THE ROMANCE OF SURGERY.

Star (Christchurch), Issue 5739, 5 December 1896, Page 3

THE ROMANCE OF SURGERY.

Micro-organisms and bacteriology in general were among the most interesting topics dealt with by Sir Joseph Lister in his presidential address to the sixty-sixth meeting of the British Association, which opened at Liverpool on Sept. 16 in the presence of nearly 3000 persons. Sir J. Lister referred in the course of his address to Professor Eoentgen's recent tliscovery, and expressed the opinion that there was no reason to suppose that the limits of the capabilities of the rays had yet been reached. This was the jubilee of anaesthesia in surgery ; a priceless blessing to mankind which came from America. Tho discovery of anesthesia inaugurated anew era in surgery. Not only was the pain of operations abolished, but the serious and sometimes mortal shock which they occasioned to the system was averted, while the patient was saved the terrible ordeal of preparing to endure them. After reviewing at length the discoveries in fermentation which led to the great general idea, "la cjenaralion spontanve cst unc chimerc," and to the specific science of bacteriology, the president continued: — Pasteur's labours on fermentation have had a very important influence upon surgei y. 1 have been often asked to speak on my share in this matter before a public axidience, but I have hitherto refused to do so, partly because the details are so entirely technical, but chiefly because I have felt an invincible repugnance to what might ' seem to savour of self-advertisement. The latter objection now no longer exists, since advancing years have indicated that it is right for me to leave to younger men the practice of my dearly loyed . prof ession. And it will perhaps be expected that if I can make myself intelligible, I should say something upon the subject on tho present '■ occasion. Nothing was formerly more striking in surgical experience than the difference in the behaviour of injuries aoeording to whether the skin was implicated or not. Thus, if the bones of the leg were broken and the skin remained intact, the surgeon applied the necessary apparatus without any other anxiety than that of maintaining a good position^ of the fragments, although tho internal injury to bones and soft parts might be very severe. If, on the other hand, a wound of the skin was present, communicating withthebvoken bones, although the damage might be in other respects comparatively slight, the compound fracture as it was termed, was one of the most dangerous accidents that could happen. Mr Syme, who was, I believe, the safest surgeon of his time, once told me that he v/as inclined to think that it would be, on the whole, better if all compound fractures of the leg were subjected to amputation, without any attempt to save the limb. What was the cause of this astonishing difference ? It was clearly in some way due to the exposure of the injured parts to the external world. One obvious effect of such exposure was indicated by the odour of the discharge, which showed that the blood in the wound had undergone putrefactive change by which the bland nutrient liquid had been converted into highly irritating and poisonous substances. I have seen a man with a compound fracture of the leg die within two days of the accident, as plainly poisoned by the products of putrefaction as if he had taken a dose of some potent toxic drug. These and macy other considerations had long impressed me with tho greatness of the evil of putrefaction in surgery. I had done my best to mitigatb it by scrupulous ordinary cleanliness and the use of deodorant lotions. Eut to prevent it altogether appeared hopeless while we believed with Liebig that its primary cause was the atmospheric oxygen which, in accordance with the researches of Graham, could not fail to be perpetually diffused through the porous dressings which were used to absorb the blood discharged from the wound. But when Pasteur had shown that putrefaction was a fermentation caused by the growth of microbes, and that these could not arise de novo in the decomposable substance, the problem assumed a more hopeful aspect. If the wound could be treated with some substance which, without doing too serious mischief to tho human tissues, would kill the microbes already contained in it, and prevent the future access of others in the living state, putrefaction might be prevented, however freely tho air with its oxygen might enter. I had heard of carbolic acid as having a remarkable deodorising effect upon sewage, and having obtained from my colleague, Dr Anderson, Professor of Chemistry in tho University of Glasgow, a sample which ho had of this product, then little more than a chemical curiosity in Scotland, 1 determined to try it in compound fractures. Applying it undiluted to the wound, with an arrangement ■for its occasional renewal, I had the joy of

seeing these formidable injuries follow the samo safe and tranquil course as simple fractures, in which the skin remains unbroken. The appliances which I first used for carrying out the antiseptic principle were both rude and needlessly complicated; The years that have since passed have witnessed great improvements in both respects. Of the various materials which heave been employed by myself and others, and their modes of application, I need say nothing, except to express my belief, as a matter of long experience, that carbolic acid, by virtue of its powerful affinity for the epidermis and oily matters associated with it, and also its great penetrating power, is still the best agent at our disposal for purifying the skin around tho wound. But I rnusfc say a Jew wprds regarding a most important simplification of our procedures. - Pastexu*, as wo have seen, had shown that the air of every inhabited room teems wiih microbes ; and for a Jong time I employed various more or less elaborate precautions against the living atmospheric dust, not doubting that, as all wounds except the few which healed completely by the first intention underwent putrefactive fermentation, tho blood must be a peculiarly favourable soil for the growth of putrefactive microbes. But I afterwards learnt that such was by no means the case. I had performed many experiments in confirmation of Pasteur's germ theory, not indeed in order to satisfy niyself of its trnth, but in the hope of convincing others. There is one golden rule for all experiments upon our fellow men. Let the tiling tried be that which, according to our best judgment, is the most likely to .promote the welfare of the patient. In other words, do as you would be done by. Nine years later, however, at the Berlin Congress in 1890, 1 was able to bring forward what was, I believe, absolute demonstration of the harmlessness of the atmospheric dust in surgical operations. This conclusion has been justified by subsequent experience ; the irritation of the wound by antiseptic irrigation and washing may . therefore now bo avoided, and Nature left quite undisturbed to carry out her best methods of repair, while the surgeon may conduct his operations as simply as in former days, provided always that, deeply impressed with the tremendous importance of his object, and inspiring the same conviction in all his assistants, he vigilantly maintains from first to last, with a cave that, once learnt, becomes instinctive, but for the want of which nothing else can compensate, the use of the simple means which will suffice to exclude from the wound the coarser forms of septic impurity. THE NEW SCIENCE OF BACTERIOLOGY. Turning to another point, he observed that a host of earnest workers in different countries had cultivated, the new science of bacteriology, and while opening up a wide fresh domain of biology, had demonstrated in so many cases the casual relation between special micro-organisms and special diseases, not only in wounds but in the system generally, as to afford ample confirmation of the induction which had been made by Pasteur that all infective disorders wero of microbic origin. Not that we could look forward with anything like confidence to being able ever to see the materies niorbi of evevy disease of this nature. One of the latest of such discoveries had been that by Pi'eiffer, of Berlin, of the bacillus of influenza, perhaps the most minute of all micro-organisms ever yet detected. The bacillus of anthrax, the cause of a plague common among cattle in some parts of Europe, and often communicated to sorters of foreign wool in this ..country, was a giant as compared with this tiny being ; and supposing the microbe of any infectious fever to be as much smaller than the influenza bacillus as this was less than that of anthrax, a by no means unlikely hypothesis, it was probable that it would never be visible to man. That such parasites, however, were really the causes of all this great class of diseases could no longer be doubted. The first rational step towards the prevention^ or cure of disease was to know its cause ; and it was impossible to over-estiinato the practical value of . researches such as those to which he was referring. THE VALUE OF VACCINATION. Speaking of the value of vaccination as a protection against small-pox, Sir Joseph observed that, while they could not be astonished that the centenary of Jenner's immortal discovery should have failed to receive general recognition in this country, it was melancholy to think that this year should, in his native country, have been distinguished by a terrible illustration of the results which would sooner or later inevitably follow the geiieral neglect of his prescriptions. He had no desire to speak severely of the Gloucester Guardians. They were not sanitary authorities, and had not the technical knowledge necessary to ' enable them to judge between the teachings of true science and the declamations of misguided through well-meaning' enthusiasts. They did what they believed to be right, and when roused to a sense of the greatness of their mistake did their very best to repair it, so that their city was said to be now the best vaccinated in Her Majesty's dominions. But though , by their praiseworthy exertions, they succeeded in promptly checking the raging epidemic, they could not recall the dead to life, or restore beauty to marred, j features, or sight to blinded eyes. Would that the entire country and our Legislature might take duly to heart this objectlesson. A WEIRD SPECTACLE. Lastly, he had to bring before them a subject which, though not bacteriological, had intimate relations with bacteria. If a drop of blood were drawn from the finger by a prick with a needle and examined microscopically between ."'. two plates of glass, there was seen in it minute solid elements of two kinds— the onepale orange bi-eoncavo discs, which, seen in mass, gave the red colour to the vital fluid ; the other more or less granular spherical masses of the soft material called protoplasm, destitute of colour, and therefore called the colourless or white corpuscles. It had been long known that if the miscroscope was placed at such a distance from a fire as to have the temperature of the human body, the white ' corpuscles might be seen to put out and retract little processes or pseudopodia, and by their means crawl over the surface of the glas3, just like the extremely low forms of animal life termed, from this faculty of changing their form, amceba;. It was somewhat a weird spectacle, that of seeing what had just before been constituents of our own blood moving about like independent creatures. Yet there was nothing in this inconsistent with what we knew of the fixed components of the animal frame. These white corpuscles, however, had been invested.with extraordinary new interest by the researches of the Russian naturalist and pathologist, Metchnikoff. H© observed that, after passing through the walls of the vessels, they not only crawled about like amoeba), but, like them, received nutritiqus materials into their soft bodies and digested them. It was thus that the effete materials of a tadpole's tail were got rid of, so that they played a most important part in the function of absorption. But still more interesting observations followed. He found that a microscopic crustacean, a kind of waterflea, was liable to be infested by a fungus which had exceedingly sharp-pointed spores. These were apt to penetrate the coats of the creature's intestine, and project into its body-cavity. No sooner did this occur with any spore than it became surrounded by a group of the cells which were contained in the cavity of the body, and corresponded to the white corpuscles of our blood. These proceeded to attempt to devour the spore; and, if they succeeded in every such case, the animal was saved from the invasion of the parasite. But, if the spores were more than could be disposed of by the devouring cells, the water- flea succumbed. Starting from this fundamental observation, he ascertained that the microbes of infective diseases were subject to this samo process of devouring and digestion, carried on both by the white corpuscles and by cells that lined the blood-vessels. And by a long series of most beautiful researches, he had 'firmly established the great truth that this was the main defensive means possessed by the living body against the invasion of its microscopic foes.