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counter, her forehead reddened with regrettable circumstance, but she acshame, her hands twisted together in cused me of cruelties - Cruelties? ... self-loathing.
I called her a 'worm.?” The old shop“Get me some hot tea, my dear," keeper's eyes twinkled. “On the whole, gasped Miss Frenzy. She still shook and I am glad I did so.” her voice was as the voice of a dying Later, when the roses came again and person. The fine raiment of courtesy the two sat with their sewing in the little and punctilious speech that she had all garden, Miss Frenzy cheerfully reher life worn had been torn from her by marked upon the entire absence of roseher own fierce old hands; in her own
“Without conceit," she regentle eyes she was hopelessly degraded marked—"without conceit, I should be Yet she smiled triumphantly at the anx inclined to say that the Lord has inious young face of the girl as she prof- dorsed my activities.” She looked affered the steaming tea. “Young,” mut fectionately at the slender figure sewing tered Miss Frenzy, her eyes following the near the honeysuckle and called attenmovements of the other. “Young. tion to the young cherry-tree shooting At last she roused herself and went in
green assurance. slowly toward the door of the little "My mystery!" announced Miss private room, the girl hurrying to assist Frenzy. “Not planted by human hands. her. She paused, took the dark young The seed doubtless dropped by a bird in head between her wrinkled hands and fight. Whether the fruit will be sweet kissed it. "I called her a 'worm,' my or bitter is to me a matter of pleasing dear,” said Miss Frenzy. "It was a conjecture.”
The Revival of Antisepsis
BY ROBERT G. SKERRETT
@NY one whose wound years ago, for the leaders of their general
suppurates has the staff, so to speak, to make this positive right to demand of his pronouncement: "The treatment of supsurgeon the reason purating wounds by means of antiseptics why.” Such is the text is illusory, and belief in its efficacy is upon placards posted founded upon false reasoning.'
conspicuously in every Half a century ago Joseph Jackson ward of the Hospital of the Maison Lister, later Lord Lister, began the Blanche, over which Doctor Tuffier pre- preaching of the doctrine of antisepsis. sides in Par
At that time conditions in the average To the uninformed, this message may civil hospital were little short of awful. not seem impressive, but to the medical Because of ignorance of the genesis of profession that pronouncement is of the infection, lockjaw, blood poisoning, eryutmost import. In so many words, it sipelas, and gangrene flourished in the means that infected wounds should no path of the surgeon's benign efforts. longer dismay the physician or entail Compound fractures then, if they did continued and needless suffering upon not entail death, nearly always necesthe patient. Not only that, but this sitated the amputation of the affected victory over disease, won in the first limb, owing mainly to the complication place within the sound of hostile can of septic developments. non, is bound to prove a lasting boon to But Pasteur, in his laboratory, dissuffering humanity at large.
covered the manner in which microThis achievement is primarily the con- organisms were carried broadcast upon sequence of the brilliant work of Dr. particles of dust floating in the atmosAlexis Carrel, who, in the face of profes- phere; and he proved that these germs sional antagonism of a marked character, were responsible for the decomposition had the courage to attack what the great of vital tissues exposed to them. Pasmajority of his confrères declared a lost teur's experiments appeared to Lister in battle; and, by persistence, was able to the light of a veritable revelation. His prove that a septic wound can be steril- logical mind questioned, Why, since the ized by antiseptic treatment if proper cause of decomposition is now known, care and skill be exercised. As one of should we not be able to prevent the England's foremost military surgeons, suppuration of wounds and banish, at Sir Anthony A. Bowlby, has said, “The the same time, those hospital diseases lesson he has taught was very neces that are due to microbes transported by sary.
the air? Infected wounds are an old story, and, Judged by past conditions, Lister as well-nigh every one now knows, are achieved wonders in his day; with a the consequence of microbial activities.
paste of lime saturated with carbolic Man has waged many struggles with acid he both sterilized wounds and efgerms of one kind or another, and the fectually kept out baneful microbes. tactics employed have varied from time True, his protective agents cauterized to time. The strategists of the medical the injury and actually destroyed sound profession have by no means been in tissues; but the hurt closed in time withagreement always as to the best plan of out infection, and the pain and resultant campaign; but after some decades of scar were deemed by him triling comprofessional wrangling they had com pared with the greater sacrifices which monly arrived at an understanding might otherwise have been exacted. which made it possible, less than three Lister was able to banish suppuration
and to effect cures in cases of compound His problem, as Doctor Carrel saw it. fracture. Gauged by modern standards, was very much akin to that which had that great surgeon worked somewhat confronted Lister half a hundred years crudely, but he nevertheless fashioned a before. It was not a case of preventing foundation stone for the upbuilding of infection by aseptic precautions, but of modern surgical practice.
eradicating virulent micro-organisms alWith a growing understanding of the ready lodged in the torn and exposed true functions of disinfectants, sterilizing body substance. His task was twofold: mediums, and germicides generally, the first, to discover a germicidal liquid of practice of antisepsis in or at the wound sufficient potency and yet non-toxic and was largely supplanted by what came to so mild that it would not irritate the be known as aseptic treatment, or asep healthy parts of the raw surfaces; and, sis. This, in so many words, is a pre second, to apply the antiseptic in a way ventive measure, and amounts to noth that would make sure of its reaching ing more than holding the potential every section of the infected area. The causes of infection farther away from the battling soldiers on the firing-lines were hurt, thus leaving the curative work of using ancient weapons brought up to nature to proceed more advantageously. date, and Doctor Carrel, in his openPlainly, aseptic treatment is logically a mindedness and desire to achieve benefidirect evolution of Lister's antiseptic cent results, saw reason why he method; but it is not what he urged as should not borrow freely from Lister's a remedy for conditions as they then teachings and modernize his method so existed in so many of the hospitals of his
that it would meet in every respect time. That is to say, with a betterment present requirements. This was a stroke in the sanitation and the administration of genius. of surgical wards, asepsis has sufficed Working with him abroad were Dr. when everything was subject to precau H. D. Dakin, of New York city, and tionary control. These distinctions Dr. Maurice Daufresne, of Paris; and should be held in mind in order to appre after trying out more than two hundred ciate what Doctor Carrel has done and antiseptics-trying them out under conhas made possible.
ditions that left no room for doubt-it As a patriotic Frenchman, he hastened was determined that hypochlorite of abroad soon after the beginning of hos soda was the sterilizing liquid that would tilities. Shortly after arriving in France best fulfil the exacting requirements Doctor Carrel was busily engaged in which Doctor Carrel imposed. Strange ambulance service just back of the as it may seem, the antiseptic is fundawestern battle-line. The thing that im- mentally nothing other than the compressed him most was the rarity of the mon chloride of lime known to most of uninfected wound. The germ-laden soil us as a household disinfectant of long of the fields and trenches and the bac- standing; but before the solution was teria wafted by the dust of the highways acknowledged fit for the service expected were fundamentally responsible. These of it, Doctor Dakin had to free it of a lurking microbes were borne into the certain irritating alkali and to devise, bodies of the soldiers on bits of clothing with the aid of Doctor Daufresne, a and fragments of missiles, and, accord- technique for its preparation that would ing to the violence of the impact and the insure purity and an extremely nice denature of the injuring agent, the
germs gree of strength in application. were buried more or less deeply in the A peculiarly valuable characteristic of torn tissues. In this fashion a bacte- the hypochlorite solution, apart from its rial colony was established. Once so marked antiseptic powers when much implanted, the micro-organisms soon diluted, is its remarkable property of started to multiply by a process of self- quickly separating and dissolving dead divisioning at maturity. In the course tissues present in an injury, and faciliof only half a day, starting with a single tating their removal by drainage without microbe, the splitting-up action led in harming, even after continuous applicathe end to a septic array of more than tion covering many days, perhaps, the fifteen million bacilli!
tender living body substance exposed to
it. There is something well-nigh magical The climax of the labors abroad of in the way Dakin's solution does its dis- Doctor Carrel and his able co-workers, criminatory work. This has been strik- Drs. G. Dehelly, M. Guillot, and H. ingly emphasized in certain experiments Woimant, is typified in the present promade upon the extremely delicate ab cedure followed at the War Demonstradominal wall of the tadpole. If the tion Hospital, established by the Rockecreature were alive and the normal cir feller Institute for Medical Research, in culation active, the hypochlorite would New York city. This hospital was made not erode the tissues, and latent vitality, ready for service early last fall, and was lasting for some time after the death of intended primarily to teach our own the tadpole, also sufficed to check the military surgeons how to give our fightsolvent action of the antiseptic. It was ing men the benefit of a revolutionary only after the organism had surrendered advance in the treatment of battle its residual bond with life that the solu wounds. As it happened, the executive tion was able to dissolve the abdominal staff found it necessary to draw upon substance.
various domestic sources for patients, One of the things most feared in sup and without exception these were chosen purating wounds is erosion that may lead because of the obstinate character of to secondary hemorrhage. This is a their afflictions and the failure of other peril that is present in the case of any accepted surgical practices to effect seriously infected injury, whatever be
Indeed, the fact that warthe cause. An impressive example of wounded were not available and that how the Carrel-Dakin treatment has civil sufferers, instead, were used for the lessened this hazard was reported re purpose of demonstration, has brought cently by a British surgeon. In one of to light the amazing potentialities of the his cases he had occasion to ligature a Carrel - Dakin treatment in every - day large blood-vessel in an open wound. life. The free end of the artery, from which The hospital is modeled along the the circulation was cut off by the liga- most approved lines for military service, ture, began to show signs of disappearing and represents a unit type of structure under the action of the hypochlorite susceptible of ready expansion agreeably solution, and secondary hemorrhage was to the growing demands of the base. apprehended. However, nothing of the The patients there, as a rule, see the sort happened; just before the point of paths to complete recovery opening beligature was reached, and the zone where fore them, grave though their cases may circulation was maintained was neared, have been considered previously; and the erosion stopped!
week by week members of their colony Hypochlorite of soda has, in itself, no leave restored and sound who a short curative properties, but by killing the time before faced the prospect of conbacilli present in a hurt it leaves Nature inual pain and crippled limbs. Cruel to carry on her work of repair untram burns that would not yield to ordinary meled. When a wound is satisfactorily treatment, raw wounds upon which new sterilized, then, from the surgical view cuticle would not form, gangrenous sores point, the worst is over. The raw sur that threatened the loss of an arm or a leg, faces, with their ruddy, healthy granu and deep-seated and persistent inflamlations, can be brought together in a mation of bones, have all surrendered to variety of ways and closure of the injury surgical cunning aided by the hypoeffected. Doctor Carrel has demon chlorite solution. The germicidal liquid strated that the freest use of the scalpel has achieved what possibly the knife in opening up a wound is desirable, for could not have done as thoroughly and in this way every foreign body, so often well; it has battled with insidious the focus of infection, can be removed microbes and won, and the cleansed
and all parts and byways of the injury body-substance has reacted and lent it· can be made accessible to the sterilizing self vigorously to the work of repair. Auid. Hurts so treated heal without Hung above each cot is a glass resercomplications, or, as they say in medical voir containing hypochlorite of soda, parlance, by first intention.
and the antiseptic liquid is led to the
wound or wounds by rubber tubing. At can it be definitely determined when it predetermined intervals, ranging from
is safe to halt the sterilizing process and an hour to two hours, according to the to suture or otherwise close a wound nature and extent of infection, the anti- without fear of reinfection.
By this septic liquid flushes afresh the cavity of typically modern method it is possible the injury. The tubing at its lower end to avoid distressing, if not fatal, misis provided with perforated branches, if takes. This is an innovation which is the hurt have many recesses, and in this bound to benefit any one upon whom a way the germicide reaches and spreads surgical operation has been performed over all of the exposed surfaces. The and who may have become unsuspectperiodic renewal of the antiseptic is edly the victim of incipient infection. erfected by releasing a compressor on the The average layman does not know supply-tube, and it is practicable for a that in cases of suppurating wounds, no single attendant to take care of a large matter what their original cause, micronumber of patients.
organisms may be imprisoned within the Because of the variableness of the scar-tissues and be held there without chlorine content of the raw materials of indicating their presence by septic accommerce used by Dakin and Daufresne tivity. However, in suturing a wound of in France, and other objectionable char this sort, the closing stitches may be acteristics, the preparation of the hypo- the means of frezing the microbes and chlorite solution took much time. To- thus bringing about reinfection. On the day the antiseptic is far easier to make other hand, the germs may be encaphere because of native technical facili- suled in the scar-tissues and kept impoties. Liquid chlorine is passed into a tent for
so, they constitute solution of carbonate of soda, and labor a potential peril, for they may be libatory apparatus make it possible to erated by a subsequent injury at that control to an exact degree the propor- point or by the promotion of a physical tion of this ingredient.
condition favoring their multiplication. While Dakin's solution, so-called,
solution, so-called. It is to prevent this dreaded secondary does not irritate the raw surfaces, which infection that Doctor Carrel insists upon it sterilizes, still it affects the sound the thorough excision and surgical cleancuticle surrounding a wound, and the liness of septic wounds. skin must, therefore, be protected. Vase At the foot of the cot of each patient line answers admirably for this purpose at the War Demonstration Hospital and is extensively employed, but a paste there are two charts. One is the record made of thiosulphate of soda has also of the number of microbes found in the given very satisfactory results. Thio wound from day to day by the microsulphate of soda is commonly used as a scope; the other is a comparative graph “fixative” in photography, and has the which indicates by two curves whether power to neutralize the irritant action
or not the healing process is favorable. of the antiseptic's chlorine content. It The standard or control curve, based is this chemical, so helpful in the treat fundamentally upon discoveries made ment of infected wounds, that likewise by Doctor Carrel about ten years ago, plays an important part in the finished is the result of an algebraic formula degas-mask. The respirator is saturated veloped by Captain de Noüy, a young with this stuff, and this suffices to rob the French physicist, at Compiègne. This enemy's asphyxiating attack of its bane curve shows how any uninfected wound, ful potency.
of ascertained measurement, would heal The mere clinical appearance of a from day to day. If the periodic measwound is, unfortunately, a very uncer urement of the injury betrays a contain index of its readiness for closure. spicuous lag in the rate of repair, then The
eye of the surgeon alone will not the attending physician knows that there suffice to detect lurking microbial flora. is something wrong, and it is incumbent Doctor Carrel has shown that only by upon him to discover the cause. This means of the microscope and bacterial may be due to a tiny bit of infected bone,
smears," made from specimens taken hidden deep in the hurt; it may be the from numerous parts of the open injury, result of microbes multiplying in recesses
Vol. CXXXVI.-No. 816.—109