THE PRESENT STATUS 
OF 
ANTISEPTIC SURGERY. 
A PAPER READ DURING THE THIRTY-SIXTH ANNUAL SESSION 
OF THE AMERICAN INSTITUTE OF HOMOEOPATHY, 
HELD AT NIAGARA FALLS, N. Y., JUNE, 1883. 
By WM. TOD HELMUTH, M.D., 
Prof, of Surgery in the New York Homoeopathic College, New York City. 
Reprint from the Transactions. 
PITTSBURGH: 
Prkss of Stevenson & Foster, 151 Wood Street. 
1883. THE PRESENT STATUS OF ANTISEPTIC SURGERY. 
Wm. Tod Helmuth, M.D., New York City, N. Y. 
The difficulties that surround that portion of the subject of 
antiseptics which has been assigned to me, can only be appre- 
ciated when one attempts to classify the opinions and experi- 
ments of those in the profession who have given attention to 
the subject, and to arrange systematically the vast amount of 
facts which for the past decade have been accumulating. 
With the varied discussions relative to the germ theory and 
the labors of Pasteur, Schwan, Schroeder, Dusch, Roberts, 
Drysdale, Koch, Spina, Peter and many others, this paper has 
nothing to do, nor will its author undertake to detail the 
many very careful and prolonged experiments that have been 
made to ascertain the true nature of the micro-organisms that 
inhabit the atmosphere, (whose presence yet causes and has 
heretofore developed such disastrous effects during the treat- 
ment of wounds), only in so far as the opinions of the distin- 
guished authors bear upon the question which forms the sub- 
ject of this paper. 
In the outset, then, we draw a distinct line of demarcation, 
between what is known as “ antiseptic surgery ” and “ aseptic 
surgerythe former being the treatment of all wounds bv the 
best methods of preventing putrefaction and the consequent 
infectious diseases, the surgeon employing any of the so-called 
antiseptics in any way most in accordance with his opinion ; 
while the latter (the “ aseptic method”), will be considered as 
synonomous with “ Listerism” the sheet anchor of which is 
Carbolic acid, and main-stay “ complete occlusion of the 
wound.” 2 
The majority of surgeons at present, I think, are of the 
opinion that most if not entirely all germs come from with- 
out, either by the means of instruments, the hands of the 
operator, or bv floating from the surrounding atmosphere, and 
that if these be perfectly excluded many complications will be 
avoided, perfect disinfection of the whole wounded surface and 
the complete exclusion of air being the two main conditions 
upon which the aseptic treatment rests. 
There are three parties, however, at present in dispute re- 
garding the theory of both the antiseptic and aseptic methods, 
and although all appear to agree that the introduction of the 
aseptic (Listerian) method, has been productive of a vast amount 
of good, the one side are disposed to believe that these results 
are obtained by simply care and cleanliness, while another at- 
tributes them to the distinctive power that Carbolic acid has 
upon bacteria, spores, micro-organisms and germs of all kinds, 
while again a third are of the opinion that the acid itself has 
some peculiar inherent power over the varied processes of re- 
pair. 
There is, however, another point which is claimed by true 
antiseptic surgery, which exists in the fact that a really true 
antiseptic not only should exclude all septic ferments from the 
wound, but should be capable, (as Dr. Chein says in his 
“ Antiseptic Surgery ”), of rendering inert the causes of putre- 
faction. 
Let us first, then, consider the aseptic method as briefly as 
possible. That the entire surgical world is indebted to Mr. 
Lister for the antiseptic method of treating wounds there can 
exist no doubt, and that following his example, and his teach- 
ing, most minute carefulness and perfect cleanliness have suc- 
ceeded carelessness and filth, especially in hospital practice, is 
also well authenticated. That the results he has obtained in 
the treatment of wounds under his care are remarkable when 
compared to the older method, it is true. The practical 
value of his teaching in saving human life and prevent- 
ing an immense amount of human suffering, is a fact which 
cannot be gainsayed. While, therefore, I think the major- 
ity of the profession at the present day are willing and ready 3 
to accord to the aseptic method a vast practical improvement 
in its results, yet there is a wide difference of opinion regarding 
what I may term “Theoretical Listerism.” 
The first main proposition in this system is the perfect and 
complete acceptance of the germ theory of putrefaction, vi z., 
that bacteria floating in the dust of the atmosphere not only 
infect the wounded surfaces, but enter into the tissues, deeply 
poison the whole mass of blood and produce rapidly those in- 
fectious diseases known as septic; that these micro-organisms 
are the only sources of putrefaction, and that Carbolic acid is 
the substance par excellence which is to be relied upon as 
most potent in preventing the entrance of these destructive 
bacteria, and offering obstacles more or less complete to the 
fermentations which these particles would otherwise occasion. 
This in a word is the theoretical Listerism, practical Lister- 
ism being the preparation of no less than twenty-one articles, 
which, as Mr. Chein in the Encyclopedia of Surgery says, w’ll 
be necessary for each dressing. Many of the articles men- 
tioned are in the plural, which in themselves cumber very 
materially the room and require a long time for their prepara- 
tion and considerable expense for procuration. 
The Theoretical Aseptic Method. 
It is in this, as I have already said, that a wide discrepancy 
of opinion prevails, for while no one at the present day can 
deny the germ theory of certain diseases, (and it appears 
from very recent experiments that additional evidence can be 
adduced in its favor), yet many do deny that germs are the 
sole agents of putrefaction. I may here by way of parenthe- 
sis remark, that one of the best received and most carefully 
prepared works on the germ theory of disease has issued from 
the pen of my esteemed friend, Dr. Drysdale, of Liverpool, for 
a long number of years one of the editors of the veteran 
“ British Journal of Homoeopathy.” 
The question now is, are there no other influences than the 4 
presence of germs, to account for the obstreperous deport- 
ment of wounds, and does this bad behavior always arise, (as 
Mr. Lister and his followers strictly contend,) solely from the 
presence of bacteria ? 
In the “ Present Status of Antiseptic Surgery,” it can be shown 
without doubt, that these very bacteria instead of being in all 
cases hurtful are indeed beneficial, and while they may be in 
many instances the essential agents in fermentations, decom- 
positions and putrefactions, at the same time may be import- 
ant factors in the maintenance of health. 
A large proportion of our food is prepared by saprophytes. 
To bacteria we are indebted for butter, cheese, vinegar and even 
bread; wines, beers and spirituous liquors. In fact, the tre- 
mendous influence of these organisms in consuming the waste 
thrown off from the animal and vegetable kingdom is indeed 
astounding; were it not for these, the debris would not be con- 
sumed, and would accumulate as a tremendous load upon the 
earth. Animals would be overburdened by their own excre- 
ment, and plants die for want of nutriment. Therefore, look- 
ing at the germ theory in this light, there is reason to doubt 
theoretical Listerism. 
Again, certain varieties of bacteria, under peculiar circum- 
stances, are absolutely of service in the process of repair. At 
the present time there are many renowned names who, I 
think, would give testimony in favor of such a statement. 
Dr. Wm. Hunt, senior surgeon to the Pennsylvania Hos- 
pital, thus speaks : “ Having noticed wounds healing kindly 
under masses of maggots, I reflected that they were scavengers, 
eating only dead materials and so converting harming matter 
into harmless living substance. We have to get rid of them, 
it is true, because they will persist in getting into wrong places, 
and so give an infinite amount of trouble. “ To my mind,’’ 
further says Dr. Hunt, and he italicizes the words, “ there is no 
positive proof as yet of the organisms being specific and primary in 
their operation,” and further on he says, and backs up his 
opinion by no less authorities than Formad and Dr. Joseph 
Leidy, “ No micro-necrosis, no micro-maggots, that is food 5 
mostly in the shape of necrotic products precedes the advent of 
the micro-organisms ; however these may originate, whether 
animal or vegetable, and in disease these necrotic products, 
first, plus the micro-organisms, second ; play havoc with their 
environment.” Formad says, “ The presence of baccilli (so far 
as our present research goes) is secondary, and appears to con- 
dition the complete destruction of the tissue already diseased 
and infested by them, and this destruction is in direct propor- 
tion to the quantity of the organisms which thus regulate the 
prognosis. 
According to this view of the theory, bacteria are useful in 
some instances and hurtful in others, and a still more singular 
fact has been noted by Kocher, who says, “ In different forms 
of inflammation different forms of organisms come into action, 
and the different changes in a wound cannot be laid to the 
same coco-bacteria.” And again, our friend, Dr. Drysdale, 
also has proved that there is a specific parasite for almost every 
human tissue. Therefore, to account for every variety of septic 
poisoning by the presence of micro-organisms cannot at the 
present be tenable. And this may be proven by the fact that 
the most minute attention to all the details of Listerism does 
not completely exclude bacteria, for they have been found in 
the best dressed and healthiest wounds, even, I believe, in Car- 
bolized catgut ligature; they have also been discovered in 
wounds proceeding rapidly to adhesion. “ Billroth and Ehr- 
lich, after careful experiments, declare that no difference is 
discoverable in the putrefaction of blood drawn directly from 
an artery and sealed up under spray and that taken without 
such protection.” Besides, if mere bacteria acted as a pyaunic, 
poison as self-producing and in the minimal dose, like the 
poison of rabies, syphilis, and small-pox, nobody could survive 
the smallest cut or abrasion, and vaccination and subcutaneous 
injection would be certain death. (Drysdale, p. 45). As Dr.. 
Hunt also says, if these organisms are specific and primary, 
4‘ I do not comprehend how any of us are alive.” 
Dr. Bryant also writes in his latest work, “ I am no convert as 
yet to the theory on which it (Listerism) is based, nor to the 6 
great value of the special practice based upon it, neither is it 
yet proved. It is much to be regretted, that the originator of 
the system should not have listened to the repeated requests of 
surgeons to publish the results of his practice as a whole, since 
it can be by such alone that the value of the method is to be 
estimated.” (Bryant’s Surgery, p. 972). 
And again, Markoe, of our country, in a valuable paper on 
Thorough Drainage in the Treatment of Wounds,” (American 
Journal of Medical Sciences, April, 1880, p. 309), says that 
though he is a firm believer in many of the most important 
doctrines connected with the germ theory, that he certainty is 
of opinion that there are very many other causes which may 
excite “ the ill-behavior of wounds.” 
Dr. Lawson Tait, (American Journal of the Medical Sciences, 
July, 1882, p. 267), writes; “ The basis of Lister’s theory of 
putrefaction by means of bacteria had long ago been proved 
beyond dispute as regards dead matter. But Mr. Lister 
assumed for living matter the same sequence of events as in 
the case of the dead.” 
Again, it has been proven that symptoms in appearance, 
progress, duration and results exactly similar to septicaemia 
have been produced by introducing fibrin ferment into the 
blood in considerable quantities, that Pepsin and Ptyalin pro- 
duced similar symptoms, and from these facts Dr. W. T. Bell- 
field, in his valuable Cartwright Lecture, states positively that 
recent experiments have demonstrated “ that the aetiology of the 
growth of clinical and anatomical appearances known as sep- 
ticaemia is by no means restricted to putrid infection.” (Medi- 
cal Record, March 3, 1883, p. 227). 
These references are sufficient to show that there are wide 
differences of opinion regarding the theoretical aseptic or Lis- 
terism methods; let us look to that which concerns us more 
closely, viz.: the practical results of the method. 
Those at all conversant with surgical literature must at once 
acknowledge that Mr. Lister has roused the medical and surgi- 
cal world to the proper application of thorough disinfection 
and perfect cleanliness, and by his most praiseworthy and per- 7 
severing efforts has wrought a complete revolution in the treat- 
ment of wounded and abraded surfaces. The most skeptical 
as to the theory are compelled to acknowledge the beneficial 
results of the practice, and I think I may say that in private 
or in hospital routine work at the present day, any surgeon 
would appear derelict in his duty did he not employ some 
variety of the antiseptic method. 
The details of the Listerism, however, as I have already 
stated, are cumbersome and trying both to the patience and to 
the time of the surgeon, and therefore many of the minutiai, 
which at one time were deemed essential, are now omitted al- 
together or applied in a very modified form with most excellent 
results. Notably is this the case in the application of the spray, 
which has been not only abolished by many, but by some is 
deemed absolutely hurtful. 
Lister, himself, has modified his opinion with regard to the 
strength of his Carbolic acid solutions, using first a spray of 
1 to 100, and now 1 to 20 ; for sponges, a solution of 1 to 40, 
and it is stated by Delacroix that 10 per cent, of Carbolic acid 
is required to destroy bacteric life. It may be said, therefore, 
that as there are means of causing putrefaction other than the 
bacteria floating in the dust of the atmosphere, and as (as 
already has been stated), different inflammations are attended 
by different forms of bacteria, and as the resistant power of 
bacteria is not always the same, (that of the reproductive 
spores being much greater than fully developed bacterial pro- 
duct), and as also as Dr. Weir writes, “ it must be admitted 
by the most devoted advocates of the Listerian system, that 
the dressings applied with the strictest attention not infre- 
quently fail in arresting the progress of putrefaction,”—that 
the good results so widely acknowledged, must be explained by 
other than the Listerian theory. Again, Kocher, Volkman’s 
assistant, is of opinion that the same antiseptic measures cannot 
be used in the treatment of all varieties of wounds, (Volkman’s 
Klinische Vortage, November, 1882), and the same surgeon 
writes after fully admitting that many wounds heal well by 
the Carbolic acid treatment says, “ I have seen colleagues who 8 
tenaciously bold to the spray with all the attributes which 
hold to the Lister-Volkman technique, have here and there 
the most grave cases of infection after complicated operations; ” 
and as Drs. Hunt and Formad have stated that in many in- 
stances the micrococci seem to be increased in the proportion 
to the necrosis of the tissue; may it not be a fact that Car- 
bolic acid (as indeed do many medicinal substances), has a 
peculiar action upon certain forms of bacterial life, in the one 
case causing the total annihilation of the organisms, in another 
but partially affecting them, while perhaps in a third variety 
they resist the action altogether? In other words, a specific 
action of Carbolic acid is found in one class of cases, and, 
perhaps, these are in the majority, while in another, it is of no 
avail. 
In looking over Mr. Chein’s late work on “ Antiseptic Sur- 
gery,” and comparing Mr. Lister’s own statistics, it will be 
found that the best and most surprising results were obtained 
by Mr. Lister in his method of treating diseases of the joints. 
Why, then, as different micro-organisms belong to different 
inflammations and tissues, may not Carbolic acid be particu- 
larly applicable to those affecting the synovial tissues of 
joints ? 
Again, there are other thoughtful men, who believing, in a 
measure, as I do myself, in the bacterial agency in the produc- 
tion of putrefaction, who see in the good results that are often 
observed from the use of Carbolic acid, something more than 
the mere destruction of baccilli, give a large share of the effi- 
ciency of the drug to its action upon the tissues themselves. 
Dr. Markoe, says, (American Journal of the Medical Sciences, 
April 1880, p. 314), “ my attention once directed to this point, 
I think I have verified this power which I claim Carbolic acid 
possesses, of modifying vital action in many striking instances. 
I have watched many commencing surface inflammations 
rapidly diminish and disappear under Carbolic dressing, when 
no exclusion of germs was attempted. I have seen wounds of all 
kinds and degrees of severity go through their stages of repair 
without a trace of inflammatory complication, and even when 9 
inflammatory complications had not been prevented. I have 
seen the morbid actions which threatened infinite mischief, so 
modified and controlled by Carbolic acid constantly applied as 
to be practically robbed of their usual power to inflict dam- 
age.” It is needless here to note the opinions of Ollier, Til- 
laux, Weir, Beal, and others, but I may say that these views 
have been for the past six years entertained by myself, indeed, 
since the perusal of a paper by John Dougall, M.D., of Glasgow, 
on “ The Relative Power of Various Substances in Preventing 
the Generation of Animalculise, or the Development of their 
Germs with Special Reference to the Germ Theory of Putre- 
faction,” I immediately endeavored to look for some other 
power in Carbolic acid in the treatment of wounds beside its 
virtues as a mere germicide. In his paper, Mr. Dougall says, 
“ If, as is alleged, germs are the source of putrefaction, then 
the strongest preventions must be the best antiseptics, and vice 
versa. Now, as seen in the table, Carbolic acid occupies a very 
mediocre place, ****** and although unable to 
formulate the change that takes place, when it unites in large 
proportion with organic bodies, for which it has a strong affin- 
ity still, the result of such change certainly is the formation of 
a compound capable of resisting the attacks of oxygen, of 
water, and consequently of germs. In other words, a com- 
pound is formed which is proof against putrefactive tenden- 
cies.” 
If, now, we take also into consideration the valuable experi- 
ments of Prudden (American Journal of Medical Sciences, Jan- 
uary, 1881, p. 96), which appear to show that strong solutions 
of Carbolic acid cause immediate cessation of amoeboid motion 
and death of the cells, and that very dilute solutions may 
cause a temporary cessation of the movement and not the 
death of the white blood-corpuscles, it would appear that the 
physiological action of Carbolic acid may have a great deal 
to do with the results which have been obtained by its use in 
the treatment of wounds. It would be interesting to enter 
upon the details of “ Carbolic acid poisoning,” but as a paper on 
that subject is to be prepared by a very able gentleman, I shall 
not venture upon it in this place. 10 
Antiseptic. 
Having now given a passing consideration to the aseptic 
method, we come to examine the second division of the sub- 
ject, viz., “ The Present Status of Antiseptics.” 
Here at once a wide field opens to the student, and a cursory- 
glance at medical literature for the past three or four years 
will show beyond cavil, that the universal antiseptic has not 
yet been discovered, nor will such a panacea lapsorum, in my 
mind, ever be revealed. I have no doubt, however, that the 
time will come when a more thorough understanding of the 
actions of the so-called antiseptics will be arrived at, and that 
the surgeon may then be enabled to select certain drugs or 
certain chemicals which, beside having antiseptic properties, 
may be peculiarly adapted to the process of repair as taking 
place in the different structures of the human body. 
I think it may be affirmed at the present that while the 
aseptic or Listerian method, or certainly portions of it, which 
were formerly deemed essential, are gradually being done 
away with. Yet that antiseptic treatment is being more 
thoroughly investigated. This may be judged even by a cur- 
sory review of the treatment of wounds in hospitals as well as 
in private practice. 
The spray, I think, is almost abolished in the majority of 
hospitals, and many antiseptics, other than Carbolic acid, are 
employed by surgeons in all parts of the world. It is well 
known that Mr. Savory, senior surgeon to St. Bartholomew’s, 
the largest of the London hospitals, rejects the antiseptic treat- 
ment and relies upon cleanliness alone, and very ably has de- 
fended his position, although Mr. Chein, in his late work, 
states that the Savory treatment was in some degree anti- 
septic. 
Mr. Lawson Tait, as has already been mentioned, is no advo- 
cate for the antiseptic method in ovariotomy, and we find in 
the American Journal of the Medical Sciences, so late as January 
this year, 1883, a most surprising record, viz., the record of one 
hundred consecutive cases of ovariotomy performed without any 
Listerian details, of which but three died, and one of these 11 
from accidental suffocation, which really ought not to be 
classed in the mortality. His increased success Mr. Tait at- 
tributes to the improved methods of operating, to his more ex- 
tended experience, and especially the complete abandonment of 
the use of Carbolic acid or any other disinfectant, and the estab- 
lishment of hospital discipline and hygiene on the best known 
principles. 
Bantock, also of the Samaritan Hospital, operates without 
spray. (Medical Record, March 10th, 1883). 
Dr. Keith, (Lancet, August 13th, 1881), it is well known, 
spoke his mind in the surgical section of the London Congress 
when he said, that after having a succession of eighty success- 
ful cases, he had five deaths in the next twenty-five cases, two 
of which were from carbolic poisoning, one from septicaemia, 
and two from acute nephritis. He had abandoned the spray 
in all operations, and in the last twenty-seven ovariotomies 
without any antiseptic treatment, he had lost but one patient. 
Holmes, at St. George’s Hospital, discards the use of anti- 
septics except in disease in the joints. 
Hutchison, at the London Hospital, also works without Lis- 
terism. 
In the hospitals in New York they are constantly investigat- 
ing substances with a view of ascertaining their antiseptic 
properties, the spray being in very many of the institutions 
entirely abolished, and even by some considered as being per- 
nicious. Sands, Stimson, Markoe, Wier and many other sur- 
geons are, in the hospitals to which they are attached, con- 
stantly experimenting with the newer dressings, some of which 
as bearing upon the subject of this paper will be mentioned 
shortly. In Bellevue Hospital the dressing is as follows, as 
communicated to me by my former pupil, Dr. Fuller, now 
house surgeon in that institution : He writes me, “The form 
of dressing now in use in our wards is one introduced by Dr. 
Lange, and is practically the antiseptic dressing that is being 
used in Germany almost entirely. The wound dressing, how- 
ever, is only one element in the treatment of the case, the secret 
is absolute cleanliness and antisepsis. Say the case is one of 12 
amputation, or excision of a joint, the parts are first washed 
with soap and water, with Ether, if necesary, and the hair 
shaved off. Then towels wet with an antiseptic solution, gen- 
erally 1-40, Carbolic acid, are spread around, the limbs so that 
the operator’s hands or the instruments may not touch the parts 
unnecessarily. Instead of a spray the wound is frequently irri- 
gated with a solution of Corrosive sublimate, four grains to 
the pint of water, the instruments are absolutely clean, and 
are lying, when not in use, in a solution of 1-40 Carbolic acid. 
The hands of those engaged in the operation are wet with the 
same. For ligatures we use Carbolized catgut or fine Carbol- 
ized silk. We keep it in pots wound in spools. In an ampu- 
tation we use absorbable drains of decalcified bone, in other 
cases, rubber tubes. After the final washing, the wound is 
sprinkled with Iodoform and protected by rubber tissue, which 
is placed over the sutured margins of the wound, and the out- 
side dressing is then applied, it may be peat, borated cotton, or 
gauze. Peat is the best absorbent, but is expensive. We gen- 
erally dress within thirty-six hours. When the oozing of blood 
and serum will have ceased, the tubes are then removed or 
not, according to circumstances. This dressing must be made 
under the same precautions as the operation, irrigation, 
guards, etc. The second dressing may remain on a week or 
longer. If the discharge comes through the outside dressing, 
the part is to be dusted with Iodoform, or an extra amount of 
cotton, or gauze applied. The only indication for the removal 
of the entire dressing is a higher temperature. With this 
dressing we have treated in the last two months over a dozen 
excisions of joints, half a dozen osteotomies, excisions of 
tumors, compound fractures, etc., without a bad result, and 
with a remarkably low range of temperatures. In all the 
wards we do not treat antiseptically, but there have been no 
results to equal these I speak of. Dr. Weir tried full Lister dress 
ing with good results; Dr. Keys also. Dr. Wood used the open 
method entirely. Dr. Lange employs the one I have just men- 
tioned.” 
In a late number of the Medical News, June 13th, 1883, Dr. 13 
Henry C. Simes, assistant surgeon to the Episcopal Hospital, 
thus writes of the general treatment of wounds in the Phila- 
delphia hospitals. He says that Listerism is far from being 
accepted, and thus continues, “ In this city (Philadelphia) I 
know of no hospital in which its surgeons have fully and thor- 
oughly carried out the details necessary to give their treat- 
ment the name of antiseptic, that is to say, that they have not 
attended to the minute directions, and in many cases the prin- 
cipal features have been omittedand then further states, 
that in the same hospital, when antiseptically treated cases 
were compared with those not subjected to the method, the 
-results of the former were much more satisfactory. 
From these facts, selected from an immense amount of ma- 
terial, it may be judged that antiseptic surgery, as we now 
regard it, is being more thoroughly investigated and improved, 
while the minute details of Listerism are being gradually 
abolished. 
The constant search for new antiseptics in the treatment of 
wounded surfaces, may be regarded as indicative of the fact that 
there are none which have as yet proved entirely satisfactory, 
and as much has been written and many experiments made 
during the past three years in regard to new substances said 
to be antiseptic in their nature, it would be scarcely proper in 
a paper on “ the present status of antiseptics” not to allude in 
a concise manner to some of these materials. 
Iodoform. 
This substance, Iodoform, must take the precedence, not 
only because it has been very much used by many distin- 
guished surgeons, but because the results obtained have been 
very surprising. In fact, I recollect reading not very long 
since, that Billroth had stated that the reason that he had not 
published his cases treated with Iodoform, was that the results 
he had obtained were so very surprising that he feared they 
would not be credited. 
Iodoform contains about 96 per cent, of Iodine, and when 
decomposition is going on, the Iodine is evolved, which, by 14 
actual experiment, has been proved to be one of the best dis- 
infectants. 
After the wound has been cleansed, the powder of Iodoform 
may be dusted over the part, and covered with a piece of pro- 
tective. This substance is very useful in parts of the body 
where Carbolic acid could not be applied, as in cancers of the 
rectum, tumors of the tongue and mouth. 
Billroth made twelve consecutive amputations of the tongue, 
and treated the wound with Iodoform without any fatal result. 
Dr. Sands, (Medical Record, March 25th, 1882), of New York, 
mentions cases of strangulated herniae, trephining for fracture 
of the skull, colotomy, enterotomy, castration, ligature of the 
external carotoid, peri-nephritic abscess, enucleation of suppu- 
rating inguinal glands, excisions of the breast, amputations, 
all of which made prompt recovery, treated with Iodoform. 
Among the German surgeons, especially Esmarch, Billroth 
and Langenbeck, the use of this drug has produced surprising 
results—out of thirty-four resections thirty-two were cured 
with a dressing once applied and allowed to remain thirty-five 
days. Billroth’s method of applying Iodoform is to powder 
the wound thickly with the substance, or, in some instances, to 
fill it; surround this with a piece of cotton wool or Iodoform 
gauze, then a water-tight dressing is put on and held in posi- 
tion by a bandage. From a paper entitled, “The use of Iodo- 
form in the London Hospitals” (Medical Record, April loth,. 
1882), we read that it is a favorite dressing in almost every 
institution. It must, however, be borne in mind, that Iodo- 
form is highly poisonous, although the Iodine is taken up 
slowly ; indeed Koenig, of Gottengen, has published a special 
warning on this subject, and, therefore, the dressing ought not 
to be allowed to remain for over five days, and then for a time 
some other antiseptic should be employed. 
The symptoms of Iodoform poisoning chiefly show them- 
selves in intoxication of varying degree and intensity, and 
often in mental derangement. It can be detected in the urine 
by adding starch and Nitric acid and shaking well, when the 
blue color will appear. The lethal dose for a guinea pig is 15 
three grains, in rabbits forty-five grains, in the dog one drachm,, 
and in man according to his susceptibility to the drug. But 
this subject has already been fully considered by others in the 
bureau. 
Bi-chloride of Mercury. 
Corrosive sublimate in dilute form is employed more espe- 
cially by some of the metropolitan surgeons. I have employed 
it in amputations, resections, and the removal of tumors with 
excellent, but not very surprising results. 
Delacroix uses it in one part to 2525 of water, and Dr. Weir 
and Sands in about 1-2000, but of this Weir says, bacteric life 
was found under such dressings, and therefor, following the 
experience of Kiimmel and Schede, of Hamburg, he used it 
stronger and with a uniformity of good unknown to Listerism. 
In preparing this dressing, the sponges, compresses, etc., 
are wet with solution No. 1 (as it is called), consisting of 8 grains 
to the pint. The ligatures are made of silk dipped for two 
hours in a solution of 8 grains to the pint, and catgut im- 
mersed in 8 grains to the pint of water for 12 hours, then 
rolled on bobbins and kept in an Alcoholic solution of 20 
grains to the pint. The gauze is prepared by immersion in a 
solution of 20 grains to the pint of Alcohol with giss of Gly- 
cerine. 
It has been found by Koch that the anthrax spores, the most 
resistant of all varieties, were completely destroyed by moist- 
ening the parts with one to live thousand of water, and if im- 
mersed for a longer period, a solution of one to twenty thou- 
sand parts was sufficient for their destruction. 
Turf Dressing. 
As Dittle discovered the elastic ligature by accident, so Neu- 
ber, two years since, recorded the case of a man brought to his 
clinic who had sustained a wound and fractures of both fore- 
arms, ten days before; a comrade had surrounded the wound 
with a turf mould, and upon its removal the cut surfaces were 16 
found healing beautifully. It has since been discovered that 
the dust resulting from the sawing of the turf into moulds 
possesses a very great affinity for Ammonia, Carbonate of Am- 
monia, and odors generally, and in the infantry barracks at 
Brunswick, the turf mould is used to disinfect privies, etc. 
This dust, beside being a great diisnfectant, possesses wonder- 
ful absorbent properties, taking up nine times its weight in water. 
A great many experiments have been tried regarding its effi- 
ciency as an antiseptic dressing with satisfactory results. The 
turf mould is used as follows: Bags are made of two sizes, 12 
and 24 centimetres square. The turf dust is placed in these, 
the smaller one having besides 2J per cent, of Iodoform. This 
is laid on the wound, which has also been disinfected ; over 
this the larger bag is lain, the mould of which is saturated 
with a five per cent, solution of Carbolic acid. 
Its absorbent powers, its cheapness—a pennyworth being 
sufficient for a dressing—and its antiseptic virtues, render it 
an excellent dressing in those countries where the mould is 
readily obtained, and so much has been said of its efficiency 
that it is now being used by surgeons in this city, and I am 
informed with most excellent results. 
The Per-oxide of Hydrogen. 
The Per-oxide of Hydrogen has received very great eulogiums 
from many and varied quarters, and C. T. Kingsett, of London, 
made a report of a series of experiments with the material in 
187G. In 1878, Giittman and Fraenkel, in Germany ; and 
Baldy, Best, and Regnard in France made many demonstra- 
tions of the value of the material, and under the name of 
“ Eau oxygene ” it has' been widely used. It is employed as 
spray, as a washing for wounds, ulcers, etc., and is devoid of 
all odor. Kingsett has lately announced a preparation called 
“ Sanitas oil,” which he claims to be an organic Per-oxide, 
which will continually yield Per-oxide of hydrogen to water, 
on being placed in contact therewith. If placed on surfaces 
it is said to keep them in a completely antiseptic atmosphere. 17 
There are a great many other of the so-called disinfectants 
and antiseptics, among which may be mentioned Boracic and 
Salicylic acids, Eucalyptus oil, by Bassini, (Medical News, Feb- 
ruary, 1881). Resorcin, which belongs ta the Phenol group, 
and has been noticed especially with reference to its substitu- 
tion for Carbolic acid, (American Journal of Medical Sciences, 
January, 1883). 
Naphthalin, which according to Fischer, of Strasbourg, is 
superior to Carbolic acid, (Glasgow Medical Journal, November, 
1882). 
And the Sub-nitrate of Bismuth, which Kocher claims as a 
new and better antiseptic than any yet discovered, ( Volkman's 
Klinische Vortage, No. 224, 1882). He discards drainage tubes 
and closes the wound its entire extent by suture. 
During the operation the parts are sprinkled with water 
holding Bismuth in solution. The wound is then closed by 
suture and the line of incision covered with Bismuth paste. 
Then the dressings wet with Bismuth water are applied. 
As the sutures are removed, Bismuth is again applied ; this 
method is called healing by second adhesion, but there have 
been also some drawbacks to this substance when applied to 
extensive abraded surfaces ; if Bismuth in powder was largely 
employed, it was found to produce diarrhoea, nephritis, stoma- 
titis and other disturbances; it was then employed in a solu- 
tion of 10 per cent., and sprinkled on the parts with great ben- 
efit. The astringency of Bismuth is said also to add to its effec- 
tive healing powers. 
This is announced as a valuable antiseptic (Lancet, 1881, 
page 971). It is prepared by passing air for a long time through 
the ordinary Oil of turpentine. Mr. Lister was said to be ex- 
perimenting with the substance, but as no report has as yet 
been given, it is reasonable to suppose that the results were not 
as satisfactory as Mr. C. T. Kingzett had anticipated. 
Oxidized Oil of Turpentine. 18 
Chloral hydrate. 
This substance has also been used in Russia, with benefit, as 
an antiseptic, especially in the treatment of ulcers and open 
wounds. Dmitrieff demonstrated in St. Petersburg, that an 
equal quantity of one per cent, solution of Chloral hydrate de- 
stroyed in twenty minutes all mobility of the bacteria in a 
putrefying infusion of flesh. 
But a sufficient number of these substances have been 
enumerated to show, as I have already stated, that as yet all of 
them have some disadvantages. It is my belief, as already 
stated, that there must reside in any application made to a 
wounded surface, something beside its germ-killing properties, 
which after all are merely mechanical. I am justified in 
asserting that because a substance is really a germicide, is no 
reason that it is a perfect vulnerary. There must reside in the 
drug a power to act upon the leucocytes, to either hasten their 
amoeboid motion to the cut surfaces of the capillaries, which 
are endeavoring to repair waste or to retard this very migra- 
tion, and by so retarding, prevent the dying of the leucocytes, 
which in the majority of instances means their conversion into 
pus. While on this subject I must say, as far as I have 
observed by actual results in the treatment of wounded surfaces 
—for I have never given any microscopical trial to ascertain 
its value as a germicide—that the Calendula officinalis has 
given me equal, if not better results than Carbolic acid, and 
while I acknowledge the fact, that since the “bacteria craze,” 
and the “ Carbolic excitement,” I have yielded to the popular 
cry and used Carbolic acid in different proportions and in dif- 
ferent solutions, yet I am convinced, that other things being 
equal, that Calendula, from its peculiar action on suppurating 
surfaces, is a medicine that sooner or later must receive the 
attention which its virtues deserve. I am quite sure of the fol- 
lowing facts, that in the past five years, when I have been em- 
ploying Carbolic acid preparations upon wounded surfaces, that 
have not appeared to be progressing as favorably as I thought 
they should, I have substituted Calendula with surprising 19 
results. In many cases of breast amputations and large 
wounds, I have employed merely cleanliness and the solution 
of Calendula, one per cent, to four of water, with a most satis- 
factory termination of the cases. 
In conclusion, it is most important to look at the results of 
antiseptics in surgery—and this also must be briefly considered, 
although on this point, viz., the welfare of humanity, the whole 
subject must rest. 
First, I will note MacEwen’s cases, because they were treated 
in Glasgow, where Mr. Lister began his investigations and 
treatment; and second, because the experiments were made 
under the pre-conceived idea that hygienic treatment was all- 
sufficient in the treatment of wounds. In the years 1875,1876, 
1877, 1878 (five years), there were 1706 cases treated by aseptic 
method of which fifty died, giving a mortality of 2.93 percent. 
During the same period, in the same number of wards, Dr. 
Morton treated 1884 cases without aseptic precautions and of 
these 110, or 5.84 per cent., died. 
After Mr. Lister went to Edinburgh, from the end of 1871 to 
the middle of 1877, a period of about five and a half years, Mr. 
Lister treated asepticall v 553 cases, of which 29 cases died. Mr. 
-Spence, during the same time (five and a half years) was oper- 
ating in the same hospital, using no very decided treatment— 
sometimes water dressing, sometimes Boracic lint, and some- 
times none whatever. In the 328 cases operated upon with 58 
deaths, showing again a large percentage in favor of the anti- 
septics. 
Again, if we turn to Mr. Lister’s figures, after he had changed 
his residence from Edinburgh to London, where, in King’s 
College Hospital, from November, 1877, till November, 1880, a 
period of three years, he performed 207 operations, of which 14 
died, a fair estimate of his success may be arrived at. As these 
last were performed by Mr. Lister after he had studied and 
improved upon his method for a period of thirteen years and 
in three hospitals, the results as bearing upon the present 
status of antiseptic surgery, are of the utmost importance, and 
therefore it may be well to mention the character and kind of 
operations performed. Thus :— 20 
There were three amputations of the hip-joint for disease, 
with one death. There were four amputations of the thigh for 
disease, of which three died. There were two amputations of 
the fore-arm, no death. There were sixteen excisions of the 
mamma, with two deaths. There were thirty-one operations 
in healthy bones for deformity, no deaths. There were eight 
abscesses, with one death. There were four cases of strangu- 
lated hernise, witli three deaths. There were three operations 
for the radical cure of hernise, no death. There were three 
cases of acute necrosis, and one death. There were twenty- 
three large abscesses, no death. Two cases of empyema, no 
death. There were also cases of nerve stretching, castration, 
varicocele and tumors. 
From a careful examination of these cases, it will at once be 
seen that in the same hospitals, with the ordinary run of cases, 
with the same surroundings, and in the same atmosphere, the 
percentage in aseptic treatment is almost double in its favor. 
This fact cannot be gainsayed, but we must now consider 
whether the aseptic method, Listerian in theory and practice : 
the Carbolic acid treatment in its minute details, gives better 
results than the ordinary antiseptic methods as employed with- 
out the Listerian minute by the majority of the profession at 
the present day. This is difficult to accomplish, and about the 
best way for me to place the subject properly is to give the 
statistics of the Hahnemann Hospital. These figures I have 
copied from the case book, and extend over a period from Sep- 
tember, 1878, to June, 1883, being four and three-fourths years. 
Among these were 17 amputations of the breast, and 1 
death. There were 15 amputations, 1 of the thigh, 5 of the 
leg, 3 Symes, 2 Pirogoff’s, 1 Choparts, 3 fingers, with 1 death. 
There were 3 excisions of the rectum for cancer, with 1 death. 
There were 2 cases rectotomy, no death. There were 9 resec- 
tions ; tibia, 3; ankle joint, 1 ; elbow, 1; wrist, 1; coccyx, 1; 
ribs, 2, with no death. There were 11 ovariotomies, with 4 
deaths. There were 17 abscesses, some of very large size, and 
no deaths. There was 1 case of empyema, and 1 death. 
Laceration of the perinseum 22, with no death. External 21 
urethrotomy 11, with 1 death. There were 2 cases of internal 
urethrotomy, no death. There were 9 cases of lipoma, some 
of large size, no death. There was 1 fistula of the thorax, 1 
vesico-vaginal fistula, 1 recto-vaginal fistula, 1 perineal fistula. 
There were 2 cases of Battey’s operation, no death; 2 cases 
cystocele, no death. There were 9 rhinoplastic operations, 1 
death. There were 3 cases of supra-pubic lithotomy, 1 death. 
There were 5 cases of lithroty, no death. Removal of superior 
maxillary 2 cases, no death. There was 1 extirpation of the 
uterus, 1 death. There were 56 cases of laceration of the cer- 
vix. no death. Besides these were 10 cases of hernia, 16 cases 
of fistula in ano, varicocele, tracheotomy 1 each, and others, 
making a sum total of 201 operations performed in the Hahne- 
mann by the visiting surgeons, with the loss of 11 cases. 
There is no absolute Listerism practiced at the hospital, but 
antiseptics are used in the shape of Carbolic acid solutions, the 
instruments carbolized, and Calendula, Balsam of Peru, the 
Bichloride of mercury or any other antiseptic used that the 
operator may deem proper. One feature in the dressing is the 
Marine lint, which I regard as an agent of the greatest value. 
The parts to be operated upon are washed with Carbolized 
solution, the floor of the operating room is scrubbed, and the 
“ ovariotomy room also ventilated and disinfected after each 
operation ” The instruments are first laid in Carbolized oil 
over night, and then in shallow pans containing Carbolic 
acid. An assistant is at hand to immediately wash an instru- 
ment which has been laid aside and replace it in the pan. 
Sponges are immersed either in a solution of Corrosive subli- 
mate, 1 to 2500, or in Carbolic solution 1 to 60. The wounds 
are closed with silver sutures carbolized. The silk is rendered 
aseptic and catgut is often employed. Salicylated India rub- 
ber plaster is the only kind used in the house, and after it has 
brought the edges of the wound in contact, a wad of Marine 
lint is laid over the entire wound, spreading some distance 
around it, over this the protective gauze, and again over that 
a bandage is placed. These dressings are not touched until 
some indications for their removal is noticed, and often remain 22 
in position for days together. It will be seen, therefore, that 
our statistics without the minutiae are even better than that 
of Mr. Lister. 
If, now, we compare all these statistics, we can formulate the 
present status of antiseptic surgery : 
OPERATOR AND 
LOCATION OF HOSPITAL. 
Cases. 
Deaths. 
Pek Cent. 
Glasgow. 
1,706 
50 
2.93 
Aseptic Treatment. 
Same Hospital. 
1,884 
110 
5.84 
Non-aseptic Treatment. 
Edinburgh. 
Lister, 5J years 
Aseptic Treatment. 
553 
29 
5.2 
Same Hospital. 
328 
58 
17.7 
Non-antiseptic. 
London. 
207' 
14 
6.76 
Aseptic Treatment. 
New York. 
Hahnemann Hospital, 4 years 
201 
11 
5.47 
So it will be found that in most hospitals the aseptic treat- 
ment, viz., Listerism, is abolished or greatly modified, and that 
the anti-septic treatment will probably give as good results as 
the a-septic, especially with proper hygienic surroundings.