Preventable Diseases

by Woods Hutchinson

Then comes the patient! If his condition will in any wise permit, he has been given a boiling hot bath and scrub the night before, and put to bed in a sterilized nightgown between sterilized sheets. The region which is to be operated upon has, at the same time, been scrubbed and rubbed and flushed with hot water, germicides, alcohol, soap,—in fact, has gone through the same sacred ceremonial of cleansing through which the surgeons' hands have passed; and a large, closely fitting antiseptic dressing, covering the whole field, has been applied and tightly bound. He is brought into a waiting-room and put under ether by an anæsthetist, through a sterilized mask; he is then wheeled into the operating-room, the dressing is removed, a thorough double scrub is again given, for "good measure," to the whole area in which the wound is to be made. A big sheet is thrown over the lower part of his body, another over the upper part, a third, with an oval opening in the centre of it, thrown over the region to be operated upon. The instrument nurse takes a boiled knife out of a sterilized dish of distilled water, hands it to the surgeon, who takes it in his gloved hand, and the operation begins.

Now, if you can think of any possible chink through which a wandering streptococcus can, by any possibility, sneak into that wound, please suggest it, and it shall be closed immediately!

The intruders against whom all these preparations are made are two in number: Streptococcus pyogenes and Staphylococcus pyogenes—cousins, as you see, by their names. Their last (not family) name really means something, and is not half so alarming as it sounds, as it is Greek for "pus-making." Their real family name, Coccus, which means a berry, was suggested, by their rounded shape under the microscope, to some poetically minded microscopist. Undesirable citizens, both of them! But the older, or Strepto, cousin is by far the more dangerous character and desperate individual, giving rise to and being concerned in nearly all the civilized and dangerous wound-fevers—septicæmia, erysipelas, etc. Staphylococcus is a milder and less harmful individual, seldom going farther than to produce the milder forms of festering, discharging, refusing to heal, pustules, etc. He is not to be given a yard of leeway, however, for if he can get a sufficient number of dirty wounds to run through, he can work himself up to a high degree of virulence and poisoning power. Indeed, this faculty of his may possibly furnish a clew as to how these pus-makers developed their power of living in wounds, and almost nowhere else. There is another cousin also, in the group, called Staphylococcus pyogenes albus, to distinguish him (albus, "white") from the other two, who have the tag name aureus (golden). He is an almost harmless denizen of the surfaces of our bodies, particularly the mouths of the sweat-ducts, and the openings of the hair follicles. Under peculiarly favorable circumstances, such as a very big wound, an aggravated chafe, or the application of that champion "bug-breeder," a poultice, he may summon up courage enough to attack some half-dead skin-cells and make a few drops of pus on his own account. He is the criminal concerned in the so-called stitch-abscesses, or tiny points of pus which form around the stitches of a big wound and in some of the smaller pimples which turn to "matter." It is conceivable that this feeble and harmless white coccus may at some time have been accelerated under favorable circumstances to where he was endowed with "yellow" powers, and even, upon another turn of the screw, with strepto-virulence. But this is a mere academic question. Practically the only thing needful is to keep all the rascals out of every wound.

Now comes the question, how is this to be done? Fortunately it is not necessary to hunt out and destroy the pus-germs in their breeding-places outside of the human body. As we have seen, they do not long retain their vitality out of doors, or as a rule even in the dust of rooms and dirt of houses, unless the latter have been recently contaminated with the dressings of, or discharges from, wounds. There are two main things to be watched: first, the wound itself, and second, any unwashed or unsterilized part of your own or some other living body. Dirt of all sorts is a mighty good thing to keep absolutely out of the wound, but practically a whole handful of ordinary soil or dust rubbed into a wound might not, unless it happened to contain fertilizer of some sort, be half so dangerous as a single touch with a finger which had been dressing a wound, picking a scab out of the nose, rubbing an ulcerated gum, or scratching an itching scalp. If it be a cut on the finger, or scratch on the hand, for instance, don't suck it, or lick it, unless you can give an absolutely clean bill of health to your gums and teeth. If not thoroughly brushed three or four times a day, they are sure to be swarming with germs of twenty or thirty different species, which not infrequently include one or both of the pus-germs. Indeed, the real reason why the bite of certain animals, and above all of a man, particularly of a "blue-gum nigger," is regarded as so dangerous is on account of the swarms of germs that breed in any remnants of food left between the teeth or in the pockets of ulcerating gums. Many a human bite is almost as dangerous as a rattlesnake's. The devoted hero who sucks the poison of the dagger out of the wound may be conferring a doubtful benefit, if he happens to be suffering from Rigg's disease.

Don't try to stop the bleeding unless it comes in spurts or the flow is serious. The loss of a few teaspoonfuls, tablespoonfuls, or, for the matter of that, cupfuls, of blood won't do you any harm, and its free flow will wash out the cut from the bottom, and carry out most of the germs that may happen to be present on the knife or nail. If water and dressings are not accessible, let the blood cake and dry over the wound without disturbing it, even though it does look rather gory.

A slight cut with a clean knife, or other instrument, into which no dirt has been rubbed, will often require no other dressing than its own blood-scab. If, however, as oftener happens, you cannot be sure of the cleanness of the knife, tool, or nail, hold the wound under running water from a pump or tap (this is not germ-free, but practically never contains pus-germs), until the wound has been thoroughly washed out, wiping any gravel or dirt out of the cut with soft rags which have been recently washed, or baked in the oven; then dry with a small piece of linen, or white goods, put on a dressing of absorbent cotton such as can be purchased for a few cents an ounce at any drug store. Absorbent or surgical cotton makes a good dressing, because it both sucks up any fluids which might leak out of the wound, and forms a mesh-filter through which no germs can penetrate.

It is not advisable to use sticking-plaster for any but the most trivial wounds, and seldom even for these, for several reasons. First, because its application usually involves licking it to make it stick; second, because it must cover a sufficient amount of skin on either side of the wound to give it firm grip, and this area of skin contains a considerable number of both sweat-ducts and hair-follicles, which will keep on discharging under the plaster, producing a moist and unhealthy condition of the lips of the wound. Moreover, these sweat-ducts and hair-follicles will, as we have seen, frequently contain white staphylococci, which are at times capable of setting up a low grade of inflammation in the wound. A wound always heals better if its surfaces and coverings can be kept dry. This is why cotton makes such an ideal dressing, since it permits the free evaporation of moisture, a moderate access of air, and yet keeps out all germs.

If the cut or scratch is of any depth or seriousness whatever, or the knife, tool, or other instrument be dirty, or if any considerable amount of street-dust or garden-soil has got into the wound, then it is, by all means, advisable to go to a physician, have the wound thoroughly cleaned on antiseptic principles, and put up in antiseptic dressing. A single treatment of this sort, in a comparatively trifling wound which has become in any way contaminated, may save weeks of suffering and disability, and often danger of life, and will in eight cases out of ten shorten the time of healing from forty to sixty per cent. The rapidity with which a wound in a reasonably healthy individual, cleaned and dressed on modern surgical principles, will heal, is almost incredible, until it has actually been seen.

The principal danger of garden-soil or street-dust in a wound is not so much from pus-germs, though these may be present, as from another "bug"—the tetanus or lockjaw bacillus. This deadly organism lives in the alimentary canal of the horse, and hence is to be found in any dirt or soil which contains horse manure. It is, fortunately, not very common, or widely spread, but enough so to make it the part of prudence to have thoroughly asepticized and dressed any wound into which considerable amounts of garden-soil, or street-dust, have been rubbed. The reason why wounds of the feet and hands have had such a bad reputation, both for festering and giving rise to lockjaw, is that it is precisely in these situations that they are most likely to get garden-soil, or stable manure, into them. The classic rusty nail does not deserve the bad reputation as a wound-maker which it enjoys, its bad odor being chiefly due to the fact already referred to, that injuries inflicted by it are most apt to be in the palm of the hand, or in the sole of the foot, and hence peculiarly liable to contamination by the tetanus and other soil bacilli.

For some reason or other which we don't as yet thoroughly understand, burns from a toy pistol in particular, and Fourth of July fireworks in general, seem to be peculiarly liable to be followed by tetanus. The fulminate used in the cap of a toy pistol, and the paper and explosives of several of the brands of firecrackers, have been thoroughly examined bacteriologically, but without finding any tetanus germs in them. So many cases of lockjaw used to follow the Fourth of July celebrations a few years ago, that Boards of Health became alarmed, and not only forbade outright the sale of deadly toy pistols, but provided supplies of the tetanus antitoxin at various depots throughout the cities, so that all patriotic wounds of this description could have it dropped into them when they were dressed. Since then, the lockjaw penalty which we pay for our highly intelligent method of celebrating the Fourth, has diminished considerably. It is probable that the mortality was chiefly due to infection of the ugly, slow-healing, dirty little wounds with city-dust, a large percentage of which, of course, is dried horse manure. What with the tetanus bacillus and the swarms of flies which breed chiefly in stable manure, and carry summer diseases, typhoid, diphtheria, and tuberculosis in every direction, it will not be long before the keeping of horses within city limits will be as strictly forbidden as pigpens now are.