“Great theologians, such as a Calvin or a Jonathan Edwards, were they recalled to life, could discourse as learnedly as ever of predestination and free will; great preachers, as a Beecher or a Spurgeon, could stir our souls and warm our hearts as of old; great jurists, as a Justinian or a Marshall, could expound the same principles of law which hold good for all time; great forensic orators, as a Burke or a Webster, could convince us by the same arguments and arouse us by the same invectives or the same eloquence that made our fathers willing captives to their silver tongues. But to-day, so rapid has been our surgical progress, a Velpeau, a Sir William Ferguson, or a Pancoast, all of whom have died within the last thirty years, could not teach modern surgical principles nor perform a modern surgical operation. Even our every-day surgical vocabulary—staphylococcus, streptococcus, infection, immunity, antisepsis and asepsis, toxin and antitoxin—would be unintelligible jargon to him; and our modern operations on the brain, the chest, the abdomen, and the pelvis would make him wonder whether we had not lost our senses, until, seeing the almost uniform and almost painless recoveries, he would thank God for the magnificent progress of the last half-century, which had vouchsafed such magical, nay, such almost divine, power to the modern surgeon.”
THE SURGERY OF WAR
One of the immediate consequences of the introduction of the antiseptic method has been a remarkable mitigation of the horrors of war. Our recent war with Spain has proved, and the present military operations in the Philippines and of the British in South Africa will still further prove, its advantages. Witness a little book written by Professor von Esmarch, of Kiel, Germany, with the apt title, The Fight of Humanity Against the Horrors of War; with an appendix, entitled, “The Samaritan on the Battle-field.” One of the most valuable means for the preservation of human life is carried by every soldier in a modern civilized army as a part of his regulation outfit, a “First Aid Package” for the treatment of any wound or injury; and one of the most valuable and interesting papers read before the American Surgical Association, at its meeting in Chicago in 1899, was by Professor Senn on the “First Aid Package.” This first aid package contains an antiseptic dressing, which can be applied to all but the gravest wounds for the purpose of preventing infection, which is the principal danger to life after accident or injury. The universal testimony of our surgeons in Cuba was that by its use most wounds were prevented from becoming infected, and, therefore, inflamed, and that the number of operations was greatly diminished by reason of its use.
BACTERIOLOGY
In experimental science, two methods of progress are observed; first, in actual practice certain methods are adopted because they are found to be the most advantageous and useful, though we cannot explain why it is so—i.e., practice outstrips theory. Again, as a result of experimental investigation, certain facts are discovered which explain why the practical methods just alluded to are the best, and this in turn suggests further improvements in our practice—i.e., theory outstrips practice and enlarges its domain. Thus outstripping theory, the practical advance made by Lister was an example of the first. His striking results in turn stimulated scientific observers to make new discoveries of the greatest importance, and thus science immensely improved and widened our practical methods.
No definite year or day can be assigned as the birth-date of Lord Lister’s antiseptic methods, as we can, for instance, for vaccination or for anæsthesia. We may assume, at least for this counrty, the summer of 1876 as the starting-point. During that year Lord Lister attended the International Medical Congress held in Philadelphia, and demonstrated his then methods and convinced a few surgeons of their immense advantages. Even before that date there had been very many experiments and observations, especially on the blood. In 1863 Davaine, in France, had discovered little rod-like bodies in the blood in wool-sorters’ disease, or anthrax, which he named from their shape “bacteria,” or “little rods.” This name has been adopted for all forms of germs, though many of them are not rod-like in their shape. Not until 1881 was the cause of inflammation and suppuration (the formation of pus or “matter”) discovered. In that year Ogston, of Aberdeen, published experiments which he believed demonstrated the fact that certain bacteria were the cause of suppuration. Since then this has been amply confirmed not only by experiments upon animals, but by observation in man. In 1882 Robert Koch, of Berlin, discovered the cause of tuberculosis, a little rod-like body, which is named the “bacillus” of tuberculosis. In 1883 Fehleisen discovered the germ of erysipelas, and in 1887 Nicolaier and Rosenbaum discovered the bacillus of tetanus or lockjaw. So recent have been the discoveries in bacteriology which have led to vast improvements in our methods of treatment of wounds and the performance of operations.
While the principles established by Lord Lister have remained unchanged, the details in the treatment have been greatly simplified and made more efficient. For the information of the general reader, let me state a few facts. Bacteria are divided into two principal classes, in accordance with their form. One, known as “cocci,” from the Greek word coccus—“berry”—may be likened to billiard-balls. Some of these occur in bunches, which have been likened to bunches of grapes, and hence are called, again from a Greek term, “staphylococci.” Others are arranged in chains, like beads, and are called “streptococci.” These last are very much more virulent and dangerous than the staphylococci. Both of these produce pus or matter, and they are the most widely diffused and most common forms found in infected or suppurating wounds. One form is the cause of erysipelas. A second form, known as “bacilli,” may be likened to a lead-pencil. Among the various bacilli that have been discovered are those of tuberculosis, glanders, tetanus or lockjaw, etc. I omit many others found in medical disorders, as they do not concern this paper. How important these discoveries are may be seen by the following facts: Tuberculosis, next to that of suppuration, is, perhaps, the most widely extended infection to which man, as well as animals, is liable. We are all familiar with it in the form of “consumption,” but the non-medical reader is, perhaps, not aware of the fact that it affects not only the lungs, but also the bowels in consumption of the bowels; the bones, as is seen by every surgeon almost daily, and especially as the cause of the crooked backs seen in spine diseases; in the joints, as is seen in hip-joint disease, white swelling of the knee, ankle-joint disease, and similar disease of all the other large joints of the body; in the brain, in tubercular meningitis; in the abdominal cavity, in tubercular peritonitis; in the skin, in certain forms of ulceration, commonly called lupus; in the glands, as in the swollen glands, or “bunches,” in the neck, and endless other varieties which I need not name.
The bacillus of lockjaw is found in great abundance around stables, and this explains the fact that hostlers, drivers, cavalrymen, all of whom had to do with horses, are especially liable to attacks of lockjaw. Moreover, certain bacteria thrive best when exposed to the open air. Other bacteria, and among them the bacilli of lockjaw, thrive best when the air is excluded, and this explains the danger of treading on a rusty nail, which is popularly and rightly known as peculiarly liable to produce lockjaw. The reason is not because it is a nail, nor because it is old, nor because it is rusty, but because from the earth in which it lies it is most apt to be the means of introducing into a punctured wound the bacilli of lockjaw. Such a wound bleeds but very little, the blood soon crusts and excludes the air, and if any of the bacilli of lockjaw have been carried into the body, they find in such a closed wound, from which the air is excluded, the most favorable conditions for growth and infection of the whole body. Knowing these facts from experiment, the treatment is clear. Lay open such a wound and disinfect it.
These two forms, the “cocci,” or berry-like bacteria, and the “bacilli,” or rod-like bacteria, comprise the great majority of dangerous bacteria.