healed 
throughout without 
suppuration. 
MarchS, 
1892. 
April 7 
1892. 
Hedwig E., 
Ravenswood, 
111. 
15 
Tuberculosis of deep cervi- 
cal lymphatic glands, in- 
creasing rapidly in size 
and number of late. 
7 years. 
Extirpation of gland; irrigation 
with iodine water; closure of 
wound with catgut sutures 
throughout. 
Wound healed 
primarily through- 
out. 
Mar. 13, 
1892, 
Mar. 27 
1892. 
Miss Nettie C., 
Racine, Wis. 
26 
Chronic pelvic peritonitis; 
repeated pelvic abscesses; 
patient confined to bed 
for months. 
1 year. 
Abdominal section; found intes- 
tines adherent to each other, to 
pelvic organs, and to abdominal 
wall; loosened adhesions; freely 
drained cavity with glass drain, 
which I removed on fourth day; 
opened intestine at point of 
adhesion; closed with two rows 
of sutures. 
Normal recovery; pa- 
tient has gained 
twenty pounds since 
and is perfectly 
well. 
April 10, 
1892. 
May 21 
1892. 
Mrs. Mathilda B. 
De Kalb, 111. 
38 
Chronic inflammation of 
the left ovary; patient has 
been treated repeatedly in 
several hospitals but with- 
out benefit; has been con- 
fined to bed for two years. 
5 years. 
Ovariotomy and breaking up of 
old adhesions. 
Primary union 
normal through- 
out. 
June 27, 
1891. 
July 21 
1891. 
Mrs. S. J., 
Lake View. 
37 
Chronic inflammation of 
ovaries. Has been in 
another hospital twice for 
several months, each time 
without benefit. Confined 
to bed for more than one 
year. 
7 years. 
Ovariotomy same as above. 
Primary union. 
Nov. 28, 
1891. 
Jan. 19 
1892. 12 
Name and resi- 
dence. 
Diagnosis. 
Duration 
of 
disease. 
Treatment. 
Result. 
Date of 
admission. 
Date of 
discharge. 
Miss Bertha H., 
Chicago. 
16 
Papillomatous ovarian cyst 
weighing thirty pounds 
adherent to mesocolon, to 
abdominal wall, floor of 
pelvis and omentum. 
2 years. 
Removal; Miculicz’s drainage; 
packing removed in three por- 
tions on fifth, seventh, and ninth 
day. 
Primary union ex- 
cept at point of 
drainage; normal 
throughout. 
Feb. 6, 
1892. 
March 5, 
1892. 
Mrs. Louise S., 
Watertown, 
Wis. 
69 
Tubercular peritonitis, 
originating in left ovary 
or tube; abdomen con- 
tained thirty pints of 
fluid. 
7 mos. 
Abdominal section, removal of 
fluid; removal of left ovary and 
tube; large glass drain left in 
position for two weeks. 
Primary union ex- 
cept at point of 
drainage tube. 
Aug. 22, 
1891. 
Sept. 15, 
1891. 
Helen M., 
Geneva, 111. 
16 
Tubercular peritonitis; 
twenty-five pints of 
yellowish fluid. 
1 year. 
Abdominal section, emptying 
cavity completely; large glass 
drain. 
The same as above. 
May 22, 
1891. 
July 2, 
1891. 
Ida N., 
Chicago. 
16 
Tubercular peritonitis; 
twenty pints of fluid. 
2 years. 
Operation the same as above. 
The same as above. 
April 5, 
1892. 
April 23, 
1892. 
Mrs. Anna R., 
Chicago. 
43 
• 
Uterine fibroid as large as 
a child’s head in the pos- 
terior portion of the body 
of the uterus, and another 
one of equal size attached 
to the former by a finger- 
like pedicle; suffers 
severely from pressure 
caused by the very mov- 
able fibroid 
2 years. 
Ligation of broad ligaments on 
both sides; ligation of uterine 
arteries; application of rubber 
ligature around cervix; removal 
of portion one inch above liga- 
ture; cauterization of cervical 
canal with Paqnelin cautery; 
closure of abdominal wound with 
silk sutures. 
Primary union; 
dressed on ninth 
day to remove the 
stitches and rubber 
ligature; dressed 
wound once a week 
until discharged. 
Mar. 21, 
1892. 
April 25, 
1892. 
Mrs. Louise W., 
Chicago. 
63 
Sarcoma of right kidney as 
large as a child’s head.* 
*This case was reported in detail 
to the Chicago Medical Society, 
November 2,1891. 
14 mos. 
Nephrectomy by abdominal sec- 
tion. 
Normal recovery; 
primary union ex- 
cept at point of 
drainage. 
Aug. 22, 
1891. 
Sept. 28, 
1891. 13 
Mrs. John P., 
Altoona, 111. 
39 
Patient has two slightly 
irregular, hard abdominal 
tumors, slightly movable. 
The urine contains a, 
trace of albumen; mens- 
truation has been irregular 
for ten months. 
10 mos. 
Exploratory abdominal section, 
demonstrating the presence of 
multilocular cysts of both kid- 
neys; closure of wound with 
deep sutures. 
Normal recovery; 
primary union. 
Oct. 17, 
1891. 
t 
Nov. 6, 
1891. 
Miss Josephine 
S., De Kalb, 
111. 
17 
During the past two and 
one half years patient has 
had five attacks of peri- 
tonitis originating in the 
right iliac region, with 
.characteristic symptoms 
of acute appendicitis. The 
last attack, three months 
ago, was especially severe, 
and leaving a distinct 
point of hardness and 
tenderness in this region. 
2 yrs. 
Longitudinal incision over 
ccecum; loosening of numerous 
adhesions between omentum and 
ccecum and ilium; ligation of 
mesentery of appendix and liga- 
tion of appendix with silk; cau- 
terization of its lumen with 
strong carbolic acid. The lumen 
of the appendix was found oc- 
cluded half an inch from its 
origin; closure of entire wound. 
Normal recovery; 
primary union. 
Jan. 6, 
1892. 
i 
Jan. 27, 
1892. 
George JL, 
La Valle, Wis, 
33 
Over two years ago I re- 
moved six inches of pa- 
tient’s rectum by means of 
resection of sacrum and 
coccyx (Kraske’s opera- 
tion) ; having a recurrence 
of the tumor in the sig- 
moid, which I removed 
with the Paquelin cautery 
two weeks ago. A stricture 
is to be expected. 
4 years. 
i 
Maydl’s inguinal colostomy; incis- 
ion parallel with the fibres of 
the external oblique muscle of 
abdomen three inches long in the 
left inguinal region; separation 
of fibres of external oblique 
and also of internal oblique; 
incision through transversalis 
fascia and peritoneum; attach- 
ment of peritoneum to skin; 
sigmoid flexure brought up into 
the wound; a glass rod covered 
with iodoform gauze passed 
through mesocolon and per- 
mitted to project beyond wound 
of abdominal wall. Transverse 
incision through colon on third 
day, leaving posterior wall. 
Patient suffered from 
pain until the intes- 
tine was opened; 
the temperature 
never exceeded 100° 
F. 
May 28, 
1891, 
June 13 
1891. 14 
Name and resi- 
dence. 
Age. 
Diagnosis. 
Duration 
of 
disease. 
Treatment. 
Result. 
Date of 
admission. 
Date of 
discharge. 
Mrs. C. G. A., 
Galesburg, 
111. 
47 
Aneurism of right vertebral 
artery as large as an 
orange, caused by a blow 
from a baseball. 
4 years. 
Removal through a longitudinal 
incision; controlled hemorrhage 
with long-jawed forceps and 
tamponing; closed remainder of 
wound with deep silk sutures. 
Primary union ex- 
cept at point of 
forceps; there 
secondary union; 
removed forceps 
after f or ty-eight 
hours. 
Feb. 17, 
1892. 
Mar. 22, 
1892. 
Mr. W. A. F., 
Whitewater, 
Wis. 
23 
Loosened fractured semi- 
lunar cartilage of right 
knee after injury. 
2 years. 
Longitudinal incision over ex- 
ternal condyle; removal of car- 
tilage; closure of wound with 
three rows of catgut sutures; 
plaster-of-paris cast. 
Primary union; one 
dressing. 
Mar. 2, 
1892. 
April 17, 
1892. 
John S., 
Chicago. 
43 
Varicose ulcer of right leg; 
internal surface. 
7 years. 
Excision of three inches of the 
internal saphenous vein; kept 
limb elevated for four weeks. 
Primary union; two 
dressings. 
Jan. 6, 
1892. 
Feb. 2, 
1892. 
Oscar J., 
De Kalb, 111. 
11 
Tuberculosis of hip-joint; 
destruction of neck of 
femur; had been treated 
for eight months with 
extension and immobiliza- 
tion without benefit. 
8 mos. 
Resection of hip; packing of 
cavity with iodoform gauze; ap- 
plied secondary sutures; one week 
later removed packing; iodo- 
formized the cavity and packed 
it with decalcified bone chips 
and tied secondary sutures and 
applied plaster cast; changed 
dressing again after four weeks. 
Later, Buck’s extension was 
applied. 
Wound united with 
exception of a small 
superficial point; 
extension to be con- 
tinued for one year 
at night; no sup- 
puration. 
Sep. 15, 
1891, 
Jan. 29, 
1892. 15 
This table contains abstracts of the histories of forty-seven con- 
secutive operations for nonsuppurative conditions upon nearly every 
portion of the body, and varying in severity from a simple incision to 
operations of the gravest character. 
These operations having been performed in the same hospital and 
with the same precautions, their number is sufficient, I think, to estab- 
lish the efficacy of the method. 
Of course I have operated during this time upon many cases suf- 
fering from conditions complicated with suppuration before the opera- 
tion, with equally good results, but this paper is already too long, and 
a further addition of histories would simply increase this fault, so I 
will reserve these for a future paper. 
For the sake of convenience I have arranged these histories in 
groups of similar cases. The first group comprises seven operations 
of various characters upon the face, all of which recovered rapidly, and 
without suppuration. The second group contains operations upon the 
scrotum. In three cases excision of enlarged veins in varicocele was 
made; in the fourth case I treated a tubercular hydrocele by open in- 
cision, packing the cavity with iodoform gauze. The cavity became 
infected two weeks after the operation. There had been severe itch- 
ing, which the patient had tried to relieve by inserting his finger 
beneath the dressing and scratching the skin. This is the only case in 
this entire list which became infected, and here it is quite apparent 
that the cause of infection was in no way connected with the operation. 
The third group comprises six non-malignant tumors, most of 
them being of a considerable size. All of these wounds healed pri- 
marily, four of them with one and two with two dressings; in the latter 
the first dressing was made to remove the drainage and the second to 
remove the sutures. These patients were in the hospital ten days on 
an average. 
The fourth group contains five cases of cancer of the breast. In 
each case the entire breast, together with the fascia of the pectoralis 
major and the fat and lymphatic glands of the axilla, were removed. 
All wounds healed primarily except the fourth, in which the tumor had 
ulcerated, necessitating the removal of a very large amount of skin. 
In this case the tension sutures destroyed a small amount of skin, 
which healed by granulation. 
Case one was peculiar in that she developed typhoid fever two 
weeks after the operation. The wound was entirely healed, and was 
not influenced by the typhoid fever. The patient recovered normally. 
These patients remained in the hospital about three weeks each. 
The fifth group consists of three herniotomies, each one of which 
healed primarily. The patients remained in the hospital four, three,. 16 
and two and one-half weeks respectively. The first case, a boy of six 
years, was kept longer than the other cases, because I desired to pre- 
vent an accident to the scar, with possible recurrence, through some 
imprudence of the child. 
The sixth group contains two amputations; one of the thigh, and 
one of the forearm, both without drainage, and both healing pri- 
marily. The first case was in the hospital four weeks, being kept two 
weeks after his stump had healed, in order to build up his general 
condition, which was much reduced at the time of the operation; the 
second case was in the hospital nine days. 
The seventh group consists of two cuneiform osteotomies of the 
tibia for faulty union of compound fractures of the leg, which healed 
primarily. 
The eighth group has three cases in which I removed superficial 
and deep tubercular glands of the neck, extending from the angle of 
the jaw to the clavicle. The wounds were treated by the use of iodo- 
form gauze packing and secondary sutures; the packing was removed 
and the sutures tied on the fifth day. These cases healed without the 
occurrence of pus, from two to four weeks. 
The ninth group comprises twelve abdominal sections. All of 
these cases recovered, and in each one the abdominal wound, varying 
from three to twelve inches in length, healed primarily. 
These sections were performed for the following conditions; In 
Case I. the intestines and the pelvic organs were adherent to each other 
and to the abdominal walls, causing severe pain, so that the patient had 
to be confined to bed for months. These adhesions were loosened, a 
glass drainage tube was introduced and left in place for four, days. 
The next two cases were simple ovariotomies for the relief of pain due 
to pressure upon the ovaries by old adhesions. Case IV., a papillo- 
matous ovarian cyst weighing thirty pounds and adherent to the ab- 
dominal wall, to the floor of the pelvis, to the mesocolon, and the 
omentum, in a girl sixteen years of age, required an incision extending 
from the ensiform appendix of the sternum to the symphesis pubis. 
The wound healed primarily throughout except at the point of drain- 
age, the patient’s temperature remaining below 100° F.,the same as in 
the simple ovariotomies. 
Cases V., VI. and YII. were operated for the relief of an enormous 
distension of the abdomen with fluid caused by the presence of tuber- 
culosis of the peritoneum, originating apparently in each case in the 
left fallopian tube. Each one of these cases recovered without a sign 
of pus infection. 
Case VIII. A fibrorayoma of the posterior uterine wall and a 
pediculated fibroid from the fundus, each as large as a child’s head, 17 
was treated by the use of an external pedicle. The patient recovered 
without a sign of shock or temperature, and without suppuration, 
requiring only four dressings. 
Case IX. A sarcoma of the kidney as large as a child’s head was 
treated by means of nephrectomy through an abdominal incision. 
Here again there was primary union except at the point of the drain- 
age-tubes. In case X. an exploratory laparotomy showed the presence 
of double multilocular cyst of the kidneys; the wound healed primarily, 
the patient leaving the hospital twenty days after her admission. 
Case XI. in which I removed the vermiform appendix because 
the patient’s life had been in danger several times from recurrent 
severe attacks of appendicitis, recovered with primary union of the 
wound throughout, leaving the hospital three weeks from the time of 
admission. 
Case XII. An inguinal colostomy according to Maydl’s method 
left the hospital two weeks after the operation, having been normal 
throughout. 
In the tenth group we have the remaining four miscellaneous 
cases. 1. Enucleation of an aneurism of the right vertebral artery as 
large as an orange; 2. removal of a fractured semilunar cartilage; 3. 
excision of three inches of the internal saphenous vein for the relief of 
a varicose ulcer. Each of these three cases healed without suppura- 
tion. 
The fourth case, a resection of the hip, was treated by means of 
what appears to me to be a novel method. A typical resection was 
made through the neck of the femur. The tubercular synovial mem- 
brane was carefully dissected out; every particle of suspicious tissue 
was removed. The cavity was then irrigated with a solution of tr. of 
iodine in water the color of sherry, then dried and thoroughly rubbed 
with iodoform, then packed with iodoform gauze and secondary sutures 
applied. One week later the packing was removed; the cavity once 
more dusted with iodoform and filled with Senn’s decalcified bone chips 
thoroughly rubbed with iodoform. Over these the secondary sutures 
of silk-worm-gut were tied and a plaster-of-paris cast applied over 
the usual dressing. The wound remained aseptic, the dressing was 
changed and the stitches removed after three weeks. The wound 
had healed throughout, except at the point of the stitches. There was 
no pus. After this extension was applied for orthopaedic purposes, 
giving the patient but slight shortening and a very good position for 
the limb. 
A study of these abstracts, in which I wish to direct your atten- 
tion particularly to the short time each patient was confined to the 
hospital, will speak for the value of the method employed. 18 
It is extremely simple. It does not annoy the patient or the 
surgeon unnecessarily. It is inexpensive and requires only such things 
as any one can readily procure. 
To secure an aseptic condition of the wound after any operation 
for a non-suppurative condition, it is but necessary to have soap and 
boiled water, a scrubbing-brush, a pint of strong alcohol, a pound of 
clean absorbent cotton, a can of commercial sterilized or antiseptic 
gauze and a number of freshly laundried towels. 
Of course I do not attribute the rapid and satisfactory recovery 
of these patients entirely to the methods employed. Much of this is 
due to the excellent care the patients received from the able and 
enthusiastic nurses of this hospital 
Literature. I had collected a list of articles bearing upon this 
subject, when the valuable book on aseptic surgery by Schimmelbusch 
(Aseptische Wundbehandlung Schimmelbusch, August Hirschwald, 
Berlin) appeared containing a much more complete list, so I will refer 
those interested to that work. 
710 Sedgwick Street.