Preventable Diseases

by Woods Hutchinson

One day a brilliant skeptic by the name of Lister (who is still living) took it into his head that perhaps the fathers of surgery and their generations of imitators might have been wrong. He tried the experiment, shut germs out of his wounds, and behold, antiseptic surgery, with all its magnificent line of triumphs, was born!

Now a single drop of pus in an operation wound is as deep a disgrace as a bedbug on the pillow of a model housekeeper, and calls for as vigorous an overhauling of equipment, from cellar to skylight; while a second drop means a commission of inquiry and a drumhead court-martial. This is the secret of the advances of modern surgery,—not that our surgeons are any more skillful with the knife, but that they can enter cavities like those of the skull, the spinal cord, the abdomen, and the chest, remove what is necessary, and get out again with almost perfect safety; whereas these cavities were absolutely forbidden ground to their forefathers, on account of the twenty, forty, yes, seventy per cent death risk from suppuration and blood-poison.

The triumphs of antisepsis and asepsis, or keeping the "bugs" out of the cuts, have been illustrated scores of times already by abler pens, and are a household word, but certain of its practical appliances in the wounds and scratches and trifling injuries of every-day life are not yet so thoroughly familiar as they should be. When once we know who our wound-enemies are, whence they came, and how they are carried, the fate of the battle is practically in our own hands.

Like most disease-germs our wound-infection foes are literally "they of our own household." They don't pounce down upon us from the trees, or lie in wait for us in the thickets, or creep in the grass, or grow in the soil, or swarm in our food. They live and can live only within the shelter of our own bodies, where it is warm and moist and comfortable. This is one great (in the expressive vernacular) "cinch" that we have on the vast majority of disease-germs, whether medical or surgical, that they do not flourish and breed outside of the body, or of houses closed and warm; and this grip can be improved, with skill and determination, into a veritable strangle-hold on most of them. In the language of biology, most of them have become "adapted to their environment" so closely that they can scarcely flourish and breed anywhere outside of the warm, moist, fertile soil of a living body, and many of them cannot even live long at temperatures more than ten degrees above or fifteen degrees below that of the body. At all events, so poorly are these pus-germs able to preserve their vigor and power of attack, not merely outside of the human body, but outside of some wound or sore spot, that it is practically certain that eight-tenths of all cases of wound-infection or blood-poisoning come directly from some previous festering wound, sore, ulcer, scab, boil, or pimple, in or on some other human being or animal. Practically whenever we get pus in a wound in a hospital, we insist upon finding the precise previous case of pus from which that originated, and seldom is our search unsuccessful. If we kept not only our wounds surgically clean, but our gums, noses, throats, skins, and fingernails, and burned and sterilized everything that came in contact with a sore, pustule, or scab, we should wipe out nine-tenths of our cases of wound-infection and suppuration; in fact, practically all of them, except such small percentage as may come from contact with infections in animals. This is the reason why, up to half a century ago, by a strange paradox hospitals were among the most dangerous places to perform operations in, on account of the abundance of wounds or sores always present for the pus-germs to breed in, and the fact that out of fifty or more wound-cases, there was practically certain to be one or two infected ones to poison the whole lot.

Surgeons, ignorant of antisepsis, and careless nurses, spread the infection along, until in some instances it reached a virulence which burst into the dreaded "hospital gangrene." This dread disease was the scourge of all hospitals, especially military ones, all over the civilized world, as recently as our War of Secession. In some wards of our military hospitals, from thirty to fifty per cent of all the wounded received were attacked, and over five thousand cases were formally reported during the war, of which nearly fifty per cent died. This plague was born solely of those two great mothers of evils, ignorance and dirt, and is to-day, in civilized lands, as extinct as the dodo. Then the dread that the community had of hospitals, as places that "help the poor to die," in Browning's phrase, had a certain amount of foundation; and cases operated upon in a farmhouse kitchen, where no one in the family happened to have had a boil or a catarrh or a festering cut within a month or so, and where the knife happened to be clean or new, would recover with less suppuration than hospital cases. Nowadays, from incessant and eternal vigilance, a hospital is surgically the cleanest and safest place in the world for an operation, so that most surgeons decline to operate outside of one, except in emergencies; and some will not even operate except in one with which they are personally connected, so that they know every step in the process of protection.

It was this terrible risk of the surgeon carrying infection from one case to another, that made the coroner of London declare, barely sixty years ago, that he would hold an inquest upon the next case of death after ovariotomy that was reported to him, on account of the fearful pus-mortality that followed this serious operation, which now has a possible death-rate from all causes connected with the operation of only a fraction of one per cent.

The brusque reply is still remembered of Lawson Tait, the great English ovariotomist, to a distinguished German colleague, who had inquired the secret of his then marvelously low death-rate: after a glance at the bands of mourning on the ends of the other's fingers, he said, "I keep my fingernails clean, sir!" There was sadly too much truth in the saying of another eminent surgeon, that in the pre-Listerian days many a poor woman's death warrant was written under the fingernails of her surgeon. This reproach has been wiped out, thank Heaven! but the labor, pains, and persistence after heart-breaking failures which it took to do it! Never was there a more vivid illustration of the declaration that genius is the capacity for taking pains, than antiseptic surgery! Not a loophole must be left unstopped, not a possibility unconsidered, not a thing in, or about, or connected with, the operating-room left unsterilized, except the patient and the surgeon; and these are brought as near to it as is possible without danger to life.

In the first place, the operating-room itself must be like a bath room, or, more accurately, the inside of a cistern. Walls, floor, and ceiling are all waterproof and capable of being washed down with a hose. There must be no casings or cornices of any sort to catch dust; and in the best appointed hospitals no one is permitted to enter, under any pretext, whose hands and garments have not been sterilized.

In the second place, everything that is brought into the room for use in, or during, the operation, is first thoroughly sterilized. The knives, instruments, and other operative objects are sterilized by boiling, or by the use of superheated steam; and the towels, dressings, bandages, sheets, etc., by boiling, baking, or superheated steam. Then begins the preparation of the surgeon and the nurse. Dressing-rooms are provided, in which the outer garments are removed, and the hands given an ordinary wash. Then the scrubbing-room is entered, where, at a series of basins provided with running hot and cold water, whose faucets are turned by pressure with the foot so as to avoid any necessity for touching them with the hand, the hands are thoroughly scrubbed with hot water, boiled soap, and a boiled nail-brush. Then they are plunged into, and thoroughly soaked in, some strong antiseptic solution, then washed again; then plunged into another antiseptic solution, containing some fat solvent like ether or alcohol, to wash off any dirt that may have been protected by the natural oil of the skin. Then they are thoroughly scrubbed with soap and hot water again, to remove all traces of the antiseptics, most of which are irritating to wounded tissues; then washed in absolute alcohol, then in boiled or distilled water. Then the nurse, whose hands are already sterilized, takes out of the original package in which it came from the sterilizing oven, a linen surgical gown or suit which covers the operator from neck to toes. A sterilized linen or cotton cap is placed upon his head and pulled down so that the scales or germs of any sort may not fall into the wound. Some surgeons of stout and comfortable habit, who are apt to perspire in the high temperature of an operating-room, will tie a band of gauze around their foreheads, to prevent any unexpected drops of perspiration from falling into the wound; while some purists muffle up the mouth and lower part of the face lightly in a similar comforter.

You would think that by this time the hands were clean enough to go anywhere with safety, but no risks are going to be taken. A pair of rubber or cotton gloves, the former taken right out of a strong antiseptic solution, the latter out of the sterilizing oven, are pulled carefully on by the nurse. Holding his sacred hands spread out rigidly before him, like the front paws of a kangaroo, the surgeon carefully edges his way into the operating-room, waiting for any doors that he may have to pass through to be opened by the nurse, or awkwardly pushing them with his elbow. In that attitude of benediction, the hands are maintained until the operation is ready to begin.