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Dr. G- C, Wellner, 
 4418 Pillsbury Ave., 
 Minneapolis. Minn. 
 
THE LIBRARY 
 
 OF 
 
 THE UNIVERSITY 
 
 OF CALIFORNIA 
 
 PRESENTED BY 
 
 PROF. CHARLES A. KOFOID AND 
 
 MRS. PRUDENCE W. KOFOID 
 
Digitized by the Internet Archive 
 
 in 2007 with funding from 
 
 IVIicrosoft Corporation 
 
 http://www.archive.org/details/antisepsisantiseOObuchrich 
 
SOME OF THE WORLD's GREATEST SURGEONS AND BACTERIOLOGISTS. 
 
Antisepsis and Antiseptics. 
 
 — BY — 
 Charles Milton JBiicliauau, M.II*, 
 
 PROFESSOR OF CHEMISTRY, TOXICOLOGY AND METALLURGY^ 
 NATIONAL UNIVERSITY, WASHINGTON, D. C. 
 
 WITH AN 
 
 i:tTTi^or)TJOTioi5r 
 
 — BY — 
 
 Professor Augustus ۥ Beruays. 
 
 THE TERHUNE COMPANY: 
 
 Publishers ®f Medical Books, Newark, N. J^ 
 
 1805. 
 
 k 
 
 t^^ 
 
COPYRIGHTED 1895. 
 
1^ I o vo^^/y 
 
 'PROE /UGUSTUS Cf/ARLES BeRMAYS. 
 
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CONTENTS. 
 
 CHAPTER I. 
 
 History — From Earliest Times to the Beginning of the 
 
 Christian Era, - - - ^ - - 3 
 
 CHAPTER n. 
 
 History — From the Christian Era to the Beginning of the 
 
 Eighteenth Century, - - - - - 12 
 
 CHAPTER ni. 
 
 History — From the Beginning of the Eighteenth to the First 
 
 Six Decades of the Present Century, - - - 23 
 
 CHAPTER IV. 
 History — From the Advent of Lister to the Present Time, 36 
 
 CHAPTER V. 
 The Products of Vital Cellular and Bacterial Activity, - 46 
 
 CHAPTER VI. 
 Infection, Susceptibility and Immunity, - - "59 
 
 CHAPTER VII. 
 Antiseptics and Their Relative Value, - - - 81 
 
 CHAPTER VII r. 
 Antiseptics — Their Use and Value in General Medicine, - 220 
 
 CHAPTER IX. 
 Antiseptics — Their Value and Use in Surgery, - - 234 
 
 CHAPTER X. 
 
 Antiseptics — Their Value and Use in Obstetrics and Gyne- 
 cology, - - - - - - - 257 
 
 CHAPTER XT. 
 The Essentials of Antisepsis and Asepsis, - - - 273 
 
INDEX. 
 
 Acetanilid, 94. 
 Acetic acid, 49, 95, 96. 
 Acetic fermentation, 33. 
 Acetone, 96. 
 
 Acetyl-para-amido-saiol, 187. 
 Acquired immunity, 64, 73, 74, 75 
 
 76, 77. 78, 79, 80, 81. 
 Acrolein, 213. 
 
 Action of antiseptics, 92, 93, 94. 
 Action of blood and tissues upon 
 
 parasitic organisms, 222. 
 Adeps lanac hydrosus, 161. 
 Advantages of antiseptics, 38, 39. 
 Alabastrine, 164. 
 Alcohol, 97. 
 
 Alkaloidal bases of dead body, 55. 
 Alkaloidal bases of decomposed 
 
 brains, 56. 
 Alkaloidal bases of decpmposed 
 
 blood, 54. 
 Alkaloidal bases of decomposed 
 
 meat, 55. 
 Alkaloidal bases of liver-sausage, 
 
 55- 
 
 Alkaloidal bases of moldy corn- 
 meal, 56. 
 
 Alkaloidal bases of poisonous 
 cheese, 56. 
 
 Alkaloidal bases of putrid yeast, 
 
 54. 
 
 Alumn, 97. 
 
 Alumnol, 98. 
 
 Aluminic acetate, 97. 
 
 Aluminic chlorid, 97. 
 
 Ammido - para - acet - phenetidin , 
 169. 
 
 Ammonia, 99. 
 
 Ammonic cai bonate, 99. 
 
 Ammonic chloride, 99. 
 
 Ammonic fluo-silicate, 99. 
 
 Ammonic ichthyo - sulphonate, 
 208. 
 
 Ammonic sulphate, 99. 
 
 Anaerobic germs, 48. 
 
 Analgessin, 102, 103. 
 
 Ancient system of medicine, 7. 
 
 Anhydro-ortho-sulphaminic ben- 
 zoic acid, 181. 
 
 Anilin dyes, 100. 
 
 Aniiin oil, loi. 
 
 Animal alkaloids, 31, 45) 50, 51. 
 
 Anisic acid, loi. 
 
 Annidalin, loi. 
 
 Anthrarobin, 102. 
 
 Anthrax, 41, 42. 
 
 Anthrax spores, 130, 131, 133. 
 
VII 
 
 Anthrax poison formed by germs, 
 
 56. 
 
 Anticholerine, 42, 57. 
 
 Antiiebrin, 94. 
 
 Antipyrin, 102, 103. 339, 346. 
 
 Antisepsin, 103. 
 
 Antisepsis, 5, 8, 81. 
 
 Antisepsis among Egyptians, 9, 
 10, II. 
 
 Antisepsis among Greeks, 11. 
 
 Antisepsis among Jews, 1 1 . 
 
 Antiseptics for internal and exter- 
 nal use, 227, 228. 
 
 Antiseptics, mode of action, 92, 93 
 
 94 
 
 Antiseptics, value and use in gen- 
 eral medicine, 220. 
 
 Antiseptics value and use in ob- 
 stetrics and gynecology, 257. 
 
 Antiseptics, value and use in sur- 
 gery, 234. 
 
 Antiseptol, 103. 
 
 Antizymotic, dry, 6. 
 
 Arbulin, 103, 104, 105, 155. 
 
 Argent nitrate 197. 
 
 Argol, 212. 
 
 Aristol, 105, 346. 
 
 Arsenious acid, 105. 
 
 Asaprol, 106. 
 
 Asepsis, 6, 83. 
 
 Asepsis dependent upon antisep- 
 sis, 83. 
 
 Aseptin, 106. 
 
 Aseptol, 106, 107, 208. 
 
 Assyrians, 9. 
 
 Attenuated cultures, inoculation 
 of, 42. 
 
 Auric chlorid, 153. 
 
 Bacillus sub tills, 141. 
 
 Bacillus tetanus, discovery of, 43;- 
 
 Bacterial proteids, 50. 
 
 Bacteriology in diagnosis, 223. 
 
 Baric chlorid, 107. 
 
 Bases of dead body, 55. 
 
 Benzene, 107. 
 
 Benzoate of beta-naphtol, 109^. 
 
 Benzoate of guaiacol, no. 
 
 Benzoate of eugenol, 1 10, 
 
 Benzoic acid, 108. 
 
 Benzoic sulphimide, i8r. 
 
 Benzol, 107. 
 
 Benzo-naphtol, 109. 
 
 Benzo-phenoncide, ii(X- 
 
 Benzosol, no. 
 
 Benzoyl-eugenol, no. 
 
 Benzoyl-guaiacol, no. 
 
 Benzoyl sulphonic-imide i8r.- 
 
 Betanaphtol, 156, 165. 
 
 Betol, III. 
 
 Bichloride of mercury, 132. 
 
 Birth of antiseptic era, 37. 
 
 Bismuth, subnitrat., 346. 
 
 Blood, action upon germs, 63, 66 
 
 67, 68, 69, 70, 71, 72, ^z, 84. 
 Blood serum therapy, 73, 84, 85. 
 Blood serum, germicidal poweF^ 
 
 63- 
 
 Boiling point, effect on putrefac- 
 tion, 7. 
 Boracic acid, 112. 
 Boric acid, 112, 345. 
 Borax, in. 
 
VIII 
 
 Borneol, 212. 
 
 8rains, alkaloidal bases of decom- 
 posing, 56. 
 Brewer, first, 8. 
 Bromin, 129. 
 Bromoform, I n.. 
 Bromol, 115. 
 Bromopheno', 115, 130. 
 Butyric acid, 49, 116. 
 Butyric acid fermentation, 33. 
 
 Calcic beta-naphtol-alpha-monc- 
 
 sulphonate, 106. 
 Calcic chlorid, 116. 
 Calcic hydroxid, 116. 
 Calcic hypochlorite, 1 1 6. 
 Calcium salicylate, 118. 
 Camphene, 212. 
 Camphor, 118. 
 Camphylene, 164. 
 Carbolic acid, 32, ^^, 43, 345. 
 Carbonate of eihyl and phenyl, 
 
 151. 
 Carvacrol, 126. 
 Caustic soda, 199. 
 Cell products, 45, 47, 48, 49. 
 Cell products, effects in causation 
 
 of disease, 45. 
 Cheese, poisonous, 54. 
 Chinese, 9. 
 Chinoline, 126. 
 Chloral, 129. 
 Chlorate of potash, 174. 
 Chloride of lime, 116, 129. 
 Chlorine, 127. 
 .Chlorine in internal medication, 
 
 129. 
 
 Chloroform, 130. 
 
 Chlorphenol, 130. 
 
 Chloro-phenol, [30. 
 
 Cholera, 43. 
 
 Cholera bacillus, 43. 
 
 Cholera, discovery of germs, 43. 
 
 Cholera, poison elaborated by, 
 
 56. 
 
 Cholera stools products, 54. 
 
 Chrysarobin, 131. 
 
 Chromic acid, 131. 
 
 Cinnamyl-eugenol, 150. 
 
 Circumcision, 11. 
 
 Citric acid, 132. 
 
 Civilization of ancient Egyptians, 
 
 10. 
 Classification of micro-organisms, 
 
 25, 43» 49- 
 Cleaning of patient, 258. 
 Cleaning of instruments, 290. 
 Coal tar, 27, 120. 
 Coal tar, preservative properties, 
 
 27, 120. 
 Coal tar saponine, 120 
 Coffee in usion, 132. 
 Cold, preservative effect?, 6. 
 Cold, effects on germs, 86, 87. 
 Columbus, 4. 
 Condition for cell life, 315. 
 Contagium animatura of Pasteur, 
 
 35- 
 Corrosive sublimate, 132, 135,345 
 Creolin, 142. 
 Creosol, 144. 
 Creosot, 144. 
 Creosotal, 144. 
 
IX 
 
 Cresalol, 169. 
 
 Cresin, 145. 
 
 Cresol, 144, 146. 
 
 Cresoliodide, 146. 
 
 Cresylic acid, 147. 
 
 Cupric chlorid, 147. 
 
 Cyanide of zinc and mercury, 346. 
 
 Cymene, 212. 
 
 Dark ages, 13. 
 Decomposing blood, 5<^. 
 Decomposing meat, 5. 
 Decomposition, organic, 6. 
 Decreased mortality of antiseptics, 
 
 38, 39- 
 
 Dehydro-di-methyl-phenyl-pyra- 
 zine, 102. 
 
 Dependence of asepsis upon anti- 
 sepsis, 83. 
 
 Dermatol, 147. 
 
 Disinfection oil, 188. 
 
 Desozy-alizarin, 102. 
 
 Dessication, effect on germs, 90, 
 91. 
 
 Development of germs, 85. 
 
 Eiapterin, 148. 
 
 Di-methyl-oxy-quinizine, 102. 
 
 Diphtheria, 43. 
 
 Diphtheria, discovery of germ, 43. 
 
 Diplococcus pneumoniae, 40, 42. 
 
 Discovery of micro-organism, 19. 
 
 Discovery ol yeast plant, 28. 
 
 J iscovery of spores, 31. 
 
 Disinfection, control disinfectious 
 diseases, 222. 
 
 Disinfectol, 148. 
 
 Di - iodo - para- phenyl-sulphonic 
 
 acid, 205. 
 Di-iodo-resorcin-mono-sulphonic 
 
 acid, 172. 
 Di - iso-bulyl-ortho-cresol- :'odid, 
 
 151. 
 DJ-meihyl-benzene, 218. 
 Drainage, 308. 
 Drainage, first attempts, 17, 24, 
 
 26. 
 Dry heat, effect on germs, 90, 91. 
 Dry pulverulent dressing, 314. 
 Dupre, 53, 54. 
 
 Earliest record of antiseptic prac- 
 tices, 9. 
 
 Farliest record of medicine, 7. 
 
 Effect of ingestion of putrid mat- 
 ter, 54. 
 
 Egyptian civil zatior, 10. 
 
 Egyptian medicine, 10. 
 
 Egyptian priest-physicians, 10, 
 II. 
 
 Fgyptians, 9, 10, 11. 
 
 Elementary principles of modem 
 midwifery, 265. 
 
 Electricity, effect upon germs, 91, 
 92. 
 
 Embalming, 9, 10. 
 
 Embalming, a crude attempt at 
 asepsis, 10, 
 
 Essentials of antisepsis and asep- 
 sis, 273. 
 
 Essential oils, 14 > 
 
 Ether, 149. 
 
 Eucalyp*ene-di-chlorid, 150. 
 
Eucalypteol, 150. 
 Eucalyptol, 140. 
 Eugenic acid, 1 50. 
 Eugenol, 150. 
 Euphorin, 150. 
 Europhen, 151. 
 Exalgine, 151. 
 
 Fatty acids, 49. 
 
 Fermentation, 4, 5, 8, 20, 22, 30. 
 
 Fermentation, acetic, 33. 
 
 Fermentation, entyric, 33. 
 
 Fermentation, putrefactive, 5. 
 
 Fermentation, vinous , 33. 
 
 Fermentation, Bellas theory, 27. 
 
 Fermentation, Gay Lussac's the- 
 ory, 28, 29. 
 
 Fermentation, Mayow's theory, 
 27. 
 
 Ferrichlorid, 152. 
 
 Ferrous sulphate, 1 52 . 
 
 Feuerbringer's method, 262. 
 
 Foroialia, 152. 
 
 Formic acid, 152. 
 
 Fowler's solution, 173. 
 
 Gallic acid, 152. 
 
 Germ effect in causation of dis- 
 ease, 45. 
 
 Germ products, 45, 48, 49, 50. 
 
 Germ theory of disease, 33, 34, 35 
 37, 44, 46, 47. 
 
 Germicidal effect, 81, 82. 
 
 Germicidal power of blood not 
 due to phagocytes, 67. 
 
 Glanders, 22. 
 
 Glycerin, 153. 
 
 Gluside, 181. 
 
 Glucusimide, 181. 
 
 Gold chlorid, 153. 
 
 Gonococcus, discovery of, 41. 
 
 Gonorrhea, 41. 
 
 Gravitation, 3. 
 
 Greeks, 11. 
 
 Guaiacol, 153. 
 
 Guards against gastric-intestinal 
 
 infection, 61. 
 Guards against infection through 
 
 blood channels, 61. 
 Guards against infection through 
 
 lymph channels, 61. 
 
 Heat as sterilizer, 285. 
 Helenin, 154. 
 Heliotropsio, 172. 
 Hydrochinone, 155. 
 Hydrofluoric acid, 1 56. 
 Hydrofluosilicic acid, 1 56. 
 Hydrogen dioxid, 155. 
 Hydrogen peroxid, 155, 346. 
 Hydronaphtol, 156, 346. 
 Hydroquinone, 104, 155. 
 Hydroxyl, 155. 
 Hydroxy 1-benzene, 118. 
 
 Iceland, 4. 
 
 Ichthyol, 208. 
 
 Immunity conferring albumose of 
 
 anthrax, 56. 
 Immunity from disease, 62, 63, 64. 
 Immunity, natural, 64, 65. 
 
XI 
 
 hnmunity, artificial, 64, 73, 74, 75 
 76. 77»78, 79»8o, 81. 
 
 Immunity, racial, 64. 
 
 Indol, 157. 
 
 Infection by inhalation, 60. 
 
 Infection through circulatory sys- 
 tem, 60. 
 
 Infection through l>mphatic sys- 
 tem, 60. 
 
 Infection through intestinal mu- 
 cous membrane, 59. 
 
 Infection through respiratory mu- 
 cous membrane, 60. 
 
 Infection through skin , 59. 
 
 Influenza, 43. 
 
 Influenza, discovery of germ, 43. 
 
 Ingestion of putrid matter, effect, 
 
 54. 
 Iodide of potash, 175. 
 Iodine, 129, 157, 345. 
 Iodine in internal medication, 
 
 129. 
 lodin-trichlorid, 157. 
 lodo-boro-thymolate of zinc, 103. 
 lodo - di - iso - butyl-ortho-cresol, 
 
 151. 
 Iodoform, 158, 345. 
 lodol, 159, 346. 
 lodophenacetine, 159. 
 lodophenin, 159. 
 lodozone, 160. 
 Irrigation, 28, 303. 
 Iso-naphtol, 165. 
 Izol, 160. 
 
 Jews, II. 
 
 Jewish priest physicians, 11. 
 Jewish vandage in Egypt, 11. 
 
 Koch's discovery of pathogenic 
 germs, 40. 
 
 Koch's discovery of specific origin 
 of anthrax, 41. 
 
 Koch*s discovery of bacillus an- 
 thracis, 41. 
 
 Koch's treatise on traumatic in- 
 fectious diseases, 41. 
 
 Koch's discovery of typhoid germ, 
 42. 
 
 Koch's discovery of cholera spiril- 
 lum, 43. 
 
 Koch's inoculations of attenuated 
 cultures, 42. 
 
 Koch's introduction of mercuric 
 chlorid, 42. 
 
 Koch's indroduction of solid cul- 
 ture media, 49. 
 
 Koch's introduction of plate meth- 
 od for pure cultures, 49. 
 
 Koch's introduction of gelatin 
 media as a means of classifica- 
 tion of germs, 49. 
 
 Lactic acid, 161. 
 
 Lanolin, 161. 
 
 Laurinol, 118. 
 
 Lead chlorid, 160. 
 
 Lead tiophen-sulphonate, 215. 
 
 Leprous tubercle, 41. 
 
 Leucomaines, 45, 50, 51, 52, 230. 
 
 Lime water, 116. 
 
 Liquor antisepticus, 142. 
 
XII 
 
 Listerism, 267. 
 
 Lister's extension of discovery of 
 
 Schwann and Pasteur, 40. 
 Lister's renewed allegiarce to 
 
 carbolic acid, 43. 
 Lister's surgical dressing, 41. 
 Losophan, 162. 
 Lysol, 162, 263. 
 Lunar caustic, 197. 
 
 Malachite green, 100. 
 
 Malarial disease, 42. 
 
 Malic acid, 163. 
 
 Meat, poisonous, 52. 
 
 Medicine among early Eg}ptians, 
 10. 
 
 Mercury, 163. 
 
 Mercuric chlor id, 132, 345. 
 
 Mercuric chlorid acfion as an an- 
 tiseptic, 264. 
 
 Meta-di-hydro-oxy-benzene, 179. 
 
 Meta-di-oxy-berzene, 179. 
 
 Meihyl-blue, ico, 163, 177. 
 
 Methyl-yellow, 100 
 
 Methyl-\ iolet 100, 177. 
 
 Meth}l-acet-anilid, 151. 
 
 Methyl pyrocatechin, 153. 
 
 Methylene-blue, ico. 
 
 Method of embalming, 9. 
 
 Method of itaining, 49. 
 
 Methozin, 102. 
 
 Microbes, 4. 
 
 Micro-organisms causing morbid 
 conditions, 226. . 
 
 Micro-organisms, classification of 
 43. 
 
 Modem progress in medicine, 12. 
 
 Moist heat, effect on germs. 87, 
 88, 89. 
 
 Monochlorphenol, 130. 
 
 Morbid conditions caused by mi- 
 cro-organisms, 220. 
 
 Morphia hydrochlorate, 164. 
 
 Mortality, decrease due to antisep- 
 sis, 38, 39. 
 
 Moldy cornmeal, eflfect of, 56. 
 
 Mustard, 346. 
 
 Mustard as a means of steriliza- 
 tion, 338, 339. 
 
 Napthalenp, 164. 
 
 Naphtalin, 164. 
 
 Naphtalol, in. 
 
 Naphtol, 165, 321. 
 
 Naphtosalol, in. 
 
 Naphtyl-a'cohol, 165. 
 
 Natural processes combated, 8. 
 
 Nature lost sight of by early phy- 
 sicians, 7. 
 
 Nature, healing power of, 13, 15, 
 16, 17, 20, 156. 
 
 Nitric acid, 166. 
 
 Nitrous acid, 166. 
 
 NorsemeD, 4. 
 
 Office of practitioner of antiseptic 
 
 surgery, 6. 
 Oil of mustard, 339. 
 Oil of turpentine, 339. 
 Oleic acid, 166. 
 Olive oil, 167. 
 Organic decompositi<.P, 6. 
 
XIII 
 
 Ortho-brom 3- phenol, 115. 
 Ortho-cresol iodid, 146. 
 Ortho-phenol, 106. 
 Ortho - phenol - sulphonic acid, 
 
 100. 
 Ortho-phosphoric acid, 171. 
 Oxalic acid, 167, 264. 
 Oxychinasep'ol, 146. 
 Oxygen, 6, 167. 
 
 Para-amido-anisol, 213. 
 Para-cresolal, 169. 
 Para-cresolic salicylate, 169. 
 Paradioxy benzene, 155. 
 Para-mono-ace tanilid, 103. 
 Para - mono - brom-phenyl-aceta - 
 
 mid, 103. 
 Pasteur's investigation, an aid to 
 
 Lister, 34, 40. 
 PjiSteur's investigation, result of, 
 
 34. 
 Peroxide of hydrogen, 263, 264. 
 Phagocytosis, 45, 63. 
 Phenazon, 102. 
 Phenic acid, 118. 
 PhenocoU, 169. 
 Phenol, 118. 
 Phenolid, 17 
 Fhenosalyl, 170. 
 Phenol sulfonic acid, 208. 
 Phenyl-acetamid, 94 
 Phenyl-alcohol, 118. 
 Phenyl-ethylic-urethane, 151. 
 Phenyl-dimethyl-pyrazo Ion , 102. 
 Phenyl-hydrate, 118. 
 Phenyl-hydroxid, 118. 
 
 Phenyl-salicylate, 186. 
 
 Phenyl-urethane, 151. 
 
 Phyloxera, 34. . 
 
 Picrol, 172. 
 
 Piperonal, 172. 
 
 Plasmodium malariae, 42. 
 
 Pneumotosine, 57. 
 
 Poisoning, acute alkaloidal, 230. 
 
 Poisonous cheese, 54. 
 
 Poisonous products of germs, 57, 
 
 58. 
 
 Poisonous sausage, 53, 54. 
 Potassic acetate, 1 73. 
 Potassic arsenite, 173. 
 Potassic bromid, 1 73. 
 Potassic carbonate, 174. 
 Potassic chlorate, 174. 
 Potassic chromate, 174. 
 Potassic cyanid, 174. 
 Potassic di-chromate, 173. 
 Potassic hydroxid, 175. 
 Potassic iodid, 175. 
 Potassic permanganate, 1 76, 26 [, 
 Predisposition of disease, 61. 
 Preparation of dressing, 293. 
 Preparation of hands, 301. 
 Preparation of ligatures and su- 
 tures, 296. 
 Preparation of sponges, 298. 
 Priest-physicians of Egypt, 10, 1 1 » 
 Priest-physicians of Hebrews, 1 1 . 
 Primitive medicine, 7, 8. 
 Principia of Newton. 4. 
 Propionic acid, 49. 
 Ptomaines, 45, 50, 51, 52, 230. 
 Ptomaines, determination of 
 
XIV 
 
 chemical nature, 53. 
 
 Ptomaines, nature of, 56. 
 
 Puerperal infection, causes of, 
 271. 
 
 Putrefaction, 48, 29. 
 
 Putrefaction, germ theory of. 5. 
 
 Putrefaction but a form of fermen- 
 tation, 8. 
 
 Putrefactive alkaloids, 50, 51. 
 
 Putrefactive fermentation, 6. 
 
 Putrefactive germs, 6, 
 
 Putrid matter, effect of ingestion, 
 
 54. 
 Putrid matter, chemical nature of 
 
 poisonous principles, 54. 
 Putrid yeast, 54. 
 Pyoktanin, 100, 177. 
 Pyroligenous acid, 96. 
 Pyrozone, 179. 
 Pyrrol, 159. 
 
 Quickine, 178, 
 Quinine, 179. 
 Quinol, 155. 
 Quinoline, 126. 
 
 Relapsing fever, 41, 
 
 Relapsing fever germ, discovery 
 of, 41. 
 
 Relative value of various germi- 
 cidal agents, 134, 
 
 Renaissance, 13. 
 
 Resinol, i8a 
 
 Resorcin, 179. 
 
 Resorcinol, 179. 
 
 Resopyrin, 179. 
 
 Retinol, 180. 
 Rosanilin, 100. 
 Rosinol, 180. 
 
 Saccharine, 187. 
 
 Saccharomyces cerevisiac, 6. 
 
 Salacetol, 182. 
 
 Salicylate of phenol, iii. 
 
 Salicylate of phenocoll, 186. 
 
 Salicylacetol, 182. 
 
 Salicylic acid, 183. 
 
 Salicylamid, 182. 
 
 Salinaphtol, iii. 
 
 Salocoll, 169, 186. 
 
 Salol, III, 186, 321, 346. 
 
 Salophen, 187. 
 
 Salt, 199. 
 
 Sanitas, 188. 
 
 Saprol, 188. 
 
 Sausage poisons, 53, 54. 
 
 Sennine, 171, 189, 218, 319, 321, 
 
 326, 328, 344, 345- 
 Sepsine, 31, 54. 
 Sepsis, 6. 
 Silver nitrate, 197. 
 Skatol, 198. 
 Smoke, 198. 
 Soda, 199, 286. 
 Sodic carbonate, 199. 286. 
 Sodic chlorid, 199, 287. 
 Sodic di-iodo-salicylate, 200, 
 Sodic di-thio- salicylate, 200. 
 Sodic hydroxid, 199. 
 Sodic meta-borate, 202. 
 Sodic paracresotate, 200. 
 Sodic salicylate, 185, 
 
xy 
 
 Sodic siJico-fluorid, 156. 
 
 Sodic sozoiodolate, 200. 
 
 Sodic sulphite, 201. 
 
 Sodic sulpho-carbolate, 201. 
 
 Sodic tetra-borate, 112. 
 
 Sodic thiophen-sulphonate, 202. 
 
 Sodic thio-sulphate, 202. 
 
 Sodium ichtyo-sulphonale, 208. 
 
 Sodium thiophen-sulphonate, 215. 
 
 Solocol, 204. 
 
 Solutol, 203. 
 
 Sozal, 204. 
 
 Sozolic acid, 106, 208. 
 
 Sozoiodol, 204. 
 
 Spirochete obermeieri, 41. 
 
 Spores, 31, 41. 
 
 Spores, Cohn and Koch*s investi- 
 gation, 41. 
 
 Spores, Robin and Perty*Sj 31. 
 
 Staphylococcus pyogenes albus, 
 258, 259, 261, 262. 
 
 Staphylococcus pyogenes aureus, 
 140, 141, 259, 261, 262. 
 
 Staphylococcus pyogenes citrus, 
 
 258- 
 
 Steresol, 206. 
 
 Sterilization of dressing, 258, 293. 
 
 Sterilization of hands, 301 . 
 
 Sterilization ot instruments, 258, 
 290. 
 
 Sterilization of ligatures and su- 
 tures, 296. 
 
 Sterilization of sponges, 298. 
 
 Sterilization of wound, 288. 
 
 Streptococcus pyogenes, 258. 
 
 Styracol, 207. 
 
 Styron, 207. 
 
 Subgallate of bismuth, 147. 
 Sulphaminol, 207. 
 Sulphaminol creosote, 208. 
 Sulphaminol eucalyptol, 208. 
 Sulphaminol guaiacol, 208. 
 Sulphaminol menthol, 208. 
 Sulpho-carbolic acid, 106, 208. 
 Sulphonic acid, 106. 
 Sulphuric acid, 209. 
 Sulphuric dioxyd, 209. 
 Sulphuric acid, 210. 
 Sulphurous acid, 31, 209. 
 Sulphurous acid gas, 209, 211. 
 Suppuration, 227. 
 Susceptibility to disease, 62. 
 
 Tannic acid, 211. 
 
 Tannine, 211. 
 
 Tartaric acid, 212. 
 
 Tarwater, 27, 28. 
 
 Temperature, effect of variations 
 
 on germs, 86. 
 Terebene, 212. 
 Terpilene, 212. 
 Tcrpine, 213. 
 Tetanin, 56. 
 Tetanus, 43, 45. 
 Tetanus, discovery of germ, 43, 
 
 56. 
 
 Tetanus poison elaborated, 56. 
 Tetra-borate of sodium, 112. 
 Tetra-hydro-para-chinonisol, 2 1 3. 
 Tetra-hydro-para-methyl-oxy-chi- 
 
 nolin, 213. 
 Tetra - methylo - diapsido-benzo - 
 
XVI 
 
 phenoncide, no. 
 
 Tetra-iodo-pyrrol, 159. 
 
 Tetra-methy -thionin, 162. 
 
 Thalline, 213. 
 
 Thilanine, 213. 
 
 Thiol, 214. 
 
 Thiophen, 215. 
 
 Thiophen-di-iodid, 215. 
 
 Thio-oxy-diphenylamin, 207. 
 
 Thio-resorcin, 215. 
 
 Thymol, 216. 
 
 Tinchlorid, 217. 
 
 Tobacco-smoke, 217. 
 
 Toxalbumen, 50, 230. 
 
 Toxines, 50, 51. 
 
 Tri-brom methane, 114. 
 
 Tri-brom-phenol, 115. 
 
 Tri-chlor-aldehyde, 127. 
 
 Tri-chlor-methane, 130. 
 
 Tri-chlor-pheno 1, 130. 
 
 Tri-iodo-methane, 158. 
 
 Tri-iodo-meta cresol, 162. 
 
 Tuberculin, 42 57. 
 
 Tuberculosis, 42. 
 
 Tuberculosis, discovery of bacil- 
 lus of, 42, 43. 
 
 Tumenol, 217. 
 Typhoid bacillus, 141. 
 Typhoid fever, 42, 43. 
 
 Typhoid fever germ, discovery of,. 
 42. 
 
 Typhoid bacillus poison elaborat- 
 ed, 56. 
 Typhotoxines, 56, 57. 
 Tyrotoxicon, 56. 
 
 Universal gravitation, 3. 
 
 Valerianic acid, 49, 217. 
 
 Vinegar, 96. 
 
 Vinous fermentation, 33. 
 
 Virtue oi antiseptic principles, 8. 
 
 Washing soda, 199. 
 
 Woodvinegar, 96, 
 
 Wounds, treatment of, :^T, 38. 
 
 Xylene, 218. 
 Xylol, 218. 
 
 Yeast plant, 6, 28. 
 
 Zinc boro-thymo-iodid, 100. 
 
 Zinc chlorid, 218. 
 
 Zinc mercuric cyanid, 218. 
 
 Zinc sozoiodolate, 219. 
 
 Zinc sulphate, 219. 
 
 Zinc sulpho-carbolate, 219. 
 
 Zinc sulphydroxid, 220. 
 

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ANTISEPSIS AND ANTISEPTICS. 
 
 I. — History. 
 
 From Earliest Times to the Beginning of the 
 Christian Era. 
 
 No great discovery, no epoch-making invention is or 
 ever has been the product of one brain. Inklings of the 
 truth have illumined the minds of others than the so- 
 called discoverers or inventors; only in the ripeness and 
 fullness of time is the actual birth of the fact culmi- 
 nated and then by some one who, standing head and 
 shoulders above the common throng, perceives the light 
 and enlightenment of coming ages and proclaims the 
 truth to his fellow man. Newton was not the first to ob- 
 serve that all unsupported bodies fell earthward and not 
 skyward, nor indeed was he the first to suspect the 
 existence of that mutual attraction between all matter 
 of the univer e which we term universal gravitation. 
 This had been suspected and supposed by philosophers 
 for ages, but Newton first elucidated and demonstrated 
 the primary laws by which its action was governed — 
 
this alone was sufficient to render his "Principia" im- 
 mortal. Columbus was not the first individual to suspect 
 the existence of a new world, nor indeed to actually dis- 
 cover it; others had gone before him, others had been 
 as brave and daring, others strong in the courage of 
 their own convictions had accomplished as much as he, 
 but the time was not ripe, the world was not ready to 
 profit by their works until the coming of Columbus, 
 who owed so much to the prior discoveries of the 
 brave and hardy Norsemen — for he had undoubtedly 
 made himself familiar with their deeds and discoveries 
 during his voyages to Iceland. It was the good fortune 
 of Columbus to have his discoveries followed up and 
 developed by others than himself. Just so Lister is 
 neither the discoverer nor inventor of antisepsis, though 
 to his work, to his investigations and to his tireless 
 energy the world owes a greater debt of gratitude than 
 to any other single individual. So then, mindful of 
 the fact that Lister was not the discoverer of the 
 agency of microbes in the causation of fermentation, 
 putrefaction, still as the originator and elaborator of 
 the first well defined and systematic method of com- 
 bating putrefactiv fermentation he rendered such ser- 
 vice to mankind as to hand his name down to pos- 
 terity as that of one to whom we owe an incalculable 
 debt of gratitude. It matters not that his methods have 
 been and will probably yet be radically modified, the 
 broad and general principles upon which they are 
 founded remain the same, and indeed will probably en- 
 dure as long as surgery is a branch of the healing art. 
 
Hence, though true antiseptic surgery is much older 
 than Lister himself, this can in nowise detract from the 
 debt which humanity owes to him. 
 
 This subject, involving as it does the hi&tory of 
 progress in all branches of medical science and intimate- 
 ly associated with the life history of the theories of 
 fermentation as well as the discovery and development 
 of the microscope, is a most voluminous one and must 
 be traced by degrees and stages. 
 
 Fermentation and putrefaction are strictly analogous 
 processes or conditions, induced by the presence of 
 minute living organisms, which highly complex organic 
 bodies undergo when subjected to proper conditions of 
 heat, moisture and atmosphere. It has been satisfac- 
 torily demonstrated that putrefaction and fermentation 
 only supervene when particles or organisms from with- 
 out gain access to the putrefying or fermenting mass, 
 whether that be dead or living tissue. This germ 
 theory of putrefaction is the only view at the basis of 
 antiseptic surgery and of which the exhibition of anti- 
 zymotic drugs, or antiseptics, is only one feature. Then 
 antisepsis consists of such management of a case as to 
 prevent the occurrence of putrefaction in any part con- 
 cerned. When this has been attained, surgery becomes 
 something entirely different from what it used to be and 
 both injuries and diseases formerly regarded as formida- 
 ble or hopeless, progress surely and quietly toward re- 
 covery. This germ theory declares that the putrefaction 
 of organic substances under so-called atmospheric in- 
 fluence is not effected, as formerly supposed, by the 
 
6 
 
 oxygen of the air but by living organisms derived from 
 germs floating in the air or as a constituent of dust, the 
 first step towards the establishment of this theory was 
 the discovery of the yeast plant (Saccharomyces cerevi- 
 siae) by Cagniard de la Tour in 1836. Then we may un- 
 derstand by the term sepsis the existence of a condition 
 in which infectious or putrefactive germs are present, 
 asepsis, the entire absence of such germs and antisepsis 
 the condition secured by any method whereby the 
 growth and fermentative action of these peculiar and 
 lower forms of organic life are more or less impeded, 
 whether they are totally destroyed or simply rendered 
 innocuous. An antiseptic or antizymotic drug is one 
 which has the power of preventing putrefactive decom- 
 position and whose power is evidenced by the ability 
 to prevent the development of bacteria or micro-organ- 
 isms in a medium suitable or favorable to their growth. 
 
 It then becomes the office of the practitioner of anti- 
 septic surgery to withdraw all obstacles to those opera- 
 tions of Nature which naturally tend to become repara- 
 tive in effect, since it is nature who heals the wound, 
 while the surgeon prevents any interference with her 
 normal efforts to that effect. 
 
 The methods of preventing organic decomposition 
 depend entirely upon the removal of some one or more 
 of the conditions necessary to the accomplishment of the 
 process, no matter by what means effected, for instance, 
 by the extreme elevation or depression of temperature. 
 The preservative effects of cold are well known; ani- 
 mals have been found undecomposed, in the ice of Sibe- 
 
ria, belonging to extinct species and which must have 
 been embalmed and enveloped in the ice for ages. A 
 boiling temperature coagulates albumen, kills organisms 
 and arrests putrefaction. These two operations are 
 probably the most familiar and common of the processes 
 by which antisepsis may be secured, but are not alto- 
 gether adapted for surgical use, for reasons which are 
 obvious. With this brief preface we may proceed to the 
 consideration and development of the subject in hand. 
 The most remarkable characteristic of the present 
 age is its desire to connect itself with preceding ages; 
 to learn how the things, which now are, grew and the 
 origins from which they sprang. In science as else- 
 where, one discovery grows out of another and cannot 
 appear without its proper antecedent. In the earliest 
 times of which we have any recorded history, mankind, 
 as now, had recourse to the skill and art of the phy- 
 sician, for indeed, medicine is probably as old as man 
 himself. But naturally the system of medicine then in 
 vogue was somewhat crude and ineffectual as compared 
 with the status of the profession of the present day. 
 Then, and indeed until comparatively recent times, the 
 sole aim and object of the physician seemed to be the 
 use of substances which would make a wound heal, 
 make flesh grow and m.ake it firm, to m^ake a good ci- 
 catrix and to m^ake a gQod recovery, as though the phy^ 
 sician himself could exercise creative power. Amid all 
 of these efforts nature was lost sight of, as was also the 
 parts and functions which she must, and she alone can, 
 perform in the healing of any wound. No attention 
 
8 
 
 was given to the wound and its natural tendency to heal 
 if uninterfered with; all natural tendencies were looked 
 upon as vicious and as something to be combated. 
 Nevertheless some bright minds, from time to time, re- 
 alized the undesirability of interference on the part of 
 the physician or surgeon and protested against the 
 methods in vogue in no uncertain tones. This and this 
 alone is the chief virtue of antiseptic principles that the 
 natural operations of recuperation and repair are al- 
 lowed to progrsss absolutely free from any extraneous 
 or inhibiting condition. 
 
 Putrefaction is but one form of fermentation, hence 
 the history of antisepsis and antiseptic surgery is in- 
 timately associated \ivith that of fermentation. We 
 have no positive account of the first brewer but from 
 history we glean the fact that his art must have been 
 practiced and its products appreciated more than two 
 thousand years ago, for Theophrastus lived and brewed 
 nearly four hundred years before the Christian era. 
 The art of making wine, beer and other fermented 
 liquors possesses such an old history, until a very few 
 years ago no one knew the reason, the true secret, of 
 their formation, indeed the little knowledge of the sub- 
 ject then existing was purely the result of empirical 
 observation, the facts^ the conditions of success were 
 known, but not the reasons. This is neither astonish- 
 ing nor unexpected when we consider that the micro- 
 scope had to be invented and perfected before definite 
 and positive information regarding the phenomena of 
 fermentation and putrefaction could be obtained. 
 
The earliest records of man's efforts to overcome the 
 ravages of time and the effects of decay are to be found 
 in the history of Egypt. Among the Egyptians these 
 efforts took the form chiefly, of embalming the dead, 
 which with them was a religious duty. The process de- 
 mands a certain amount of knowledge regarding the 
 preservative qualities of the various gums, aromatics 
 and spices. After the decease of a person the first step 
 toward embalming him was the removal of the brain 
 and abdominal viscera; the rudimentary knowledge of 
 anatomy possessed at this time was evidenced by the 
 crude means of removal of these objectionable viscera. 
 After this was accomplished the body was thoroughly 
 washed and cleaned, aromatics and spices being lavish- 
 ly used; then for seventy days was the body subjected 
 to the action of a solution of salt when it was removed, 
 and after being covered with gum or bitumen, wrapped 
 or swathed in cloths in which various gums and spices 
 were liberally enfolded. The body, in a suitable re- 
 ceptacle, was then placed in the tomb to await un- 
 changed the summons to the Elysian fields of Aahlu. 
 Here we have, crude as it is, one of the first systemati- 
 cally recorded attempts at the exclusion of what was 
 dimly thought to be the cause of decay, what is modern 
 asepsis but a more elaborate, finished and successful 
 attempt to secure the same results? 
 
 We are more or less familiar with the skill displayed 
 by the Chinese in the manufacture of gunpowder and 
 silk, we have read of the wonderful records of astrolo- 
 gical science in which the ancient Assyrians sufficiently 
 
10 
 
 attest their knowledge huDdreds of years before the 
 time of Christ; we stand amazed at the marvelous civili- 
 zation of the ancient Egyptians with their comprehen- 
 sive schemes of irrigation and agriculture and their ac- 
 complishments in the arts and manufactures, producing 
 fabrications which to this day are only excelled by 
 nature herself. We are also familiar with those master- 
 pieces of engineering ingenuity, hoary with age, and 
 offering an archetype which none have since followed 
 and the processes of whose construction none have been 
 able to fully explain. These wonderful examples of 
 skill, genius and ability substantiate, beyond perj*dven- 
 ture, the fact that these nations had attained an en- 
 viable degree of civilization and a high degree of in- 
 tellectual development. With a proper understanding 
 of the powers, aptitudes and possibilities of the ancient 
 Egyptians before us, it seems more than incongruous 
 that in their history the medical art was not permitted 
 a commensurate enlightenment and erudition or that a 
 degree of perfection was not attained in keeping with 
 their progress in the several phases of their marvelous 
 civilization. The art of embalming presents such re- 
 markable results that we are constrained to place it 
 among the greatest of the achievements of this wonder- 
 ful people. In medicine and the collateral branches of 
 science the ancient Egyptians showed as great aptitude 
 and as much natural competency as in other matters; 
 but the medical art was shackled by mystic practices 
 and amalgamated to irrational forms of worship by 
 the governing priestly classes. They were ever ready 
 
11 
 
 to construe independence of thought and action as a 
 threatened encroachment upon their own arrogated pre- 
 rogatives or powers; their action and power rendered 
 any attempt at weakening or prejudice of their investi- 
 tures impossible. 
 
 Among the Greeks we find some inklings of the truth 
 as early as the middle of the fifth century before Christ 
 and at that time by Empedocles, who had vague sus- 
 picions of the existence of contagia and miasma in the 
 atmosphere. Agrigentum had suffered a pestilential 
 plague for several seasons when Empedocles noticed 
 that it only originated when the sirocco prevailed and 
 this blew from the south-east where it came through a 
 narrow gorge; Empedocles walled up this gorge and 
 Agrigentum suffered no more, 
 
 Among the Jews we find, from the book of Leviticus, 
 a primitive appreciation of the nature of some diseases; 
 contagion was dimly understood and also the purifying 
 effects of fire, but no reason for this was known. It is 
 probable that the Hebrews, during the period of their 
 bondage in Egypt, learned many things from their task- 
 masters. Moses was educated at the court of Pharaoh 
 and was deeply versed in the so called mystic lore of 
 the period. The Jewish custom of circumcision, at 
 least, must give us some feeling of respect for the 
 methods of prophylaxis then prevailing, no matter how 
 crude. 
 
 We discover, however, among the Jews the same 
 tendency displayed by the Egyptians, that is the re- 
 striction of medicine to the priestly class, or Levites — 
 
12 
 
 they took entire charge of medical affairs and associated 
 them with their priestly functions. Their arrogance in 
 such matters and their intolerance of all advancement 
 which did not come through them is shown by the fact 
 that in Salomon's time a work appeared, said to have 
 been written by the sovereign himself; this work pro- 
 fessed to teach how to treat disease by means of natu- 
 ral methods. It was seized and destroyed by the high- 
 priest Ezechias, because he thought that it would 
 damage the interests of the priests and trench upon the 
 prerogatives of the Levite order. 
 
 This brings us down to the Christian era. 
 
 II — History. 
 
 From the Christian Era to the Beginning of 
 THE Eighteenth Century. 
 
 To quote the words of Dr. Pepper, in his presidential 
 address to the Pan-American Medical Congress so re- 
 cently convened at Washington, D. C: "Modern medi- 
 cine has made more progress in the past twenty years 
 than in the whole of the twenty centuries preceding 
 them!" Hence we can expect no remarkable strides in 
 the history of antisepsis in the earlier days — nay, even 
 centuries — of even civilization itself. Indeed, positive 
 
13 
 
 advancement would be impossible without the invalua- 
 ble aid of the microscope, upon whose precision and 
 certainty all modern progress in such direction is based. 
 
 In the seventh century after the inauguration of the 
 Christian era Paul d'Egineta lived and flourished. He 
 condemned all measures used by physicians which tend- 
 ed to hinder the action of Nature. He also declared 
 that A^e must attribute to Nature herself the successive 
 changes presented by wounds in the process of repair. 
 This is a distinct advance when compared with the pre- 
 vious opinions that a physician possessed and could ex- 
 ercise a modified form of creative power in the treat- 
 ment of wounds and traumatisms. 
 
 Medicine, as was all learning, was plunged into the 
 utter darkness of the ignorance and superstition of the 
 so-called Dark Ages, only to revive in the Renaissance. 
 Consequently it was nearly seven hundred years before 
 even a faint glimmer of light pierced the Cimmerian 
 darkness. The thirteenth century witnessed the birth 
 of Rogerius, of Lanfranc and of Bruno, each one of 
 whom bears an important relation to the development 
 of those ideas which have culminated in modern anti- 
 sepsis and asepsis. Rogerius vigorously protested 
 against the use of any dressing which would antagonize 
 in any way the natural operations of repair; he used 
 only wine and honey, as local applications. Bruno in- 
 stituted the practice of closing all incised wounds at 
 once; wounds with loss of substance he caused to sup- 
 purate, unless the nerves were injured — in which case he 
 was afraid that putrefaction might cause spasm! Here 
 
14 
 
 we have a dim but certain appreciation of the repara- 
 tive influence of the process of granulation, but, still 
 more wonderful, a most accurate hint at the etiology 
 of tetanud as elucidated by the science of to-day. 
 
 During the next two centuries, the fourteenth and the 
 fifteenth, the obsolete methods of practice were almost 
 wholly continued; in fact, this period was marked by 
 little or no advancement of any value or practical im- 
 portance. 
 
 De Yigo, in the fifteenth century, first enunciated his 
 false and pernicious doctrine as lo the poisonous nature 
 of gunshot wounds. Noticing the frequent infection of 
 open and exposed wounds, he ascribed the effects ob- 
 served to the presence of air and declared that access 
 of air to the wound was, per se, highly objectionable. 
 He made use of various powders as dressings, some of 
 which were undoubtedly antiseptic in their nature, — 
 not that he knew of the presence and existence of such 
 germs as cause putrefaction, or the germicidal virtues 
 of such agents as he used, but that empiricism, experi- 
 ence, had taught him that benefit followed their appli- 
 cation. 
 
 In 1542, Michel Ange Blondus discarded all of the 
 surgical dressings in use at that time and advocated the 
 use of water for such purposes. After arresting hemor- 
 rhage and removing foreign bodies he applied dressings 
 which were soaked in water. 
 
 From this period begins the real history of the begin- 
 nings of modern treatment. The two most influential 
 persons in laying the foundation of such methods were 
 
15 
 
 Paracelsus and Pare. Phillipus Aureolus Theophrastus 
 Paracelsus Bombastus was born at Einsiedeln, near 
 Zurich, the year following the discovery of America — 
 in 1493. He spent the early part of his life as a teacher 
 of surgery at Basle. In the treatment of wounds he 
 aimed solely at aiding^ and not combating, Nature. He 
 strenuously insisted that Nature alone was competent 
 for the task of repairing wounds, that non-interference 
 was the best policy. He believed in the existence of a 
 juice in the body which kept the tissues in health and 
 in proper repair when injured. In his opinion the office 
 of the surgeon was to prevent any alteration in this 
 liquid, which might result from contact with the air or 
 other accident. He thought that Nature was usually 
 sufficient for this, as was to be seen in the wounds of 
 the lower animals, — the essential thing, he declared, was 
 non-interference with Nature. His use of medicaments 
 was only for the preservation of this juice and the pre- 
 vention of its corruption or putrefaction. It is known 
 that he made use of silver wire sutures and bathed or 
 injected wounds with a solution of Plumbic acetate 
 (Liquor Saturni). 
 
 Ambroise Pare (1509-1584) adopted these views. He 
 mentioned a number of topical applications; his great 
 aim was to keep the part atQrest. Jeannel, in his work 
 "2>e V Infection Purulente^^^ quotes passages from Pare 
 which show that he attributed the fever which accom- 
 panies wounds to a putrefaction of pus. He was thor- 
 oughly impressed with the fact that the office of the 
 physician was to assist Nature, for he says: "Or ceste 
 
16 
 
 premiere et generale indication est parfaite par nature 
 comme le principal agent, et par le chirurgien comme 
 ministre de nature; et si nature n' est forte, le chirur- 
 gien ne pourra venir a sa fin pretendue." Moreover, he 
 looked upon pure air as beneficial to a wound and to the 
 patient; but the air of sick rooms and camps he declared 
 to be loaded with miasms and therefore very dangerous, 
 — it is the miasms in the air rather than the air itself 
 which prove dangerous, he concluded. This was a re- 
 markably accurate, though crude, statement of the basis 
 of antisepsis and modern antiseptic treatment three hun- 
 dred years before its birth! Thanks to the writings, 
 teachings and influence of these two men, old ideas be- 
 gan to give way to the newer and truer view that Nature 
 is the only healing power and that all that human skill 
 and knowledge can do is to remove anything which in- 
 terferes with the natural operations of repair. Pare 
 looked especially to the constitution, strengthening it 
 and removing local disturbing causes in accordance with 
 the time-honored teaching of ^^Tolle causam.^^ 
 
 Jean Andre Delacroix (1573) was one of the most 
 successful surgeons of his time; he adopted, to a certain 
 extent, the views just related in regard to the powers of 
 Nature and the oflice of the physician. He used anti- 
 septic substances largely, indeed he strongly recom- 
 mends such mild antiseptics as the ethereal oils and 
 alcoholic substances. After arresting hemorrhage and 
 removing foreign bodies, it was his custom to wash a 
 wound with a detergent liquid and then apply plasters 
 composed chiefly of pitch and oil of turpentine. The 
 
17 
 
 results which he obtained by his methods were excep- 
 tionally good. 
 
 Francois Arcaeus (15'74) simplitied exceedingly the 
 existing surgical methods, indeed his was the simplest 
 of methods; it is remarkable for its close approach and 
 likeness to the modern procedure. After arresting 
 hemorrhage and removing foreign bodies he washed 
 the wound with alcohol or wine and myrrh and then 
 secured coaptation by means of sutures — leaving an 
 opening^ if necessary^ which was kept patulous by means 
 of a piece of lint. He then applied a balsamic prepara- 
 tion. Here we have the first practical and successful 
 attempt at systematic drainage of wounds. The meth- 
 ods of Arcaeus gave remarkable results — indeed, it is 
 really a fair antiseptic method and is not far removed, 
 in its general principles at least, from our modern idea 
 of an aseptic one. 
 
 Wurtz (1596) lived in terror of what he believed to 
 be the contaminating influence of air upon wounds. So 
 far did he carry his fear of his bugbear that he kept the 
 door of the sick-room tightly fastened while he changed 
 the dressings as rapidly as possible. 
 
 Near the end of the sixteenth century Vicary made 
 use of balsams and balsamic preparations for dressings 
 and with excellent results. 
 
 The greatest and chiefest advances made during the 
 sixteenth century were the reassertion, in no uncertain 
 tones, of the part played by Nature as the principal agent 
 and healing power in the process of repair, the relin- 
 quishment of all idea as to the power of the physician 
 
18 
 
 in making flesh or tissue and the abandonment of the 
 idea of "feeding" wounds. We note, during this 
 period, the first recommendation to apply antiseptic 
 substances to wounds; this was the result of the obser- 
 vation of the success attendent upon the use of such 
 agents, as in the case of the balsam of Arcaeus which 
 acquired great fame. It was during this century that 
 the first declaration of the infectious nature of air, or its 
 constituent impurities or contaminations rather, was 
 made; also the first crude and somewhat grotesque at- 
 tempt to exclude air and its infectious principles from 
 wounds. We observe also, at this time, the first at- 
 tempt to drain wounds of the morbid products and se- 
 cretions upon which pyogenic and pathogenic micro- 
 organisms flourish. Such methods were, of course, 
 largely the result of either chance, shrewd observation 
 or empiricism for there was and could be no correct 
 knowledge of the principles involved in such practices 
 or in the attainment of such results — in other words, 
 lacking scientific precision and devoid of scientific arma- 
 mentaria, systematic observation and study was almost 
 an utter impossibility, hence the only recourse was em- 
 piricism and observation. Paracelsus, though correctly 
 named Bombastus, rendered an incalculable service to 
 medicine when he so scathingly denounced slavish ad- 
 herence to old and obsolete methods of practice; he was 
 among the first to assail, with dauntless intrepidity, the 
 very teachings of Aristotle and others whose opinions 
 and doctrines had prevailed for centuries — he was a 
 revolutionist of a most pronounced type. Thanks to 
 
19 
 
 him, many obsolete procedures were sent hurtling into 
 the abyss of chaos and oblivion. 
 
 Magatus (1616) is among the first whom we note in 
 the dawn of the seventeenth century. He thoroughly 
 appreciated and insisted upon the importance of rest in 
 the treatment of wounds. He revived the doctrine of 
 the evil effects of air upon wounds; he claimed that the 
 air was full of miasms which affect the parts with which 
 they come in contact. This was indisputably proven, 
 he thought, by the fact that a punctured egg began to 
 decay immediately. Hence, acting in accordance with 
 his beliefs, he seldom changed dressings for fear of the 
 contact of air and consequent infection of the wound. 
 
 The discovery of the actual existence of micro-organ- 
 isms may be said to have been made by Anthony Van 
 Leeuwenhoek. In 1675 he observed, by the aid of a 
 single lens, multitudes of animalculae swarming in a 
 drop of stagnant and putrid water which he had, by 
 chance, placed beneath his glass. This is the very first 
 recorded observation of such organisms and has passed 
 into history as the incident of the discovery of the mi- 
 crobes. This same astute old scientist, in 1683, discov- 
 ered small, motile bodies in the mucus of the mouth 
 and gave clear and minute descriptions of their appear- 
 ance and movements; he also discoyered the existence 
 of microorganisms in the feces and in the tartar of the 
 teeth. From his drawings and remarkably clear de- 
 .scriptions of the bodies there is very little reason to 
 doubt that he saw what are known to modern bacteri- 
 ology as bacteria and vibrions. While Leeuwenhoek 
 
20 
 
 discovered such bodies he had no idea of the important 
 role which the result of his discovery was to play in the 
 practice of medicine in years to come. Nevertheless 
 his discovery is a most important one, laying, as it 
 does, the first substantial foundation for the subsequent 
 discoveries upon which the whole of the modern prac- 
 tice is founded. 
 
 Robert Boyle, in 1676, made a most startling decl 
 ration in his "Essay on the Pathological Part of the 
 Physik," it was as follows: 
 
 "He that thoroughly understands the nature of fer- 
 ments and fermentation shall probably be much better 
 able than he that ignores them, to give a fair account of 
 divers diseases (as well fevers as others), which will per- 
 haps be never properly understood without an insight in' 
 to the doctrine of fermentations.'*^ (The italics are mine). 
 When we consider that Leeuwenhoek had made his dis- 
 covery only a year previously and that no ideas of the 
 connection between micro organisms, fermentation and 
 disease had, as yet, been promulgated, this statement, 
 so plainly and so unmistakably couched, seems to bor- 
 der upon the marvelously prophetic. Certainly in the 
 domain of surgery, as well as that of general medicine, 
 Boyle's surmise has been more than realized. 
 
 Richard Wiseman (1692) was a man of remarkably 
 good views and practices. In the coaptation of wounds 
 he advised the use of no violence. He declared that the 
 process of agglutination is the work of Nature alone; 
 that, since the blood is the natural glue, the physician 
 must take care that it is good and support the patient's 
 
21 
 
 strength. He made use of turpentine and cooling and 
 astringent lotions as dressings and sprinkled powders 
 over large wounds. 
 
 Sir John Colbatch (1698) made use of an aqueous 
 solution of sulphurous acid; he recommended it as fol- 
 lows: 
 
 "It is an excellent medicine, being taken by way of 
 prevention in infectious seasons; and I think if any 
 medicine deserves that name this doth deserve to be 
 called the true prophylacticon." 
 
 His Novum Lumen Chirurgicumy which appeared in 
 1704, was a most remarkable treatise — a new surgical 
 light, indeed! He described a medicament which he 
 used which gave results comparable only to the results 
 attained by the true aseptic methods of the present 
 time. Unfortunately he kept its composition a secret 
 and concealed his method also, hence it has become lost 
 to the world although the reliability and accuracy of 
 the results attained thereby are sufficiently attested to 
 insure their truth; furthermore, the graphic description 
 which he gives of the progress of his cases could not 
 have been imagined, at that time, by any one who had 
 not seen and was not practically familiar with the facts. 
 He describes with peculiar accuracy what we now call a 
 typical aseptic course; nor can there be any doubt that 
 he was familiar with the fact of the vascularization of 
 the blood clot and its repla^cement by new tissue, pre-- 
 cisely as has been described by Lister, the modern 
 "Father of Antiseptic Surgery." In his preface he as- 
 serts that the methods of former times, and indeed of 
 
22 
 
 his very own, were far from the best. He furthermore 
 says, somewhat significantly, that: "The corruption of 
 the nutritive juice cannot be performed without a sort 
 of fermentation and it is the fermentation particularly 
 that, fretting the fibres, causes inflammation in wounds 
 and by entering into the blood and dividing its texture 
 causes symptomatic fevers which frequently prove so 
 fatal." What marvel of a man have we here! What a 
 pity that he saw fit to retain a secret which would have 
 caused his name to ring with praise through every age! 
 The medical profession completely ignored the teach- 
 ings and results of Colbatch and indeed, ultimately, al- 
 most forgot them entirely; so that his brilliant mind and 
 his brilliant work made absolutely no impression upon 
 the history of medical progress. 
 
 He also referred to the fact that in all wounds the 
 patient was put on a low diet and, more often than not, 
 blood was taken from him in large quantities, thereby 
 greatly weakening him; he protested vigorously against 
 such a policy, but to no avail. 
 
 Neudorfer thinks that Colbatch's powder must have 
 been ammonic salicylate, on account of the smell of 
 roses to which the latter refers. Its action is thus de- 
 scribed by its user: "In all incised wounds, where my 
 medicines have been soon enough used and no other ap- 
 plication preceded, they are perfectly cured in a few 
 days without suppuration,'*^ He also observed the pro- 
 cess of granulation and the organization and transfor- 
 mation of the blood clot into new tissue. 
 
 In the seventeenth century but little real progress 
 
g 
 
 H 
 pq 
 
 H 
 O 
 
 t) 
 
 H 
 CO 
 
28 
 
 was made by the medical profession. The attempt at 
 exclusion of air from wounds and the insistance upon 
 mechanical rest, which in themselves were not new 
 ideas, were the chief points promulgated. True, we 
 note the discovery of micro-organisms by Leeuwenhoek, 
 the remarkable declaration of Robert Boyle and the 
 highly creditable achievements of Sir John Colbatch, 
 all of which transpired in this century, but these were 
 brilliant individual exceptions — not one made a lasting 
 impression upon the medical progress of the time, in- 
 deed they were hardly appreciated for more than a cen- 
 tury. With these exceptions, the history of the seven- 
 teenth century is almost a step in retrogression when 
 compared with the sixteenth century. 
 
 This brings us down to the eighteenth century. 
 
 Ill — History. 
 
 From the Beginning op the Eighteenth to the 
 First Six Decades op the Present Century. 
 
 The eighteenth century is somewhat remarkable for 
 its dearth of illustrious names in the history of anti- 
 sepsis, for very little true progress has been made at all 
 in that period. 
 
 Augustin Belloste (1700) reiterated the teachings of 
 
24 
 
 Magatus, to whom he allied himself. He insisted more 
 particularly upon coaptation — even of bony structures. 
 
 Parmanus (1706) made use of a lotion of his own by 
 virtue of which he claimed to be able to "resist putre- 
 faction, prevent ill accidents and take aW^y the pain 
 and inflammation of a wound." This he used in the 
 treatment of all wounds, keeping the dressings moist- 
 ened with it constantly and changing them every two 
 or three days. 
 
 Anel (1706) in the same year published his method 
 of evacuating abscesses by a process of aspiration 
 which left no open wound — similar in fact to the 
 method of removing blood from the chest which was 
 originated by Delacroix in 1573. 
 
 Boerhaave (1720), so well known in the history of 
 the development of the science of chemistry, claimed 
 that the absorption of pus caused internal abscesses; 
 this was a step in the direction of the somewhat more 
 modern pyemia. 
 
 Col de Villars (1741) insisted that dressings should 
 be frequently changed, in order to prevent putrefaction. 
 
 Heister (1753) made extensive use of balsams in 
 order to remove anything that might hinder the natural 
 processes, especially suppuration — which he classed as 
 such. Iti order to remove the products of suppuration, 
 which he correctly deemed unwholesome, he made use 
 of drainage by means of openings and counter-openings, 
 
 Bilguer (1764) was accustomed to fill all of the re- 
 cesses of a wound with an antiseptic substance and to 
 lay over the wound a piece of lint which had been 
 
25 
 
 dipped in an antiseptic solution. He decried the almost 
 universal custom of promiscuous amputation which he 
 inveighed mercilessly. Indeed, he claimed that ampu- 
 tation might be almost totally dispensed with and gave 
 both facts and figures to uphold his teachings. 
 
 Dr. Pringle, in his Observations on Diseases of the 
 Army^ published in London in 1765, called the at- 
 tention of the medical profession to the fact that cin- 
 chona bark, whether used in decoction or in powder, 
 possessed the power of preventing putrefaction of flesh 
 for a time. The peculiar antiseptic qualities of cin- 
 chona and quinia have been more recently investigated 
 and confirmed by Mayer, Pavisi, Hallier, Herbst, PoUi, 
 Binz and Bochefontaine. 
 
 Percival Pott (1768) sealed wounds very effectually 
 in cases of compound fracture; but, at the same time, 
 he insisted upon the maintenance of proper drainage by 
 means of openings and counter openings. 
 
 The valuable preservative effects of sulphurous acid, 
 its gaseous anhydride and its salts were known as early 
 as the year lYYl. 
 
 Muller (1773) made an attempt to classify the minute 
 organisms which had been observed by others. Although 
 Leeuwenhoeck first observed micro-organisms in 1675 
 It was nearly a century before an attempt was made to 
 define the character of these organisms and to classify 
 them> The knowledge of the subject possessed at this 
 time was of a most rudimentary and elementary nature, 
 hence MuUer's work possesses naught of interest save 
 
26 
 
 the fact that his was the first definite attempt at sys- 
 tematic classification. 
 
 Benjamin Bell (1784) made use of drainage in 
 wounds, using leaden tubes for that purpose. He ad- 
 vised the employment of simple wound dressing, and 
 also that all punctures of the skin, etc., should be val- 
 vular in character so as to prevent free access of air and 
 objectionable matters to the wound. 
 
 In 1785, Lombard and Percy learned that a certain 
 Alsatian physician possessed an infallible remedy for 
 wounds. This infallible remedy proved to be pure 
 river vater which was used with magic phrases and in- 
 cantations. Upon trial they found the water to possess 
 the same efficacious virtues even when used without the 
 magic phrases. 
 
 John Hunter (1792) taught that air was harmless as 
 far as its influence upon wounds was concerned and that 
 inflammation was due to an inherent tendency of 
 wounds. He instituted researches on the healing of 
 wounds beneath a scab — these researches were of much 
 importance and interest. He also maintained that the 
 process of healing must be left to Nature. 
 
 August Gottlieb Richter (1799) made use of openings 
 and counter-openings for aid in the removal of pus. 
 
 And thus the century closes, without one discovery* 
 of importance, devoid even of one plausible and im- 
 portant theory. Down to the time of Priestley's dis- 
 covery of oxygen, August 1, 1774, the deleterious 
 effects of air, with few exceptions, were supposed to 
 be due largely to temperature. Pare had declared it as 
 
27 
 
 his belief that such effects were due to miasms; others 
 looked upon the putrefaction of the discharges from the 
 wound as the source of the evil and, as in the cases of 
 Colbatch and Bilguer, succeeded sometimes in prevent- 
 ing such putrefaction. Mayow, in the latter part of the 
 seventeenth century, declared that all fermentation was 
 due to the "nitro aerial spirit" of the air — from his ac 
 curate description this "nitro-aerial spirit" was nothing 
 more nor less than our modern oxygen. Benjamin Bell 
 however, in the latter part of the eighteenth century, 
 discarded all of these views, holding that the trouble 
 was caused chiefly by "fixed air" (carbon di oxid). 
 This view of Bell's, erroneous as it was, was developed 
 and accepted by many, down until the very days of 
 modern antiseptic surgery. 
 
 The first name of any interest to attract our attention 
 in the inception of the present century is that of Von 
 Kern, He (1809) made the claim that the only essen- 
 tials in the treatment of wounds were cold water for the 
 arrest of hemorrhage, warm water for dressing, some 
 small pieces of lint, absolute mechanical rest and artifi- 
 cial heat. So popular did these views become that they 
 were adopted by Von Walther of Bonn, Fritze of 
 Prague and by Lister himself — indeed these methods 
 of wound treatment continued in vogue in England 
 until about thirty years ago. 
 
 The antiseptic and preservative properties of coal-tar 
 were recognized by Chaumette (1815), by Guibourt 
 (1833), by Sivet (1836), and by Bayard (1846). The 
 famous panacea, tar-water, recommended so highly and 
 
28 
 
 extravagantly by the celebrated Bishop Berkley has 
 become a matter of history, although as far as practical 
 use is concerned it sleeps the sleep of eternal oblivion. 
 
 Constant and intermittent irrigations of wounds was 
 recommended by many throughout the present century 
 but has been associated with the name of Langenbeck 
 since the year 1839. 
 
 However, before the processes of fermentation and 
 putrefaction could be thoroughly understood the micro- 
 scope had to be invented and brought to some degree of 
 perfection. Leeuwenhoeck, in 1680, found yeast to be 
 a mass of globules but he had not the slightest con- 
 ception of the fact that they were living organisms; 
 this fact it remained for Caignard de la Tour to eluci- 
 date in 1836, which was the first step toward the estab- 
 lishment of the rudimentary tenets of what was to de- 
 velop into the germ theory of disease. In the year 
 1836 Caignard de la Tour determined that the yeast 
 plant (Torula cerevisisB or Saccharomyces cerevisisB) 
 was a microscopic vegetable cell which, through in- 
 crease in the number of cells, broke up sugar into 
 alcohol and carbon di oxid. With the death of the 
 yeast cell or when, through any cause, it could increase 
 no longer fermentation ceased. 
 
 In this same year Schulze proved that putrefaction 
 was not due to oxygen. Gay Lussac had held that 
 putrefaction did not take place in hermetically sealed 
 vessels because the oxygen was excluded therefrom. 
 This objection Franz Schulze met by admitting air 
 which had been drawn through strong sulphuric acid to 
 
29 
 
 boiled putreecible liquids; in which case putrefaction 
 did not supervene, thus confuting Gay- Lussac's doctrine 
 utterly. This was confirmed by Schwann (1839), Ure 
 (1840) and Helmholtz (1843). 
 
 In the same year in which Caignard de la Tour made 
 his discovery and Schulze confuted Gay-Lussac's doc- 
 trine, Donne (1836) noticed micro-organisms in pus and 
 also in chancrous pus — the latter different from the 
 former and causing its virulence. In the following year 
 Beauperthuis and Adet de Roseville noticed the latter 
 organisms and declared them to be the cause of putre- 
 faction, in the next year (1838). 
 
 In 183*7 Schwann of Berlin published the results of a 
 remarkable series of experiments in the phenomena of 
 putrefaction, proving them due to organisms and not to 
 the oxygen of the air. His experiments proved that 
 meat and other albumenoids became decomposed by the 
 germs resident in the atmosphere; he clearly estab- 
 lished the connection between putrefaction and micro- 
 scopic life, but thirty years elapsed before Lister ex- 
 tended to wounds and living flesh the results of the 
 researches of Schwann upon dead flesh and animal in- 
 fusions. Prior to Lister himself the possibility of some 
 such extension of the principles had occurred to other 
 minds, such as Beauperthuis and Adet de Roseville. 
 Penetrative, thoughtful minds had appreciated the fact 
 that the germs which could cause putrefaction of meat 
 and dead flesh might also act with fatal effect upon the 
 living flesh in the hospital or sick room. Although the 
 views of Caignard de la Tour, Schwann and Schulze 
 
30 
 
 were tested and confirmed by many learned investi- 
 gators, such as Ure and Helmholtz, they did not receive 
 the attention due them, they obtained no general recog- 
 nition but remained the property of a few skilled ex- 
 perimenters. It was admitted that the fermentation of 
 sugar was due to the torulae but it was not admitted 
 that putrefaction was due to precisely analogous agen- 
 cies, yet the two processes present more than merely 
 striking parallels. 
 
 In 1841 Dujardin, who had devoted considerable at- 
 tention to the subject, classed bacteria among the infu- 
 soria. In 1843 Helmholtz confirmed the doctrines of 
 Schwann and Schulze. 
 
 In 1849 Pollender declared that he had observed 
 organisms in the blood of animals that had died of 
 splenic fever (anthrax). 
 
 In 1850 two distinguished French observers, M. 
 Davainne and M. Rayer, noticed small organisms like 
 transparent rods in the blood of animals dying with 
 splenic fever. They, at that time, however, attached 
 no especial importance to the discovery of this fact. 
 Eleven years later Pasteur published his masterly 
 memoir on the fermt^ntation of butyric acid and de- 
 scribed the organism which provoked and caused such 
 fermentation; after reading this memoir Davainne came 
 to the conclusion that splenic fever might also be 
 caused by a fermentation or putrefaction set up and 
 provoked by the germs which he and Rayer had ob- 
 served in 1850. This idea has been placed beyond the 
 pale of a peradventure by subsequent researches. 
 
31 
 
 Up to the year 1850 the existence of micro-organisms 
 had been confirmed by the investigations of many 
 scientists, but the spores or germinal elements of the 
 microbean cells were first observed by Perty in 1852 
 and by Robin in 1853. 
 
 In the year 1854 a very simple but important dis- 
 covery was made by Schroeder aud Von Dusch; this 
 was the discovery of the fact that a plug of cotton wool 
 or raw cotton placed in the mouth of test tubes would 
 preserve even nutrient media contained therein from 
 infection and consequent putrefaction. Simple as this 
 discovery was, it has been of great service in practical 
 and laboratory work in bacteriology. 
 
 In 1856 Panum demonstrated that inflammation of 
 the intestinal tract of animals poisoned by decomposing 
 matter was due to a chemical substance which was not 
 destroyed by heat. This was probably one of the first 
 observations of any value made as to the detrimental 
 action of the products of germ excrementition or elabo- 
 ration. Somewhat later Schmiedeberg and Bergmann 
 isolated from fecal matter a crystalline substace which 
 they called sepsin. They determined that when this 
 substance was introduced into bodies it caused symp- 
 toms which were peculiarly analogous to those of the 
 condition known as septicemia. As interesting and im- 
 portant as were these observations of Panum, Schmiede- 
 berg and Bergmann they were practically devoid of any 
 influence whatever upon current medical practice. 
 
 In the period from 1857 to 1861 Polli of Milan made 
 extensive observations upon the power of sulphurous 
 
32 
 
 acid and the sulphites in arresting fermentative and 
 putrefactive processes. As a result of his numerous 
 experiments and observations he initiated and formu- 
 lated a plan for their use and administration in certain 
 diseases which he thought caused by such conditions, 
 that is, in zymotic diseases. In this same period 
 Calvert had demonstrated that carbolic or phenic acid, 
 which was always present in coal tar, was a powerful 
 disinfectant and that it had been used in Manchester in 
 1867 for the preservation of dead bodies. 
 
 In 1859 M.Davainne attempted a new classification of 
 micro-organisms, placing them in the vegetable kingdom. 
 
 In 1860 Pasteur demonstrated that a temperature of 
 110°-112°C. (the boiling point of water being 100°C.) 
 was sufficient to completely sterilize. In the next year 
 (1861) he published his memoir upon butyric fermenta- 
 tion and the organism provoking it — it was this essay 
 that convinced Davainne (1863) that the organisms 
 which, in 1850, he and Rayer had observed in the 
 blood of animals infected with splenic fever (anthrax) 
 were the cause of the disease and he so announced his 
 belief. 
 
 Since the time of the discovery of the yeast plant by 
 Caignard de la Tour the question of the origin of such 
 organisms had been one which had given rise to conti- 
 nuous discussion and investigation on the part of a few. 
 In 1862 Pasteur published a memoir in the Annales de 
 Chimie which marked the inauguration of a new epoch; 
 to the continuation of the investigations therein first set 
 forth he has devoted the whole of the remainder of his 
 
33 
 
 life. His solutions of the secrets of vinous, ace- 
 tic and butyric fermentations unlocked the secrets of 
 putrefactive fermentation — a discovery whose inesti- 
 mable value we can only duly appreciate when we con- 
 sider the woes which these wafted particles of micro- 
 scopic life have caused in ages both historic and pre- 
 historic. Compared with this record the mortalities of 
 the world's battlefields pale into insignificance itself. 
 
 In this same year (1862) Dr. William Budd drew up 
 a series of suggestions for the investigation of epidemic 
 and epizootic diseases. To this he adds: "What we 
 most want to know in regard to this whole group of 
 diseases is where, and how, the specific poisons which 
 cause them breed and multiply,'*^ There cannot be the 
 slightest doubt, after perusal of this passage, that Dr. 
 Budd had what might be considered — even at this day 
 — a good modern conception of the subject, for his 
 ominous words are in no sense ambiguous. 
 
 in the next year (1863) Lemaire, stimulated by Cal- 
 vert's investigations into the antiseptic properties of 
 carbolic acid and by numerous similar facts which had 
 been laid before the Committee of the French Academy 
 studied the subject diligently. The results he embodied 
 in his memoir "De I'acide phenique," published in 1863. 
 In this essay he recognized the germ theory of disease 
 as the actual basis of antiseptic surgery and was one of 
 the first to recognize its extensive use in the treatment 
 of wounds. He extended the already existing belief in 
 the preservative properties of carbolic acid and coal tar 
 — for the Egyptians themselves used pyroligneous acid. 
 
34 
 
 creosote and analogous compounds for these very pur- 
 poses in the preparation of their mummies. 
 
 These, the first six decades of the present century, 
 mark an important era in the development and growth 
 of the belief and practice which was to pervade the 
 latter decades of the century, much to its enlightenment 
 and much to the value of the science of medicine whose 
 prophylactic functions at least are thereby greatly 
 widened. Among the many men of note in tbp period, 
 among even so many worthy investigators Pasteur, as 
 yet, stands head and shoulder above them all. Although 
 the views of de la Tour, of Schwann and of Schulze 
 were confirmed by several trustworthy investigators yet 
 they made no marked impression, remaining the 
 property solely of a few skilled investigators. It was 
 Pasteur who first conclusively convinced the scientific 
 world. Because of his precision and accuracy his ex- 
 periments remain, even to day, unimpugned and above 
 reproach. Pasteur's observations first resulted in facts 
 of value — especially from a surgical and medical stand 
 point. The practical application has saved the vine- 
 yards of France from the dreaded depredations of phyl- 
 loxera and has prevented and eradicated many parasitic 
 diseases of both plant and animal life. But most of all 
 they enabled Lister to formulate his immortal system 
 of antiseptic surgery which has saved many useful 
 lives. He first claimed that the processes of fermenta- 
 tion, decomposition, suppuration and the occurrence of 
 contagious diseases were all due to the presence of 
 micro-organisms — which principle he called contagium 
 
35 
 
 animatum. He also claimed that the processes which 
 were due to the access, proliferation and multiplication 
 of germs might be prevented by securing non-access of 
 such germs. 
 
 He was not the first nor was he the only one to ob- 
 serve the facts embodied in his contagiutn animatum. or 
 infection by an organism, for the belief in its rudiment- 
 ary state can be traced back to the year 1700 when the 
 question was warmly discussed under the subject of 
 spontaneous generation. Nevertheless his work, his in- 
 vestigations, his discoveries prepared and paved the 
 way for the deductions of Lister who himself acknowl- 
 edges his indebtedness to Pasteur and his researches. 
 
 In ]864 Spencer Wells, before the British Medical 
 Association, pointed out the fact that the recent experi- 
 ments of Pasteur had "all a very important bearing 
 upon the development of purulent inflammation and the 
 whole class of diseases most fatal in hospitals and other 
 overcrowded places." He said further: "Their in- 
 fluence (germs) on the propagation of epidemic and 
 contagious diseases has yet to be made out." Strange 
 to say, though he recognized and admitted the effect and 
 power of the organisms, he introduced no systematic 
 method of combating them or of eliminating their in- 
 jurious effects and yet in his own particular and peculiar 
 sphere of practice has antiseptic surgery been most con- 
 spicuous and complete in its triumph. 
 
 As we observe, the time is now ripe, medical theory 
 and practice is ready to receive the truths of a new and 
 doughty champion whose work prior to this time 
 
36 
 
 would doubtless have fallen upon sterile and unfruitful 
 soil. The time has come when the efforts are to be 
 crystallized, or the blossom to merge into the tangible 
 fruit. Only at this particular time would his advent 
 have been successful and at the precise moment of the 
 need of his trenchant blade Joseph Lister steps into the 
 scientific arena. 
 
 IV. — History. 
 
 From the Abvknt of Lister to the Present 
 Time. 
 
 In the fullness of time appeared the man for whose 
 coming the fates seemed to have conspired together. 
 Neither too late nor too early did he appear, but when 
 scientific discoveries had prepared the way and had made 
 the minds of men ready to receive and profit by the ob- 
 servations which he had made and the conclusions which 
 he had drawn from his observations. That the seed fell 
 on good soil and flourished the splendid achievements of 
 modern medicine, surgery and obstetrics fully attest. 
 What medical science would have been without these 
 grand generalizations and their subsequent results is 
 shown by the condition in the era immediately preced- 
 ing their enunciation and demonstration. To-day the 
 
HOSPITAL IN THE FRENCH THEATRE. 
 
38 
 
 microorganisms should not irritate the wound at all, or, 
 at best, very little." 
 
 Lister's system of treatment consisted essentially in 
 the exclusion of such micro-organisms as might possibly 
 by their presence induce fermentative changes; or if, in 
 spite of such precaution?, such have gained access, to 
 remove, or destroy them or at least render them innocu 
 ous. Such ends, he said, were to be attained by the use 
 of certain germicidal substances. In this way pyemia, 
 septicemia and erysipelas, once the scourges of surgical 
 hospitals have, within a short period, become diseases of 
 rarer occurrence than formerly. His favorite antiseptic 
 was carbolic acid dissolved in various menstrua or im- 
 pregnated in gauze, cotton wool or other surgical dress- 
 ings. He claimed that if the treatment was thoroughly 
 carried out the result would be no pain, no fever, no ptis, 
 no bacteria, no putrid smell, no septic infection and 
 progress uninterrupted by any septic process. His claims 
 in this respect seem to be almost fully borne out by the 
 results achieved, for many operations are now safely 
 and fearlessly performed which were formerly very for- 
 midable and fraught with considerable danger; such 
 were the operations upon joints, bones, the peiitoneum 
 and other serous membranes. Then too in laany cases 
 where amputation was formerly and correctly (under the 
 circumstances) deemed absolutely necessary the limb 
 has been saved by the U8e of antiseptic methods; before 
 the introduction of antiseptic methods the mortality fol- 
 lowing major operations was very high — in the period of 
 1864-1866 statistics place it at forty-five per cent (45%). 
 
39 
 
 In the period immediately following the introduction of 
 the antiseptic method (still in its infancy, still crude and 
 undeveloped) the rate dropped marvelously to the low 
 figure of fifteen per cent (15^) — which meant that 
 thirty more lives out of every hundred were saved by 
 this method that would have been sacrificed by the use 
 of the methods in vogue in surgery before the introduc- 
 tion of the antiseptic method. In the period of 1871- 
 1877, after Lister had somewhat modified his method, 
 the rate dropped to twelve per cent (12%)! This was 
 one of the greatest triumphs which modern medicine 
 has ever witnessed, — indeed its effect should not for a 
 moment be underestimated. Volkmann, the renowned 
 surgeon of Halle, was about to close his wards on ac 
 count of the prevalence and virulence of pyemia and 
 septicemia; as a last resort he tried the methods of Lister 
 and in the next five years the total mortality did not ex- 
 ceed six per cent (6%)! 
 
 That surgical "dirt" was fatal to success if not life 
 itself in surgical operations had been noticed long be- 
 fore Lister's time, but few know the reason why. It 
 was at this point that Lister sprang full panoplied into 
 the scientific arena, coming forward with a theory or a 
 scientific principle rather, which rendered it all very 
 plain and rational. This surgical "dirt" then was fatal 
 of infectious not because it was "dirt" but because it con- 
 tained, as Schwann first proved, living germs which 
 were themselves the direct causes of putrefaction and 
 decomposition. In the year 1837 Schwann clearly dem- 
 onstrated and established the connection between putre- 
 
40 
 
 faction and microscopic life, that one followed from the 
 other, that they were coincident and coexistent. But 
 thirty years elapsed before Ligter extended to wounds 
 and living flesh the results of the researches of Schwann 
 upon dead flesh and animal infusions. Prior to Lister 
 himself the possibility of some such extension of prin- 
 ciples had occurred to others — indeed Hueter had dis- 
 tinctly said twenty-five years before "no germ, no pus." 
 Lister discovered no great scientific fact, yet he more 
 than any one man created antiseptic medicine. To him 
 pre-eminently belongs the honor and glory of extending 
 the generalization of Schwann from dead to living mat- 
 ter; but by this apparently simple step he at once re- 
 volutionized the whole art and practice of surgery — in- 
 deed, now it became in truth a science. It was he too 
 who first formulated a systematic method by means of 
 which to fight these microscopic enemies of life and 
 health. But his researches dealt with and applied to 
 decomposition and putrefaction and conditions depen- 
 dent upon them. It remained for Koch to further ex- ' 
 tend the generalizations, it remained for Koch to dis- 
 cover the existence of specific pathogenic germs, that 
 each one of the infectious or zymotic diseases was 
 caused by its own and peculiar germ. It was sufficient 
 glory for Lister to have laid the foundation and he was 
 magnanimous enough to acknowledge the aid which he 
 had received from Pasteur in this great work (See Etudes 
 sur la JBiere — Pasteur, page 43) — indeed he expressly 
 thanks Pasteur for having given to him the only prin- 
 ciple which could have conducted the antiseptic systme 
 
41 
 
 ot treatment to a successful issue. To these three — Lister, 
 Pasteur and Koch — the founders of the triumphs of 
 modern medicine, be all the glory. 
 
 In the y^ar 1870 Lister presented to the medical 
 world his method of surgical dressing; this is now dis- 
 carded even by himself, but the principles upon which 
 it was based remain true to this day. 
 
 In the year 1873 Obermeier announced his discovery 
 of the specific germ of relapsing fever. This the dis 
 coverer named, after himself, the "Spirochete Ober- 
 meieri." 
 
 In 1876 Cohn and Koch devoted considerable time to 
 an investigation of spores — the peculiar reproductive 
 bodies of some forms of germ life. Until this time 
 comparatively little attention had been paid to them, 
 through ignorance of their importance. 
 
 In the next year Koch announced his discovery of the 
 fact that the terrible disease anthrax was due to a pecu 
 lier and specific germ which he had succeeded in isolat- 
 ing. In this same year Weigert introduced his method 
 of staining germs in order to make them plainly visible 
 in the microscopic field and thus to facilitate observa- 
 tion of their habits, peculiarities, etc. 
 
 In the year 1878 Koch, who was becoming exceeding- 
 ly prominent in the field of bacteriology, published his 
 important work on traumatic infectious diseases. 
 
 In the next year Hansen announced his discovery of 
 the specific bacillus of leprous tubercles. In the same 
 year Neisser discovered the gonococcus, supposed to be 
 the specific cause of gonorrhea. 
 
42 
 
 In 1880 Laveran successfully demonstrated the rela- 
 tion of the "Plasmodium malarise" to the etiology of 
 malarial disease. In this same year E berth and Koch 
 made their discoveries of the specific germ which caused 
 typhoid fever. Sternberg and Pasteur also made im- 
 portant researches into the nature and origin of pneu- 
 monia and discovered its diplococcug. But the most 
 important work and discovery of the year was Koch's 
 announcement of his experiments and belief in the effi- 
 cacy of protective inoculations of attenuated cultures of 
 germs. Thus he points a way for the medicine of the 
 fnture. Indeed the important work of the past few 
 years has been mainly in this direction — its legitimate 
 outcome was the tuberculin of Koch, the anti-cholerine 
 of Klebs, etc. 
 
 In the next year Koch called attention to what he con- 
 sidered the greater potency of mercuric chloride as an 
 antiseptic; this he recommended in the strength of 1:1,- 
 000. In the same year he made important researches on 
 the resistive powers of anthrax spores to heat. He also 
 introduced the use of solid culture media and the plate 
 method for pure cultures. 
 
 In 1882 Schutz and Loffler announced their discovery 
 of the bacillus of glanders and Pasteur issued his first 
 communication on the subject of rabies — a field of work 
 in which he has so justly become famous. But the 
 greatest work of all was to come in the demonstration 
 of the cause of tuberculosis. This was accomplished by 
 Robert Koch. In the month of March, 1882, he read a 
 paper on the subject before the Berlin Congress; so 
 
43 
 
 complete and thorough was his work and so convincing 
 were his conclusions and proofs that no one left that 
 hall unconvinced that the true cause of that dread dis- 
 ease which carries off more than war and famine com- 
 bined had at last been discovered. This did not neces- 
 sarily mean its cure, but it was a vast stride in that 
 direction. And this work he achieved in the face of 
 what were thought to be insurmountable obstacles. 
 
 In the next year the BritisTi Government, recognizing 
 the service which Lister had rendered humanity, 
 knighted himj bestowing upon him the title of Baronet. 
 
 In 1884 Gaffky made important researches upon the 
 bacillus of typhoid fever. In this same year Nicolaier 
 discovered the bacillus of tetanus, Loffler the bacillus of 
 diphtheria and Koch the cholera spirillum or "comma 
 bacillus." In the next half-dozen years comparatively 
 little was accomplished. 
 
 In 1890 Baumgarten made a new classification of 
 micro-organisms. 
 
 In 1892 Pfeiffer and Canon independently discovered 
 the specific germ of influenza, the bacillus inflaenzsB. 
 
 In 1893 Sir Joseph Lister, after twenty years of ex- 
 periment and research renewed his allegiance to carbolic 
 acid as the antiseptic par excellence. He announced 
 that carbolic acid is not only a more efficient germicide 
 than corrosive sublimate (that is, mercuric chloride 
 which had previously been the favorite antiseptic, des- 
 pite its poisonous nature in even comparatively small 
 amounts) but that it is much more efficient in cleansing 
 the skin. Also that it has a powerful affinity for the 
 
44 
 
 epidermis, penetrating deeply into its substance and 
 mingling with fatty matters in any proportion. Whereas 
 corrosive sublimate cannot penetrate greasy substances 
 in the slightest degree, hence when used it requires 
 elaborate preparation of the field of operation in the 
 way of scrubbing and cleansing the skin. In accordance 
 with these the latest conclusions of the pioneer in the 
 field of antiseptic surgery, American enterpise has met 
 the emergency by putting into the surgeon's armentarium 
 a new antiseptic composed of carbolic acid and boracic 
 acid; this product has been very fittingly named Senn- 
 ine after one who has done so much for American sur 
 gery. 
 
 As Dr. Pepper recently said in his presidential ad- 
 dress to the Pan-American Medical Congress: **Every 
 one now knows, or ought to know^ that disease is due in 
 a vast majority of instances to micro-organisms which 
 live, flourish and die subject to certain and peculiar 
 laws." So that it almost seems like folly in these clos- 
 ing years of the nineteenth century to insist upon the 
 truth of the germ theory of disease; it is a part of the 
 history of the medical progress of the century and there 
 are, indeed, none so blind as those who will not see. 
 
 Research has undoubtedly established and demon- 
 strated a distinct and direct relation between certain 
 forms of infectious diseases and their specific micro- 
 organisms. All authorities and investigators agree that, 
 whether these organisms are the virtual causes or but 
 concomitants, the processes and phenomena attendant 
 upon their invasion, development and decay within the 
 
45 
 
 tissues give rise to the elaboration of substances as 
 deadly as the most toxic of drugs. These substances, 
 called ptomaines, leucomaines, etc., are chiefly the re- 
 sult of the processes of excrementition and elimination 
 which are naturally coincident with the life history of 
 the germ and unless neutralized, destroyed or eliminated 
 in some manner are as fatal to life or health as the most 
 powerful of toxic agents. It is now definitely known 
 that the alarming symptoms of many of the infectious 
 diseases are due more to the presence of these products 
 rather than to the presence of the germ per se. As in 
 tetanus, the germ may be localized in its action but its 
 excrementitious products, may be absorbed and carried 
 through the avenues of the vessels to all parts of the 
 system and thus from many points of attack completely 
 overwhelm it. 
 
 But the presence of germs is not necessarily destruc- 
 tive to the life of the human organism. In health the 
 pathogenic germ does not find sustenance and can not 
 thrive in the normal and healthy secretions of the body 
 and when such germs invade the system they are des- 
 troyed by certain of the white blood corpuscles by 
 means of the process of phagocytosis. But when the 
 organism becomes debilitated and disordered the omni- 
 present germs find sustenance in its depraved secretions 
 and thrive and multiply there until they completely 
 overwhelm and destroy it. When health, the great and 
 universal antiseptic, is impaired in its virtues then 
 Nature must of necessity lean and depend upon Art. 
 
46 
 
 -Thb Products of Vital Cellular and 
 Bacterial Activity. 
 
 The time has long past when the doctrine of the 
 micro- organic origin of disease and infection was forced 
 to contest its claims to recognition and acceptance. It 
 stands to-day in the position of a demonstrated and 
 generally accepted fact. Indeed the purely deductive 
 argument advanced as to the causation of infectious dis- 
 eases by living organisms has been staunchly supported 
 during the past twenty-five years by a mass of reliable 
 observations and experiments which render the doctrine 
 no longer an hypothesis, or a theory, but a clearly de- 
 monstrated and established fact. Upon such a strong 
 foundation of fact the argument by analogy possesses 
 added force in support of the micro-organic origin of 
 those infectious diseases in which the specific organisms 
 have not as yet been either discovered or isolated. The 
 proof becomes complete and absolute when three con- 
 ditions are fulfilled; these are first, the demonstration 
 of the constant presence of a special or specific germ in 
 association with the lesions and symptoms of the dis- 
 ease; second, the isolation and cultivation of this specific 
 organism by means of a series of pure cultures; third, 
 the production or generation of the disease in an organ- 
 ism free from it by means of the inoculation of the 
 organism so isolated. The presence of all three condi- 
 tions is sufficient proof, indeed most convincing proof. 
 
47 
 
 Not only has the micro-organic origin of putrefaction 
 and fermentation been settled beyond any possible 
 shadow of donbt bat the same principles have been 
 more widely applied in their relations to the cause of 
 disease in general. For this generalization and exten- 
 sion of principles we are indebted to the illastrious 
 Koch. To Schwann we are indebted for the demonstra- 
 tion of the dependence of putrefaction in dead flesh up- 
 on micro organisms; to Pasteur and to Lister for the 
 extension of these principles to living flesh; but to Koch 
 for the extension of the principle to the specific causes 
 of various infectious diseases. 
 
 All living cellsy whether of animal or vegetable 
 origin, while in the conditions of active growth and de- 
 velopment appropriate for their nutrition, by processes 
 of selection it may be, certain desirable elements from 
 among those which constitute the food with which they 
 are supplied. At the same time they also excrete vari- 
 ous substances which, in some cases at least, it may be 
 their special and peculiar function ty produce. In the 
 case of members of the higher orders of the animal and 
 vegetable kingdoms these functions of secretion and ex- 
 cretion may be delegated to special cells whose peculiar 
 function may be the elimination of substances injurious 
 to the economy or to the secretion of substances neces- 
 sary its existence. For example, among the higher ani- 
 mals we have the special function of the excretion of 
 urea delegated to the epithelial structure of the kidneys, 
 while to the mucous membrane of the stomach with its 
 gastric glands are delegated cbe functions of gastric 
 
48 
 
 secretion so necessary to the material existence of the 
 organism. The functions of which these are a type may 
 be found in a simpler and possibly more modified de- 
 gree in even the lower members of both kingdoms, all 
 of which functions seem to serve, either directly or in- 
 directly, the promotion and preservation of the health 
 of the organism. Even the deadly ptomaines, so preju- 
 dicial to the health and life of the unwilling host of the 
 pathogenic bacteria, subserve the interest of the germ 
 by paralyzing the vitality and resistive power of the 
 organism upon which, and at the expense of which, it 
 thrives. 
 
 It was generally believed, until quite recently, that 
 air and its contained oxygen were absolutely necessary 
 to all forms of animal life. The life of a more or less 
 complex organism is necessarily the sum total of the 
 lives of its various component parts which are, in the 
 main, animal cells. Gautier has successfully proven 
 that at least one -fifth of these are anaerobic; that is, the 
 generation of the vital force is not in these special 
 forms dependent upon the presence of air. But whether 
 dependent or not all cells excrete cetain products which 
 must of necessity be expelled from the organism or else 
 its vitality must succumb. Were the carbon di-oxid, 
 the urea, the water or even the heat generated in the 
 vital processes of the human organism allowed to accu- 
 mulate either one could and would eventually destroy 
 the very vitality which brought it into existence. 
 
 Indeed the products of vital activity on the part of 
 the germ or cell are exceedingly numerous and varied. 
 
49 
 
 A considerable number of species possess the peculiar 
 power of forming certain pigments of various shades 
 and colors which may run the whole chromatic gamut 
 of the solar spectrum from the violet on the one side to 
 the red on the other. This fact is made use of in the 
 classification and nomenclature of certain micro- 
 organisms. Again, certain species have the power, 
 when placed in a culture medium of gelatin, of 
 liquefying the gelatine in their immediate vicini- 
 ty; while others may thrive and multiply abundantly in 
 the same medium without the production of such 
 phenomena. Indeed this fact, as was first shown by 
 Koch, is an important one in the differentiation of many 
 species resembling each other in many respects. More 
 over certain bacteria have the property of causing the 
 development of an acid reaction in the media in which 
 they are cultivated. This power may well be shown by 
 adding litmus infusion to neutral or alkaline culture 
 media. The change in color from blue to red, due to 
 the formation of an acid, may be followed macroscopic 
 ally by the naked eye. Among the acids which may be 
 so produced are formic, acetic, butyric, propionic, valeric 
 and many others of the group of so called ^'fatty acids," 
 as well as others. Then also the putrefactive decompo 
 sition of proteid bodies may be effected by a great va- 
 riety of micro-organisms, giving rise to as great a 
 variety of products, some of which are gaseous, ephem- 
 eral and exceedingly malodorous. Of course such pro- 
 ducts of putrefaction vary with the nature and compo- 
 sition of the body decomposed, the conditions by which 
 
50 
 
 it is surrounded and by the micro organisms present 
 affecting such decomposition. 
 
 But probably the most important of all the substances 
 resulting from germ life which can engage our consi 
 deration are those which have been variously termed 
 ptomaines, leucomaines, toxines, toxalbumins, animal 
 alkaloids, putrefactive alkaloids, bacterial proteids, etc. 
 The fact must have been known even to primitive man 
 that the ingestion of putrid flesh was liable to affect 
 the health to an extent more or less serious in nature. 
 Consequently he must then have made some attempts at 
 preservation, however crude; these may or may not 
 have been successful, in the latter case giving rise to an 
 increase in and multiplication of cases of poisoning 
 from putrefactive products. These facts must have re- 
 solved themselves into questions of prime importance 
 very early in the history of the race, for coeval with our 
 first periods of history we find definite records which 
 show that man was, even at that remote time, busily 
 engaged in his serious battle against the ravages of 
 time, decomposition and decay. Though the facts them- 
 selves were known and the causes but dimly dreamed, 
 no attention was paid to the consideration of the 
 products of decay themselves until the eighteenth cen- 
 tury. Since then chemists have at various times isolated 
 from putrefactive products, or from cultures of the bac 
 teria concerned in putrefaction, or from certain other 
 pathogenic species, various nitrogenous substances re- 
 sulting from the action of bacteria upon organic sub- 
 stances; these were basic m character and strongly re- 
 
51 
 
 sembled in nature and in chemical constitution, as well 
 as physiological action, the so-called vegetable alka- 
 loids — indeed they have been variously termed animal 
 and putrefactive alkaloids. 
 
 It is hardly possible even in the present advanced 
 status of science to closely follow up all of the various 
 chemical changes which complex histologic molecules 
 may undergo, yet it is hardly sufficient to say that a 
 ptomaine is the alkaloidal waste product of the cell. It 
 is in reality something more than this, representing as 
 it does the result of a series of cyclical changes which 
 in themselves represent the tremendous cellular activ- 
 ity by means of which they were engendered. However 
 the essential idea is that of putrefactive change; while 
 leucomaines are supposed to be those vital and essential 
 and analogous alkaloids which are formed in the living 
 organism and prior to its death. Some of these sub- 
 stances are non-toxic while others, graphically termed 
 toxines by Brieger, are extremely poisonous, even in 
 minute doses. While some of them may be non-toxic 
 however, yet their continual retention, accumulation and 
 consequent absorption may result in serious harm, al 
 though not the direct result of active toxicity. Indeed 
 the products of life are largely excrementitious in char- 
 acter and cannot be retained within the organism for 
 any appreciable length of time with impunity. Nor- 
 mally they undergo destruction or excretion by those 
 ordinary physiological processes which are, in perfect 
 health, in constant operation. If from any cause these 
 processes are interrupted, whether that cause be emo- 
 
52 
 
 tional or physical, defective absorption, oxidation or 
 excretion results and the blood becomes charged with 
 abnormal products; these are carried to the centres of 
 life and function and the result is the institution of one 
 or more of the various protean forms of disorder. 
 With each and every micro organism the function of 
 excretion is obligatory — indeed it is but a link in the 
 completed chain of vital activity. Ptomaines and leu- 
 comaines are the result, the first in the dead body and 
 the second in the living body; they are residual 
 products just as much as the carbon dioxid and urea of 
 the human organism. When these residual products of 
 micro-organic life are once generated within the system 
 the tissues seem incapable of selection, making no dis- 
 tinction either as to origin or intended destination. 
 
 The term ptomaine (a cadaver or that which has 
 fallen) was first suggested by the Italian toxicologist 
 Selmi as a suitable name for certain cadaveric alkaloids 
 which he had isolated. Although the effect of the in- 
 gestion of putrid matter upon man and the lower ani- 
 mals must have been observed ages ago, yet Albert von 
 Haller, the distinguished physiologist, seems to have 
 been the first person to institute systematic and scien 
 tific experiments with a view to a more exact knowl- 
 edge of the phenomena involved. He injected aqueous 
 extracts of putrid matter into the veins of animals and 
 found that death followed. Later in the eighteenth 
 century Morand gave an account of symptoms induced 
 by the eating of poisonous meat. Very little other re- 
 search was indulged in until the present century. Gas- 
 
53 
 
 pard (1806 — 1813) carried on experiments similar to 
 those of Haller and Morand; he produced nervous dis- 
 turbances, stiffness of the limbs, opisthotonos and teta- 
 nus. He thought the untoward symptoms were not 
 due to carbon di oxid or hydrogen sulphid, as had 
 been suggested, but admitted the possibility that am- 
 monia might play some part in the production of such 
 symptoms. When we remember that most of the 
 ptomaines are either amines or analogous compounds 
 and that the first determination of their exact chemical 
 nature was made by Nencki in 1876 we can hardly re- 
 strain our admiration of the accuracy of this surmise of 
 Gaspard which anticipated in a measure the results re- 
 vealed by chemical science sixty -five years later. Ker- 
 ner (1820) published his first essay upon poisonous 
 sausage, followed by a second in 1822. He at first 
 thought the poisonous principle to be due to the pres- 
 ence of a fatty acid (which he termed caseic acid) gene- 
 rated in the putrefactive process; later he thought it 
 was a compound resulting from the union of the fatty 
 acid and a volatile principle. Thus Gaspard and 
 Kerner clearly hint at the basic character of the poison- 
 ous principle of decomposition. Dupre (1822) observed 
 and reported the existence of a peculiar diseese which 
 existed among the soldiers of a garrison compelled to 
 drink very foul water during a warm and dry summer. 
 Magendie, Leuret, Dupuy and Trousseau carried on 
 investigations but contributed comparatively little to 
 the knowledge of the subject, Dann, Weiss, Buechner, 
 Schumann, Cadet de Gassicourt and Orfila all devoted 
 
54 
 
 considerable study to the active principle of poisonous 
 sausage but made no advance upon Kerner's original 
 work. Henneman, Huennefeld, Westrumb and Ser- 
 tuerner investigated the principle of poisonous cheese; 
 this however they believed to be the caseic acid of 
 Kerner. Schmidt of Dorpat (1850) made researches 
 into the nature of the decomposition products and vola- 
 tile substances found in cholera stools. Meyer (1852) 
 studied the effects produced by the injection of the 
 blood and stools of cholera patients into the lower ani- 
 mals. Stich (1863) discovered that putrid matter in 
 sufficient quantities produced intestinal catarrh and 
 choleraic stools when ingested. These were accom- 
 panied by nervous tremblings and other symptoms 
 together with an unsteady gait, but produced no lesions. 
 He concluded from these results that putrid matter 
 must contain a ferment capable of producing rapid de- 
 composition of the blood. 
 
 Panum (1856) made a most important contribution to 
 the subject. He demonstrated positively the chemical 
 nature of the posionous principle of putrefaction and 
 showed that the aqueous extract of putrid material re- 
 tained its poisonous properties even after heating and 
 such treatment as would insure the destruction of organ- 
 isms if present. The results thus obtained were con- 
 firmed in the next ten years by Weber, Hemmer and 
 Sch Wenninger. Bence Jones and Dupre (1866) obtained 
 a similar body from liver. Bergmann and Schmiede- 
 berg (1868) separated a poisonous substance, which they 
 called sepsine, from putrid yeast and decomposing 
 
55 
 
 blood. Even when administered in small doses this 
 substance produced vomiting and profuse bloody diar- 
 rhea in dogs and, in suflScient doses, death. Zuelzer and 
 Sonnenschein (1869) prepared a nitrogenous base from 
 decomposing meat. In its chemical reactions and phys- 
 iological behavior it strongly resembled atropin and 
 hyoscyamin; it was also found in the bodies of those 
 dead from typhoid fever and it was thought possible 
 that the belladdonna like delirium of the latter stages of 
 the disease might be caused by an ante-mortem genera- 
 tion of the poison within the body. Though many ef- 
 forts had been made to isolate as well as to produce 
 these peculiar substances such isolation was first suc- 
 cessfully accomplished by Francesco Selrai (ISYS-ISYB). 
 He made extensive and valuable researches, it is true, 
 but remained in ignorance of the chemical constitution 
 and composition of the bodies which he had isolated. 
 Indeed Nencki (1876) made the first ultimate chemical 
 analysis and determined the first chemical formula for 
 a ptomaine; this was an isomer of collodine. Roersch 
 and Fassbender obtained in a case of suspected poison- 
 ing a liquid which could be extracted by ether from 
 either acid or alkaline solutions; it gave all of the char- 
 acteristic alkaloidal reactions, resembling digitalin in 
 particular. Gunning found the same alkaloid in liver- 
 sausage, from which poisoning had occurred. From 
 human bodies which had been dead for several months 
 Selmi removed many alkaloidal bases; one was found 
 to be a very violent poison, producing in rabbits 
 tetanus, marked dilatation of the pupils, paralysis and 
 
56 
 
 death. Lombroso (1871) showed that the extract from 
 mouldy corn meal produced tetanic convulsions in ani- 
 mals. These investigations threw some light upon the 
 causes of sporadic cases of illness among the peasants 
 of Lombardy who eat fermenting and mouldy corn meal. 
 In 1S16 Brugnatelli and Zenoni obtained an alkaloidal 
 substance from this mouldy meal. Guaresohi and 
 Mosso obtained various volatile and non-volatile bases 
 from decomposing human brains. Brieger of Berlin 
 isolated and determined the composition of a number of 
 ptomaines and in 1885 published a valuable work upon 
 the subject. From pure cultures of the typhoid bacillus 
 of E berth and Koch he obtained a poison (typhotoxine) 
 and from similar cultures of the tetanus germ of Rosen- 
 bach he produced a similar body (tetanine). Brieger 
 calls special attention to the fact that most of the char- 
 acteristic ptomaines are diamines; that chemically they 
 are more simple in composition than the vegetable alka 
 loids, which they resemble, and that many of the ptoma 
 ines are derivatives of hydro-carbons of the ethylene 
 series and are in distinction from true alkaloids rep- 
 resenting the pyridine group. Vaughan, who is by far 
 the leading American authority upon the subject of pto- 
 moines, isolated in 1884-1885 an active agent (tyrotox- 
 ican) from poisonous cheese. Koch and others demon- 
 strated the presence of a poisonous substance in cultures 
 of the cholera bacillus; Hoffa did the same in the 
 case of the anthrax bacillus. Hankin (1889) isolated a 
 toxic albumose from cultures of the anthrax bacillus 
 which proved fatal in quanties but in small doses cuf- 
 
57 
 
 forded immunity. The investigations of the past few 
 years have been mainly in the direction indicated by the 
 results of Hankin. Now the fact that a germ is patho- 
 genic is considered to be sufficient evidence of the fact 
 that it elaborates poisonous products and the study of 
 these products is justly regarded as one of the greatest 
 importance in the investigation of the germ and the 
 disease which it causes. The interest in the subject is 
 not confined alone to the study of the aetiology of dis- 
 ease but strenuous efforts are being made with a view 
 towards the securing of immunity from disease and in- 
 deed even to effect cures of disease by means of the use 
 of these self-same bacterial products. If the excreinent- 
 itious products of the human organism possess the 
 power, when retained, of ultimately destroying the life 
 or impairing the health of that organism, why should 
 not such be true also of the germ which likewise gener- 
 ates excrementitious products? Our knowledge of the 
 latter conditions is as yet in the embryonic stage, but 
 to that knowledge, crude and imperfect as it is, we owe 
 the tuberculin of Koch, the anti-cholerine of Klebs, the 
 pneumotoxine, typhotoxine, etc., which though not as 
 successful and infallible as enthusiesm had anticipated, 
 yet in spite of their crudities and imperfections, suc- 
 ceeded in making a vast and manifest stride in the 
 proper direction; when they failed they taught lessons 
 as valuable as those imparted by their successes. In this 
 direction lies the domain of the medicine of the future; 
 in this direction Science points with inexorable finger. 
 Who can predicate the successes of the future which 
 
68 
 
 lie as yet UDborn within the matrix of Eternity? 
 
 Indeed we may now regard it as conclusively proven 
 that the pathogenic power of those bacteria instrumental 
 in the development of so many and various infectious 
 diseases in man and the lower of animals is largely if 
 not entirely dependent upon their power of producing 
 toxic ptomaines or toxalbumins. They may affect the 
 organism directly or indirectly by the medium of the 
 food or ingested articles. That is, the toxic substances 
 maybe produced within the body by septic or other 
 processes and then after absorption give rise to systemic 
 infection. Or the products may be elaborated in such 
 articles as cheese, milk meat, etc., and the toxic pro- 
 ducts resulting from an extraneous action may upon in- 
 gestion give rise to symptoms strongly resembling in 
 their dangerous and alarming nature the characteristics 
 of acute alkaloidal poisoning. 
 
 The field of research in the direction of the therapeu 
 tic applications and value of the products of vital bac- 
 terial activity lies almost fallow. Its primitive cultiva- 
 tion has afforded such rich fruit that we are justified in 
 looking to it for an abundant harvest. When Science 
 shall have placed within the hands of the physician 
 those potent weapons which the germ itself uses with 
 such deadly effect, then shall begin such a battle with 
 disease as the world has never witnessed and then shall 
 ensue a victory which shall be not more glorious than 
 complete. 
 
QQ 
 
 H 
 
 GC 
 
 O 
 O 
 
 M 
 
 H 
 D 
 
 ;^ 
 << 
 
 H 
 
 O 
 P^ 
 H 
 pq 
 
 QQ 
 
 H 
 ;^ 
 
 H 
 
 PL4 
 
 H 
 
 M 
 
 H 
 
59 
 
 VI. — Infection, Susceptibility and Immunity. 
 
 The human organism is exposed to infection of vari- 
 ous kinds at every point. The infection of open and 
 exposed wounds is, or rather was, a thing of daily oc- 
 currence; thanks however to the principles of antiseptic 
 and aseptic surgery the occurrence or formation of pus 
 at the present day is comparatively rare under proper 
 treatment and is really nothing more nor less than an 
 evidence of the ignorance or carelessness of the physi- 
 cian or surgeon in charge Schimmelbusch has definite- 
 ly proven in his experiments with the Staphylococcus 
 pyogenes aureus^ Bacillus authracis and other micro- 
 organisms that infection is undoubtedly possible through 
 the channel of the unbroken skin. Machnoff in his ex- 
 periments with the effects of the Bacillus anthracis 
 upon guinea pigs came to the same conclusion. Indeed 
 these results have been further confirmed by the results 
 obtained by Roth, Braunschweig, Ribbert and others. 
 
 Buechner instituted researches for the purpose of 
 determining the possibility of infection through the 
 channel of the intestinal mucous membrane. For this 
 purpose he used mice and guinea pigs and fed them up- 
 on anthrax spores. In four cases out of thirty- three 
 positive results were obtained, that is, the disease devel- 
 oped. This definitely proves that while infection does 
 not necessarily follow the ingestion of infected material, 
 it is nevertheless posible. Indeed it is more than ex- 
 
60 
 
 ceedingly probably that this is the usual mode of infec 
 tion in typhoid fever. 
 
 Buechner also made experiments with a view to test- 
 ing the possibility of infection by means of the mucous 
 membrane of the respiratory tract. In these experiments 
 he obtained positive results in fifty cases out of sixty six, 
 — showing that the chances of infection by the channel of 
 mucous membrane of the respiratory tract are greater 
 than in the case of the intestinal tract. The possibility 
 of infection by the former channel is substantiated by 
 the disease termed "wool sorter's disease"; heire the in- 
 fectious material set free by the handling of infected 
 wool is inspired by the sorter, instituting the peculiar 
 disease. Hildebrandt has experimentally demonstrated 
 that under ordinary circumstances the majority of bac- 
 teria suspended in the air do not reach the lungs or 
 even the trachea, but are usually deposited upon the 
 mucous membrane of the mouth, nares or fauces; but 
 that in prolonged respiration in an atmosphere so charg- 
 ed with bacteria, the micro organisms may be found 
 deposited in the lungs. This may probably explain, in 
 some degree, the relative frequency with which laryn- 
 geal or pharyngeal tuberculosis accompanies the pul- 
 monary form of the disease, especially its more virulent 
 forms. 
 
 In general however, we may say that man is most 
 frequently attacked by the infectious diseases through 
 the media of the alimentary canal, the circulatory or 
 lymphatic systems and the respiratory tract. The gas- 
 tric ]uice and the absorbent cells of the stomach and 
 
61 
 
 intestinal tract afford physiological guards against in- 
 fection by means of the alimentary canal; hence, sus- 
 ceptibility to the various infectious intestinal diseases 
 must depend, to a certain extent, upon those causes 
 which render the physiological guards defective. All 
 germs which have the power of generating toxic sub- 
 stances are dangerous when introduced into the intesti- 
 nal canal; this is dependent upon their capability of 
 producing chemical poisons which are usually proteid 
 in character and probably produce their objectionable 
 actions by virtue of some process of catalysis. When 
 the complex cellular molecules are split up, simpler ones 
 are formed ; but the chemical action implies the genera- 
 tion of a certain amount of heat and hence fever is the 
 most common and predominant manifestation. 
 
 The physiological guards against infection through 
 the channel of the blood or of the lymph lies in the germi- 
 cidal powers of the proteids of these fluids and suscepti 
 bility to infection by such channels is, to a certain ex- 
 tent, dependent upon the impoverishment of the fluids. 
 Hence the treatment of consumption and other similar 
 diseases by means of liberal diet, constitutional remedies 
 and plenty of exercise in the open air is founded upon a 
 true and proper scientific basis and is not purely empir- 
 ical in character. 
 
 It has long been known and observed that certain 
 species are specially predisposed to certain diseases 
 while other species enjoy more or less immunity to the 
 same. Thus man is especially subject to attacks of such 
 diseases as typhoid fever, relapsing fever, cholera and 
 
62 
 
 others while the lower animals do not suffer at all with 
 them. On the other hand man possesses immunity to 
 many of the infectious diseases of the lower animals. 
 Immunity to disease may also be racial in character. 
 For instance the negro is decidedly less subject to yel- 
 low fever than is the white man, but on the other hand 
 he is especially susceptible to small pox. Then again, 
 Algerian sheep are immune to anthrax, a disease which 
 is markedly fatal among other sheep Immunity may 
 also be individual in character; thus we have certain 
 diseases, of an exanthematous type especially, to which 
 adults seem more or less immune but to which children 
 possess such a marked and peculiar susceptibility that 
 such are frequently termed ^^ children! s diseases." 
 
 The most essential, indeed the essential difference 
 between a suceptible animal and an immune animal lies 
 in the fact that in the one the pathogenic germ invades 
 the tissues and multiples, producing certain changes in 
 the tissues and fluids of the animal so infected which 
 prove prejudicial to its life or health. In the immune 
 animal on the other hand even though invasion is ac- 
 complished, multiplication does not usually occur, or if 
 it does it is restricted to a circumscribed area in which 
 the invader is ultimately destroyed by the operation of 
 the natural processes. The question then resolves itself 
 into this — in what consists this difference, or upon what 
 does it depend? The question is a simple one, it is true, 
 but its solution has been fraught with much labor. 
 Upon what does this difference depend? Surely not 
 upon the germ, for that is, as it were, a common factor 
 
63 
 
 in each case, whether it be of susceptibility on the one 
 hand or immunity on the other. It must then depend 
 upon conditions of some kind surrounding the germ and 
 which are either favorable or unfavorable to its develop- 
 ment. 
 
 As early as the year 1881 Sternberg suggested that 
 the leucocytes might pick up, assimilate and dispose of 
 bacterial organisms. This suggestion was based upon 
 the observation that leucocytes did take up inorganic 
 granules, that bacteria had been found within their sub- 
 stance and also that amosbae fed upon bacteria and 
 similar organisms. 1884 Metschnikoff took the idea up 
 and elaborated it, suggesting the name of phagocytosis 
 for this so called function of leucocytes, which was based 
 upon the idea that the phagocyte actually ate up the 
 micro-organism which it took within its substance. 
 Baumgarten, Weigert and others suggested that perhaps 
 the bacteria observed within the substance of the leuco- 
 cytes may have been already dead when picked up, hav- 
 ing been destroyed outside of the white blood-corpuscle. 
 Indeed we now have the conclusive experimental evi- 
 dence of Buechner and others that blood-serum posses- 
 ses considerable germicidal power independent of its cell- 
 ular constituents. 
 
 It seems then that the cells of the animal body must 
 be concerned in the production of this condition called 
 immunity, this may be either the result of direct or in- 
 direct action; that is, either the cells may possess this 
 power or they may contain or elaborate a substance 
 vested with such powers. Immunity may be acquired 
 
64 
 
 or natural. Among the best examples of the natural 
 variety we might cite the case of the immunity of the 
 common rat, the frog, the dog and the common domestic 
 fowl to anthrax. The chick from the earliest period of 
 its existence is naturally immune to even the most vir- 
 ulent cultures of the anthrax bacillus, as has been de- 
 monstrated by Lazarus and Weyl. True it is that a 
 susceptibility may be induced artificially but this is 
 practically but a perversion of natural properties. Racial 
 immunity is supposed to be more or less due to an ac- 
 quired tolerance due to processes of natural selection 
 and inheritance. This, it is claimed bv some, results 
 naturally from an application of the law of the survival 
 of the fittest as well as that of the law of heredity. In this 
 view of the subject it is supposed that the feebler cells are 
 killed or destroyed in the struggle for existence and that 
 when recovery supervenes the body resumes its normal 
 functional activity. But now it will contain the pro- 
 geny of those cells whioh were originally strong enough 
 to resist the effect of that particular disease through 
 which it has passed. It is but natural to suppose that 
 those parent cells have transmitted their qualities to 
 to their offspring. Thus it is rather by a death of the 
 weaker and less resistive cells than by an acquisition of 
 new powers on the part of the surviving cells that im- 
 munity is afforded. The strong survive by virtue of 
 their strength and this tends to perpetuate and improve 
 the species. Certain it is that animals transmit their 
 personal peculiarities to their prcgeny^ — and what is an 
 animal but a collection of cells, the sum total of whose 
 
65 
 
 vitalities forms the vitality of the animal? If this is 
 true of a collection or aggregation of cells, may it not 
 be also true of a single cell? It is certainly plausible 
 to believe that properties already possessed by cells may 
 be transmitted to their descendants, for the transmission 
 of congenital traits seems established beyond a perad- 
 venture. Oar conclusion then must be that immunity, 
 where it exists racially, is due to inherent properties of 
 the parent cell and their natural development with that 
 of functional activity; also that these properties may be 
 transmitted to their pregeny. 
 
 The natural immunity which is peculiar to the individ- 
 ual usually becomes more prominent or active with 
 adolescence or adult life. Thus the young rat is sus- 
 ceptible to anthrax while the adult is immune and can 
 only be rendered susceptible by redu3ing, in some man- 
 ner, the vital strength or resistive power. Again, the 
 child is highly susceptible to those peculiar diseases 
 called "children's diseases," such as scarlatina, diphthe 
 ria and the acute exanthems; the adult, while not en- 
 tirely immune, possesses little susceptibility. This 
 seems to be in some way dependent upon a higher vital 
 resistive power, for the adult does not usually contract 
 the disease unless exposed to it for a long period or else 
 reduced in vitality. As Vaughan says: "The only 
 resonable explanation of this immunity is that it is in- 
 herent in the parent cell and comes as naturally as the 
 changes in form and voice at puberty or as the growth 
 of the beard in early manhood." If this be so then we 
 may reasonably conclude that immunity is, in all prob- 
 
m 
 
 ability, one of the phenomena inherent in the vital acti- 
 vity of certain cells. 
 
 Lewis and D. Cunningham, as early as 1872, showed 
 that bacteria rapidly disappear when injected into the 
 circulation. 
 
 In 1874 Traube and Gschiedlen demonstrated that 
 when arterial blood, under antiseptic precautions, was 
 taken from a rabbit, into whose jugular vein a fluid 
 rich in putrefactive* germs had been injected forty-eight 
 hours previously, it failed to undergo decomposition 
 for months. These germicidal properties they errone- 
 ously attributed to the "ozonized oxygen" of the blood. 
 
 Wyssokowicz had also noticed that bacteria rapidly 
 disappeared from the circulation when injected therein; 
 he stated that this was due to their deposition in the 
 capillaries of the tissues. 
 
 Grohmann and Schmidt experimented with extra- 
 vascular blood and found that anthrax bacilli which had 
 been kept in plasma were modified in virulence; this 
 they attributed to the process of coagulation. 
 
 Fodor (1887) combated the theory of Wyssokowicz 
 that the disappearance of bacteria from the circulation 
 was due to their deposition and retention in the capil- 
 laries. He proved that blood freshly drawn from the 
 heart possesses consiberable germicidal power; that even 
 when kept without the body, in blood in a pipette, the 
 germs rapidly diminished in number. After awhile the 
 blood seemed to lose its germicidal properties and there 
 followed an increase in the number of germs. 
 
 In the next year Nuttall demonstrated the power of 
 
67 
 
 defibrinated blood to destroy various pathogenic and 
 nonpathogenic organisms. He also confirmed Fodor's 
 conclusion that after a time blood loses its germicidal 
 properties and then becomes an excellent culture 
 medium, 
 
 Behring has shown that the blood of various animals 
 differs in the intensity of germicidal powers — thus in 
 some cases it was found to be decided in the case of 
 certain pathogenic bacteria, less so for others and abso- 
 lutely lacking in the case of certain common saprophy- 
 tes. He demonstrated that the blood of the rat and 
 frog, which possess special immunity to anthrax, is 
 especially fatal to the anthrax bacillus. While this 
 germicidal action is very prompt it is very limited and 
 when the number of germs is excessive, development 
 may follow an interval of limited destruction — thus it 
 seems that the power is ultimately neutralized or exhaust- 
 ed after its exercise for a definite period. These results 
 were somewhat similar to those of Fodor and Nuttall. 
 
 Buechner, Voit, Sittmann and Orthenberger made 
 most exhaustive researches into the germicidal proper- 
 ties of blood and (1890) made a most valuable and im- 
 portant contribution to the subject. The work of these 
 investigators is of such importance that a statement of 
 the results of their work is justifiable; they may be 
 tersely summed up as follows: 
 
 1. The germicidal action of blood is not due to 
 phagocytes, because it is not influenced by the alternate 
 freezing and thawing of the blood, by which the leuco- 
 cytes of the rabbit are destroyed. 
 
68 
 
 2. The germicidal properties of the cell-free serum 
 must be due to its soluble constituents. 
 
 3. Neither neutralization of the serum, nor the addition 
 of pepsin, nor the removal of carbon di oxide gas, nor 
 treatment with oxygen has any effect upon the germi- 
 cidal properties of the blood. 
 
 4. Dialysis of the serum against water destroys its 
 activity, while dialysis against 0.75 percent salt solution 
 does not. In the diffusate there is no germicidal sub- 
 stance. The loss by dialysis with water must be due 
 to the withdrawal of the inorganic salts of the serum. 
 
 5. The same is shown to be the case when the serum 
 is diluted with water and when it is diluted with salt 
 solution. In the former instance the germicidal action 
 is destroyed, while in the latter it is not. 
 
 6. The inorganic salts have in and of themselves no 
 germicidal action. They are active only in so far as 
 they affect the normal properties of the albuminates of 
 the serum. The germicidal properties of the serum 
 reside in its albuminous constituents. 
 
 7. The difference in the effects of the active serum 
 and that which has been heated to 55°C. is due to the 
 altered condition of the albuminate. The difference 
 may possibly be a chemical one (due to changes within 
 the molecule) or it may be due to alterations in mycelial 
 structure. The albuminous bodies act upon the bacteria 
 only when the former are in active state. 
 
 Vaughan in commenting on these results says: *'We 
 wish at this point to call attention to an inconsistency 
 between the results obtained by Buechner and the con- 
 
69 
 
 elusion that he draws. In experiment No. 45 he renders 
 the serum slightly acid and adds 0.1 gram of pepsin to 
 each live c. c. of serum (showing by a side experiment 
 that this pepsin actively digests coagulated egg albumin 
 in neutral solution) and finds that the digestive action 
 of the pepsin does not lessen the germicidal properties 
 of the serum. In fact he states this in his conclusions, 
 but his ultimate opinion, and the one held by him in 
 his latest contribution, is that the germicidal constituent 
 of the blood is the serum albumin. How much serum- 
 albumin remains in blood serum after it has been 
 thoroughly digested with pepsin? He could scarcely 
 have chosen a more positive method of demonstrating 
 that the germicidal constituent is not serum-albumin. 
 Either his pepsin was not active, (Mr. Vaughan seems 
 to forget that it was expressly stated that a control ex- 
 periment demonstrated the activity of the pepein in its 
 ability to digest coagulated egg-albumin. However, 
 this does not affect his argument or its truth in the 
 slightest degree.) and on this supposition his experiment 
 is without value, or the active constituent of blood- 
 serum is a substance that is not destroyed or materially 
 altered by peptic digestion. We know that the pep- 
 tones not only have no germicidal properties, but that 
 they belong to that class of proteids that is most favor- 
 able to the growth and development of germs. We re- 
 cognize this fact when we add peptones to the various 
 artificial media on which we cultivate germs." This 
 objection of Vaughan's certainly appears to us to be 
 well taken, nevertheless the fact remains that the results 
 
7a 
 
 announced by these observers are among the most im- 
 portant that have been made upon the subject. Indeed 
 the success with which they met induced many others 
 to enter this new field of research. The result is that 
 although much useful information as to the germicidal 
 powers of the blood under various conditions has been 
 thereby elucidated yet as far as the exact nature of that 
 germicidal constitutent is concerned but little or no 
 progress was made — if we except the comparatively re- 
 cent and masterly collaborations of Vaughan, Novy and 
 McClintock. Behring and Nissen obtained results 
 which seem to indicate that the action of blood within 
 the natural channels and that of extra-vascular blood is 
 vastly different. Pekelharing's experiments proved that 
 the disappearence of anthrax spores, enclosed within 
 parchment, when introduced beneath the skin of rabbits 
 was not due to phagocytes but to some soluble poisonous 
 substance. Halliburton separated a cell-globulin from 
 lymphatic glands; Hankin found that this substance 
 possesses marked germicidal properties. Christmas 
 also prepared a germicidal substance from the spleen 
 and other organs. 
 
 Attempts have been made also to determine the exact 
 nature of this germicidal constituent of the blood and 
 tissues by the action of precipitating reagents upon the 
 proteids of blood-serum. Buechner, Christmas, Bitter, 
 Emmerich, Tsuboi, Steinmetz, Loew and others have 
 given much attention to the subject. 
 
 Fodor and Zuntz had shown some time ago that freshly 
 drawn blood decreases rapidly in alkalinity upon stand- 
 
71 
 
 ing, just as it seems to lose in germicidal powers. In- 
 deed Behring had suggested that the action of the blood 
 of the white rat upon anthrax bacilli was due to its 
 great alkalinity. Vaughan too has suggested that the 
 blood of the adult rat, which is not susceptible to an- 
 thrax, is more alkaline than that of the young rat, which 
 is susceptible to the disease. Emmerich and his co- 
 workers demonstrated that blood-serum rendered faintly 
 acid not only has no germicidal power but furnishes a 
 good culture-medium. Behring demonstrated that the 
 white rat lost his immunity to anthrax when the acid 
 phosphate of calcium was mixed with its food in quan- 
 tities sufficient to neutralize the alkalinity of the 
 blood; Fodor also demonstrated that the resistance of 
 rabbits to anthrax was markedly increased after the 
 administration of sodium phosphate or of the alkaline 
 carbonates. In 1887 he had noticed that after awliile 
 infected blood lost its germicidal properties and became 
 an excellent culture medium. May this not have been 
 due to a loss of alkalinity, dependent upon the forma- 
 tion of acid products and subsequent neutralization of 
 the natural alkalization ? Certainly it is proven that 
 bacterial activity may generate many and various acids, 
 such as formic, acetic, butyric, propionic, lactic, etc. 
 
 Hankin, in a paper published in the past year, sug- 
 gests that the germicidal substance is a special secretion 
 of the eosinophile granular cells; according to his the- 
 ory the granular matter of these cells is the antecedent 
 of the germicidal substance. 
 
72 
 
 ' In summiDg up the evidence we may summarize as 
 follows: 
 
 1. It has been incontestably proven that blood-serum 
 contains a substance which possesses considerable 
 germicidal power. 
 
 2. Buechner has demonstrated that pepsin does not 
 affect or extract the active germicidal constituent from 
 blood serum; ergo, this active constituent cannot be 
 serum albumin, because pepsin converts it into peptone 
 which is especially favorable to the development of 
 germ life. 
 
 3. A temperature of 65°C., as Buechner and others 
 have demonstrated, destroys or impairs the germicidal 
 activity of blood-serum. It is probable then that the 
 substance is a proteid. 
 
 Vaughan adds to these a statement that the only 
 proteid likely to be present in blood-serum, and which 
 is not destroyed by peptic digestion, is nuclein. This 
 conclusion would be rendered probable if he could iso- 
 late the nucleins themselves and demonstrate that they 
 possess germicidal properties — if the residue remained 
 inert it would strongly confirm the first result. To the 
 solution of these questions Vaughan has given consider 
 able time and attention. The results which he has ob- 
 tained are exceedingly striking and hardly less than 
 convincing. Suffice it to say that he has demonstrated 
 that blood serum does contain a nuclein — he asks the in- 
 teresting question, does it come from the disintegration 
 of the pol J nuclear cells, or shall we regard certain 
 white blood corpuscles as unicellular organs whose 
 
73 ^ , 
 
 function it is to secrete this nuclein? He has demon- 
 strated by repeated experiments that this nuclein pos- 
 sesses considerable germicidal power. He has also 
 made many experiments with various nucleins extracted 
 from the testes, the thyroid gland and yeast cells and 
 proves conclusively that they likewise possess marked 
 germicidal power. Indeed it now seems that immunity 
 depends largely upon cell-nucleins, as well as upon the 
 reaction and composition of the fluids of the body, 
 upon vital resistive power and cellular activity. Wool- 
 dridge of England has also obtained results which seem 
 but to confirm those of Vaughan, to whom we owe a 
 large part of our present knowledge of the subject. 
 
 The fact that the germicidal constituent of the blood- 
 serum can be isolated and utilized has an important 
 bearing upon therapeutics, — indeed it is exceedingly 
 analogous to the advance which was made when it 
 became possible to extract the active alkaloidal prin- 
 ciples from crude drugs. Blood-serum therapy has 
 been proven impracticable not on account of a lack of 
 virtue but because of the large amount of the fluid 
 which it is necessary to inject in order to secure favor- 
 able results. The isolation and use of nuclein now 
 seems to indicate a method of avoiding this difliculty — 
 it is even hinted that the future may witness the use of 
 the various nucleins as therapeutic agents in the treat- 
 ment of disease. 
 
 But persons or animals naturally susceptible to dis- 
 ease may, by means of certain processes, secure an im- 
 munity, usually termed acquired in contradistinction to 
 
74 
 
 that which exists naturally iu some species, races or in- 
 dividuals. It has long been a well-known fact that 
 certain of the infectious diseases, such as typhoid fever, 
 yellow fever, parotitis, pertussis, etc. confer upon the 
 individual so infected a freedom from or immunity to 
 subsequent development; this immunity while general 
 is not always absolute. 
 
 Certain other infectious diseases such as epidemic in- 
 fluenza, croup, pneumonia, Asiatic cholera, etc. do not 
 confer immunity against subsequent attacks. It is ex- 
 ceedingly probable, however, that in this latter case a 
 certain degree of immunity of a limited duration is 
 afforded, because we seldom have an individual stricken 
 with these diseases twice during the same epidemic. If 
 such immunity is afforded it must be transient in nature. 
 Even that afforded by the first class of diseases is not 
 everlasting in its effects, for a man may have small-pox 
 a second time if several years have elapsed since the 
 first attack and provided also tha ^ the second exposure 
 brings him in contact with a virulent form of infection 
 or consists of an exposure through an unusually long 
 period or at a time when health and vitality are im- 
 paired by any cause. Until the discovery of Jenner the 
 only form of acquired immunity known was that ob- 
 tained or conferred by an actual attack of the disease 
 ending in recovery. We now know at the present time 
 that' immunity is also conferred by vaccination with a 
 modified form of infection; by the introduction of a 
 small number of virulent germs followed by a succes- 
 sive iqQculatioQs with larger numbers until a tolerance, 
 
75 
 
 as it were, is established; and by treatments with 
 sterilized germ-cultures. 
 
 Pasteur (1880) produced immunity by inducing a 
 mild attack by means of an injection of attenuated cul- 
 tures. He, in this way, made successful inoculations 
 against chicken-cholera and anthrax. Emmerich and 
 his pnpils succeeded in immunizing animals to swine- 
 erysipelas by employing small numbers of the virulent 
 germs and gradually increasing the dose. This is prac- 
 tically the rationale of Pasteur's method in rabies. 
 However, the immunity consequent upon inoculation 
 -with a germ full of virulence is not only more marked 
 than in the case of the use of modified or attenuated 
 cultures but is also more lasting in its effect. Ogata • 
 and Jasuhara have fully demonstrated the fact that 
 anthrax cultures in the blood of an immune animal 
 (such as the rat, dog or frog) become attenuated as far 
 as their pathogenic power is concerned. Also that in- 
 jection of these cultures, so attenuated, into the blood 
 of a susceptible animal gives rise to a mild attack fol- 
 lowed by immunity. Moreover that if even a drop of 
 blood from the dog or frog be injected into a mouse, 
 before or after the latter is inoculated with a virulent 
 culture of the anthrax bacillus, that it proves protective 
 against a fatal attack, the mild attack thus induced 
 being followed by immunity. Similar results have been 
 attained by Behring and Kitasato. 
 
 Tizzoni aud Cattani fnid that in the case of tetanus, 
 the blood-serum of an immune animal will protect 
 either against^the living germ or the germ-free culture. 
 
76 
 
 Salmon and Smith (1886) succeeded in rendering 
 pigeons immune to hogcholera by inoculations with 
 sterilized cultures of the bacilli. Roux (1888) obtained 
 similar results in the case of anthrax and Behring and 
 Kitasato in the case of tetanus and diphtheria. 
 
 Fraenkel determined that 10-20 c. c. of a three-weeks 
 old culture of diphtheria babillus, if heated to 65° or 
 70° for one hour, and then injected into a guinea-pig, 
 secures immunity against subsequent inoculations by 
 the virulent germ if such subsequent inoculations 
 are not made sooner than the fourteenth day after 
 treatment by the sterilized culture. He declares that 
 in his opinion the cultures contain two special albumin- 
 ' ous bodies, one toxic in nature and destroyed or ren- 
 dered innocuous by a temperature of 65°-70° C and the 
 other conferring immunity yet retaining its properties 
 at that temperature. 
 
 Tizzoni, Cattani, Klemperer, Ogata, Jasuhara, Kita- 
 sato, Behring, Buechner and others hold to a belief 
 that some substance is formed in the blood of the im- 
 mune animal and that this substance has the peculiar 
 power of neutralizing the toxic products of pathogenic 
 micro organisms. Some conclude that this eftect is not 
 due to ptomaines but to proteids, though the latter need 
 not necessarily be direct products of the germ against 
 which immunity is sought nor indeed even necessarily 
 of bacterial origin. Others however hold that this im- 
 munity-conferring substance partakes of the nature of 
 an antitoxin. Sternberg says on this point: "The 
 experimental evidence detailed gives strong support to 
 
77 
 
 the view that acquired immunity depends upon the for- 
 mation of antitoxin 68 in the bodies of immune animals. 
 As secondary factors it is probable that tolerance to the 
 toxic products of pathogenic bacteria and phagocytosis 
 have considerable importance, but it is evident that the 
 principal role cannot be assigned to these agencies." 
 
 Others, like Vaaghan, Novy, McClintock and Wool 
 drige, believe immunity resides within the cell sub 
 stance, and cite the germicidal power of the nuoleins 
 of blood, testicle, thyroid gland, yeast and other cells. 
 Their side of the question is certainly upheld by ex 
 perimental proof at least as strong as that of those ad- 
 vancing the antitoxin theory alone. 
 
 If a sterilized culture affords immunity what consti- 
 tuent of it possesses this peculiar property? All are 
 agreed that it is not the function of ptomaines. 
 Vaughan says strikingly: 
 
 "We can answer the question as to which constituent 
 of sterilized cultures gives immunity with considerable 
 confidence if we recognize the following facts: 
 
 1. Marked artificial immunity to an infectious disease 
 has not been obtained except by the introduction into 
 the animal of the germ substance, either enclosed in the 
 cell wall or in solution. 
 
 2. Sterilized cultures contain the germ substance in 
 one or both of these forms. 
 
 3. The same immunizing substance exists in the 
 bodies of bacteria grown on solid media and killed by 
 the action of chloroform. 
 
 4. The same immunizing effects, varying, however. 
 
78 
 
 in degree, are obtained with the bodies of the dead 
 bacteria morphologically intact or in solution, with 
 living bacteria modified and reduced in virulence and 
 with very small numbers of the virulent germ." 
 
 From this he very logically concludes that the immun- 
 izing substance is a constituent of the bacterial cell 
 itself; and further that as each kind of germ has its 
 own peculiar poison, conferring immunity when ex 
 hibited in small doses; the poison cannot come from the 
 cell wall, nor can it be a decomposition product of bac- 
 terial activity but an essential, characteristic portion of 
 the cell itself, to which is due its distinctive properties. 
 He believes this to be the nuclein. Certainly his prem 
 ises are peculiarly upheld by facts, for all of the 
 methods of producing immunity depend upon the in- 
 troduction of the germ- substance into the body. Immu- 
 nity conferred by an attack of disease is certainly 
 caused by an introduction of germs which are not only 
 living but more or less active in virulence. That which 
 is induced by vaccination or inoculation by attenuated 
 cultures is due to the introduction of germs which are 
 living but whose virulent activity is more or less modi- 
 tied or reduced. That which is induced by inoculation 
 with sterilized cultures is due to the introduction of 
 the germ substance (or as Vaughan says, the germ- 
 nuclein) so modified that it is no longer capable of re- 
 production. 
 
 True it is that a susceptible animal may be rendered 
 immune by treatment with the blood serum of an im- 
 mune ^animal. For example a ,horse is rendered im- 
 
79 
 
 mune to tetanus by treatment with the modiiied bac- 
 terial proteid and from these treatments it results that 
 an immunity-conferring substance is generated within 
 the horse and circulates in its blood. If now this 
 blood- serum of the horse be injected into a mouse the 
 animal becomes, under certain conditions immunized to 
 tetanus. But as Vaughan most aptly says — "The im- 
 munity actually does not belong to the mouse. It still 
 belongs to the horse. It is stolen property and will soon 
 be lost,'''* The immunity-conferring substance is formed 
 by the ceils of the horse not of the mouse. Behring 
 says that subsequent inoculation of the mouse may 
 awaken its cell activity and the immunity which then 
 results is the direct property of the mouse, but this does 
 not become true prior to the introduction of tJie germ. 
 
 Upon what does the inciting cause act in the pro- 
 duction of immunity? Tizzoni and Cattani have demon- 
 strated that rabbits cannot be immunized to tetanus 
 after removal of the spleen. Lindemann and others 
 have shown that a dog which has undergone extir- 
 pation of the thyroid gland will not stand the doses of 
 caffein which the same dog was able to bear prior to ex- 
 tirpation. The effects of extirpation, or atrophy of the 
 thyroid gland, are now well known, as are also the bril- 
 liant results following the administration of the gland 
 in certain diseases. It is suggested that these organs 
 are the sources of nucleated leucocytes, — these differ 
 from the red corpuscles in that they possess nuclei. 
 This naturally suggested that nuclein might play an im- 
 portant role in the production of immunity. This 
 
80 
 
 thought occured to Brieger, Wasserman and Kitasato; 
 they obtained negative results but is is significant that 
 they used a temperature of 100° C in the elaboration of 
 their preparations— we know now that a temperature of 
 55° C seriously impairs indeed almost destroys their 
 virtues. Wooldridge of England, whose work seems to 
 have been entirely overlooked, obtained very favorable 
 results as indeed has Vaughan even more recently. We 
 may now consider it conclusively proven that the blood- 
 serum, thyroid gland, spleen, marrow of bones, etc. have 
 considerable germicidal power and this power is possessed 
 by their nucleins. That the nucleins do exert a powerful 
 influence in immunity Tizzoni and Cattani have shown 
 by failures to produce immunization of rabbits to teta- 
 nus when the spleen had been removed. We now know 
 that Nature has provided special physiological guards 
 against infection by the ordinary channels and further 
 that she has supplied general physiological guards in 
 the nucleins whose germicidal power is dependent 
 largely upon vital cellular activity. This forces us to 
 the conclusion that immunity is in a large measure due 
 to the production of antagonistic substances which are 
 produced by the stimulation of certain organs, chiefly 
 the spleen, the thyroid gland and marrow of bones 
 which manufacture nucleins — does it not seem reason- 
 able then that these antidotal substances should be 
 nucleins? Their kind and amount then would depend 
 upon the nature of the incitant and the organ or organs 
 specially incited. This would indicate that the pro- 
 cesses of Nature are eminently conservative, that they 
 
81 
 
 are constantly striving for the attainment of such an 
 ideal state of health as would render the system proof 
 against hostile attacks of pathogenic organisms. It is a 
 question whether this end might not be attained were it 
 not for our vitiation and antagonism of Nature's own 
 efforts by our habits and frequent infractions of all 
 hygienic law. Clearly then anything which depresses 
 vitality predisposes to susceptibility to disease while it 
 is only to an exaltation of vitality that we can look for 
 immunity. 
 
 VII. — Antiseptics and Their Relative Value. 
 
 Antisepsis is a condition in which the development 
 of micro-organic life is retarded or rather prevented. 
 The germ is not necessarily destroyed or killed; it is 
 sufficient simply to arrest and prevent its development, 
 its power of exercising the reproductive functions. An 
 antiseptic is an agent capable of preventing putrefac- 
 tion, that is, the growth of those organisms which cause 
 putrefaction. If the agent also possesses the power to 
 kill or destroy organisms, it is germicidal in effect al- 
 though, of course, antiseptic; because a substance which 
 possesses the power of destroying the organisms which 
 cause putrefaction possesses the power, ipso facto^ of 
 preventing putrefaction. All^germicides are necessarily 
 
82 
 
 antiseptics but all antiseptics are not necessarily germi- 
 cides — all potatoes are vegetables but all vegetables are 
 not necessarily potatoes. In order to demonstrate 
 antiseptic power it is only necessary to demonstrate or 
 show that the substance is capable of preventing the 
 exercise of those functions of bacterial activity which 
 usually result in decay or putrefaction. The germ is 
 thus rendered innocuous or harmless by inhibition of 
 its normal vital activity. When the inhibiting condi- 
 tion, the actual presence of an antiseptic substance, is 
 removed then the interrupted processes may supervene. 
 Thus alcohol, godic chlorid, sodic tetraborate^ ferrous 
 sulphate and many other substances commonly used as 
 germicides do not, even in concentrated solutions, de- 
 stroy the spores of various germs, hence they are not 
 true germicides. The true germicide kills or destroys 
 the microbean element, rendering future development 
 an impossibility except by renewed infection. The ac- 
 tion of an antiseptic is very similar to that of judicial 
 incarceration, in which the offending entity is isolated 
 and shorn of his social and political functions— he is 
 rendered incapable of doing harm, Germicidal action 
 on the other hand is somewhat analogous to judicial 
 execution — the offending entity is destroyed. An anti- 
 septic substance must not only have the power of pre- 
 venting the growth of putrefactive organisms but must 
 also be capable of exercising such restrictive power 
 even in culture media favorable to their growth, devel- 
 opment and proliferation. 
 
 So many persons discuss asepsis and antisepsis as 
 
83 
 
 though antithetical terms. Asepsis is, of course, a de- 
 sirable, an ideal condition and antisepsis is a means to 
 that end. Most wounds and injuries are infected be- 
 fore coming under the care of the physician or surgeon, 
 there is no possibility of asepsis, in a strict sense. The 
 germ has already gained access, no opportunity having 
 been offered the physician to exclude it. Infection is so 
 exceedingly insidious, even in conditions where every- 
 thing seems favorable to the success of aseptic proced- 
 ures, that it certainly seems rational to err, if at all, up- 
 on the safe side by a conjunction of asepsis and anti- 
 sepsis. In so-called aseptic procedures everything is 
 dependent upon sterilized dressings, sterilized instru- 
 ments — sterilized by what means? Either by the anti- 
 septic action of moist heat or by the use of antiseptics 
 themselves. It is exceedingly difficult to say where 
 asepsis ends and antisepsis begins, for asepsis is usually 
 attained by an antecedent antisepsis. 
 
 Undoubtedly the greatest of all antiseptics and germ- 
 icides is health. It is only when the natural and nor- 
 mal efficiency is vitiated that Nature becomes dependent 
 upon Art. The healthy tissues of the human body 
 neither harbor infectious organisms nor favor or aid 
 their subsequent development when introduced. Indeed 
 there cannot now be the slightest doubt but that the 
 highest type of histologic vitality, which we commonly 
 term health, is highly prejudicial to the action of path- 
 ogenic bacteria. Furthermore when such have been in- 
 troduced within the system, either by accident or de- 
 sign, they are quickly destroyed either in the circula- 
 
84 
 
 tion or tissues or else discharged through the various 
 emunctory channels. Cunningham and others have 
 proven that bacteria are frequently destroyed in the 
 blood; Vaughan too has demonstrated the germicidal 
 power of the nuclein of blood-serum. Wyssokowicz 
 claimed that those organisms which are not destroyed 
 rapidly in the blood are deposited materially in the tis- 
 sues, just as is done in the case of particles of pigment. 
 He introduced anthrax bacilli, in small quantities, into 
 the blood of rabbits and found that they disappeared in 
 twenty-four hours; he claimed however to have found 
 them deposited in large numbers in the liver and the 
 spleen. Cheyne, Ogston, Ribbert and others have 
 proven the possibility of excretion of germs by the 
 genito- urinary tract, demonstrating their actual pres- 
 ence in the kidneys and urine. It has also been proven 
 that germs may be excreted by the mammary, and pos- 
 sibly also the parotid glands. Indeed Passet and Lon- 
 gard have shown that, in the case of mice at least, it was 
 possible for cocci to be excreted by the conjunctival 
 membranes. 
 
 The medical literature of the past few years contains 
 many references to the germicidal properties of blood- 
 serum. May there not have been something of fact as 
 well as fancy in the results ascribed to the old fashioned 
 and almost obsolete practice of sending invalids with 
 impaired vitality to abattoirs to partake freely of the 
 warm, freshly drawn blood of recently slaughtered ani- 
 mals? Not only has the blood-serum germicidal prop- 
 erties but those of different animals vary in the intens- 
 
85 
 
 ity of their powers. Thus the common domestic rat is 
 highly resistant to the action of most bacteria which 
 are pathogenic in their effects upon the human or- 
 ganism. 
 
 So it seems that all of the normal functions of the 
 body work together for its good in the preservation of 
 its hygienic and vital activity. When we consider how 
 slight a cause may interrupt the normal operations of 
 this delicate and highly complex machine called the 
 human organism, how careful and watchful of its health 
 we should be. These natural conditions and beneficient 
 tendencies of the organism may be perverted by various 
 causes such as injury, cold, inflammation, embolism, 
 local or general depression of vitality, etc. For cen- 
 turies men have climbed mountains, crossed oceans, 
 bridged chasms, delved into the bowels of the earth, 
 burned the midnight oil, courted death in a thousand 
 forms in a vain and endless search for the illusive and 
 delusive "Elixir of Life." All this time they labored 
 in ignorance of the fact that the treasure sought lay 
 constantly within their reach — nay, more — pulsing 
 through their very beings. And yet — and yet — they 
 found it not. 
 
 For the most favorable development of germs and an 
 exercise of vital activity certain physical conditions are 
 necessary. Thus there must be (a) a certain degree of 
 temperature, (b) a certain degree of moisture and (c) a 
 suitable nutrient medium; a combination of these three 
 conditions produces ideal surroundings for the develop- 
 ment of micro-organic life. The growth and develop- 
 
86 
 
 ment of germs can then be restrained physically by (a) 
 elevation of temperature, (Jb) depression of temperature, 
 (c) absence of nutrient media, and (d) absence of mois- 
 ture — indeed they can be destroyed by sufficient ele ora- 
 tion of temperature. Clearly then, where surroundings 
 are favorable, even physical conditions may sometimes 
 be used as antiseptic agents. Some few germs, how- 
 ever, are able to multiply at the freezing point (0° C, 
 32°F.), while others possess powers of proliferation at 
 temperatures as high as 60^-70° C, (140°-158° F.)— we 
 must remember in this connection that the freezing 
 point is zero on the Centigrade scale in common scientific 
 use and thirty-two degrees above zero on the Fahrenheit 
 scale which is in commen domeshc use; and that the 
 temperature at which water boils is one hundred degrees 
 above zero on the Centigrade scale and two hundred and 
 twelve degrees above zero on the Fahrenheit scale. The 
 temperature favorable for the growth of most bacteria 
 is 20*^-40° C, (68°-104° F.), but as a rule most parasitic 
 species require a temperature of 35°-40° C. (95°~104° F.), 
 that is about the normal bodily temperature. In very 
 high elevations of bodily temperature, if the blood be 
 not altered, its germicidal power is increased owing to 
 the inhibiting influence of elevated temperature; this 
 advantage is inappreciable however because of the con- 
 comitant depressed vitality of the body itself. Let us 
 proceed then to a consideration of the virtue of physi- 
 cal agents as antiseptics. 
 
 Cold. — The weight of experimental evidence goes to 
 Bhow that low temperatures do not usually kill bacteria, 
 
87 
 
 although elevated temperatures do. Frisch (ISYY) ex- 
 posed various cultures to a temperatura of 87° C. below 
 the freezing point — he obtained this exceeding low tem- 
 perature by the evaporation of liquefied carbon di-oxid. 
 Even after exposure to such a degree of cold he found 
 that micrococci and bacteria multiplied abundantly 
 when again placed under favorp.ble conditions. Prud- 
 den found that some species resisted low temperature 
 while others did not. He based this latter conclusion 
 upon the fact that some bacteria died, although he did 
 not clearly prove such to be the result of the low tem- 
 perature. As Sternberg aptly says, there would proba- 
 bly have been a similar diminution in the cultures, more 
 especially if old, owing to an exhaustion of pabulum; 
 this of course might be independent of freezing for 
 bacteria, like higher plants, die in time — indeed contin- 
 ued vitality depends upon continued reproduction. 
 Prudden also found that repeated freezing and thawing 
 was more fatal to some forms, such as the typhoid ba- 
 cillus. Cadeac and Malet kept portions of a tuberculous 
 lung frozen for four months; at the end of that time the 
 injection of even a small qu-entity into guinea pigs, was 
 capable of producing tuberculosis in the animal so inoc- 
 ulated and infected. 
 
 Moist Heat. — The burden of experimental evidence 
 seems to indicate that the thermal death point of bac- 
 teria is comparatively low when subjected to the influ- 
 ence of moist heat. Indeed a large number of patho- 
 genic organisms are killed by exposure to temperatures 
 of Sd^^eo*' O. (131°^U0° F.) for Xm min^tes; some are 
 
88 
 
 killed at even slightly lower temperatures and by extend- 
 ing the time of exposure it is exceedingly probable that 
 somewhat lower temperatures still may effect the same 
 result. Non-pathogenic bacteria as a rule require higher 
 temperatures, such as 58°-65° C. (136 4°-149*' F.), and 
 some even higher still to effect their destruction. Glo- 
 big has obtained several species, from the soil, which 
 grew at 50°-70° C. (122^-158° F.), while Miquel (1881) 
 found a motionless bacillus in the water of the Seine 
 which grew luxuriantly in bouillon at 69°-70° C. 
 (156.2°-158° F.). 
 
 The resistant powers of spores are, as a rule, greater 
 than those of germs themselves; however, these resist- 
 ant powers vary in strength among the various species. 
 Even the spores of all known pathogenic bacteria are 
 quickly destroyed by exposures (even though short, 
 Sternberg says that five minutes is fully sufficient) to a 
 temperature of 100° C. (212° F.), namely that at which 
 water boils. The spores of the JBacillus anthracis^ the 
 most resistant and tolerant of all the commoner patho 
 genie organisms, are killed in four minutes by exposure 
 to moist heat at 100° C. (212° F.). The results ob- 
 tained by Y ersin and Sternberg seem to indicate that 
 the spores Bacillus tuberculosis are destroyed by an ex- 
 posure of ton minutes to a temperature of 70° C. 
 (158° F.), although Voelsh claims that a temperature as 
 high as 100° C. (212° F.) is insufficient for this. We may 
 however reasonably and certainly rely upon the fact 
 that exposure to moist heat at the boiling point (100° 
 C. or 212° F.) is sufficient to destroy all pathogenic 
 
89 
 
 germs and spores in a few minutes. Some non-patho- 
 genic germs and spores resist this temperature but be- 
 ing non-pathogenic in character (that is, incapable of 
 causing disease) the fact possesses little practical im- 
 portance to the physician and surgeon. 
 
 Dry Heat.— Koch and Wolffhuegel (1881) fully de 
 monstrated that when micro-organisms are exposed, in 
 a dessicated condition, to the influence of dry heated 
 air a higher degree of temperature is required for their 
 destruction than when they are moist, or exposed to the 
 action of hot water or moist steam. These deductions 
 were reached as the direct result of experiments made 
 with a large number of pathogenic and nonpathogenic 
 species. 
 
 Exposure for an hour and a half to a temperature of 
 78^-123° C. (l72.4°-253 4° F ), and for one hour to a 
 temperature above 100° C. (212° F.) failed, in the case 
 of dry heat, to kill various nonpathogenic germs but 
 did destroy the bacteria of mouse septicemic and rabbit 
 septicemia. A temperature of 120°-128° C. (248®- 
 262.4° F.) and an exposure of an hour and a half was 
 required to insure the destruction of all species treated 
 in the absence of spores. The spores of Bacillus anthra- 
 cis and Bacillus subtilis resisted this temperature, requir 
 ing a timperature of 140° C. (284° F.), and an exposure 
 of three hours to effect their destruction But this 
 temperature is decidedly injurious to bedding, clothing, 
 and most of the commoner domestic objects requiring 
 disinfection. Since the specific germs of diphtheria, 
 typhoid fever, erysipelas and cholera do not form 
 
90 
 
 spores, objects infected by these diseases may be dis- 
 infected by dry heat at a temperature of 120° C. 
 (248° F.) and an exposure of two or three hours. 
 
 Pry h^at is not only less active than moist heat but 
 is also less penetrating, especially so in the case of 
 folded blankets and other articles fashioned of poor 
 conductors of caloric. Koch and Wolff huegel demon- 
 strated this by placing registering thermometers within 
 folded blankets and various packages. After exposure 
 for three hours in a hot air oven to a temperature of 
 133°C. (27l.4°F.) the thermometers showed that a suffi- 
 cient temperature to kill bacteria had not been attained 
 internally. Rohe conducted similar experiments, sub- 
 jecting rolls of blankets to a temperature of 280°F. 
 (137.8°C.) for three hours; he found that they were but 
 very slightly affected in their interior. 
 
 Hence it seems that moist heat is much more effective 
 as a germicidal agent than dry heat. In the case of 
 moist heat the liquid pierces or penetrates mechanically 
 thus carrying the heat to every portion; it must be evi- 
 dent then that to secure thorough disinfection of cloth- 
 ing, blankets, sheets, etc., boiling is necessary. 
 
 Dbssication. — Cultures in the moist condition may 
 retain their vitality for a considerable length of time. 
 Paul says that the typhoid bacillus has retained its vi- 
 tality more than six months. Dessication is however 
 quickly fatal to some pathogenic bacteria, such as the 
 £b^^^r8L spirillum which Paul says perishes after dessica- 
 that ex>r one half hour at the ordinary temperature. 
 C. or ^hoid bacillus withstands this treatment for eight 
 
91 
 
 or ten weeks, the bacillus of diptheria four or five months 
 and the bacillus of tuberculosis five months. Spores 
 however retain their vitality, even in a dessicated condi- 
 tion, for a great length of time. 
 
 Light. — Downes and Blunt (IS'ZY), in a report to the 
 Royal Society of London, first called attention to the 
 fact that light has an injurious effect upon bacterial life 
 — indeed they even claimed that cultures might be ster- 
 ilized by exposure to direct sunlight. Tyndall verified 
 these claims to some extent by experiments showing that 
 development is restrained at least by direct exposure. 
 This does not seem altogether improbable when we re- 
 member that many of the bacteria are lower forms of 
 vegetable life devoid of chlorophyll and on this account 
 would thrive better in absence of direct sunlight. Then 
 too we know that light undoubtedly has certain definite 
 actinic and chemic powers. 
 
 Gaillard's experiments seem to conclusively prove 
 the germicidal power of sunlight in the presence of 
 oxygen. Geisler thinks that such effects are partially 
 due to the action on the gelatin culture media and Koch 
 confirms this result with his experiments with the tub- 
 ercle bacillus. 
 
 Sternberg says that exposure to sunlight is one of the 
 most potent and the cheapest of agents for the destruc- 
 tion of pathogenic bacteria and is a practical atd valua- 
 ble hygienic measure. 
 
 Electricity.— Attempts have been made recently to 
 utilize this force for the destruction of germ life. Re- 
 cent experiments make it seem doubtful that the elec • 
 
92 
 
 tricity acts directly; if so, strong currents and moder- 
 ately long exposures are essential. It is, or seems rea- 
 sonably certain, that the chief virtue of electricity lies in 
 the virtue of the products of its electrolytic action. For 
 instance the decomposition of aqueous media would 
 yield nascent oxygen and hydrogen, the former of which 
 possesses undoubted antiseptic value. 
 
 The number of antiseptic substancas proposed and 
 recommended by various authors and experimenters is 
 considerable and is furthermore constantly increasing 
 without cessation. It is important then that the physi- 
 cian and surgeon should be moderately familiar with 
 these substances, or their comparative values at least. 
 These different products do not act uniformly in their 
 resistance to different pathogenic micro-organisms; one 
 agent may be exceedingly active against one species 
 and inert towards other. Then again spores are often 
 and indeed usually more resistant than the parent germ. 
 Not only do becteria vary in their resistive power to 
 the action of antiseptic substances but the activity and 
 value of the latter may be influenced by various sur- 
 rounding conditions. Chief among these are the nature 
 and quantity of the material with which the bacteria 
 are associated. Some disinfectants act by an oxidation 
 of the offending entities and a mutual destruction of the 
 germ and germicide results, as is the case with potassic 
 permanganate. But this substance oxidizes organic 
 matter of all kinds; hence, if organic matter exists as- 
 sociated in quantity with germs the value of the ger- 
 micide may be impaired because it may oxidize the or* 
 
93 
 
 ganic matter and be itself destroyed before the bacteria 
 are affected. Then again we must consider the chemi- 
 cal nature of the substances thus associated with bac- 
 teria. For example, silver nitrate is a very efficient 
 germicide and antiseptic but if used to disinfect urine 
 its germicidal efficiency would be highly impaired if 
 not entirely counteracted by the action of the sodic 
 chlorid of the urine upon the silver salt, the latter be 
 ing precipitated as an insoluble and comparatively inert 
 argentic chlorid, thus — 
 
 Ag NOs+Na Cl=Ag Ci+Na NOs- 
 
 Moreover the presence of albumin may inhibit the 
 action of mercuric chlorid (Hg CI 2) and other metallic 
 salts. Van Ermengem states that the spirilla of cholera 
 are destroyed in bouillon in one half hour by mercuric 
 chlorid in the proportion of 1:60,000; while im 6^ooc?- 
 serum a proportion of 1 :800 was required to effect the 
 same result that is, a solution nearly seventy- five times 
 as strong in the latter case as in the former. Why is 
 this? Bouillon, as has been conclusively proven, con- 
 sists chiefly of the extractive salts of beef, it contains 
 little or no albumin, being analogous in chemical compo- 
 sition to urine. Blood-serum is rich in albumenoids — 
 the inference is obvious. 
 
 Some agents are rapid in action, others extremely 
 slow. Then again different species of bacteria require 
 different exposures, some of short duration while others 
 require a lengthy exposure; this is on account of the 
 varying resistive powers. Nissen found that a solution 
 of "chloride of lime" (the hypochlorite is whs^t is really 
 
94 
 
 meant) contaiDing .12% destroyed anthrax bacilli in one 
 minute and the cholera spirilla and typhoid bacilli in 
 five minutes. Other agents might require several hours. 
 As a rule the stronger the solution the shorter the time 
 of exposure required and vice versa. 
 
 The temperature at which an exposure is made may 
 directly afi'ect the result. Very high temperatures in- 
 hibit vital activity (and indeed may even destroy), 
 hence under such conditions of restraint of resistive 
 power we would naturally expect to find the germ espe- 
 cially susceptible to antiseptics. 
 
 The number of antiseptic substances is legion and as 
 no definite and rational method for grouping them has 
 as yet been devised, perhaps an alphabetic arrangement 
 may prove most convenient for their individual consi- 
 deration. 
 
 AcETANiLiD, (Antifebrtn), also termed Phenyl 
 aeetamid. The drug is chemically an anilin in which 
 one atom of hydrogen has been displaced or replaced 
 by the compound radical acetyl, thus: NHCgHjCaHsO. 
 It is a white, crystalline substance when pure, occurring 
 in brilliant rhombic plates. It is usually prepared by 
 the action of strong acetic acid upon anilin and by 
 prolonged contact with hydrochloric acid is resolved 
 into its constituents. Acetanilid is insoluble m water 
 at ordinary temperatures but is readily soluble in chloro- 
 form and ether; it is also somewhat soluble in alcohol, 
 in the proportion of 1 :3.5. It is chiefly used as an 
 antipyretic but has been recommended as a local anti- 
 septic. Its abuse gives rise to toxic symptoms. 
 
95 
 
 Acetic Acid. — Pure acetic acid is a colorless liquid, 
 having a peculiar pungent odor like that of strong vin- 
 egar (which usually contains 4-6% of acetic acid), free 
 from empyreuma and possessing an intensely acid taste. 
 It is, in concentrated conditions, somewhat escharotic 
 and corrosive. It is the second member of the group 
 of so called "fatty acids", resulting from the direct ox- 
 idation of ethyl aldehyd or the ultimate oxidation of 
 ethyl alcohol. Its chemical formula is HCaHjOa or 
 CHj COOH. The acid as usually sold contains about 
 thirty -six per cent of monohydrated acetic acid; abso- 
 lute acetic acid is a crystalline solid somewhat analo- 
 gous to ice in appearance and hence termed glacial 
 acetic acid. In a concentrated form it is a corrosive 
 poison. 
 
 Koch found that 5% failed to kill anthrax spores 
 even after five days exposure. Abbott found that the 
 same spores resisted the action of 50% glacial acetic 
 acid, even after an exposure of two hours — indeed the 
 spores of the anthrax bacillus seem to possess peculiar 
 resistant power to the action of the acid. Kitasato 
 however found that 3% would kill typhoid bacilli in 
 five hours while 2% effected the same result in the same 
 time with the spirilla of cholera. 
 
 M. Haschimodo has reported from Paris that a vine- 
 gar containing 2:2-3.3% of acetic acid saturated with a 
 pure culture of the spirilla of cholera can, after an in- 
 terval of fifteen minutes be inoculated into animals 
 without danger — or even eaten with impunity by human 
 beings. 
 
96 
 
 In 1874 Klein made the statement that corrosive 
 sublimate had no more germicidal value than vinegar. 
 It is interesting to note that McClintock, in testing the 
 truth of this statement, found that vinegar containing 
 6:3-7% of acetic acid prevented the growth of micro- 
 organisms as efectually as a l:\000solution of corrosive 
 sublimate These results completely verify Klein's 
 statement. 
 
 Crude acetic acid (pyroligneous acid), sometimes 
 called "wood vinegar," is the crude product obtained 
 when wood is subjected to destructive distillation. It 
 IS a dark-brown liquid, almost black, the color depend- 
 ing upon the amount of tar contained; it possesses a 
 characteristic, penetrating, smoky odor very like that of 
 burnt wood. The tar present is rendered soluble by the 
 acetic acid — indeed acetic acid has also the power of 
 effecting a partial solution, at least, of albuminous sab- 
 stances; the presence of this tar, no doubt, adds much 
 to the antiseptic qualities of the liquid. Some attention 
 has been paid to this substance during the past year; 
 its accessibility, its cheapness and other properties 
 would make it very desirable if subsequent researches 
 and experiences can indubitably prove that it has de- 
 cided antiseptic qualities. During the past year it has 
 been constantly used in various morgues and hospitals 
 and, as Squibb says, has worked admirably. 
 
 Acetone. — Produced by the dry distillation of an 
 acetate, such as calcic acetate; its chemical formula is 
 (C £13)200. Koch has demonstrated that anthrax spores 
 grow freely after two days exposure to the action of 
 
97 
 
 acetone and that they are not destroyed by five days ex- 
 posure, although their action is somewhat enfeebled. 
 
 Alcohol. — Chemically the hydroxid of ethyl (the 
 second member of the radicals of the marsh-gas series), 
 its chemical formula being CaHgOH. The properties of 
 this substance are too well known to need description. 
 It was one of the first antiseptics used, though now 
 almost entirely discarded. It was advocated in a 
 pamphlet by Bataille (1859) and adopted by Nelaton 
 (1863) and also by Le Fort. Schill and Fischer demon- 
 strated that tuberculous sputum had its infectious 
 nature destroyed by alcohol, but that ^we volumes of 
 absolute alcohol were necessary to destroy the bacilli, 
 equal volumes being inefficient. Pure cultures of the 
 bacillus were completely sterilized by five minutes ex* 
 posure to the action of absolute alcoho . Koch found, 
 however, that even an exposure of one' hundred and ten 
 days had no effect upon anthrax spores. 
 
 Alum — The alums are hydrated double sulphates of 
 aluminum and some other positive radical — more com- 
 monly either potassium or ammonium, thus; KjAlj 4 
 (SO,) .24H,0 or (NH,)2 Al^ 4 (SO,) .24Ufi. Miquel has 
 determined that while alum is not germicidal it is anti- 
 septic and that a proportion of 1:222 is sufficient to 
 restrain putrefactive decomposition in bouillon. 
 
 Aluminic Acetate. — Al (CaHjOa).,. Kuhn has de- 
 termined that it is antiseptic in action in the proportion 
 of 1:5,250 while De la Croix places its antiseptic power 
 at 1:6,310. 
 
 Aluminic Chlorid. — AICI5. Miquel has deter- 
 
98 
 
 mined that this substance is antiseptic in the proportion 
 of 1:714. 
 
 Alumnol. — This new aspirant is an aluminum salt of 
 naphthol-sulphonic acid. It is a reddish white, non- 
 hygroscopic powder, darkening in color by age or ex- 
 posure. It has but recently been introduced to the 
 notice of the profession; this was done at the late 
 International Congress of Dermatologists in Vienna. 
 The drug is readily soluble in cold water, much more so 
 in hot water, less so in glycerin and alcohol and insolu- 
 ble in ether. It has an acid reaction and precipitates 
 gelatin or albumin, this precipitate being soluble in ex- 
 cess of gelatin or albumin and thus allowing penetration 
 of the drug within the tissues by virtue of this peculiar 
 property. It is closely allied to Sozal and Sozo iodol 
 but is much more astringent than either. 
 
 Eraud, of Paris, has u?<ed the drug extensively and 
 declares that it neither irritates nor gives pain. Spen- 
 gler found that it is comparatively free from poisonous 
 properties but that when large quantities were intro- 
 duced beneath the skin or within the stomach the kid« 
 neys were apparently affected — although Spengler does 
 not state it, this is probably due to renal elimination. 
 Indeed Drs. G. B. Wood and A. Stille hold that other 
 salts of aluminum, analogous to alumnol, are found in 
 the urine of persons taking them. 
 
 The drug has not, as yet, been largely used in this 
 country. Blount and Delavan, of New York City, re- 
 ported favorable results from its use at the late Pan- 
 American Medical Congress. Dr. Delavan says how- 
 
 ^ 
 
99 
 
 ever that he could not put it on as high a plane of use- 
 fulness as was claimed for it. Its high price (costing 
 four times as much in this country as in Germany) also 
 stands in the way of its general use. Good reports have 
 been given of its use in gynecology and otology, but it 
 is probably too early as yet to put a proper estimate 
 upon its value. 
 
 Ammonia. — Occurs as a gas (NH,) and in aqueous 
 solution (NH4OH, ammonic hydroxid, ammonic hydrate 
 and "ammonia water"). Kitasato found that .3% would 
 kill the typhoid bacilli and the cholera spirilla after an 
 exposure of live hours. 
 
 Ammonic Carbonate. — (NHJaCOg. Kitasato found 
 that a solution of 1:125 restrained the development 
 while 1 :100 killed the typhoid bacillus in five hours. A 
 strength of 1:77 was required to kill cholera spirilla in 
 the same time. 
 
 Ammonic Chlorid. — NH4CI. Koch found that a 5% 
 solution did not kill anthrax spores even after twenty- 
 five days exposure. Indeed the substance has no germ- 
 icidal power, butMiquel gives it antiseptic power in the 
 proportion of 1:9. 
 
 Ammonic Fluo Silicate.— (NH4),SiF5. Strongly germ- 
 icidal and antiseptic. Faktor demonstrated that a 2% 
 solution killed anthrax spores after from one-quarter to 
 three-quarters of an hour exposure. A solution of 1:1- 
 000 prevented the growth of the bacilli of anthrax and 
 typhoid fever, even in nutrient gelatin media. 
 
 Ammonic Sulphate. — (NH4),S04. Koch found that a 
 4% solution required five days to kill anthrax spores. 
 
100 
 
 Miquel found the substance antiseptic in the proportion 
 of 1:4. 
 
 Anilin Dyes. — Those used as antiseptics are chiefly 
 ,rosanilin, methylene blue, methyl violet and methyl yel- 
 low, the two latter being sold by Merck as a patented 
 preparation under the name of Pyoktanin, These sub- 
 stances are all intense coloring agents, even in minute 
 quantities. Sternberg says that recent researches indi- 
 cate that these agents possess decided germicidal pow- 
 ers, even in dilute solution. Boer found that the vari- 
 ety known as ''malachite green" was even more effica- 
 cious than methyl violet, yet gave them both a germici- 
 dal value far above that of mecuric chlorid. Roswell 
 Park after a most exhaustive series of experiments 
 denies utterly all such claims to efficiency. He says: 
 *'I have been led to detail my experiments with the 
 material not merely as illustrative of a method, but be- 
 cause numerous articles have recently appeared with re- 
 ference to it, in some of which the writers appear to 
 have allowed their verdicts to be influenced by what the 
 manufactures have claimed for it, rather than by any- 
 thing like a scientific test of its genuine value. 
 
 I would not wish to be understood as inveighing 
 against a certain well-known value which most all of 
 these anilin preparations have in common. In 1872, Dr. 
 Chas. Curtman, of St. Louis, made known the fact that 
 they possess antiseptic properties, and common experi- 
 ence confirmed his statement. Stilling has gone so much 
 further as to assert that they are absolutely non-poisonous, 
 a statement which is far from justified by facts. * * 
 
101 
 
 On the whole, then, it has but few qualities by which 
 we are to commend it above numerous other drugs of 
 its general class, while in all that may answer to the 
 more scrupulous demands of aseptic surgery it has 
 proved in my hands — as in those of others who have 
 tested it from the purely clinical standpoint — disappoint- 
 ing," (See PyoJctanin and Methylene blue), 
 
 Anilin Oil. — Riedlin says that anilin water, in the 
 strength of 1:5, has the power of preventing the devel- 
 opment of bacteria even in nutrient gelatin media. 
 
 Akisic Acid. — CaH^OCHsCOOH. This substance is 
 a constituent of the oils of anise and fennel and is an 
 isomer of methyl salicylic acid, which latter is closely 
 similar to synthetic oil of wintergreen (a compound 
 ether, or ester, namely methyl saliclyate). The acid 
 occurs in the form of colorless prisms which are insolu 
 ble in water but are freely soluble in hot and cold alco- 
 hol. The drug possesses antipyretic as well as antisep- 
 tic properties; it has been used in the treatment of 
 wounds. 
 
 Annidalin. — This substance is frequently confounded 
 with Aristol which it closely resembles chemically and 
 physically. Annidalin is dithymol in-iodid while aris- 
 tol is the Ji'iodid. It is a reddish brown powder in 
 which light and heat cause the liberation of iodin. It 
 is insoluble in water, slightly soluble in alcohol and 
 readily soluble in ether and chloroform. Cerna says 
 that aristol is only slightly soluble in chloroform; if this 
 is so it would be a ready means of distinction between 
 annidalin and aristol, since the former is freely soluble 
 
102 
 
 in chloroform. But the manufacturers of aristol claim 
 that it is freely soluble in chloroform. 
 
 Annidalin is used chiefly as a local antiseptic and 
 dusting power, probably owing its chief virtue to the 
 gradual decomposition and consequent liberation of 
 iodin. It is proposed as a substitute for iodoform, but 
 like the latter is practically devoid of active germicidal 
 properties. 
 
 Anthrarobin. — Also termed Desozy- alizarin. This 
 substance, a derivative of phenol and allied to chryso- 
 phanic acid, is obtained from alizarin^ the crystalline 
 principle of the common madder-plant. It is a yellow- 
 ish powder readily soluble in alcohol, glycerin and 
 dilute alkaline solutions; sparingly soluble in ether and 
 chloroform and insoluble in water or acids. It is used 
 chiefly as an anti-parasitic in dermatology and has been 
 of special value, it is claimed, in psoriasis, ptyriasis 
 versicolor and also herpes; it is usually used in the form 
 of an ointment. 
 
 Antipebrin, (see Acttanilid). 
 
 Antipyrin, (Ana^gesin), — Also called Phenazon^ 
 Methoziriy Phenyl di mtthyl pyrazolone Di methyl oxy- 
 (juinizine and Dehydro di'inethy I phenyl pyrazine. It is 
 a derivative of coal tar, its chemical formula being 
 C11H12N2O. Antipyrin is a white or reddish white, 
 crystalline, odorless powder of somewhat bitter taste 
 and used chiefly as an antipyretic and analgesic. It is 
 readily soluble in cold water, rectified spirits, and chloro- 
 form — also in ether in the proportion of 1:50. It has 
 been demonstrated that the drug also possesses antisep- 
 
103 
 
 tic properties. Experiments seem to contirm the state- 
 ment that, in vitrOy it has the prower of destroying the 
 diphtheritic bacillus in forty-eight hours. 
 
 Antisepsin (Asepsin). — Called also Para mono- 
 brom phenyl' acetamid and Para-mono hrom-acetanilid 
 and having the chemical formula C6H4BrNHC2HsO. 
 It occurs in odorless, tasteless crystals which are 
 soluble in alcohol and ether, slightly so in gly- 
 cerin and insoluble in water. It has been used 
 in typhoid fever, pneumonia and phthisis and 
 also locally in wounds and hemorrhoids. Has attracted 
 but little attention. 
 
 Antiseptin. — Called also Zinc borothymo4odid 
 and lodo horo thymolate of zinc. It is not however 
 a definite chemical compound, as either of these names 
 would indicate, but a mixture of at least four definite 
 and distinct chemical compounds. Its composition has 
 been given by Squibb, Goldmann and Cerna as follows: 
 
 
 SQUIBB. 
 
 GOLDMANN. 
 
 CF.RNA. 
 
 Zinc Sulphate, 
 
 85 
 
 85 
 
 80 
 
 Zinc iodid. 
 
 2i 
 
 2k 
 
 — 
 
 Thymol, 
 
 2i 
 
 2i 
 
 2 
 
 Boric acid, 
 
 10 
 
 10 
 
 10 
 
 It is apparently but little used and noticed and indeed 
 can hardly be said to be in general use now. 
 
 Antiseptol. — This substance chemically is the iodo- 
 sulphate of cinchonin. It is a reddish-brown powder 
 which is soluble in water, alcohol and chloroform. It is 
 chiefly suggested as a substitute for iodoform. 
 
 Arbutin. — CiiHigO^. This substance is a glucoside, 
 
104 
 
 found (about 3.6%) in the leaves of the common bear- 
 berry {Arctostaphylos Uva ursi) and in other plants, 
 especially the members of the natural order Ericaceoe. 
 It occurs in long, colorless and brilliant silky needles or 
 bunches of such needles which are sparingly soluble in 
 cold water, slightly so in ether and readily soluble in 
 hot water and alcohol. The crystals have the formula 
 {G\t^\fii)% •H,0, but lose this water of crystallization 
 at the boiling point (100^ C); they possess a bitter 
 taste and a neutral reaction. This substance is chiefly 
 employed in affections of the genito urinary tract and is 
 said to be a most valuable antiseptic in this respect. 
 This effect is probably not due to direct action of the 
 drug itself but to the hydroquinone (CeH^Oj) which is 
 set free in the organism. When arbutin is boiled with 
 dilute sulphuric acid or subjected to the action of emul- 
 sm or another ferment contained in the bearberry it is 
 converted into hydroquinone and glucose. It has 
 been proven by Von Mering and Steffen that the dis- 
 coloration of the urine which ensues upon the adminis- 
 tration of arbutin is due to the breaking up of the ar- 
 butin in the body into glucose and hydroquinone. • This 
 change probably takes place in the kidneys, as arbutin is 
 free from toxic properties while, as Brieger, has demon- 
 strated, hydroquinone is poisonous; Forster has shown 
 that the latter is a powerful disinfectant and anti- 
 ferment. It is stated that a one per cent solution will 
 arrest putrefaction and alcoholic fermentation while 
 one half per cent is sufficient to arrest butyric fermen- 
 tation. 
 
105 
 
 Wher administered internally usually about 75 grains 
 per dieniy in divided doses, are given. 
 
 Abistol.— Sometimes erroneously termed Annidalin. 
 Chemically it is di-thymol di-iodid and consists of two 
 molecules of thymol (C10H13OH) in which two atoms of 
 hydrogen and two radicals of hydroxyl (OH) have been 
 displaced by two radicals of iodoxyl (01). The empiri- 
 cal formula then would be C22H84 (OI)^. It is a reddish- 
 brown powder with an aromatic odor and is produced 
 by the action of an aqueous solution of iodin in 
 potassic iodid upon an aqueous solution of thymol in 
 the presence of potassic hydroxid. It is readily soluble 
 in ether, chloroform, collodion and traumaticin; slight- 
 ly so in alcohol, and insoluble in water, glycerin and 
 alkalies. It has been largely used as a local antiseptic, 
 in the form of powder, solution and ointment, in many 
 conditions — especially as a succedaneum for iodoform, 
 which is unbearable on account of its intolerable and 
 disagreeable odor. 
 
 Arsbnous Acid. — This is the substance formerly 
 termed "arsenious acid" but which the last edition of 
 the Pharmacopeia changes to its present form by elimi- 
 nation of the letter **i". Arsenous acid properly so- 
 called has the chemical formula H, AsO,, but its anhy- 
 drid (As, Oj) is so frequently called by this name as to 
 give rise to some confusion. The solution of the anhy- 
 drid in water gives a dilute solution of the acid how- 
 ever. Koch found that 10% destroyed the vitality of 
 anthrax spores only after an exposure lasting ten days, 
 no such result being produced in six days. Miquel has 
 
106 
 
 detei mined that it is antiseptic in the proportion of 
 1.166- 
 
 AsAPROL.-— Chemically this substance is Calcium beta' 
 naphihol alpha-mono sulphonate and has the formula Ca 
 (OH.CioHgSOsjaSH'O. It is a white scaly powder ob- 
 tained by the action of heated sulphuric acid upon beta- 
 naphthol and then forming the calcium saltT)y combina- 
 tion with the resulting acid. It is readily soluble in 
 water and alcohol. 
 
 It is recommended as an antiseptic in solutions with 
 a strength of 5%. It destroys cholera spirilla in strong 
 solutioDsand prevents the growth of microbes in weaker 
 solutions and is quite popular in France but has gained 
 little or no foothold in this country. 
 
 AsEPTiN. — Is said to be an empirical mixture of boric 
 acid, borax and alum. Is seldom heard of, clinical 
 literature on the subject being somewhat scarce. 
 
 AsEPTOL. — Also called Ortho phenol^ Suipho-carbolic 
 acidf Sul phonic acid, Ort ho phenyl sulphv7iic ac*W and 
 Sozolic acid. It is usually found in the form of small, 
 deliquescent and crystalline needles or else, more 
 frequently, as a heavy, reddish, volatile liquid nearly 
 one and a half times as heavy as water and of a syiiipy 
 consistency. It has an astringent taste and an odor 
 strongly resembling that of carbolic acid. It is ob- 
 tained by the chemical action of equal parts of concen- 
 trated sulphuric acid upon carbolic acid in the cold; 
 its chemical formula is C\Ef^OHSOj,OH. It is freely 
 soluble in water, alcohol and glycerin. It is used inter- 
 nally in the form of a lemonade and locally in solutions 
 of l^to 10%. 
 
107 
 
 AccordiDg to Hueppe a 10^ aqueous solution kills 
 anthrax spores in ten minutes, but a 3-5% solution is a 
 reliable disinfectant in the absence of spores. Squibb 
 says that "It has not supplanted carbolic acid so far, 
 however, although it has now had several years to ful- 
 fill the original expectation." In the last number of his 
 **Ephemeris" he says that Aseptol "has not fulfilled 
 its promised mission of supplanting carbolic acid and 
 may now be considered on the retired list." 
 
 Baric Chlorid. — BaClj. The salts of barium have 
 practically little or no use in medicine. Miquel has 
 determined however that the chlorid has antiseptic 
 properties in the proportion of 1:10. 
 
 Benzbne (Benzol). — CgHg. A colorless volatile 
 liquid, slightly lighter than water and obtained by the 
 distillation of coal tar. Benzene or Benzol is a definite 
 chemical compound and is not to be confounded with the 
 commercial "benzine" used for the removal of grease, 
 etc.; this latter substance is a complex mixture of the 
 hydrocarbons of the marsh gas series and is not a defin- 
 ite chemical compound but a mixture of compounds. 
 Benzol has been used of late in the treatment of influ- 
 enza. It is also used as a parasiticide; Sneguersky and 
 others have reported the successful treatment of scabies 
 (itch) by inunctions of benzol alone, or mixed with 
 equal parts of fat. Redness of the skin is produced, by 
 brisk friction with a thick cloth, before the application 
 of the drug. Sneguersky finds that the pure article is 
 best adapted for the treatment of the parasitic condition 
 uncomplicated, but when accompanied by an eczema- 
 
108 
 
 tous condition the best results are obtained when the 
 benzol is conjoined with an emollient fat. 
 
 Koch made experiments with a view to deciding the 
 germicidal power of this substance; he found that 
 twenty days exposure was insufficient to kill anthrax 
 spores. 
 
 Benzoic Acid.— HCtHsO^ or CeHsCOOH. This sub- 
 stance occurs naturally as a constituent of gum benzoin, 
 which is the concrete juice of a tree indigenous to Peru. 
 Benzoic acid may be prepared by the sublimation of this 
 gum or it may be prepared artificially from naphthalene. 
 It usually occurs in the form of white feathery crystals 
 of a silky lustre and a fragrant aromatic odor due to 
 the presence of a volatile oil — the pure acid is free from 
 odor. It melts and volatilizes without decomposition 
 at 250°. It is but slightly soluble in cold water, more 
 so in warm or hot water and freely so in ether, alcohol, 
 fixed oils and alkaline solutions. Benzoic acid is widely 
 distributed throughout the vegetable kingdom, consti- 
 tuting the peculiar principle of all true balsams and is 
 occasionally present in the urine of herbivora. In 1872 
 Dougall announced that benzoic acid is one of the most 
 active of antiseptic drugs; this statement caused experi- 
 mentation and investigation on the part of Bucholtz, 
 Grube, Fleck and Salkowski, they were all unanimous 
 in ascribing to benzoic acid a first rank as regards its 
 efficiency in destroying bacteria and preventing putre- 
 faction. In the majority of these investigations benzoic 
 acid was found to be much more efficient than salicylic 
 acid. Bucholtz found that while .02% of benzoic acid 
 
109 
 
 had a very perceptible effect upon the development of 
 bacteria their growth was entirely inhibited by .1%; he 
 found also that sodic benzoate was no less effective 
 than the acid itself. His experience with .1% is very 
 similar to the result obtained by Miquel. The acid has 
 the property of preventing the decomposition of animal 
 fats and inhibiting the development of rancidity; it is 
 much used, because of this property, as an ingredient 
 of various ointments. 
 
 More recent and complete bacteriological investiga- 
 tions as to the action of benzoic acid determine, as 
 Sternberg says, the entire absence of germicidal power 
 although it possesses antiseptic properties. Miquel has 
 determined that the substance is antiseptic in the pro- 
 portion of 1:909, a result strongly similar to that of 
 Bucholtz with a preparation containing .1% of the acid. 
 The substance and its derivatives have been used in sev- 
 eral of the zymotic diseases with asserted good results. 
 
 Benzo-Naphthol. — Chemically this substance is the 
 benzoate of beta naphthol and has the chemical formula 
 CioHyO.CyHbO. It occurs in small, dull, white, odorless 
 and tasteless crystals which are insoluble in water and 
 ether at ordinary temperatures and freely soluble in 
 alcohol especially when hot. It is said to break up in 
 the intestinal tract into its constituents, as does salol. 
 It is ganerally used as an antiseptic and is said to have 
 afforded good results in the treatment of both simple 
 and tuberculous enteritis. Benzo-naphthol possesses 
 slight toxic properties. It has never been claimed by 
 the most conservative that it will act beneficially in any 
 
no 
 
 but mild cases, best in mild chronic cases, especially 
 when treatment has been instituted sufficiently early — 
 that is, before the micro organisms have multiplied to 
 any great extent or have exhibited much activity by be- 
 coming firmly established in surroundings favorable to 
 their rapid multiplication. 
 
 It is best administered in wafers in doses of 4 to 8 
 grains. 
 
 Benzo-Phenoneide. — This substance is a new com- 
 pound, is obtained from anilin dye and is, chemically, 
 Tetra mfihylO'diapsido benzo phenonelcle. It has been 
 accredited virtue as a microbicide when locally applied. 
 It is but little used or heard of, although it is said to 
 have given favorable results in the treatment of various 
 affections of the optic tract. 
 
 Benzoyl • Eugenol. — CeH, .C3H5 (OCH,) COAH5. 
 This substance is a derivative of eugenol and benzoic 
 acid; it occurs in the form of acicular, colorless and 
 odorless crystals which are soluble in "alcohol, chloro- 
 form, ether and acetone but insoluble in water. But 
 little is definitely known about this substance as yet, 
 except that it is being employed experimentally in the 
 treatment of tuberculous conditions. 
 
 Benzoyl-Guaiacol (Benzosol). — This substance is 
 the benzoate of guaiacol and is analogous to Benzoyl- 
 eugenol. It contains fifty-four per cent of guaiacol and 
 is represented by the chemical formula CeH^OCHj 
 OCOCeHj. Benzosol occurs in small colorless, odorless 
 and almost tasteless crystals, having a slightly aromatic 
 flavor. It is practically insoluble in water but soluble 
 
Ill 
 
 freely in hot alcohol, ether and chloroform. The ali- 
 mentary juices split up the compound into its constitu- 
 ents and liberates the effective guaiacol under conditions 
 that avoid the unpleasant taste and that reduce the 
 local irritation which results when guaiacol itself is 
 used. It has been used successfully, it is said, wherever 
 creosote or guaiacol are applicable; it is said to be es- 
 pecially useful as an antiseptic in intestinal disorders 
 and in phthisis pulraonalis. 
 
 Benzoyl-guaiacol is best administered in chocolate 
 pastilles with peppermint oil or sugar, or else in powder 
 of doses of 3-12 grains. 
 
 Bbtol. — Also known as Napktalol^ Napklosalol and 
 Salifiaphtol. Chemically it is a salicylic of beta-naph- 
 thol, closely allied to salicylate of phenol {Salcl)^ and 
 is represented by the chemical formula CeH^OHCOOCjo 
 H^. When pure the substance occurs as a crystalline, 
 colorless, tasteless and odorless powder which is insolu- 
 ble in water and glycerine, slightly soluble in alcohol and 
 turpentine at the ordinary temperature and readily solu- 
 ble in boiling alcohol, ether, benzene and linseed oil. 
 ' Betol has been favorably used as an intestinal antisep- 
 tic and also with advantage in vesical catarrh, cystitis 
 and gonorrhea.* 
 
 Betol can be administered in pill or in emulsion in 
 doses of 2-5 grains. For making bougies or supposi- 
 tories it may be mixed with cacao-butter in the strength 
 of 1:4. 
 
 Borax. — This substance is the sodium salt of boric 
 or boracic acid and is frequently, though most errone* 
 
112 
 
 ously, termed "sodium borate" and "sodium bi-borate" 
 — it is really the tetra borate although most others than 
 chemists describe an entirely different body under this 
 name. Its chemical formula is NaaB^Oy .10H2O. It 
 may be considered as four molecules of boraoic acid 
 (HjBOj) in which only two of the hydrogen atoms have 
 been displaced by two atoms of sodium, producing a 
 chemical compound whose formula would be NajB^Oy, 
 the remaining ten atoms of hydrogen uniting with the 
 remaining five atoms of oxygen to produce "water of 
 crystallization." Or it may be considered as the sodium 
 salt of tetra boric acid, whose chemical formula is 
 
 H,BA- 
 
 Borax occurs in colorless, transparent crystals but is 
 also sold in the form of a white, non crystalline pow- 
 der. It is soluble in cold water, freely soluble in boil- 
 ing water or warm glycerin and insoluble in alcohol. 
 When heated it puffs up like alum, losing its "water of 
 crystallization." It possesses antiseptic properties, 
 although, as Sternberg says, even a saturated solution 
 of the substance has no germicidal power. Miquel has 
 determined that it is antiseptic in the proportion 1:14.^ 
 
 BoBACic Acid (Boric Acid). — HsBOg. This substance 
 occurs in glittering, scaly crystals; it is also found in 
 natural solutions in volcanic regions, as in Nevada and 
 California and the fumeroles and sofflani of Tuscany. 
 It is soluble in 26 parts of cold water and 3 parts oi 
 warm or hot water, but is freely soluble in alcohol. 
 
 As an antiseptic Lister considers it almost as efficient 
 as carbolic acid. By reason of its insipidity, its entire 
 
113 
 
 freedom from odor and irritating properties and the 
 almost utter absence of toxic properties, as well as its 
 cheapness, it is of great utility as an antiseptic, though 
 possessing little or no germicidal power. It is highly 
 praised as an antiseptic and deodorant, arresting putre- 
 faction and fermentation — the Bacterium iermo seeming 
 to exhibit special susceptibility to its action. 
 
 In the experiments of Dr. Walb, a solution of 2% 
 distinctly checked the putrefaction of a solution of 
 fibrin, while 5% kept it fresh for nineteen days. Buch 
 oltz found .T5% sufficient to prevent the development 
 of bacteria. The experiments of Sternberg seem to 
 show, as he himself says, that boracic acid possesses 
 considerable antiseptic power but no great germicidal 
 power. Rosenthal demonstrated its power to check 
 urinary fermentation in cystitis accompanied by ammo- 
 niacal urine, even when administered internally — indeed 
 Johnson has proven that it appears in the urine within 
 ten minutes after its ingestion. The experiments of 
 Kitasato show that a 2.7% solution had the power of 
 killing typhoid bacilli after an exposure of five hours 
 and that a 1.5% solution killed cholera spirilla in a simi- 
 lar length of time. Miquel places its antiseptic power 
 as 1:143. 
 
 By virtue of its freedom from irritating properties 
 and its exceedingly low toxic power it is of great prac- 
 tical value in the treatment of wounds, ulcers, abscesses, 
 burns, inflammations of the throat and eye, and is espe- 
 cially valuable for continuous irrigation either in ob- 
 stetrical or surgical operations; these properties make 
 
114 
 
 it also very useful in the local antiseptic treatment of 
 the newly-born. 
 
 Boracic acid may be administered internally in doses 
 of 10-15 grains, from three to six times a day. 
 
 Bromoform. — Also termed Tri-bromo-methane) a 
 compound analogous to chloroform and iodoform — this 
 analogy is best seen by a comparison of the chemical 
 formulae which are as follows: 
 
 CHBr, CHCI3 CHI, 
 
 It may be prepared by the action of bromin and 
 potassic hydroxid upon methyl alcohol or by the action 
 of sodic hypobromite upon acetone. Bromoform is a 
 colorless, clear, limpid liquid with an agreeable odor and 
 a sweetish taste. Any coloration of the substance indi- 
 cates its decomposition with a consequent liberation of 
 bromin; euch specimens should be rejected if intended 
 for internal use. The liquid is quite heavy, being 
 nearly three times as heavy as water and with a boiling 
 point higher than that of the latter; it is soluble in 
 alcohol and ether but insoluble in water. It possesses 
 to a marked extent the antispasmodic, hypnotic and 
 analgesic properties of the bromids (due no doubt to 
 the bromin contained therein) but possesses also some 
 antiseptic properties. Dr. S. Solis-Cohen reports favor- 
 able results from its use in ozena and tuberculous as 
 well as other ulcerations of the larynx. In England 
 success is said to have followed the use of inhalations of 
 bromoform in the treatment of diphtheria—particularly 
 80 in recent epidemics. The drug is of special value in 
 the treatment of pertussis (whooping cough) although 
 
115 
 
 its value here is probably due more to its hyp- 
 notic and antispasmodic properties than to antiseptic 
 activity. It has also anesthetic properties somewhat 
 similar to those of chloroform. Usual dose 1-5 minims 
 in alcoholic liquors or syrup of acacia or paregoric. 
 
 Bromol. — This substance, also called Tri bromo- 
 phenol, is prepared by the action of bromin upon an 
 aqueous solution of phenol and has the chemical 
 formula C«H,BrsOH. When pure it occurs as a white, 
 crystalline substance with a sweetish yet astringent 
 taste and a strong disagreeable odor like that of bromin 
 itself. It is insoluble in water but is readily soluble in 
 alcohol, ether, chloroform, glycerin and the fatty and 
 ethereal oils. Bromol has been employed successfully 
 as an intestinal disinfectant in cholera infantum and 
 typhus fever and also as a local remedy in diphtheria. 
 
 Bromol is best used, locally, as a solution in glycerin 
 of a strength of 1:25. Internally, especially in choleraic 
 troubles in children, it may be given in doses of 1-12 
 to 1-4 of a grain. 
 
 Bromo Phenol. — This substance, which is Ortho- 
 hromo 'phenol^ is a dull, violet- colored liquid with an odor 
 like that of carbolic acid (phenol), of which it is a bro- 
 min derivative. According to Squibb this substance 
 must have the chemical formula CgBrgOH. It is soluble 
 in water, alcohol, ether and alkalies. Tchourilow 
 reports, from St. Petersburg, excellent results follow- 
 ing its use in twenty cases of erysipelas; he employed it 
 in the form of a 1-2% ointment made by incorporation 
 with soft paraffin. Good effects followed its use iu 
 
116 
 
 anthrax and tetanus experimentally produofd in 
 rabbits. 
 
 Butyric Acid. — This substance is utterly devoid of 
 germicidal power. Koch found that an immersion of 
 anthrax spores in the acid for five days did not result 
 in their destruction. This acid is the fourth member 
 of the group of so called "fatly acids" and has the 
 chemical formula C3H7COOH 
 
 Calcic Chlorid. — CaCl2. Highly deliquescent and 
 freely soluble in water. Koch demonstrated that even 
 a saturated aqueous solution of the salt is incapable of 
 killing anthrax spores. Miquel has determined that it 
 is antiseptic in Ihe proportion 1:25. 
 
 Calcic Hydroxid (Lime Water). — Ca (OH) 2- Pfuhl 
 found in experimenting upon the effect of "lime water" 
 upon typhoid stools that 3% would sterilize them in six 
 hours and that 9% would sterilize them in two hours. 
 Lime water is produced by the action of water upon 
 quicklime; Kitasato found that a solution containing 
 .1% of quick-lime (CaO) had the power of kiDing the 
 typhoid bacilli and the cholera spirilla in five hours. 
 Jaeger made experiments with a view to determining 
 the power of lime-washes; one application destroyed 
 several pyogenic and pathogenic species in twenty-four 
 hours but had no effect upon the Bacillus tuberculosis^ 
 even after three successive applications. 
 
 Calcic Hypochlorite ("Chloride of Lime").— 
 Ca(C10)2. Commonly called "chloride of lime" — it is 
 not the chlorid (CaClj) but chiefly the hypochlorite 
 (CaClaOa), although it does frequently contain portions 
 
117 
 
 of the chlorid. It is prepared on the large scale by 
 the action of chlorin upon calcic hydroxid or else 
 quick-lime and is a white powder with a chlorin- 
 like odor. When exposed to the air it becomes 
 damp by absorption of atmospheric moisture, that 
 is, it is hygroscopic; this absorption of moisture 
 is accompanied however by a chemical decompo- 
 sition with a gradual evolution of free chlorin, 
 which is an active disinfectant and bleaching agent. 
 Good "chloride of lime" should contain at least 25-30% 
 of available chlorin. This substance is one of our best 
 domestic germicides and is of great value — not in the 
 treatment of wounds but in the disinfection of infected 
 articles. In order to be effective against bacilli and 
 spores, as found in the fecal discharges, it must be used 
 in a 4 per cent solution containing at least 25 per cent 
 of available chlorin, although somewhat weaker solu- 
 tions will be almost as efficacious. The American Pub- 
 lic Health Association maintains that a solution con- 
 taining .25 per cent of available chlorin is an efficient 
 germicide even when allowed to act for one or two 
 minutes. Duggan found that .06 per cent would kill 
 the spores of Bacillus anthracis and Bacillus sub t His in 
 two hours. Nissen in his important experiments upon 
 this substance with a view to determining its germicidal 
 power demonstrated that a .12 per cent solution was 
 able to kill typhoid bacilli and cholera spirilla in five 
 minutes; a .1 per cent solution would kill anthrax bacilli 
 in one minute; a 5 per cent solution would destroy 
 anthrax spores in thirty minutes and a 1 per cent solu- 
 
118 
 
 tion would produce the same result in seventy minutes. 
 He also determined that .5-1 per cent would destroy the 
 germs of cholera and typhoid, in feces, in ten minutes. 
 Certainly it seems to be the d\muieGt3int/>ar excel/ence 
 for sterilization of infectious stools and other dis- 
 charges. 
 
 Calcium Salicylate. — CaC7H408 .H2O. This sub- 
 stance occurrs as a white, tasteless, odorless and cry- 
 stalline powder not readily soluble in water. It is said 
 to be especially valuable in such intestinal disorders of 
 children as diarrhea and gastro-enteritis. It is usually 
 administered in doses of 8-24 grains. 
 
 Camphor (Laurinol). — CioHigO. A gummy sub- 
 stance obtained from the Laurus camphora which is in- 
 digenous to the eastern portion of Asia. It is a vola- 
 tile solid which occurs in white, translucent masses of 
 a tough consistency and a crystalline structure. It has 
 a characteristic penetrating odor and toxic properties. 
 It is nearly entirely insoluble in water but is soluble in 
 alcohol, ether and chloroform. The experiments of 
 Arloing, Thomas, Cornevin, Cadeac and Meunier dem- 
 onstrate that camphor has little if any germicidal power. 
 It required from eight to ten days to kill the spirilla of 
 cholera and the bacilli of typhoid fever, which germs 
 are by no means highly resistant. 
 
 Carbolic Acid (Phenol). — Also termed Phenyl al- 
 cohol, Phenyl hydroxide Phenyl hydrate^ Hydroxylbenzene. 
 CfiHgOH. Crude carbolic acid is a reddish-brown 
 neutral (not acid) liquid with a strong empyreumatic 
 and disagreeable odor. It is obtained by the distil la- 
 
119 
 
 tion of coal-tar and contains phenol, cresol and other 
 substances. The pure acid is obtained by the fractional 
 distillation of the crude product and occurs either in the 
 form of colorless acicular crystals or else in crystalline 
 masses produced by the interlacing of such crystals. It 
 18 usually colorless when pure but becomes faintly 
 pinkish upon keeping or upon exposure; it has a charac- 
 teristic aromatic odor, which in the imperfectly purified 
 grades is like that of creosote. Carbolic acid is deli- 
 quescent — indeed the very best acid to be obtained in 
 the market contains from two to four per cent of water 
 and even very good acids may contain more than thip. 
 When exposed freely it forms an oily liquid, due to 
 the absorption of atmospheric moisture. When diluted 
 it has a sweetish taste followed by a burning and caus- 
 tic sensation. It produces a benumbing effect when 
 placed in contact with the living tissues and hence is 
 used, either free or combined, for the production of 
 local anesthesia. It is also caustic in strong solutions 
 Carbolic acid is freely soluble in alcohol, glycerin 
 benzene, ether, chloroform, carbon di sulphid, the vola 
 tile oils, the fixed oils and aUo to some extent in aque 
 ous solutions of the alkalies. It is generally stated 
 even by many go* called authorities upon the subject, 
 that the acid is soluble in twenty parts of water only 
 but this is untrue, for Allen has found it to dissolve in 
 10.7 parts by weight of water for one part of absolute 
 acid — making its solubility nearly twice as great as that 
 ordinarly given. The acid has also the power of dis 
 solving about 27% of water, as Allen has also deter 
 
120 
 
 mined, and not 5% as usually given. With elevation 
 of temperature a larger proportion of water can be held 
 in solution, becoming turbid upon cooling. When 5% 
 of wAter has been absorbed it becomes permently liquid 
 and the acid is usually dispensed in this condition. 
 
 By far the greatest use of carbolic acid, or phenol, 
 in medicine is as an antiseptic and germicide. The an- 
 tiseptic and disinfectant properties of coal-tar were 
 recognized by Chaumette as early as the year 1815. 
 These valuable propertise were recognized and their 
 existence in coal tar confirmed by (ruibourt (1833), 
 Siret (1839), Bayard (1846), Le Boeuf (1850), Calvert 
 (1857), Lemaire (1860) and Dumas. Dumas called at- 
 tention to the fact that carbolic acid existed in coal-tar 
 and to it was probably due its antiseptic virtues. 
 Lemaire experimented with coal-tar saponine and also 
 carbolic acid — in 1863 appeared his little work '"-De 
 Pacide phenique^^^ wYiiGh created such wide-spread in- 
 terest. Since that time the manufacture of carbolic 
 acid became an industry. Lemaire was the first to use 
 carbolic acid to any extent and was among those who 
 early recognized the truth of the germ theory as applied 
 to wounds and wound complications — he was, as some- 
 one has said, "an advanced treater of wounds with an- 
 tiseptics, nothing more." But really what more could 
 one want or demand at this early stage, before the 
 birth, of systematic antiseptic methods? Carbolic acid 
 was also the first antiseptic agent made use of by 
 Lister; it is one of the oldest and bent studied of all 
 antiseptics — indeed^to this^very drug is due the credit 
 
121 
 
 ofi opening and founding the new era in surgery. 
 
 Hare ranks carbolic acid next in importance and 
 efficiency to mercuric chlorid (corrosive sublimate) 
 which he places first as an antiseptic and germicide. 
 He calls special attention to the fact that it is equally 
 valuable in albuminous and non-albuminous solutions, 
 which is not true of mercuric chlorid. Carbolic acid is 
 a reliable antiseptic in comparatively weak solutions, 
 such as 1:20, and even 1:40 may be depended upon. Its 
 complete admixture with all of the secretions allow of 
 its complete penetration into all parts of a wound sur- 
 face and thereby thorough disinfection is obtained. 
 Carbolic acid also possesses the advantage of not being 
 neutralized by the substances found in the excreta or 
 by the presence of albumin, although it causes coagula- 
 tion of the latter. Bolton found that the addition of 10 
 per cent of albumin to a bouillon culture did not ma- 
 terially influence the action of the carbolic acid thereon. 
 Even Koch, who advocated corrosive . sublimate so 
 strongly at one time, says that carbolic acid affords an 
 excellent means of destruction for a certain category of 
 micro organisms, indeed a very great number. While 
 carbolic acid or phenol is of undoubted value as an an- 
 tiseptic and germicide yet its compounds, of which 
 there are hundreds, are all inferior to carbolic acid it- 
 self, according to Koch. 
 
 The antiseptic virtues of the acid have been indubit- 
 ably proven by numerous experiments. Cheyne found 
 that if milk was poured from one vessel to another 
 within the influence of the carbolic spray and then se- 
 
122 
 
 curely sealed that it would remain unchanged for at 
 least two months. Grace Calvert (ISlO) found that 
 albumen was preserved by admixture with carbolic acid. 
 Dougall found that a solution of the strength of 1:2,500 
 was sufficient to destroy not only spermatozoa but also 
 the higher infusoria. Sohroeter (1878) found that a 
 solution of 1:2,000 was sufficient to preserve flesh four 
 weeks and that a strength of .2% (1:500) preserved it 
 permanently. Hoppe-Seyler and Baxter determined 
 that a 2% solution the acid destroyed the infective 
 power of vaccine with certainty; this was also corrobo 
 rated by many others. The germicidal power of the 
 drug has been studied by Calvert, Dougall, Schroeter, 
 Baxter, Sternberg, Hoppe-Seyler, Hugge, Koch, Rosen- 
 bach, Davaine, Blythe, Arloing, Cornevin, Thomas and 
 others upon almost all known forms of organipms. 
 Many of these investigators claim that an aqueous solu- 
 tion of 1% is sufficient to destroy the infective power 
 of ordinary septic and purulent matters and that 2% 
 will destroy the infectious principle of vaccine and 
 glanders. Miquel has determined that it is antiseptic 
 in the proportion of 1:333 but the experience of Dougall, 
 Schroeter and others seem to indicate that this is far 
 too low a power to assign to it. 
 
 Koch found that in the absence of spores a 1 % solu- 
 tion was sufficient to quickly destroy baoteria, but that 
 anthrax spores require at least 3 per cent in order to ob- 
 tain this result and 5 per cent in some cases. The ex- 
 periments of La Place however indicate that the addi- 
 tion of hydrochloric aqid materially increases the germ- 
 
123 
 
 icidal power for spores. Yersin found that 1 per cent 
 would destroy the tubercle bacillus in one minute while 
 5 per cent would do this in thirty seconds. Nicali and 
 Rietsch determined that .5 per cent (1:200) would kill 
 cholera spirilla in ten minutes. Schill and Fischer 
 found that a 3 per cent solution was sufficient to destroy 
 the infectious power of tuberculous sputa, but that a 5 
 per cent solution was required to destroy pure cultures. 
 
 Davaine determined that 1 per cent would destroy 
 anthrax bacilli in fiesh blood in one hour. Sternberg 
 found that 1:125 solutions destroyed pus cocci and 
 1:200 solutions destroyed the Micrococcus Pasteuri in 
 two hours. It is interesting to note that Koch has prov 
 en that solutions in oil or alcohol are much less efficient 
 than aqueous solutions. Bolton proved by two hours 
 action upon fresh bouillon cultures that a 1 per cent 
 solution would destroy the bacilli of typhoid fever, the 
 spirilla of cholera, the bacteria of green pus and Staphy 
 lococcus pyogenes albus^ aureus and citrus and Streptococcus 
 pyogenes (the pus cocci causing putrefaction, the chief 
 foes of the surgeon). The experiments of Douglass and 
 Baxter led them to the conclusion that aerial disinfec- 
 tion by carbolic acid was practically impossible. Stim- 
 son corroborated these results as far as the use of the 
 spray for this purpose is concerned. 
 
 It is clear then that to be effective as germicides 
 solutions must have a strength of at least 1:40. The 
 two chief objections which have been raised against the 
 use of carbolic acid in wounds are {a) the oozing which 
 its use seems to cause, and (^) its caustic or irritating 
 
124 
 
 properties which are not great. Attempts have been 
 made to meet these objections in several ways; the 
 methods which seem to give more promise of success 
 than all others are those in which the acid is combined 
 with something else in the form of a powder which is 
 not only absorbent but which also, either by direct 
 union with the acid or else by its own peculiar soothing 
 and emollient effect, robs the acid of its irritant prop- 
 erties, slight as they are. 
 
 At the German Congress of Medicine, held at Wies- 
 baden, April 12-15, 1393, Professor von Ziemssen re- 
 ported very satisfactory results from the use of injec- 
 tions of 1-2 c.c. (about eight minims) of a 2 per cent 
 solution of carbolic acid into the substance of the tonsil 
 in many cases of catarrhal inflammation of the throat. 
 The temperature fell almost immediately, and in every 
 case recovery took place rapidly. The same method of 
 treatment was also successful, though less constantly, 
 in diphtheria, where its effects, however, were less rapid. 
 In a case of scarlet fever of a grave character, compli- 
 cated with erysipelas, which caused a considerable rise 
 of temperature, the desired result was obtained with 
 two injections. It a late issue of his "Ephemeris" 
 Squibb says: "Carbolic acid still holds prominence 
 over its many and increasing rivals. * * * During 
 the past year a new series of derivatives of this acid 
 has been produced from essential oils, and patented in 
 Germany, which claim to be odorless, tasteless, neutral 
 in reaction and to cause no irritation. These deriva- 
 tives when obtainable will have to be closely studied 
 therapeutically." 
 
125 
 
 It is of the very greatest interest iu this connection 
 to note how history repeats itself; carbolic acid was 
 among the first of antiseptic substances introduced into 
 common practice. For a period of time recently corro- 
 sive sublimate has enjoyed the confidence of practi- 
 tioners of antiseptic surgery. Since the time when he 
 first announced his principles Sir Joseph Lister has been 
 working unceasingly in a search for the ideal and per- 
 fect antiseptic; many were devised only to be cast aside. 
 Carbolic acid has received renewed prominence over its 
 great rival, mercuric chlorid (corrosive sublimate), by 
 the renewed allegiance of its original promoter, Lister. 
 In his "Address on the Antiseptic Management of 
 Wounds," delivered in the London Post Graduate 
 Course, at King's College Hospital, on January 18, last 
 {Brit. Med, Journ.^ Vol. L, 1893, p. 161), he declared 
 his complete and unqualified abandonment of corrosive 
 sublimate in favor of his first choice, carbolic acid. The 
 strength which he now adopts is 1:20, which he de 
 clares to be completely trustworthy for surgical pur- 
 poses. Its greater efficiency as a germicide is not 
 only established, but he also finds it greatly to be 
 preferred in other respects. He furthermore said: 
 
 "Carbolic acid has a powerful affinity for the epider- 
 mis, penetrating deeply into its substance; and it min- 
 gles with fatty materials in any proportion. Corrosive 
 sublimate solution, on the other hand, cannot penetrate 
 in the slightest degree into anything greasy and there- 
 fore as the skin is greasy, those who use corrosive sub- 
 limate require elaborate precautions in the way of 
 
126 
 
 cleansing the skin — treating it with oil of turpentine or 
 ether, not to mention soap or water, to remove the 
 grease which they feel it essential to get rid of for the 
 efficient action of the corrosive sublimate. Now all 
 this is unnecessary care if you use carbolic lotion. I 
 can testify to this from very ample experience. For 
 my part I do not even use soap and water. I trust to 
 the carbolic acid, which, by its penetrating power and 
 great affinity for organic substances, purifies the in- 
 tegument in a way that inorganic salts, like corrosive 
 sublimate, cannot." This renewed allegiance of Lister's, 
 coming as it does at a time when the investigations at 
 the Johns Hopkins University and the University of 
 Michigan cast considerable doubt upon the existence of 
 the high degree of activity which has usually been as- 
 cribed to corrosive sublimate, has a peculiarly weighty 
 significance. 
 
 Carvacrol. — A substance, said to be a phenol, oc- 
 curring in the essential oil of several plants of the 
 species Origanum. Its chemical composition is C12H14O. 
 It is a thick oily body, its iodid being a yellowish- 
 brown powder. The salt is insoluble in water but 
 freely soluble in ether, chloroform and olive oil. It 
 has been used locally, in the form of powder, ointment 
 and as gauze, as an antiseptic in diseases of the skin 
 and as a substitute for iodoform in the treatment of 
 wounds and ulcerations. 
 
 Chinolinb (Quinoline). — C9H7N. A substance ob- 
 tained from chinonine or quinine by distillation; it may 
 be also synthetically prepared. It is, when pure, a 
 
127 
 
 colorless liquid with a characteristic, pungent and arom- 
 atic odor. It is almost insoluble in cold water but 
 freely soluble in alcohol, ether and hot water. It has 
 been mainly used as an antiseptic. It is used locally as a 
 10% solution in rectified spirit or else peppermint water 
 Internally the dose of chinoline itself is 3-10 minims; 
 of the tartrate, 5-15 grains. 
 
 Chloral (Tri-chloraldehyd). — Sternberg found 
 that a 20% solution required two hours to kill pus 
 cocci. Miquel has determined that it is antiseptic in 
 the proportion 1:107. Evidently it possesses no great 
 germicidal power. Chemical formula, CClsCOH; the 
 hydrate, CCI3CH (OH), or better CCUCOII.H^O. 
 
 The antiseptic properties of chloral were first noticed 
 by Hirne and Dujardin Beaumetz in 1872. The subject 
 has been also investigated by Keen and Personne. It 
 has been shown, as Wood says, that a solution of twenty 
 to forty grains to the ounce will preserve animal tissues 
 for a great while, probably indefinitely. Even the 
 finest microscopical structure appears to remain un- 
 injured by this strength. In his first experiences with 
 the drug. Dr. Keen hoped that as long as it does not 
 affect the color of the tissues it might prove useful in 
 the dissecting room; subsequent trials have confirmed 
 this. Dr. Keen has also found the drug eflScient in 
 keeping the urinals of paraplegics and others suffering 
 from incontinence of the urine free from the objection- 
 able odor. However the drug has no great germicidal 
 power. 
 
 Chlorin. — Chemical symbol, CI. Chlorin is a gas, 
 
130 
 
 Chloroform (Tri chlor methane). — This substance 
 has the chemical formula CHCI3 Its chemical and 
 physical properties are too familiar to physicians to 
 need further discussion or description. 
 
 Kirchner found that 1 per cent killed cholera spirilla 
 in less than one minute while typhoid bacilli required 
 exposure for at least an hour to the influence of 1-2 per 
 cent ( 5 per cent) to effect the same result. In the ex- 
 periments of Salkowski it was determined that, in the 
 absence of spores, anthrax bacilli and cholera spirilla 
 were killed in half an hour by exposure to the drug. 
 Koch found that anthrax spores, however, did not have 
 their vitality destroyed even by one hundred days' im- 
 mersion in chloroform. Evidently then the action of 
 the drug, as a germicide, is directed to the parent cells 
 and seems to have little or no effect upon spores — at 
 least those of the more resistant germs. 
 
 Chloro-phenol (Tri chlob -phenol). — This sub- 
 stance is a derivative of phenol (carbolic acid) in which 
 three' atoms of hydrogen are replaced by three atoms of 
 chlorin and hence it has the chemical formula CeHaCla. 
 OH. It occurs in the form of colorless, needle-like 
 crystals with an odor of phenol, which is more strongly 
 marked than in its allied substitution product called 
 Bromo phenol and which it remarkably resembles in solu- 
 bility as well as properties. 
 
 Chlorphenol (Mono chlor phenol). — This sub- 
 stance is phenol in which one of the hydrogen atoms 
 of the phenyl (CeH^) is replaced by one atom of 
 chlorin, thus CgH^CLOH. It occurs as a volatile 
 
131 
 
 liquid heavier than water and possesses antiseptic prop- 
 erties. It is said to have been employed with good re- 
 sults in tuberculous diseases, bronchitis, laryngitis, 
 ozena, discharging glands, ulcers and wounds. It is 
 usually administered by inhalation but is also employed 
 as a local application. 
 
 Chromic Acid. — This substance has the chemical 
 formula HaCrO^ It is obtained by the treatment of 
 potassic di-chromate with sulphuric acid and by dis- 
 solving the resulting long, red, hygroscopic, rhombic 
 prisms of needles of chromic anhydrid (CrOg) in water. 
 It mixes with water in almost all proportions. The 
 substance is employed in concentrated solutions as a 
 powerful caustic in the treatment of tumors, excrescen- 
 ces, syphilitic tumors or ulcers, etc. It can be used in 
 various strengths, such as 1-5 per cent. It is often used 
 for sterilizing and hardening various surgical prepara- 
 tions. In ozena and gonorrhea, aqueous solutions of the 
 drug in the strength 1:1000 have been used. As anti- 
 septics chromic and osmic acids are of about equal 
 values. Koch's experiments indicate that it is markedly 
 germicidal, a 1 per cent solution destroying anthrax 
 spores in one to two days. Miquel has determined that 
 it is antiseptic in the proportion 1:5000» Its chief ob- 
 jection is the fact that it is exceedingly irritating and 
 caustic, indeed cases are reported in which death has 
 been ascribed to its free use. 
 
 Chrysarobin. — C30H26O7. Obtained from the wood 
 of the tree, Andira araroba. The drug occurs in orange- 
 yellow or golden, shining, tasteless needles which are 
 
130 
 
 Chloroform (Tri chlor methane). — This substance 
 has the chemical formula CHCI3. Its chemical and 
 physical properties are too familiar to physicians to 
 need further discussion or description. 
 
 Kirchner found that 1 per cent killed cholera spirilla 
 in less than one minute while typhoid bacilli required 
 exposure for at least an hour to the influence of 1-2 per 
 cent ( 5 per cent) to effect the same result. In the ex- 
 periments of Salkowski it was determined that, in the 
 absence of spores, anthrax bacilli and cholera spirilla 
 were killed in half an hour by exposure to the drug. 
 Koch found that anthrax spores, however, did not have 
 their vitality destroyed even by one hundred days' im- 
 mersion in chloroform. Evidently then the action of 
 the drug, as a germicide, is directed to the parent cells 
 and seems to have little or no effect upon spores — at 
 least those of the more resistant germs. 
 
 Chloro-phenol (Tri chloe -phenol). — This sub- 
 stance is a derivative of phenol (carbolic acid) in which 
 three' atoms of hydrogen are replaced by three atoms of 
 chlorin and hence it has the chemical formula CgHaClg. 
 OH. It occurs in the form of colorless, needle-like 
 crystals with an odor of phenol, which is more strongly 
 marked than in its allied substitution product called 
 Bromo phenol and which it remarkably resembles in solu- 
 bility as well as properties. 
 
 Chlorphenol (Mono chlor phenol). — This sub- 
 stance is phenol in which one of the hydrogen atoms 
 of the phenyl (CeH^) is replaced by one atom of 
 chlorin, thus CgH^CLOH. It occurs as a volatile 
 
131 
 
 liquid heavier than water and possesses antiseptic prop- 
 erties. It is said to have been employed with good re- 
 sults in tuberculous diseases, bronchitis, laryngitis, 
 ozena, discharging glands, ulcers and wounds. It is 
 usually administered by inhalation but is also employed 
 as a local application. 
 
 Chromic Acid. — This substance has the chemical 
 formula HaCrO^ It is obtained by the treatment of 
 potassic dichromate with sulphuric acid and by dis- 
 solving the resulting long, red, hygroscopic, rhombic 
 prisms of needles of chromic anhydrid (CrOs) in water. 
 It mixes with water in almost all proportions. The 
 substance is employed in concentrated solutions as a 
 powerful caustic in the treatment of tumors, excrescen- 
 ces, syphilitic tumors or ulcers, etc. It can be used in 
 various strengths, such as 1-5 per cent. It is often used 
 for sterilizing and hardening various surgical prepara- 
 tions. In ozena and gonorrhea, aqueous solutions of the 
 drug in the strength 1:1000 have been used. As anti- 
 septics chromic and osmic acids are of about equal 
 values. Koch's experiments indicate that it is markedly 
 germicidal, a 1 per cent solution destroying anthrax 
 spores in one to two days. Miquel has determined that 
 it is antiseptic in the proportion 1 :5000. Its chief ob- 
 jection is the fact that it is exceedingly irritating and 
 caustic, indeed cases are reported in which death has 
 been ascribed to its free use. 
 
 Chrysarobin. — C30H26O7. Obtained from the wood 
 of the tree, Andira araroha. The drug occurs in orange- 
 yellow or golden, shining, tasteless needles which are 
 
132 
 
 soluble in alcohol, ether, chloroform, benzene, alkaline 
 and acid solutions and slightly so in water. It is chief- 
 ly used as anti-parasitic in the treatment of various 
 affections of the skin and is said to have given especial- 
 ly good results in psoriasis. Externally it is applied 
 usually in the form of an ointment of 10 per cent 
 strength. Internally the dose is from 1-8 to 1-4 of a 
 grain. Its internal use is however comparatively re- 
 stricted and seldom resorted to 
 
 Citric Acid. — HgCsHjOy.HaO. Citric acid is a tri- 
 basic organic acid found in the juices of many fruits 
 such as the strawberry, raspberry, currant, cherry, etc., 
 but e8pecia[ly in the lemon, from which fact it receives 
 its name. It occurs in the form of colorless crystals 
 which are readily soluble in water. Van Ermengera 
 determined experimentally that .5 per cent (1:200) was 
 sufficient to kill cholera spirilla in half an hour. Kita- 
 sato found that ,43 per cent killed typhoid bacilli in 
 five hours and .3 per cent would kill the cholera germ 
 in the same time. Clearly then the substance possesses 
 germicidal powers which are very manifest in the case 
 of the less resistant germs at least. 
 
 Coffee Infusion, — The experiments of Heim and 
 Luederitz indicate that this substance possesses antisep- 
 tic and feeble germicidal power. To what ingredient 
 this was due they did not determine but agreed that it 
 was not dependent upon the caffein. 
 
 Corrosive Sublimate (Bi- Chloride of Mercury, 
 Mercuric Chlorid). — HgCl,. This substance occurs 
 as a heavy white powder or iq colorless, rhombic crys- 
 
133 
 
 tals or else in crystalline masses; it crystallizes from 
 concentrated solutions in hot water in the form of 
 acicular or needle-like crystals. When heated it fuses. 
 It has an acrid, metallic taste and an acid reaction and 
 is strongly poisonous and antiseptic. Is used chiefly in 
 medicine as an antiseptic or else in the internal treat- 
 ment of syphilis. It is soluble in cold water and gly- 
 cerin but much more so in hot water, alcohol and ether. 
 Up till the year 1881 the favorite and indeed almost 
 universal antiseptic was carbolic acid; but in that year 
 Koch announced his belief in the superior efficacy of 
 mercuric chlorid and the tide of popular favor surged 
 largely in the direction of the latter drug. This action 
 was based upon experimental evidence which seemed to 
 indubitably demonstrate the superior germicidal power 
 of the mercurial salt. For instance it was stated that a 
 1:300,000 solution would restrain the growth of anthrax 
 spores while a'l:l,000 solution would destroy them. In- 
 deed most of the authorities of the surgical world 
 seemed convinced by the evidence brought to bear in 
 favor of mercuric chlorid. Sternberg said that the ex- 
 perimental data indicated that its use for disinfection 
 in strengths of 1:500-1:1,000 was reliable for material 
 containing spores and in the strength of 1:2,000-1:5,000 
 for pathogenic bacteria in the absence of spores, but 
 that due regard must be had for the fact that the pres- 
 ence of albumin very materially reduces its germicidal 
 potency. We now know, however, that even the very 
 strongest solution (1:500) which he gave is not able to 
 destroy pus cocci ^.nd other micro-organisnjs, even in the 
 
134 
 
 absence of spores. We know now that its aiction is that 
 of inhibition and not destruction. In the year 1883 
 Sternberg gave the following table of the relative values 
 of various germicidal, or supposed germicidal, agents: 
 
 Efficient. 
 
 Mercuric chlorid 1:20,000. 
 
 Potassic permanganate . . . 1:833. 
 
 lodin 1:500. 
 
 Creosote 1:200. 
 
 Sulphuric acid 1:200. 
 
 Carbolic acid 1:100. 
 
 Hydrochloric acid .... 1:100. 
 
 Zinc chlorid 1:50. 
 
 Tr. of Ferric chlorid .... 1 :25. 
 
 Salicvlic acid ^ 1:25. 
 
 (Dissolved with borax). 
 
 Potassic^hydroxid . . . . 1:10. 
 
 Citric acid 1 :8. 
 
 Chloral hydrate 1:5. 
 
 Failed. 
 
 PER CENT. 
 
 Fowler's solution 40. 
 
 Sodic "hyposulphite" 32. 
 
 Sodic sulphite (exsic.) 10. 
 
 Ferric (?) sulphate 16. 
 
 (J^evYous is probably meant). 
 
185 
 
 20. 
 4. 
 4. 
 4. 
 
 he micrococci of 
 
 Potassic iodid . . . 
 Zinc chlorid (liquid) . 
 Zmc sulphate . . . 
 Boracic acid (sat. sol.) 
 Sodic borate (sat. sol.) 
 Sodic salicylate .... 
 
 In these experiments of Sternberg 
 pus were used and further experimentation conducted 
 with the micrococci of septicemia, the Bacterium iermo 
 and the bacteria of *'brokendown beef tea" indicated 
 that their relative values as germicides remained prac- 
 tically the same. 
 
 For a long time it (mercuric chlorid) wa3 considered 
 one of the very best of all germicides. 
 
 Even Koch in his advocacy of corrosive sublimate 
 said that while solutions of 1:10,000, 1:20,000 or even 
 1:30,000 exert an inhibitory and sometimes toxic action 
 upon germs and spores when brought into direct con- 
 tact with them, a much stronger solution is required for 
 prompt destruction. In some cases the results obtained 
 where wholly negative; thus, fresh tubercular sputum 
 remained infectious even after an exposure for twenty' 
 four hours to a solution of a strength of 1:2,000, More- 
 over the substance is exceedingly prone to decompose 
 in the presence of albumin, chemically combining with 
 it and thereby losing much of its antiseptic activity and 
 also rendering it difficult to forecast the certainty and 
 extent of its action when such conditions obtain. 
 
 Recent investigations conducted at the Johns Hop- 
 
1^6 
 
 kin8 University and at the University of Michigan have 
 shown that solutions of mercuric chlorid, when Used as 
 germicides, are often inert and still oftener actually in- 
 jurious to the tissues when applied in surgical opera- 
 tions. A long series of experiments at the Johns Hop- 
 kins Hospital resulted in defining the limitations of the 
 drug as follows: 
 
 1. Under the most favorable conditions, a given 
 amount of sublimate has the power of rendering inert 
 only a limited number of individual organisms. (It 
 does not destroy them). 
 
 2. The disinfecting activity of the sublimate against 
 organisms is profoundly influenced by the proportion of 
 albuminous material contained in the medium in which 
 the bacteria are present. 
 
 Kelly, Robb and Ghriskey, as well as others, have 
 proven that even strong solutions (such as 1:500) while 
 antiseptic and inhibitory are devoid of d^uy germicidal 
 power. Kelly says: "Corrosive sublimate solutions as 
 strong as 1:500 are not germicidal after' immersion of 
 the hands from two to five minutes. The mercury salt 
 acts either by mechanically coating or chemically com- 
 bining with some portion of the coccus, thus only in- 
 hibiting further growth until the salt is precipitated or 
 removed. This I have repeatedly shown to be true fol- 
 lowing both the ordinary practice of immersion of the 
 hands from two to five minutes in 1:500 and 1:1,000 
 solutions after a preliminary washing for ten minutes 
 with soap and water, and again after carefully follow- 
 ing out Fuerbringer's method, now so generally adopted. 
 
137 
 
 The latter method was distinctly shown to be inefficient 
 in almost every instance." After considerable research 
 upon the subject he furthermore decides that corrosive 
 sublimate, although dangerous on wounds on account 
 of the property of coagulating and causing necrosis of 
 the albuminous tissues, yet has the valuable property 
 of inhibiting, not destroying, the action of those germs 
 with which it comes in contact. Indeed Halsted has 
 shown that the irrigation of fresh wounds by a solution 
 of corrosive sublimate as weak as lo^ooo is followed by 
 a distinct line of superficial necrosis which is clearly 
 demonstrable under the microscope. Then also, its dis- 
 tinct toxic properties must not be forgotten for an in- 
 stant; especially is this the case when the substance is 
 to be used in intra uterine or vaginal injection, or in 
 the serous cavities, or in irrigation in surgical opera- 
 tions. 
 
 The quondam virtues of corrosive sublimate were 
 founded primarily upon the dicta of Koch and other ex- 
 perimenters. It remained for the present decade to 
 demonstrate the faulty conditions underlying these pri- 
 mary experiments upon which the reputation of the 
 drug was founded and to show that the extravagantly 
 high value placed upon the substance, as a direct result 
 of such experimentation, was also faulty, not to say 
 false. Clinical experience has demonstratad that cor- 
 rosive sublimate does possess inhibitory power in a high 
 degree, but modern bacteriological research has just as 
 clearly demonstrated thSit such power is purely inbibi' 
 torjr m^ pot ^i alj germicidal ip nature. J^ot only \% 
 
138 
 
 its action purely inhibitory but even this action is in- 
 fluenced to a great degree by the conditions surround- 
 ing the application. Indeed the differences in power 
 of corrosive sublimate under different conditions are 
 very much greater than those of carbolic acid, — or most 
 of the other germicides in fact. Aside from the pres- 
 ence of oily materials, which are distinct checks to the 
 efficiency of corrosive sublimate, the greatest obstacle 
 against its use in the animal tissues and fluids is the 
 fact of its precipitation by and with albuminous sub- 
 stances. So great are the dimensions of these obstacles 
 that many claim that it may be seriously doubted 
 whether it is possible to thoroughly disinfect, with cor- 
 rosive sublimate, wounds infected with bacteria. It is 
 also doubted whether irrigation with solutions of cor- 
 rosive sublimate is able to accomplish much more in the 
 way of disinfection than is obtained by the use of sterile 
 solutions of common salt. 
 
 It is chiefly and especially to Geppert that we owe the 
 demonstration that the former methods of testing and 
 ascertaining the germicidal power of mercuric chlorid 
 were subject to such very grave errors that the results 
 obtained therefrom were entirely untrustworthy and far 
 from reliable. It was formerly claimed that mercuric 
 chlorid had the power of absolutely destroying bacteria. 
 Geppert has shown that in order to prove this not only 
 must the germ be subjected to the action of the sub- 
 stance but at the termination of the exposure the anti- 
 septic must be thoroughly removed from the germ; if 
 such removal is not thorough even a slight remaining 
 
133 
 
 amount of the antiseptic may be sufficient to inhibit fu- 
 ture development and the erroneous conclusion 
 reached that the germ is dead because it does not de- 
 velop. 'Geppert has also shown that the best means of 
 ridding the germ of the sublimate is the precipitation 
 of the mercurial salt by means of ammonic sulphid, or 
 ^ny other alkaline sulphid, in order to determine whether 
 bacteria which have been originally subjected to the 
 action of the sublimate have been destroyed or not. 
 When this precaution of precipitation is taken it is 
 found that corrosive sublimate (mercuric chlorid) is far 
 less energetic than has been generally supposed. Thus 
 Koch believed that from his experiments he had demon- 
 strated that corrosive sublimate in the strength 1:1,000 
 destroyed anthrax spores in one minute. Geppert has 
 shown, however, that the same strength may not have 
 killed all of the spores in watery suspension, even at the 
 end of three days! Indeed in a recent article he 
 has even shown that it is exceedingly difficult to deter- 
 mine with any degree of accuracy whether all of the 
 spores are destroyed by the sublimate or not; for a 
 definite concentration of the reagent (the sulphid) used 
 for such precipitation is required in order to effect a 
 complete separation of the sublimate from the germ. 
 Hence neither failure to obtain cultures after such precip- 
 itation, ror failure of cultures, so treated, to infect an ani- 
 mal are proof that the germs or spores have been killed 
 by sublimate; for a different concentration or strength of 
 the substance used to precipitate the sublimate, or else 
 the use of some reagent less injurious^ per se, to the 
 
no 
 
 gpofes or g^rins might show that they possessed still 
 greater resistance to the action of the sublimate, as 
 Welch has also stated. This is exceedingly plausible 
 when we remember that definite concentrations of the 
 alkaline sulphids must possess some antiseptic virtues 
 and these but reinforce the action of the sublimate, as 
 far as the action upon the germ is concerned, although 
 resulting in the ultimate precipitation of that compound. 
 
 Abbott has also confirmed several of these results. 
 His recent experiences (189J) show that 1:1,000 does 
 not always destroy Staphylococcus pyogenes aureus^ even 
 after five minutes exposure — in some cases requiring 
 as much as ten, twenty or even thirty minutes to in 
 hibit their action. In his experience the cyanid and 
 iodid are both of higher inhibitory power — although 
 the first is exceedingly poisonous. 
 
 In 1884 Professor Klein made the curious statement 
 that corrosive sublimate has no more germicidal power 
 than vinegar — such vinegar, containing from 6 3 to 7.0 
 per cent of acetic acid, prevented the growth and devel 
 opment of micro organisms just as effectually as a 
 1:1,000 solution of the sublimate. McClintock, of the 
 University of Michigan made elaborate experiments 
 with a view to testing such statements of Klein. His 
 results strongly corroborated those obtained by Klein, 
 Geppert, Welch, Kelly, Robb, Ghriskey and others, 
 confirming the statement that the actual germicide 
 value of corrosive sublimate is very low. Lister 
 distinctly states that it is, as a germicide, far inferior 
 to carbolic acid. McClintock made exhaustive experi* 
 
141 
 
 merits with various germs, using solutions of corrosive 
 sublimate as the inhibitory agent. His results show 
 that it is possible for germs to withstand the action of 
 that drug as follows: 
 
 Staphylococcus pyogenes aureus: 
 
 1:1000—23 hours. 1:100-— 11 hours. 
 
 Saturated solution for one hour! 
 Bacillus subtilis: 
 
 1:1000—41 hours. 
 
 Saturated solution for eighty-five 7ninutesl 
 The germ of Stvine Plague: 
 
 1:200—1 hour. 
 Typhoid bacillus: 
 
 1:1000— 1 hour. 
 Germs in Feces: 
 
 1:1000— 24 hours. 
 
 Saturated solution for twenty four hours! 
 These results fall with astounding effect upon him 
 who sees naught save perfection in corrosive sublimate; 
 they come home with telling force to Ephraim "who 
 is wedded to his idols." 
 
 We may consider it conclusively proven that cor- 
 rosive sublimate has comparatively low germicidal pow- 
 er although high in inhibitory activity. In using it we 
 must be mindful of the following facts: 
 
 1. It is exceedingly poisonous, even in small quanti- 
 ties. 
 
 2. It corrodes all of the common metals, depositing 
 upon them a thin film of metallic mercury. 
 
 3. It causes superficial necrosis when brought into 
 
142 
 
 contact with living tissue, even in solutions as weak as 
 1:10,000. 
 
 4. It unites with albuminous substances with great 
 facility, forming an isoluble and inert (while insoluble) 
 compound. Lister has suggested that the albuminate 
 of mercury thus formed has antiseptic properties if ren- 
 dered soluble. Laplace recommends the combination 
 of tartaric acid with the sublimate to overcome this 
 tendency to decompose or to combine with albumin. 
 Others have recommended the combination of common 
 salt or of ammonic chlorid for this same purpose. 
 
 5. It does not owe its virtue to the fact that the germ 
 is destroyed, as is commonly believed, but simply to the 
 fact that it prevents development of the germ while it 
 is present. 
 
 6. The substance when left in contact with organic 
 matter, such as sponges or dressings, especially in the 
 presence of light or heat, is prone to decompose — be • 
 coming thus inert. 
 
 Creolin (Liquor Antisepticus). — This substance is 
 a form of Cresol obtained by the dry distillation of Eng 
 lish coal. It is said to be a coal-tar product resembling 
 carbolic acid in appearance but with an odor of tar. It 
 appears as a black alkaline fluid of the consistency of 
 syrup and a specific gravity slightly higher than that of 
 water. Its odor is characteristic. It is soluble in alco 
 hoi, ether and chloroform and insoluble in methyl alco- 
 hol and water— with the latter it forms an opaque emul- 
 sion, on this account it can never supersede carbolic 
 acid for the sterilization of instruments and the main- 
 
143 
 
 tenance of an aseptic condition of such instruments dur- 
 ing a surgical operation. It undoubtedly possesses de- 
 cided germicidal power but is inferior in its action upon 
 pathogenic organisms to carbolic acid — except in the 
 ca^e of the spirilla of cholera. It has by no means de- 
 veloped the high germicidal power at first claimed for 
 it. It. is a cheap and efficient germicide but is decidedly 
 inferior to carbolic acid — especially in the presence of 
 albumin, its efficiency being almost neutralized by the 
 occurrence of as small a proportion of albumin as one 
 part in one hundred. It is highly extrolled by Neu- 
 doerfer who says that it is "absolutely non-toxic to man; 
 is ten times more germicidal than carbolic acid ; is solu- 
 ble in water, alcohol and glycerin; it controls hemorrhage 
 and pain; it limits suppuration; it injures neither met- 
 al nor hands; it is very cheap." He not only enlarges 
 upon its advantages, giving the substance properties 
 which it never possessed, but he neglects to give its dis- 
 advantages. In the first place, it is not **absolutely 
 non-toxic," this has been disproven by experience — 
 Martin distinctly says that it is not only toxic but that 
 it causes nausea, vomiting and albuminuria. In the 
 second place, it is not as efficient, all in all, as carbolic 
 acid. In the third place, it is not only insoluble in 
 water but forms a non-transparent emulsion with that 
 substance. Moreover its odor is decidedly unpleasant 
 and the compound itself is unstable. 
 
 It has been previously stated to be a coal-tar product 
 but i^ reported by Dr. F. Raschig to be nothing more 
 nor less than a mixture containing about one part of 
 
144 
 
 resin soap with two parts of crude carbolic acid of about 
 twenty per cent strength, although its manufacturers 
 claim that it is entirely free from carbolic acid. Squibb 
 says that its action as a disinfectant reminds one strong- 
 ly of carbolic acid. He also says that unfavorable re- 
 sults have also been presented in regard to its use. 
 
 Creosotal. — A short name recently adopted for the 
 so-called carbonate of creosote, which is supposed to 
 result from the union of creosote and cardon di oxid. 
 At ordinary temperatures it is an oily, amber-colored 
 liquid, becoming more fluid upon warming it. It is 
 neutral to litmus, odorless and with a faint sweetish 
 taste of creosote. It is insoluble in water, dilute alco- 
 hol and glycerin, but readily soluble in alcohol, ether, 
 chloroform and benzine. It is claimed that the sub- 
 stance contains ninety per cent of creosote and is yet 
 free from all of the disagreeable properties of the latter 
 drug. It is recommended in doses of i to 1 drachm daily, 
 increasing to one and a half drachms or even as high as 
 half an ounce. It is recommended'especially of in tuber- 
 culous affections of the lungs, or indeed in any condi- 
 tion where creosote itself is applicable. 
 
 Creosote. — This substance is a product of the dis- 
 tillation of wood tar and resembles carbolic acid in 
 many of its properties, more especially those of an an- 
 tiseptic nature. It consists chiefly of a mixture of sub- 
 stances, such as creosgl (CgHioO,) an^ cresol (CtHsO) 
 which are members of the phenol series. The creosote 
 prepared from beech wood is chiefly recommended for 
 iptenaal adpainistr^ttiou Yfh^^^ sq use^. fMj pinety 
 
145 
 
 per cent of the substance dispensed as "pure beechwood 
 creosote" in drug stores is naught else than carbolic 
 acid. The latter is eliminated chiefly by the kidneys, 
 giving the characteristic color to urine, while creosote 
 is supposed to be eliminated, in part at least, by the 
 lungs. 
 
 Sternberg in his experiments upon the substance in 
 order to determine its germicidal activity found that 
 1:200 was fatal to micrococci. Guttman found that it- 
 was antiseptic in its action upon pathogenic organisms 
 in solutions as weak as 1:3000 or 1:4000, but that in 
 such proportions it did not necessarily kill the organism. 
 Schill and Fisher demonstrated that 1 per cent failed, 
 even after twenty hours exposure, to destroy the Bacil- 
 lus tuberculosis in tuberculous sputa. Yersin's experi- 
 ments were somewhat confirmatory, he found that a 
 saturated aqueous solution did not destroy the tubercle 
 bacillus in twelve hours. 
 
 Cresin: — Sometimes also spelled Kresin, Crude 
 carbolic acid consists of a mixture of cresols or phenols 
 and would be of great antiseptic value but they are al- 
 most insoluble in water and according to Laplace are 
 almost worthless as disinfectants on that account. In 
 order to meet this objection Cresin, which is a solution 
 of cresol (25%) in an equal amount of Sodio Cres oxyl- 
 acetate, was prepared. It is a brown liquid, said to be 
 entirely free from carbolic acid and with an odor of 
 Creeol and forming a clear neutral solution when mixed 
 with water. It is said to possess antiseptic properties. 
 It is recommended for local w^e ip eolutiop^ of strengtb^t 
 
146 
 
 of from J to 1 per cent. It has not as yet been recom- 
 mended for internal use. Its chemical formula is CgH^. 
 CH3. OCH3. COOtL 
 
 Crbsol, — The cresols, as Squibb says, are still used 
 as disinfectants, but their disadvantages are of such a 
 nature that they continue to retard their utility. The 
 so-called "Cresol saponate" is now recommended by 
 German practitioners. It is prepared by mixing crude 
 carbolic acid with melted soft soap in equal proportions 
 to form finally a homogeneous mass which is soluble in 
 water. This however but increases the objectionable 
 quality inherent in all of the compounds of cresol, name- 
 ly that of rendering the surgeon's hands and instru- 
 ments disagreeably and dangerously slippery. 
 
 As ordinarily found cresol is a dark reddish-brown 
 liquid which is transparent and rather thinner than 
 creolin. It has the characteristic odor of tar and forms, 
 like creolin, an objectionable and opaque emulsion with 
 water. Behring, after a very elaborate series of experi- 
 ments with the substance, concludes that it certainly 
 has no advantage over carbolic acid. 
 
 Cresol Iodid. — This substance, also called Ortho' 
 cresol iodid^ is another of the innumerable proposed sub- 
 stitutes for iodoform. It is a fine pale-yellow powder 
 with a pronounced odor, which is agreeable in compari- 
 son with that of iodoform however; the drug is insolu- 
 ble in water. The compound has not been in use long 
 enough to give it any positive status. As Squibb says> 
 though the compounds of cresol possess antiseptic power 
 they all have the disadvantage of adhering to and ren- 
 
 M 
 
147 
 
 dering the hands and instruments extremely slippery; 
 they also readily oxidize in the atmosphere. These dis- 
 advantages apply to all of the various compounds of 
 cresol thus far known, such as lysolj saprol, solutol, 
 solveol, and others. 
 
 Cresylic Acid. — The article usually sold as cresylic 
 acid is commonly a substance of variable composition 
 containing various cresols and also sometimes xylenols. 
 Whatever antiseptic power it may possess is due en- 
 tirely to these substances which it contains. 
 
 CuPRic CHLORiD.—CuClg. This substance is not in 
 general use as an antiseptic but Miquel has determined 
 that it is antiseptic in the proportion 1:1,428. This 
 gives it higher power than the sulphate, which is better 
 known. 
 
 CuPRic Sulphate. — CuSO^. The sulphate of copper 
 is better known than the chlorid although its antiseptic 
 properties are not as high as those of the latter com- 
 pound. Miquel has determined that the sulphate is 
 antiseptic in the proportion 1:11. Its action is decidedly 
 inhibited by the presence of albumin. 
 
 Dermatol. — This term is applied to the Sub gallate of 
 bismuth; it contains about 55 per cent of the oxid of 
 bismuth. It is usually represented by the chemical 
 formula, — Vt\Q^^O>i, It is an odorless, yellow, saffron- 
 like and non-hygroscopic powder insoluble in the ordi- 
 nary solvents. Colasanti has made comparative bac- 
 teriological experiments with aristol, iodoform and 
 dermatol in order to determine their relative germicidal 
 potency. None of these agents seemed to affect dried 
 
148 
 
 cultures even after three days contact; but when moisture 
 was present dermatol was effective in little more than 
 half the time required by the other two. It also pos- 
 sesses remarkable dessicating powers although its anti- 
 septic powers are in dispute in many quarters. It is 
 chiefly used as a substitute for iodoform. It may be ap- 
 plied locally as a dusting powder, on gauze, in glycerin, 
 collodion emulsion or in ointment in the strength of 
 10-20 per cent. It has been used internally with good 
 results in disorders of the gastro-intestinal tract, as a 
 substitute for the sub-nitrate of bismuth. Flint reports 
 good results from such uses. 
 
 DiAPTHERiN.— (OH.CgHeN^) (OH) (SO3U) C^H,. Ah 
 so called Oxy chin aseptol. It occurs as a whitish or 
 yellowish powder with an odor somewhat like that of car- 
 bolic acid and a ready solubility in water and the ordi- 
 nary solvents, It is said to be an excellent antiseptic. 
 Kronacher, Emmerich and others claim great virtue for 
 it. Its odor is slight and it is said to be entirely free 
 from irritating properties. It has been tried with ap- 
 parent success in the treatment of wounds, sores and 
 putrefactive disorders and many excellent reports of its 
 virtues have been made. Unfortunately, however, it 
 cannot be used for the disinfection of instruments for it 
 attacks even silver and nickel plating; it also stains the 
 hands and nails a light yellow. 
 
 Kronacher says that a one per cent solution is fully 
 strong enough for surgical dressings, — indeed he has 
 even used it in solutions as strong as 50 per cent. 
 
 DisiNFECTOL — This substance is usually termed a 
 
 ■ ^ 
 
149 
 
 coal tar product similar to creolin and largely used in 
 Germany* The statement has also been made that it is 
 a mixture of hydrocarbons, soaps, carbolic acid and soda. 
 It occurs as an oily, dark-brown fluid, analogous to 
 lysol and creolin, and slightly heaivier than water. It 
 is claimed that it possesses energetic disinfectant pro 
 perties but if so this has not resulted in its general use. 
 It has been employed locally in the form of an emulsion 
 of a strength of two to five per cent. 
 
 Beselin concludes, after having made numerous ex- 
 periments with it upon typhoid stools, that while superi- 
 or to creolin in this respect, it has no advantage over 
 carbolic acid. 
 
 Essential Oils. — These have been found to possess 
 varying values. Riedlin reports that the oils of laven- 
 der, eucalyptus, rosemary and cloves have the greatest 
 antiseptic values of any of the essential oi^s. Cadeac 
 and Meunier demonstrated that the typhoid bacilli were 
 killed by oil of cloves in twenty-five minutes, by oil of 
 Ceylon cinnamon in twelve minutes while oil of sandal- 
 wood required twelve hours. 
 
 Ether.--(C2H5)20, or C3H5OC2H5, This substance is 
 too familiar to need description. Yersin found that ten 
 minute's exposure was sufficient to kill the tubercle ba- 
 cilli but Koch found that anthrax spores would germi- 
 nate even after eight day's exposure to the action of the 
 same. - 
 
 EucALYPTOL. — CioHigO. The essential oil obtained 
 by distillation from the eucalyptus. When pure it oc- 
 curs as a colorless liquid with an odor somewhat similar 
 
160 
 
 to that of camphor. It is insoluble in water but soluble 
 in the fatty oils, in alcohol, ether and chloroform. It 
 is said to possess marked therapeutic properties but its 
 chief use is as a local antiseptic in ulcers. 
 
 Behring has determined that it is four times less act- 
 ive than carbolic acid. Perret found that a five per 
 cent solution had no effect upon tuberculous sputa. 
 
 Recently M. Anthoine has produced a new antiseptic, 
 which he calls Eucalypteol, by the action of hydrochlo- 
 ric acid upon eucalyptus oil. This substance chemically 
 is eucalyptene di-chlorid; it occurs in colorless, scaly 
 crystals with an odor resembling camphor. It is almost 
 tasteless. Laf age claims that it is far superior to euca- 
 lyptus oil as an antiseptic. It is practically insoluble in 
 water and glycerin and readily soluble in ether, chloro- 
 form and alcohol, though decomposed by the latter. 
 
 EuGBNOL.^ — Also termed Eugenic acid^ with a chemi- 
 cal formula CgHj C3H5.OH.OCH5. This substance is a 
 phenol derived from oil of cloves by oxidation; it may 
 also be obtained from other various essential oils, such 
 as those of sassafras, bay, pimento and cinnamon. It 
 usually occurs as an aromatic liquid freely soluble in 
 alcohol but only slightly so in water. The substance 
 has been used internally as an antiseptic in doses of 45 
 minims /^r diem^ in alcoholic solution. There is also a 
 derivative, Cinnamyl eugenol, which occurs in colorless, 
 odorless, tasteless crystals which are soluble in hot al- 
 cohol, ether, chloroform and acetone; it has been used 
 in the treatment of tubercular diseases. 
 
 EuPHOBiN. — This substance is also termed Carboiiate 
 
151 
 
 of ethyl and phenyl, Pheriylethylic urethane and Phenyl 
 urethane. It is represented by the chemical formula 
 C6H5NHCOOC2H5. Euphorin must not be confounded 
 with Europhen, which is an altogether different sub 
 stance. Euphorin occurs in the form of a white pow- 
 der with a slight aromatic odor and a taste like that of 
 cloves. It is slightly soluble in water but freely so in 
 alcohol. It is employed locally as a dusting powder; 
 internally it is given in doses of 7-15 grains from two 
 to three times a day. As a local application it is said 
 to be more powerfully antiseptic but less dessicating 
 than dermatol. 
 
 Europhen, — lodo-di-iso-butyl-ortho-cresol or Di-iso- 
 butyl-ortho-cresol-iodid and is represented by the chemi- 
 cal formula (C4H9.CH8.C6H30)2HL It occurs as an 
 amorphous powder, with a yellow color and an odor of 
 saffron; it is soluble in alcohol, ether, chloroform and 
 oils but insoluble in water. It is used chiefly locally as 
 a dusting powder as a substitute for iodoform. It is 
 also used hypodermically in the treatment of syphilitic 
 disorders. Its best effects are obtained by a local use, 
 and even then only by its application to secreting or 
 otherwise moist surfaces. Kopp reports excellent re- 
 sults from a mixture of europhen and boracic acid. 
 Christmann concludes from his experiments that the 
 evolution of iodin is necessary before an exhibition 
 of germicidal power — this is dependent upon the de- 
 composition of the drug, as in the case of iodoform. 
 
 ExALGiNE. — A substance, also termed Methyl-acetani- 
 lid, obtained by the action of acetyl chlorid upon mono- 
 
152 
 
 methyl-anilid and possessing the chemical formula 
 C6H5N(CH3)CH3CO. It occurs as a tasteless powder 
 made up of crystalline, needle like particles which are 
 readily soluble in alcohol and sparingly soluble in water. 
 It is said to possess antiseptic properties but these are 
 not marked, at least not sufficiently marked to make the 
 substance of any great value in this connection. 
 
 Fkeric Chlorid. — FeClg, frequently given as FejClg. 
 A 5 per cent solution of the substance required ^\e 
 days to destroy anthrax spores, failing to do so in two 
 days. No marked germicidal power. 
 
 Ferrous Sulphate. — FeSO^. Sternberg found that 
 a 20 per cent solution failed to kill putrefactive organ- 
 isms — that it was antiseptic, not germicidal. 
 
 Formalin. — H COH. This substance is nothing 
 more nor less than an aqueous solution of formic alde- 
 hyde of the strength of 40 per cent. It has its laurels 
 yet to earn. •• 
 
 Formic Acid. — H.COOH. This irritating substance 
 is formed either by the distillation of the bodies of ants, 
 as was formerly done, or else by the oxidation of formic 
 aldehyde, which is in turn produced by the oxidation of 
 methyl alcohol. Kitasato determined experimentally 
 that .35 per cent would destroy typhoid bacilli in five 
 hours and that .22 per cent would produce a like result 
 in the i^ame time upon the spirilla of cholera. 
 
 Gallic Acid. — Abbot determined that a 2.37% solu- 
 tion destroyed the bacteria of broken-down beef tea but 
 failed to kill anthrax spores in two hours. A solution 
 pf l;U2 Jiilled vanpus paiprpqopci ip two howre, 
 
153 
 
 Glycerin.— Cgtis (0H)3. Glycerin was used as an 
 antiseptic by Demarquay as early as 1855; he thought 
 it the very best antiseptic substance, in fact almost a 
 panacea; but it has been tried and found wanting. 
 Koux and others have shown that the addition of five 
 per cent of glycerin to culture media w?^^ favorable to 
 their subsequent growth. Koch found that it had no 
 effect upon the spores of either symptomatic anthrax 
 nor indeed upon those of anthrax itself. Miquel has 
 determined that its presence in the proportion of 1 :4 
 will prevent putrefactive decomposition in bouillon. 
 
 Gold Chlorid. — AuOIg. •Also termed the tri chlorid, 
 or Auric Chlorid. Miquel has determined that t\i8 
 substance is antiseptic in the proportion of 1:4000. A 
 solution of 1:1000 will destroy the germs of cholera, 
 anthrax or diphtheria. 
 
 GuAiACOL.— This substance, also called Methyl pyro 
 catechin, is obtained from beech wood tar. Its formula 
 is said to be CgH^OHOCHg and it is claimed to contain 
 60-90% of creosote. It occurs as a liquid having a 
 pleasant odor and a specific gravity only slightly greater 
 than that of water. It has also been produced synthe- 
 tically as a solid product which i» colorless and crystal- 
 lizes readily in prismatic form; it has a sweetish and 
 marked astringent taste and is said not to attack 
 mucous membranes. ^ 
 
 Guaiacol is soluble in water in the proportion 1:85 
 and in petroleum benzin in that of 1:8. It seems to 
 have antipyretic, as well as antiseptic, properties — even 
 when applied locally. Its chief use has been in tuber- 
 
154 
 
 culous affections, and indeed wherever creosote may be 
 exhibited with profit. It is said to prove an advan- 
 tageous substitute for creosote in the early stages of 
 tuberculosis. It is best administered after meals either 
 in alcoholic solution, or mixed with cod-liver oil or else 
 in capsules. The usual dose is from five to ten minims; 
 continued use establishes a tolerance, as in the case of 
 creosote, and the dose may be gradually increased if 
 its full effect is to be exercised. 
 
 Various salts of the substance, such as the iodid, car- 
 bonate, salicylate and others, have been prepared and 
 put upon the market as su(3^edanea for guaiacol itself; 
 the indications for their use are the same as those for 
 guaiacol, the jonly virtue claimed for any of them over 
 guaiacol is that they are supposed to possess the dis- 
 advantages, such as irritation, etc., in a more modified 
 degree than the substance itself. 
 
 Helenin.— This substance is derived from elecam- 
 pane root. It exists in the form of white acicular 
 crystals with the chemical formula CgHgO These crys- 
 tals are only slightly soluble in water but are readily so 
 in hot alcohol, ether and the oils. It is claimed to be 
 an effective antiseptic where it has been used in Europe. 
 In Spain it is highly favored as a surgical dressing; 
 indeed Ferran claims active germicidal properties for it, 
 claiming that it is more destructive in its action upon 
 the cholera bacillus than any other agent. It has been 
 used with favorable results in pertussis, ozaena, diar- 
 rhea, leucorrhea and other disorders; but its excessive 
 cost is an effective barrier to its general use. It has 
 
155 
 
 been administered in doses of 1-6 to 1-3 of a grain in 
 the course of twenty-four hours. 
 
 Hydrochinone. — Also termed Hydro quinone, Para 
 di oxy benzene ^.ndiQuhiol, is obtained from Arbutin 
 
 (which see) by the action of sulphuric acid, or else by 
 the oxidation of anilin by chromic acid and has the 
 chemical formula CgHeOa. 
 
 It occurs in long, dimorphous colorless crystals 
 which are freely soluble in hot water, alcohol or ether; 
 soluble in cold water in the proportion 1:20. The sub- 
 stance has been recommended as an internal antiseptic 
 and has apparently produced good results. It is usually 
 administered in doses of from 1-2 to 5 grains. 
 
 Hydrogen di oxid (Hydrogen Peroxid). — This 
 substance is sometimes described as "an aqueous solution 
 of hydroxy]," thus HaO^ or (OH),. The solution used 
 in practical medicine is of about "ten volume" strength. 
 It has been lauded as a general disinfectant and germi- 
 cide. It has one great advantage in that it is non- 
 toxic. It seems to possess a special predilection for 
 pus, which it destroys; this property is made use of in 
 some cases for the diagnostication of the presence of 
 pus where it may be concealed in cavities — its presence 
 causes a marked effervescence when the peroxid is 
 introduced. Shimwell, however, says that it is not ap- 
 plicable to fresh wounds or fresh surfaces but to those 
 that are septic in nature. It has lately been introduced 
 into the U. S. Pharmacopeia of 1890. 
 
 Surgeon- General Sternberg says that unless chemists 
 can furnish stronger and more stable solutions of the 
 
156 
 
 substance than they seem at present able to do, we are 
 not likely to derive any practical benefit from, its use as 
 a disinfectant. Indeed its instability is marked and 
 forms the chief objection, since one cannot rely upon 
 all preparations unless assured of their freshness. The 
 substance owes all of its virtues to the oxygen which it 
 disengages when brought into contact with oxidizable 
 matter. The action of oxygen and ozone are discussed 
 under their proper headings, which see for furtiier in 
 formation. 
 
 Hydrofluoric Acid. — HF. This substance, which 
 normally exists in a gaseous condition, has been sug- 
 gested and used in the treatment of tuberculosis. The 
 experiments of Chautard and Grancher with the sub- 
 stance show that its direct and prolonged action dimin- 
 ishes the virulence of the germ but fails to kill it. 
 Hydrofluosilicic acid or its sodium salt (Sodic silico- 
 fluorid, NaaSiFe) have also been suggested and indeed 
 were highly praised by Neudorfer, but, as Shimwell 
 properly says, have now been discarded having no ad- 
 vantage over boracic acid. Hydrochloric acid the con- 
 gener of hydrofluoric acid is equal to sulphuric acid in 
 germicidal power. 
 
 Hydronaphthol. — This substance is derived from 
 Beta-naphthol by the substitution of hydroxyl (OH) 
 for an atom of hydrogen, hence the chemical formula 
 would be CioH6(OH)2. It is soluble in water in the 
 proportion of 1:900-1000. The drug has recently been 
 suggested as a prophylactic in the treatment of cholera 
 or other infectious affection of the alimentary tract, Jn 
 
157 
 
 the proportion of 1:400 it is Baid to possess powerful 
 germicidal and inhibitory power. Its internal use is 
 resorted to in doses of eight to ten grains three or four 
 times a day, 
 
 Indol. — Koch found that even an excess of this sub- 
 stance in water did not destroy anthrax spores, even in 
 eighty days. 
 
 loDiN. — In 1853 Duroy pointed out the fact that iodin 
 possessed preservative properties, having a direct action 
 upon pus and organized ferments; also that it caused 
 aqueous solutions to keep indefinitely and that its syrups 
 do not ferment. These facts and many other similar 
 ones he embodied in a memoir presented to the Acade- 
 my of Medicine of Paris in the year 1853. Velpeau 
 again called the attention of the medical profession to 
 the virtues of iodin in the year 1859; he said that it had 
 been in use at that time for thirty years or more. 
 Modern researches have corroborated the germicidal 
 properties of both iodin and bromin. In such strength 
 iodin is considerably stronger than bromin but less 
 strong than chlorin. 
 
 Iodin Tri Chlorid. — ICI3 Behring claims that this 
 substance, as an antisptic, has all of the potency of free 
 chlorin or iodin without their disadvantages. It is a 
 yellowish-red powder with a peculiar and penetrating 
 odor; it is soluble in water. Langenbuch found that it 
 would restrain the development of bacteria, when added 
 to nutrient gelatin, even when present in as small an 
 amount as 1:1200, while 1:1000 would kill even spores 
 in a short time, A solution with a strength of one per 
 
158 
 
 cent destroyed anthrax spores suspended in water al- 
 most instantly and a Yi© per cent solution effected the 
 same result in a few minutes. Behring found that a 
 one per cent solution would kill anthrax spores in blood- 
 serum in forty minutes. 
 
 Iodoform. — CHIj. Sometimes termed Tri-iodo me- 
 thane. This substance is too familiar to need descrip- 
 tion. The chief objection to it is its intolerable and al- 
 most imperishable odor. The experiments of Tilanus, 
 Neisser^ Buechner and others show that it is no germi- 
 cide itself but has some antiseptic power; that is, it 
 possesses inhibitory power. Neudoerfer says that it 
 possesses toxic properties for some individuals, that 
 "they lose their appetites, become morose, absent- 
 minded, and if the drug be continued there result phy- 
 sical changes and death." 
 
 Recent investigations have demonstrated that under 
 certain conditions the substance does possess some 
 germicidal power — that is, the decomposition of the sub- 
 stance, accompanied by the liberation of free iodin 
 gives it the antiseptic and germicidal properties which 
 are peculiar to iodin. Sir Joseph Lister has recently 
 called attention to the antiseptic properties of iodoform, 
 claiming however, that the function of the iodoform 
 was not to kill the germs but to destroy the products 
 of their vital activity. This is certainly an extraordi- 
 nary claim and a most valuable property, if experience 
 can but demonstrate its truth. 
 
 Iodoform is chiefly of value in various tubercular 
 affections and remains the favorite remedy in such dis- 
 eases. 
 
159 
 
 Squibb says: **It8 extremely disagreeable penetrating 
 and persistent odor is still against it and deodorizers 
 continue to be recommended from every quarter. It 
 should be constantly borne in mind that the character- 
 istic odor of iodoform is inherent to it and we might 
 just as rationally expect to remove the sweetening prop- 
 erty of sugar and still expect to retain the usefulness of 
 that necessary article as to remove the odor of iodoform 
 and retain its identity. We can adopt all manner of 
 expedients to mask this objectionable quality, but we 
 may rest assured that the iodoform is still there as long 
 as we hold its combining elements together, and as soon 
 as we split these up we no longer have this useful 
 agent." 
 
 loDOL — This substance, obtained by the action of an 
 alcoholic solution of iodin upon pyrrol, and called 2\tra 
 iodo pyrrol y has the chemical formula CJ^NH. It occurs 
 in the form of a grayish-brown, odorless, tasteless 
 powder; it is said to be yellowish and rather crystalline 
 when pure. At elevated temperatures it decomposes, 
 giving off vapors of iodin. It is soluble in alcohol and 
 ether but almost entirely insoluble in water. It is 
 claimed to be non-toxic and to possess the favorable 
 qualities of iodoform in addition. Sternberg (1885) as 
 a result of his investigations stated that it was entirely 
 without germicidal power. Riedlin also found that it 
 had no effect upon even the spirilla of cholera, which 
 are among the least resistant of all germs. 
 
 loDOPHENiN. — Also termed lodo-phenacetin. This sub- 
 sta nee is a combination of iodin and phenacetin and is 
 
supposed to contain 50 per cent of the former substance. 
 It is a brownish powder, but when pure exists as a crys- 
 talline body with a characteristic iodin like odor and a 
 burning taste. Like iodin it discolors the skin yellow. 
 It is soluble in alcohol, glacial acetic acid and boiling 
 hydrochloric acid. Most of the reports, with the ex- 
 ception of those from the Paris Charity Pospital, are 
 against the drug. Seibel says that it gives off iodin in 
 excess too readily and that it possesses no advantage 
 over free iodin itself. This observation has been con- 
 firmed and corroborated by other investigators also. 
 
 loDozoNE. — This is the name given by Robin to a 
 solution of iodin in ozone. The solution has all of the 
 appearance of a complete one and gives no reactions by 
 means of which a different condition can be detected. 
 This was first suggested by the well known value of 
 sea-air whose virtues were supposed by some to be due 
 to ozone and traces of iodin. lodozone is recommended 
 as a spray in tuberculosis pulmonalis and open wounds 
 — rather lodozone was recommended in such cases, for 
 it appears now to have utterly gone out of existence as 
 a pharmaceutical or remedial preparation. 
 
 IzAL. — This is a trade name for an emulsion contain- 
 ing thirty per cent of a new oil which it is claimed is 
 produced by a patent process used for the manufacture 
 of a special variety of coke. Squibb says that: "It 
 appears to belong to a series analogous to the terpenes, 
 with characteristics between those of the paraffins and 
 the benzins. No phenol proper can be detected in the 
 emulsion." It has not gone beyond the land of its birth 
 
161 
 
 (England) as yet. It is claimed that it is a powerful 
 antiseptic, that it does not injure the hands, that it has 
 no objectionable smell, that it is non-toxic and in fact 
 altogether valuable. This is based entirely upon the 
 reports of a few enthusiasts, it is entirely too early to 
 place any definite value, or lack of value, upon it as 
 yet. Time will demonstrate its advantages, whatever 
 they may be. 
 
 Lactic Acid. — HCsHjOj. The second member of a 
 group of monobasic, di-atomic acids. It is a colorless 
 syrupy liquid of strongly acid properties, mixing with 
 water and alcohol in all proportions; it occurs in many 
 plant juices, either free or combined. It is also pro- 
 duced by the fermentation or "souring" of milk. 
 
 Kitasato found that a .4 per cent solution would de- 
 stroy the typhoid bacillus in five hours while a 3. per 
 cent would do the same in the case cholera spirilla in 
 .the same length of time. 
 
 Lanolin. — This substance is a fat extracted from 
 sheep's wool and containing about thirty per cent of 
 water — whence its name of Adeps lance hydrosus. It is 
 a white odorless substance which does not affect litmus 
 and is used as a base for many ointments or prepara- 
 tions used in the local treatment of diseases of the skin, 
 etc. It is insoluble in water, partly soluble in alcohol 
 and readily so in ether, acetone and benzene. 
 
 Gottstein found that various organisms ceased to 
 grow after contact with pure lanolin from five to seven 
 days; hence it appears to possess inhibitory powers. It 
 is one of the best ointment bases known to pharmaceu- 
 tical science. 
 
162 
 
 Lbad Chlorid. — PbClg. This substance is not in 
 common or general use but Miquel has determined that 
 it is antiseptic in the proportion of 1:500. 
 
 Lead Nitrate — Pb(N03)2. This substance is fre- 
 quently credited with germicidal properties which it 
 does not really possess. Miquel has determined that it 
 is antiseptic in the proportion of 1:277. 
 
 LosoPHAN. — Tri-iodo-mda-cresoL This substance is 
 a new antiseptic produced by the action of iodin upon 
 w-oxytoluic acid. It occurs in the form of colorless, 
 need If -like crystals containing about eighty per cent of 
 iodin. It decomposes readily in dilute solutions of al- 
 cohol, but not in solutions containing seventy-five per 
 cent of alcohol. Its use is, as yet, restricted almost en- 
 tirely to dermatology. 
 
 Lysol. — This substance is the saponified product of 
 coal-tar; it is obtained from tar-oils by boiling with 
 alkalies and fats and contains about fifty per cent of, 
 cresols. It occurs as a clear, brown, oily liquid slightly 
 lighter than water and with an aromatic odor like that 
 of creosote. It is soluble in alcohol, chloroform, water, 
 glycerin, carbon di-sulphidand benzin. Experience has 
 not justified the extraordinary claims which have been 
 made for it. Its soapy nature renders instruments or 
 objects immersed in solutions of the substance disagree 
 ably and dangerously slippery. 
 
 Cadeac and Guinard, after elaborate experimentation 
 with the substance, have concluded that while it is an 
 undoubted microbicide it has no advantage over the 
 antiseptics of establiihed reputation; that it is only effi- 
 cacious in solutions sufficiently strong to prove irritat 
 
163 
 
 ing or caustic and that its sphere of usefulness will not 
 extend beyond the disinfection of stools, privies, ships, 
 stables, etc., aiding thus in the prophylaxis, prevention 
 and arrest of epidemics. It is used by some locally in 
 solutions of strengths of from three to five per cent. 
 
 Malic Acid. — Has about the same germicidal value 
 as citric acid. 
 
 Mercury. — The various soluble salts of this metal 
 seem all to have more or less antiseptic activity al- 
 though the fallacious belief in their unsurpassed gerniu 
 cidal powers has been entirely exploded by the results 
 attained by recent investigators. The succinate, the 
 phenylate, the salicylate, the thymol-acetate, the thymo 
 late, the iodid, the cyanid and a host of others have 
 their respective adherents. None of them however 
 have attained the eminence of the so-called "bi chlo- 
 ride." Mercuric iodid however is but slightly inferior 
 to this chlorid; it is moreover, more stable, less toxic 
 and altogether more agreeable. According to Lister, 
 until his recent declaration in favor of carbolic acid 
 above all other germicides, the double cyanid of mer- 
 cury and zinc more nearly accorded to the requisites of 
 an ideal antiseptic. This substance is non-volatile, non- 
 irritant, insoluble to the extent that wound secretion 
 does not wash it out of the dressing; its great disad- 
 vantage, however, is its feeble germicidal power which 
 is almost balanced though by its inhibitory power. 
 (See Corrosive Sublimate). 
 
 Methylene Blue. — This substance is one of the 
 amlin dyes, being called Tetra-methyl-thionin. The 
 
164 
 
 drug is usnally found as a bluish powder composed of 
 scaly crystals of a bronze like tinge; it is somewhat 
 soluble in water and more so in alcohol. It has been 
 recommended especially as an antiperiodic, particularly 
 where quinine has failed. It has also been used locally 
 in diphtheria. (See Anilin Dyes). 
 
 MiCROciDiN. — This name is applied to a mixture of 
 beta-naphthol and sodic hydroxid — it is presumably 
 termed sodic naphtholate. It is a white powder soluble 
 in water in the proportion of 1:3. It is employed as an 
 antiseptic both internally and externally. When used 
 locally it is employed in the strength of from three to 
 five parts to the thousand. It is but little heard of now, 
 although Cozzolini of Naples thinks that it has given 
 him excellent results in suppurations of the ear and in 
 inflammatory conditions of the nose and throat. 
 
 Mono chlor-phbnol (see Chlor-phbnol). 
 
 MoBPHiA Hydrochlorate. — This substance has fee- 
 ble inhibitory powers. Miquel has decided that it is 
 antiseptic in the proportion of 1:13. 
 
 Naphthalene. — Also termed Naphthalin^ having a 
 chemical ^formula of CioHg. It is a hydrocarbon ob- 
 tained from coal-tar; it is also formed in the manu- 
 facture of ordinary illuminating gas. As usually found 
 it occurs as a grayish white substance either in powder 
 or brilliant, scaly crystals which have an odor of coal- 
 tar and an aromatic bitter taste. It is soluble in alcohol 
 ether, the fixed and volatile oils and in acetic acid, but 
 insoluble in water. Is is also sold in molded blocks 
 under the nam^ of Alahastrime and Camphylenc and 
 
165 
 
 used for preserving furs and flannels from moths and 
 also in urinals for purposes of disinfection. It is claimed 
 that the inhalation of the vapor of the substance has 
 given good results in the treatment of pertussis, etc. 
 
 Naphthol. — Also termed Naphthyl alcohol and Iso- or 
 Beta-naphthoL It may be obtained by the action of sul- 
 phuric acid for some time upon naphthalene. The 
 chemical formula is CioHtOH. It occurs in brilliant, 
 colorless, shining, crystalline laminsB having an odor 
 resembling that of phenol, v^ith a slight burning taste. 
 It le readily soluble in alcohol, ether, chloroform, ben- 
 zene and the fatty oils; it is fairly soluble in hot water 
 but almost insoluble in cold water. It is used as an 
 antiseptic in cutaneous diseases and affections of the 
 respiratory tract, also as an intestinal antiseptic, Foote 
 says that the substance exercises some germicidal power 
 even in the proportion of 1:2300 but concludes that a 
 saturated aqueous solution (1:1150) does not equal the 
 action of one per cent solution of carbolic acid or of 
 creolin. 
 
 It has been used internally in the dose of two to fif- 
 teen grains and ezternally in solutions or ointments of 
 the strength of from 2 to 10 per cent. 
 
 There are a great number of derivatives of naphthol 
 such as iodo-beta naphthol, benzo-naphthol, microcidin, 
 naphthol camphor, etc. It is undoubtedly an efficient 
 antiseptic, as indeed are many of its derivatives, but, as 
 Squibb says, "Naphthol and all its derivatives cannot be 
 gaid to have superseded carbolic acid, although they no 
 
166 
 
 doubt will find a permanent place on the list of valuable 
 agents." 
 
 Nitric Acid. — HNO,. This substance is too well 
 known to need description. Nitric, hydrochloric and 
 sulphuric acids are approximately of the same germici- 
 dal strengths. (See sulphuric acid). 
 
 Nitrous Acid. — HNOj. Nitrous acid represents the 
 first degree of reduction or de-oxidation of nitric acid. 
 Sternberg (1880) determined that the activity of dry 
 vaccine virus was destroyed when exposed upon ivory 
 points for six hours to the action of an atmosphere con- 
 taining one per cent of nitrous acid. 
 
 Oil of Mustard. — The presence of this substance in 
 the proportion of 1:33000 is sufficient to prevent the 
 development of anthrax spores, though so weak a prepara- 
 tion does not kill them. 
 
 Oil op Turpentine. — Koch found that though oil of 
 turpentine failed to destroy the spores of anthrax in one 
 day they were destroyed by such exposure for five days; 
 he found also that their development was effectually 
 prevented by the presence of the substance in the pro- 
 portion of 1 :75000. Christmas, in his experiments upon 
 the pus cocci, says that an excess of oil of turpentine ad- 
 dad to liquefied gelatin cultures of the Staphylococcus 
 pyogenes aureus was unable to destroy the micrococci even 
 in eight hours. 
 
 Oleic Acid. — HCigHajOa- Oleic acid is a constituent 
 of most facts, especially oily fats — olive oil for instance 
 being almost entirely an oleate of glyceryl. The ex- 
 periments of Koch seem to indicate that the sub8tapq§ 
 
167 
 
 has little if any antiseptic power. A five per cent solu- 
 tion in ether failed to destroy anthrax spores in iive 
 days. 
 
 Olive Oil. — This substance, as has been stated, is 
 almost entirely, when pure, glyceryl oleate. Koch has 
 determined that anthrax spores germinate even after 
 ninety days immersion in this substance; indicating an 
 apparent absence of any germicidal action whatsoever. 
 
 OsMic Acid. — H,0804. Koch has determined that 
 this substance will kill anthrax spores in twenty-four 
 hours if present in the strength of one per cent. Miquel 
 has determined that the substance is antiseptic in the 
 proportion of 1:6666. 
 
 Oxalic Acid. — H2C2O4. Kitasato has determined 
 that this substance, in the strength of .36 per cent, will 
 destroy typhoid bacilli in five hours and that a solution 
 of the strength of .28 per cent will kill cholera spirilla 
 in the same time. 
 
 Oxygen. — This element exists in two conditions — one 
 the free and normal element whose molecule is ex- 
 pressed by the symbol O2 and the other, an allotropic 
 modification,termed ozone whose molecule is represented 
 by the symbol O,. Free oxygen is necessary for the 
 development of a large number of species of bacteria — 
 indeed it is essential to all aerobic species; on the other 
 hand it completely prevents the growth and develop- 
 ment of the anaerobic species. 
 
 Oxygen has no great power of destruction of bacteria 
 unless nascent — that is, freshly generated. The common 
 belief is that all oxygen under all conditions is possessed 
 
168 
 
 of mar\i elous^po wers over germ life — such is not alto- 
 gether the case. Indeed, as we have said, the presence 
 of oxygen so far from being restrictive is absolutely 
 necessary for the development and growth of all aerobic 
 species. Nascent oxygen, on the other hand, is a po- 
 tent agent — indeed it is to the virtues of the element 
 generated in this peculiar condition that potassic 
 permanganate, and other oxy-antiseptic substances 
 owe their entire antiseptic powers. Duclaux says that 
 oxygen has the power of destroying bacteria but that it 
 is exceedingly difficult to make an application of the 
 substance to man except in the form of "oxygenated 
 water" (it is thus that he designates hydrogen peroxid) 
 which, as he says, has not always given the most happy 
 results to those using it. Indeed although hydrogen 
 peroxid is a valuable antiseptic and deodorant its germ- 
 icidal value is highly overestimated. 
 
 Ozone. — It was formerly supposed that this allotropic 
 modification of oxygen would prove to be a valuable an- 
 tiseptic agent but unfortunately for its reputation in this 
 respect recent experiments show that it does not possess 
 the anticipated activity — indeed that it possesses little 
 value from a practical standpoint. 
 
 Lukaschewitsch found that one gramme in the space 
 of a cubic metre utterly failed to kill anthrax spores 
 even in twenty -four hours. So much for its vaunted 
 activity. Then also, Sonntag, Friedlaender, Nissen and 
 others secured negative results in their experiments 
 upon the germicidal activity of this substance. So far 
 from being the valuable agent previously supposed, a 
 
169 
 
 careful consideration of all of the experimental data 
 leads one to the conclusion that, as a germicide, ozone 
 is utterly devoid of practical value in therapeutics and 
 disinfection. It is possible that the splitting up of a 
 molecule of ozone may yield us either nascent oxygen 
 or else a mixture of molecular and nascent oxygen, thus: 
 
 O, = O, + O 
 in this case whatever germicidal action may ensue is 
 due not to the ozone, for it has been destroyed the 
 moment that the molecule Os has been decomposed, but 
 to the nascent oxygen set free. Ozone then would have 
 less virtue than any of the various processes by means 
 of which nascent oxygen itself is generated. 
 
 Paracrbsolal. — This substance, also called Cresaloly 
 is paracresolic salicylate and is represented by the 
 chemical formula CeH^.OH.COO.CeH^CHs. It occurs 
 as a whitish crystalline powder with an odor like that of 
 salol, it is insoluble in water but slightly soluble in alco- 
 hol. This substance, which is strongly analogous to 
 salol (phenylic salicylate) in its therapeutic functions, is 
 used more largelv, as is salol, as an intestinal antiseptic 
 in doses of from three to thirty grains /^r diem. 
 
 Phenol. — (See carbolic acid). 
 
 Phenocoll. — This substance is also termed Amido- 
 para-acet-phenetidin. It has been more largely used, 
 not only itself but also in the form of the hydrochlo- 
 rate or hydrochlorid and salicylate (Salocoll), as an an- 
 tipyretic. The acetate and carbonate have also been 
 used for this same purpose. Certain investigators have 
 called the attention of the medical profession to the an 
 
170 
 
 tiseptic value of the substance. Dr. Beck of New York 
 conducted experiments with a view to determining the 
 exact value of such properties of the substance. He 
 found that phenoooll excelled phenacetin, acetanilid, and 
 iodol in such activity and indeed even excelled iodoform 
 to which he considered it superior otherwise on account 
 of the ready solubility of phenocoll, its freedom from 
 odor and irritating properties and its freedom from 
 toxic properties. The substance occurs as a white crys- 
 talline powder readily soluble in water or alcohol but 
 very sparingly soluble in benzol, chloroform or ether. 
 
 Phenolid. — A 50 per cent mixture of acetanilid and 
 sodicbi-carbonate; it seems to have passed entirely from 
 use. 
 
 Phbno-Salyl. — This substance is not a definite com- 
 pound but a mixture of four or five substances. The 
 formula is as follows: 
 
 Carbolic acid, about - - 9 parts. 
 
 Lactic acid, " - - 2 parts. 
 
 Salicylic acid, *^ - - 1 part. 
 
 Menthol, " - - 7io part. 
 
 The menthol is added to the combined acids which 
 are heated up to the point of liquefaction. The mixture 
 is said to be soluble in water to the extent of making a 
 4 per cent solution. The formula has been somewhat 
 extended by the addition of eucalyptol to the other in- 
 gredients; this is mixed in small quantity along with 
 the menthol and then the whole resulting mixture is 
 mixed with four times its volume of glycerin. The 
 formula was introduced by Dr. Christmas after some 
 
171 
 
 experimentation at P.isteur'fi Institute in Paris, Dulerly 
 reports its successful use in various uterine affections, 
 in gonorrhea and as a wash for rectal sores and ulcera- 
 tions. Yersin claims that it is especially effective 
 against the bacillus of anthrax — indeed he gives it high 
 antiseptic power which, if present at all, must be due to 
 the large amount of carbolic acid (about 75%) present 
 in the mixture; it must however be inferior to carbolic 
 acid when combined, as has been suggested, with other 
 acids of higher activity, such as hydrochloric orboracic 
 acids — indeed in the latter case an excellent substance 
 results. The latter fact has at last been properly ap- 
 preciated and a combination of carbolic and boracic 
 acids has been put upon the market under the name of 
 Sennine — named after Senn, who has done so much for 
 the advancement of antiseptic principles in American 
 surgery. For a full description of this substance see 
 the article Sennine under its proper and appropriate 
 heading. Because of the introduction of such superior 
 and more valuable compounds Pheno salyl and analo- 
 gous substances are passing out of general use — indeed 
 Pheno-salyl has already done so according to Squibb. 
 
 Phosphoric Acid — H3PO4. This substance, the or- 
 dinary tri-basic or ortho phosphoric acid, hardly needs 
 description. Kitasato hss conducted experiments with 
 a view to a determination of the germicidal activity of 
 the substance, using an acid which contained 152 milli- 
 grams of acid per cubic centimetre. A solution contain- 
 ing three-tenths of one per cent (.3%)of this prepara- 
 tion destroyed typhoid bacilli in from four to five hours 
 
172 
 
 while a solution of .183 per cent strength (that is, slight- 
 ly more than one-half as strong) killed the spirilla of 
 cholera in the sam« time. 
 
 PiCROL.— This substance is Di-iodo-resorcin-mono- 
 sulphonic acid. It is a new antiseptic, said to contain 
 aboubt 52 per cent of iodin, and is described by Darzens 
 and Dubois as possessing great potency. It is prepared 
 by adding, while constantly stirring, an alcoholic solu- 
 tion of iodic acid and iodin to resorcinmonosulphonic 
 acid, produced by the action of concentrated sulphuric 
 acid upon resorcin. The potassium salt of this sub- 
 stance is usually described as existing in the form of 
 colorless, odorless crystals with an exceedingly bitter 
 taste. These crystals are readily soluble in water and 
 the ordinary solvents. It is usually cpnsidered non- 
 toxic but its reckless use is not without danger. It is 
 too soon to express an opinion on the status or value of 
 the substance as no clinical reports of its use have been 
 collaborated as yet. 
 
 PiPERONAL. — CgH^Os. This substance is also termed 
 Heliotropin and is obtained from piperic acid by oxida- 
 tion. It usually occurs in the form of white and scaly 
 crystals which are soluble in alcohol and ether but are 
 insoluble in water. At present the substance is more 
 generally employed in the arts, in the manufacture of 
 perfumes, though its use as an antipyretic and antisep- 
 tic has been suggested; such use has been largely re- 
 stricted by the exceedingly high price of the substance. 
 When administered it is usually given in single doses of 
 about fifteen grains. 
 
It3 
 
 PoTAssiC Acetate. — KC^HgOa. This substance is 
 the potassium salt of acetic acid, analogous to plumbic 
 acetate ("Sugar of Lead") which is the lead salt of the 
 self-same acid. It is hardly necessary to describe its 
 chemical and physical properties. Suffice it to say that 
 Koch found that a saturated solution of the salt in water 
 failed to kill anthrax spores in ten days. 
 
 PoTAssic Arsbnite. — This substance, or rather the 
 potassic hydrogen arsenite which has the chemical for- 
 mula KHAsOj, is used in medicine under the name of 
 "Fowler's Solution." It is an acid potassium salt of 
 arsenous acid. The substance has been found to pos- 
 sess absolutely no germicidal action. It may be slight- 
 ly antiseptic however for Miquel has determined that it 
 is so in the proportion of 1:8. 
 
 Potassic Di-Chbomate. — KjCrjOT. This substance, 
 which exists in beautiful yellowiffh-red crystals, was 
 supposed to possess active germicidal properties but the 
 experiments of Koch demonstrate that a five per cent 
 solution failed to destroy anthrax spores even after two 
 days exposure. Miquel has determined, however, that 
 it is antiseptic in the proportion of 1 :909. 
 
 Potassic Bromid. — KBr. This substance is more 
 familiarly known and used as a nerve sedative or a 
 hypnotic but Kitasato has proven that it also possesses 
 antiseptic and indeed even germicidal properties. He 
 found that when typhoid bacilli and cholera spirilla 
 were immersed in a solution containing from 9 to 10.6 
 per cent of potassic bromid they failed to grow. Indeed 
 they were killed when exposed for four or five hours to 
 
174 
 
 the action of sobitions with strengths of 10-12 percent. 
 
 PoTASsic Carbonate. — K2CO3. Kitasato has also 
 proven the antiseptic and germicidal action of this sub- 
 stance. He found that the development of typhoid and 
 cholera germs was prevented by solutions containing 
 as small an amount as .74- 81 per cent and indeed even 
 killed by five hours exposure to the action of a one per 
 cent solution. 
 
 PoTAssic Chlorate. — KCIO3. This substance is 
 probably more familiarly known to many of us as chlo- 
 rate of potash, in common use for the treatment of the 
 various inflammatory conditions of the naso-pharynx. 
 Its efficacy in such affections together with their fre- 
 quent micro-organic nature led many to suspect that the 
 drug had a specific action which was due, it was thought, 
 to a specific action of the substance upon the germ di- 
 rectly. Contrary tolhe general belief, the substance is 
 devoid of any germicidal power. A careful considera- 
 tion of the experimental data now at our disposal forces 
 this conclusion upon us Sternberg found that a four 
 per cent solution failed to destroy or kill the Micrococ- 
 cus Pasteuri even after an exposure of two hours to its 
 action. Koch also found that a five per cent solution 
 failed to kill anthrax spores in five days. 
 
 PoTAssic Chromate — KjCrO^. This substance is 
 apparently no stronger than the chlorate of potassium, 
 for Koch found that a five per cent solution failed to 
 kill anthrax spores in five days, as was the case with the 
 chlorate. 
 
 PoTASSic Cyanid. — K (CN). This substance seems 
 
175 
 
 to possess little or no germicidal power — indeed Miquel 
 gives it the same power in this respect as potassic di- 
 chromate, that is it is antiseptic in the proportion of 
 1:909. 
 
 Potassic Hx^droxid. — KOH. This substance is more 
 familiar to many, especially those who studied Chemis- 
 try when the old system of nomenclature was in vogue, 
 as "caustic potash" or as potassium hydrate. Sternberg 
 demonstrated that while an eight per cent solution was 
 unable to destroy the pus cocci in two hours a ten per 
 cent solution of the same substance was. able to effect 
 this result in the same time. Kitasato found that an .18 
 per cent solution would kill the typhoid bacillus m from 
 four to ^we hours while a .237 per cent solution was re- 
 quired to effect the same result in the same time with chol- 
 era spirilla. This fact presents a curious and interesting 
 condition. Usually the spirilla of cholera are less resist- 
 ant than the bacilli of typhoid fever but here we have 
 the reverse true; as a rule the cholera germ is especially 
 susceptible to the action of acid antiseptic solutions. In 
 this case we have an alkaline substance and the spirilla 
 are less susceptible to its influence than the typhoid 
 bacilli. 
 
 Potassic Iodid. — KI. This substance, more com- 
 monly called iodide of potash, is used frequently in the 
 treatment of certain stages of syphilis and also of rheu- 
 matism, etc. It has been determined that it possesses 
 slight germicidal properties though these are not present 
 to a marked extent. Koch demonstrated that a five per 
 cent solution failed to destry anthrax spores in eighty 
 
176 
 
 days. The typhoid bacilli and the cholera spirilla fail 
 to grow in an eight per cent solution, but are destroyed 
 by five hours exposure to a 9.23 per cent solution. Miquel 
 has determined that it is antiseptic in the proportion of 
 1:7, a very low power. 
 
 PoTAssic Permanganate. — KMn04, or in the older 
 system KjMnjOg. The experiments of Jaeger show 
 that a one per cent solution is not reliable for the de- 
 struction of pathogenic bacteria but that a five per cent 
 solution is very effectual, although it does not kill the 
 bacillus of tuberculosis. Miquel has determined that it 
 is antiseptic in the proportion of 1 :285. 
 
 The experiments of Kelly, Welch, Robb, Ghriskey 
 and others, at the Johns Hopkins University, upon the 
 various cocci and the germs usually found upon the 
 hands and beneath the nails of physicians and surgeons, 
 indicate that exposure of the hands to the action of a 
 saturated aqueous solution of the substance with a 
 further bath in a saturated aqueous solution of oxalic 
 acid to remove the stain of the permanganate and to re- 
 inforce its germicidal action was by far the most effic- 
 ient means of sterilization of the hands — especially if 
 preceded by a thorough scrubbing of the hands and 
 nails with brush, warm water and common soap. They 
 found by rigid experiment that this was far superior to 
 the action of corrosive sublimate as used in Fuerbring- 
 er's method, so commonly resorted to in obstetrical and 
 surgical practice for the sterilization of the hands of 
 the operator. Many operators of advanced opinions are 
 
117 
 
 now adopting the permanganate method so highly fa 
 vored by Kelly. 
 
 Pyoktanin. — This is a name patented by Merck for 
 the two anilin dyes more commonly known as methyl- 
 violet^ or yellow pyoktanin, and methyl-blue or blue 
 pyoktanin. The substance occurs as an odorless pow- 
 der which is soluble in alcohol and soluble in seventy- 
 five parts of hot and fifty parts of cold water. This 
 substance has had remarkable exaltations and damna- 
 tions in its short career as an antiseptic. (See Anilin 
 dyes). Certain oculists and laryngologists have claimed 
 to obtain benefit from its use. Roswell Park and others 
 say that its use is disappointing if not entirely worth- 
 less, which latter term he thinks more nearly describes 
 the value of the medicament. Dr. Doering claims very 
 favorable results from its local use in diphtheria. Gold- 
 schmidt has pronounced it useless in Lepra tuherosa, 
 N. S. Roberts says that "it is of much less value than 
 the standard remedies now in use, but is worth thinking 
 of when these fail." 
 
 It has the great disadvantage of highly coloring the 
 skin or clothing, being an snilin dye and having all of 
 the intense coloring power peculiar to that class of sub 
 stances. It not only stains the skin and clothing but 
 the dressings and the hands of the operator himself. 
 This produces exceedingly disagreeable results. More 
 over, prolonged contact with certain of the anilin dyes 
 has been productive of various eczematous conditions 
 of the skin. 
 
 Pyrozonb. — This is a name given by its manufacturer 
 
178 
 
 to a preparation of a concentrated solution of hydrogen 
 peroxide in ether. It is claimed that it contains about 
 fifty per cent of the peroxid; it seems to be an efficient 
 agent as far as hydrogen peroxid can be, having all of 
 the properties of that substance which is its active 
 principle. 
 
 QuiCKiNH.— A trivial, silly and senseless name for 
 what the manufacturer terms 'Hhe new antiseptic, anti- 
 pyretic and antizymotic." When we consider the 
 formula it puzzles one to discern how even the wildest 
 of dreams could ascribe antipyretic properties to the 
 substance. According to the Pharmaceutische Zeitung^ 
 Qaickine consists of one part of corrosive sublimate, 
 fifty of carbolic acid and fifty two of dilute alcohol. It 
 consists, according to Squibb, of one part of pure car- 
 bolic acid, two-hundredtbs of a part of corrosive chlorid 
 of mercury and one-thousandth of a part of a mixture of 
 alcohol and water. All of this, as Squibb satirically 
 quotes, is manufactured by a process of "dynamization 
 and potentialization that guarantees to the medical pro- 
 fession the absolute accuracy and uniformity" of the 
 product — or rather mixture. That it has met with little 
 or no success is shown by the fact that in spite of the 
 adoption of catch-penny methods it has been relegated 
 to innocuous desuetude. Whatever of virtue the sub- 
 stance possessed was due to the presence of carbolic 
 acid and corrosive sublimate; these virtues were no 
 greater than those attained by the use of the substances 
 themselves. Hence, having no claim to attention, the 
 mixture has died a death of inanition. 
 
179 
 
 Quinine. — This alkaloid and its salts are too familial* 
 to ihe physician to need description. These substances, 
 although possessing no marked germicidal power, are 
 yet somewhat antiseptic. The experiments of Arloing, 
 Cornevin and Thomas have proven that the sulphate, 
 in ten per cent solution, does not destroy the bacilli of 
 symptomactic anthrax. Sternberg found that the sul- 
 phate, in the proportion 1 :800, while it did not destroy 
 various micrococci and bacilli upon which he experi- 
 mented, yet had the power of preventing their develop 
 ment — that is, in such proportion it was antiseptic but not 
 germicidal. Miquel has determined that the hydrobro- 
 mate is antiseptic in the proportion 1:182 and Ceri has 
 determined that the hydrochlorate is antiseptic in the 
 proportion of 1;900 — that is, its antiseptic power is 
 greater than that of the hydrobromate. 
 
 Resopyrin. — This substance M. Portes describes as 
 a compound resulting from the mixture of resorcin and 
 antipyrin in solution in the proportion of their chemical 
 equivalents. It occurs in oblique, colorless crystals 
 which are usually of a rhombic and prismatic structure; 
 it is soluble in alcohol but insoluble in water. 
 
 The substance has been knownr for several years but 
 has now practically passed out of use. 
 
 Resorcin. — CeH4(OH)2. This substance is also 
 termed Mefa-di-hydroxy-benzene, Meta-di-oxy -benzene 
 and ResorcinoL As the chemical formula indicates, it is 
 a di-atomic phenol. It may be produced synthetically 
 from benzene but is also made by fusing different res- 
 ins, such as those of asafetida, galbanum, etc., with the 
 
180 
 
 fixed or caustic alkalies. Resorcin is a yellowish or 
 white, flocculent or crystalline powder with a somewhat 
 sweetish and pungent taste and a slightly aromatic odor 
 somewhat resembling that of normal fresh urine. It is 
 soluble in about its own weight of water; it is also solu- 
 ble in alcohol and ether but very sparingly soluble in 
 chloroform, carbon di-sulphid or benzene. Resorcin is 
 used to some extent in the arts in the manufacture of 
 certain dyes. 
 
 Resorcin is said to possess antiseptic properties and 
 on that account is of use in the treatment of various 
 diseases of the stomach and intestinal tract. Its use 
 has been recommended in dysentery, cholera infantum, 
 gastric ulcer, gastritis, diphtheria and affections of the 
 larynx, pertussis and also, by Unna, in acne rosacea. 
 For local use, solutions of 1-3 per cent may be used, or 
 ointments of 5-10 per cent, or even in some cases as 
 high as 25 per cent may be exhibited. When used in- 
 ternally resorcin is usually administered in doses of one 
 or two grains. 
 
 Retinol. — CjsHu. This substance, also termed Resi- 
 nol and Rosinoly is obtained by the distillation of 
 Burgundy pitch, or pitfe-resin. It occurs as a thick, 
 oily and yellowish liquid, slightly lighter than water. 
 It is said to be a good antiseptic; it is used chiefly as a 
 solvent for various drugs, such as salol, aristol, iodol, 
 creosote, carbolic acid, camphor, cocaine and other simi- 
 lar bodies; indeed the effects of such medicaments are 
 often enhanced by the antiseptic properties of the reti- 
 nol used as the vehicle. 
 
181 
 
 Desnos, a French observer, has reported very gratify- 
 ing results from the use of solutions of 5-10 per cent of 
 salol in retinol in certain cases of sub-acute cystitis. 
 He has claimed that it frequently affords prompt relief 
 even after other agents have failed. The peculiarity of 
 the solution is, it is said, that it will remain in the blad- 
 der even after from six to eight distinct acts of micturi- 
 tion — of course in such case there is a diminution in 
 quantity after each urination but all is not voided at 
 one act. When used locally retinol may be applied in 
 substance or in ointment; internally it is administered 
 in doses of about one grain. 
 
 Saccharin. — CeH^.CO.SOzNH. This substance is al- 
 so termed Gluside, Glucusimide^ Benzoic sulphinide^ Ben- 
 zoyl-sulphonic-imide and Anhydro-ortho-sulphafnine-hen- 
 zoic acid. Saccharin is a derivative of benzoic acid the- 
 oreticaUy; practically however it is produced from 
 toluol by a series of complicated synthetical processes. 
 
 Saccharin occurs as a white, amorphous or somewhat 
 crystalline powder with an intensely saccharine or sweet 
 taste followed by a slightly bitter after-taste and has a 
 slight odor of bitter almonds — this odor becomes more 
 prononnced upon heating the substance. It is soluble 
 in alcohol and ether, also in glycerin, dilute ammonic 
 hydroxid and in an aqueous solution of sodic bi-carbon- 
 ate. It is only sparingly soluble in water — one part dis- 
 solving in about 230 of water; this solution is intensely 
 sweet and is somewhat acid in reaction. The intense 
 sweetening power of saccharin is its chief characteristic — 
 it is even perceptible when saccharin is dissolved in 70,- 
 
182 
 
 000 parts of water, being nearly three hundred (280) 
 times sweeter than ordinary cane sugar. It is employed 
 as a sweetening agent in diabetes where the useof sugar 
 is interdicted. It is also a good antiseptic and is said to 
 have given marked benefit in the treatment of cystitis. 
 It has also been used as a vehicle to mask the taste of 
 intensely bitter remedial agents. 
 
 Saccharin may be used either locally or internally; 
 the dose is said to be indefinite. 
 
 Salacetol. — Also termed Salicyl-acetol. This is a 
 new synthetic product obtained by Fritsch by the de- 
 composition of sodic salicylate by means of mono chlor- 
 acetone, while heat is applied. It has been proposed, 
 like salophen, as a substitute for salol. It occurs in fine 
 acicular crystals or scales with a slightly bitter taste. 
 Salacetol is but sparingly soluble in cold water, but 
 freely so in hot alcohol and the other various ordinary 
 solvents. 
 
 It has been used by Bourget of Switzerland in doses 
 of ;^0-45 grains in incipient diarrhea and choleraic 
 affections. It has also said to have given good results 
 in gout, sub-acute rheumatism and various genito- 
 urinary affections. 
 
 It is too soon however to express a positive opinion as 
 to its value or its probable status in therapeutics. 
 
 Salicylamid. — CjH4.OH.CO.NH2. This substance is 
 an amido compound or derivative of salicylic acid; it 
 was first prepared by Limpricht by treating oil of win- 
 tergreen with saturated ammonic hydroxid, it has since 
 been prepared by the action of the latter substance upon 
 
183 
 
 methyl salicylate (the artificial oil of wintergreen), or 
 by the action of heat upon amnionic salicylate. Salicyl- 
 amid usually occurs in the form of colorless, thin, trans- 
 parent laminar crystals, which are tasteless, leaving a 
 sensation of grittiness in the mouth. It is soluble in 
 alcohol, ether and chloroform; in water it is soluble in 
 the proportion of 1:250. 
 
 It has been recommended as a substitute for salicylic 
 acid, and it is said to have several advantages over the 
 latter drug, being tasteless, more soluble, more prompt 
 and powerful in action and possessing greater analgesic 
 power. It has also germicidal powers similar to those 
 of salicylic acid. It is claimed that it has been used 
 with good results in tonsillitis, chronic rheumatism, 
 ovarian pains, neuralgia, etc. When used internally, 
 about fifteen grains are administered per diem^ in doses 
 of from three to five grains each. 
 
 Salicylic Acid. — CeH^.OH.COOH. This substance 
 has been known to chemists for some time, but its intro- 
 duction into medicine has been comparatively recent. 
 Kolbe found that it could be prepared by treating a 
 solution of carbolic acid in sodic hydroxid with carbon 
 di-oxid at a moderate degree of temperature. It may 
 also be obtained by fusing potassic hydroxid with sali- 
 cin, the latter substance being a glucoside found in 
 willow bark. Salicylic acid occurs in several species 
 of violet; it also exists as the methyl* salt in oil of 
 wintergreen. It is usually sold as a dull white powder, 
 or in long acicular crystals; it has usually a peculiar 
 aromatic and pungent odor, and a peculiar sweetish yet 
 
184 
 
 acrid or acidulous taste, which, as Wood says, is accom- 
 panied by a transient sense of numbness. Salicylic 
 acid is readily soluble in hot water, alcohol, ether etc., 
 and but sparingly soluble in cold water and glycerine. 
 It is irritant to mucous or fresh wound surfaces. 
 
 The drug is usually described as non-toxic, but 
 Quincke, Ogston, Empis, Gubler and Dixneuf, as well as 
 others, have reported cases of death from the substance 
 — indeed, in one case reported, death ensued as a result 
 of the administration of forty eight grains in four hours. 
 The acid has the peculiar property of macerating flesh, 
 and in this way sometimes attacks the hands when used 
 as an antiseptic — it is owing to this peculiar property 
 that salicylic acid is an almost constant ingredient of 
 the various forms of "corn salves." It is also readily 
 absorbed and is eliminated largely by the kidneys and 
 hence is found in the urine. 
 
 Kolbe found that the presence of .04% had great in- 
 fluence in preventing the souring of milk; on account of 
 this property it is widely used in beer, and in perishable 
 food products, to prevent fermentation and decomposi- 
 tion, although such use has been forbidden in some coun- 
 tries. Sternberg found that a two per cent, solution 
 destroyed pus cocci in two hours. Abbott found that 
 micrococci were destroyed by a solution of the strength 
 1:400. Kitasato found that 1.6% destroyed typhoid 
 bacilli in five hours, and that 1.3% produced the same 
 effect in the same time upon cholera spirilla. A four 
 per cent, solution however failed to affect the organisms 
 of broken-down beef solution* Kochialso found that a 
 
185 
 
 five per cent, alcoholic solution failed to destroy the 
 spores of anthrax. Miquel has determined that the 
 substance is antiseptic in the proportion 1:1000. 
 The substance was introduced into surgery by Thiersch, 
 of Leipzig, as a substitute for carbolic acid; it was 
 then thought to possess as much germicidal efficiency as 
 carbolic acid, but experience has failed to deraonstate 
 this, moreover it is irritant. As Wood says in his 
 classic work upon Materia Medica and Therapeutics, 
 "There can be no doubt that salicylic acid is capable 
 of accomplishing much in antiseptic surgery, but it does 
 not seem to be replacing carbolic acid, as it at one time bid 
 fair to do. Its freedom from odor and comparative free 
 dom from poisonous and irritant (?) properties are cer 
 tainly strong recommendations in its favor; neverthe 
 less, carbolic acid is more generally employed, and Mr 
 Callender, after twelve months' trial in the wards of St 
 Bartholomew's Hospital, has formerly condemned sali 
 cylic acid as much inferior to carbolic acid." 
 
 It can be used dry with good effect, but it does not 
 adhere firmly to the parts, and therefore in the presence 
 of free secretion it is washed away, leaving the wound 
 surface exposed to infection. In acid diarrheas and 
 fermentative conditions of the intestinal tract it owes 
 its chief value to its restraining and inhibitory in- 
 fluence upon the development and vital activity of the 
 various micro-organisms to which the acid intestinal 
 fermentation is due, rather than to direct germicidal 
 action. 
 
 The sodium salt of the acid, sodic salicylate, is said 
 
186 
 
 to be a feeble antiseptic and hardly worthy of the 
 name. Indeed all of the salicylates have much less 
 power than the free acid. 
 
 Salocoll. — This is but the trade name for the salicy- 
 late of phenocoll; it is claimed to be more advantageous 
 than the hydrochlorate, being less soluble and therefore 
 freer from the disagreeable concomitant and after- 
 effects. It is said to have been used with satisfaction 
 in influenza. 
 
 Salol. — Also called Phenyl salicylate^ it is repre- 
 sented by the formula C,H, OH.COOCeUs. It usually 
 occurs as a white crystalline and tasteless powder with 
 a slight aromatic odor; it is soluble in alcohol, ether, 
 turpentine, sandalwood oil, copaiba balsam and the 
 fixed oils, but is insoluble in water. The substance has 
 been suggested as a succedaneum for salicylic acid; it 
 has also antiseptic properties. The drug is said to be 
 of value in diseases of the urethra and bladder and in 
 inflammatory affections of the pharynx and respiratory 
 tract. It has also been used locally in coryza, ozena, 
 skin diseases and as a dusting powder. But by far its 
 most important application is in infectious disorders of 
 the intestinal tract. This is dependent upon the fact 
 that under the influence of the alkaline fluids of the in- 
 testines the substance is split up into its components, 
 carbolic and salicylic acids. Loewenthal and others 
 have praised its value in Asiatic cholera, but Reiche 
 says that the expericence of the Hamburg epidemic of 
 1892 was sufficient to demonstrate that the drug was 
 useless in this affection whether given internally or by 
 
187 
 
 injection in ethereal solution. Reynier believes that 
 the internal use of the medicament will sterilize the 
 urine unless pus be present in large amounts; for this 
 purpose its administration must be continued for some 
 time. It is probably inferior to boric acid in this re- 
 spect however. 
 
 It is usually administered in doses of 5 to 30 grains. It 
 is folly to expect this amount to sterilize completely 
 the many square feet of mucous membrane of the intes- 
 tinal tract, especially when loaded down with infectious 
 material. To produce the best results from its use com- 
 plete catharsis, followed by irrigation, must precede its 
 administration. 
 
 Salophen. — Also termed Acetyl-para-amido-saloL 
 The chemical formula is C,H4.0H.COOC6H,.HCOCH,- 
 It is anew synthetic product, the first stage of the manu- 
 facture of which is the mixture of equal parts of para- 
 nitro-phenol and salicylic acid. Then follow a series of 
 more or less complicated changes, which result in the 
 ultimate formation of the completed product, which 
 occurs in small, thin, lamellar crystals which are odor- 
 less, tasteless and have a neutral reaction upon litmus. 
 Salophen is freely soluble in alkalies, ether and alcohol, 
 but practically insoluble in water 
 
 This substance is proposed as a substitute for salol. 
 The gastric juice has no effect upon it, but when it 
 comes in contact with the alkaline pancreatic secretion 
 it is broken up into salicylic acid and acetyl para amido- 
 phenol, which latter is eliminated by the urine and the 
 f^ces. W. H. Flint, of New York thinks th^ sub- 
 
188 
 
 stance of special value in acute rheumatic arthritis; in- 
 deed Hitschmann claims that it is almost a specific in 
 such condition. These results and conclusions were 
 also reached by Hare, E. Koch, Oswald and Harden- 
 bergh. E. Koch in experiments upon the value of salo- 
 phen says that its antiseptic action is trifling, but that 
 its chief field is in nervous affections of various forms, 
 such as neuralgia, hemicrania, cephalagia, sciatica, neu- 
 ritis, pleurodynia, etc. The remedy when used inter- 
 nally is exhibited in doses of from one to one and a 
 half drachms daily. 
 
 Sanitas. — This substance, which is used as an exter- 
 nal disinfecting fluid, contains of an aqueous solution 
 of turpentine, which has become oxidized by the oxy 
 gen of atmospheric air; it contains camphor, thymol, 
 hydrogen peroxid and a small amount of camphoric 
 acid, the result of such oxidation. It is prepared by 
 Kingzett by passing air and steam through oil of tur- 
 pentine. It is said to be a good antiseptic and to be 
 free from poisonous properties; it is used chiefly as a 
 domestic disinfectant. To judge by the formula one 
 would hardly give the preparation high germicidal 
 power however. Its use seems on the decline at the 
 present writing. 
 
 Saprol.— Also termed "Disinfection Oil." This sub- 
 stance is a dark and brownish oily mixture, consisting 
 chiefly of crude cresols in an excess of those liquid 
 hydrocarbons of the marsh gas series which are obtained 
 in the refining of petroleum. 
 
 Laser found that the application of one per cent, of 
 
 m 
 
189 
 
 saprol was snfficient to sterilize urine and feces contain- 
 ing typhoid bacilli, or cholera spirilla or other similar 
 germs. It is cheap and of some value as a disinfectant, 
 but of course has no place in medicine proper except as 
 a general disinfectant. It is exceedingly inflammable; 
 this property must be remembered or danger may re- 
 sult from disregard of its combustibility — the menstrua 
 being closely related to benzine, we should naturally 
 expect a high degree of combustibility. 
 
 Sennine. — This substance occurs in the form of a 
 white powder with a pleasant faintly aromatic odor and 
 an agreeable sweetish taste; it is readily soluble in 
 water and most of the ordinary solvents. The product 
 is a new one and the result of American enterprise, 
 and is certainly worthy of commendation. Why 
 should we import not only our ideas but even our 
 remedial agents, when American brains and Ameri- 
 can hands are just as able and competent as those 
 of foreign nationalities? Sennine is composed of 
 phenol and boric acid, and possesses all of the virtues 
 and none of the disadvantages of those substances (see 
 carbolic acid and boracic acid). Both of its ingredients 
 are substances of more than recognized virtue and 
 merit. Lister has very recently declared carbolic acid 
 superior to all other antiseptics and germicides, more- 
 over, he places boric acid nearly as high in the scale of 
 efficiency. In this product, "Sennine," the odor of 
 carbolic acid has been entirely removed; a powder re- 
 sulting which is not only free from objectionable odor 
 and irritating properties, but is also comparatively non- 
 
190 
 
 toxic; it is readily applied in substance as a dusting 
 powder or as a dry dressing — so much in favor at the 
 present time — and is dispensed in a most convenient 
 metal dusting box for this purpose. It may also be 
 applied in ointment, or, where moist dressings are de- 
 sired, in solution; a five per cent, aqueous solution being 
 sufficiently strong for general use. Its field of applica- 
 tion and usefulness is quite extended; it has been re- 
 commended not only in general surs^ery, obstetrics and 
 gynecology, but in general medicine as well. Reports 
 indicate that it has been used very effectively in num- 
 erous conditions, such as otorrhea, otitis, bromidrosis, 
 gangrene, eczemata of various kinds, herpes, laryngitis, 
 thrush, diphtheria and various infectious inflammatory 
 conditions of the naso-pharynx, vaginitis, chancroid, 
 dysentery, erythema, catarrh, typhoid fever, in derma- 
 tology and dental surgery; in short, wherever a good, 
 efficient and thoroughly reliable antiseptic can be of any 
 value whatever. It has been used internally in fermen- 
 tative dyspepsia, in cholera and infectious gastro-intes- 
 tinal diseases, in gonorrhea, typhoid fever, etc. When 
 administered internally, it is usually given in doses of 
 one to five grains. 
 
 Sennine is a comparatively new claimant for honors, 
 consequently its claims must not only be carefully con- 
 sidered, but they must also be substantiated by clinical 
 experience sufficiently extended and sufficiently strong 
 to place its virtues beyond a peradventure. Certainly, 
 in my experience, Sennine has done more than this. I 
 have used it quite frequently as a dry dressing in various 
 
191 
 
 minor surgical cases and have found it very efficacious 
 — superior to Aristol and the various other dry dressings. 
 Indeed I oniie used it in my own case, sprinkling the 
 powder freely over the fresh wound; healing was com- 
 plete in a very few days without the formation of a drop 
 of pus. The effect was most happy. 
 
 Prof. Bernaysj in a recent letter, to the author of these 
 papers, upon the subject of antiseptics, calls special at- 
 tention to Sennine as a dry dressing as follows: '*Re- 
 cently an excellent powder for the dry treatment of 
 wounds has been put before the profession in a most 
 convenient form under the name of ^^ Sennine?'* In a 
 very recent contribution he reports a most interesting 
 and successful operation for the removal of an excess- 
 ively large cervical fibro-myxo-chondro osteo-sacroma of 
 branchial origin; in this operation the only antiseptic 
 used was Sennine — the result was most excellent, leav- 
 ing, indeed, nothing to be desired, if results mean any- 
 thing. To quote his own words: "There was union by 
 first intention; no elevation of temperature and no sup- 
 puration. The dry dressing was used and the incision 
 or line of suture thickly dusted with an antiseptic 
 powder consisting of boric acid and phenol. This pre- 
 paration has recently been introduced by the Dios 
 Chemical Company, and is put up in a tin box with per- 
 forated lid. It is called 'Sennine,' and is made by a 
 chemist whose qualifications I know, and I am glad to 
 recommend the preparation, because it is a scientific 
 one, and is put up in such a neat and practical manner, 
 
192 
 
 ae to readily answer the requirements of the busy sur- 
 geon in private, as well as hospital practice." 
 
 He says further of it that: *'It affords me pleasure 
 to state that I have used *Sennine' in my practice with re- 
 sults entirely satisfactory to myself. I say without any 
 hesitation as a dry dressing it is unexcelled. I consider 
 it preferable to aristol, europhen and iodoform, as it is 
 free from toxic and irritating effects as well as unpleas- 
 ant odor. Five per cent is perfectly soluble in 100 parts 
 of water, making a reliable antiseptic wash as well." 
 
 A. H. Ohmann-Dumesnil, late Professor of Dermatol, 
 ogy and Syphilology to the St. Louis College of Physi- 
 cians and Surgeons, and President of the Sections of 
 Dermatology and Syphilography of the American 
 Medical Association and the first Pan American Medi- 
 cal Congress, has used the substance in various derma- 
 toses and as a dressing after such operations as the ex- 
 tirpation of wens or sebaceous cysts. In giving a 
 detailed report of three cases of removal of sebaceous 
 cysts, he says: 
 
 "In all of these cases the powder was employed in 
 preference to any solution and care was taken not to 
 apply the powder until the flow of blood had ceased. 
 # * * rpjjg powder acts as an effectual barrier to the 
 entrance of any micro-organisms and secures a dry, 
 clear wound, a condition not so readily obtained from the 
 employment of liquid antiseptics?'^ He has also used the 
 same substance to advantage in herpes progenitalis and 
 gives his method in full thus: 
 
 "The method consists in^treating an attack as soon as 
 
193 
 
 it occurs. Each vesicle is opened with a needle knife, 
 thus emptying it of its content!. The wall of the vesi- 
 cle should not be merely punctured but cut so as not to 
 give it an opportunity to refill. In this manner the pos 
 sibility of suppuration is avoided. After the vesicles 
 have been opened the following powder should be ap 
 plied : 
 
 lE^ Sennine, 
 
 Zinci stearat. co., - • - ■ aa 5^3' 
 
 M. 
 
 Sig. Apply twice a day. 
 
 This should be applied twice daily, the proportion of 
 Sennine being gradually increased until it is used pure. 
 
 Should the vesicles have ruptured and suppuration 
 set in, the pure Sennine powder should be applied twice 
 daily. In all cases before applying the powder, be 
 there suppuration or not, the parts should be cleansed 
 by letting warm water drip on them. The rapidity of 
 the healing is marked, as well as the disappearance of 
 the subjective symptoms." 
 
 He also says further: 
 
 "Sometime ago my attention was called to Sennine 
 as a good dry surgical dressing. I have had occasion 
 to use it in my dermatological practice and I find it is a 
 most excellent application in various troubles. It is of 
 value after the removal of sebaceous cyst, insuring a 
 rapid union by first intention. It is also a good prepa- 
 ration in the moist or 'weeping' forms of eczema, not 
 only protecting the inflamed tissue and relieving them 
 from the moisture, but acting as an antipyretic as well. 
 
194 
 
 In furuncle it also acts well after the lesion has been 
 opened and emptied of its contents. It is also excellent 
 (when used as a dusting powder) in many cases of 
 herpes simplex and herpes progenitalis. In fact, as a 
 dry surgical dressing, it is possessed of valuable proper- 
 ties and is in itself a cleanly preparation, devoid of 
 odor. 
 
 "It is composed essentially of boracic acid and phenol. 
 It is a good antiseptic and is not irritating. On the 
 contrary it possesses anti-pruritic properties and has 
 the advantage of being susceptible to use in powder, 
 ointment or liquid form. It is feoothing to the end 
 terminations of irritated nerves and is destined to ac- 
 quire a place in dermatological therapeutics." 
 
 Yarnall has had an extensive experience with Sennine 
 and in a recent report to the St. Louis Medical Review 
 says of it: 
 
 "Since the introduction of *Sennine' to the profession 
 I have been using it in all appropriate cases and with 
 such satisfactory results that I cannot refrain from 
 recommending it. 
 
 "In vaginitis and leucorrhea it is admirable and it 
 has proved especially efficacious in pruritus. An espe- 
 cially obstinate case of the latter with a pregnant 
 woman yielded after resorting to every method that had 
 suggested itself to the writer. Improvement set in at 
 once in this case with the use of Sennine. Local ap- 
 plications were made not only within the vagina on pre- 
 pared wool, but were also freely applied externally. At 
 this writing the pruritus and irritation is entirely con- 
 
195 
 
 trolled. For ulcerations specific and non-specific it is 
 equally applicable. 
 
 "In chancroidal sores it is in my opinion equal to any 
 treatment that can be resorted to, — in short it is valua- 
 ble in any and all the various antiseptic uses for which 
 it is designed and recommended. 
 
 "It is remarkable how largely preparations of this 
 character enter into the practice of every medical man 
 and how many there are offered. The eligible form in 
 which *Sennine' is presented — its non-toxic and unirri- 
 tating properties — except in cases of extreme sensitive- 
 ness, when it should be mitigated with powdered starch 
 or fuller's earth, and its real therapeutic value must 
 place it at the head of the long list of similar articles." 
 
 Dr. C. H. Mastin, of Mobile, who is one of the best 
 known surgeons of the South, has used Sennina and 
 says that "it is a good combination for dry dressing. 
 It is put up in a convenient form and I shall continue 
 to use it," Dr. Mastin's opinion always carries great 
 weight, he being a serious and thorough investigator. 
 
 Dr. Morse, the author of "New Therapeutic Agents," 
 says: "I consider Sennine as an ideal antiseptic. It 
 has no faults, chemical or therapeutical. In composi- 
 tion 'a chemically pure product of boracic acid and 
 phenol,' it has the full properties of both drags. It is 
 not poisonous. It cannot irritate. It effectually de- 
 stroys all germs. It has a lasting effect. It grows in 
 favor." 
 
 Professor Senn has used the substance most success- 
 fully as an antiseptic dry dressing in twenty-four cas^s 
 in bis Chicago cUnics. 
 
196 
 
 Dr. Heine Marks, Surgeon in-Chief of the St. Louis 
 City Hospital is preparing a report of forty-eight cases 
 of gun-shot wounds in which the use of Sennine as a 
 dry dressing gave most satisfactory results. 
 
 Very recently Dr. Broome read a paper before the 
 Medical Society of St. Louis, reporting an exceptional 
 operation in which Sennine as a dry dressing gave ex- 
 cellent results. 
 
 Oatman has used it successfully in rectal ulcerations 
 with stenosis. Roger Williams considers it superior to 
 Aristol, Europhen and other similar preparations. Nold, 
 Scrivner, Harder, Brodnax, Hardesty and indeed many 
 others who have used the product have been uniform in 
 their praise; their experience has been fully confirmed 
 by the results given in the author's own practice, he, at 
 present, using Sennine almost exclusively as a dusting 
 powder and dry dressing. 
 
 In view of the fact that antiseptics are numerous and 
 thoroughly reliable ones so scarce (in spite of the opti- 
 mistic claims of each particular manufacturer) the 
 writer has seen fit to occupy much space in attempting 
 to put forward, though hardly in an adequate manner, 
 this new claimant for antiseptic honors because it seems 
 to him a preparation in which the physician and sur- 
 geon will find much of use and value. The present is 
 peculiarly an era of dry dressings and Sennine is cer- 
 tainly gaining in popularity and favor each day — what 
 more the future will do with it remains to be seen. As 
 for the present, certainly its virtues and record suf- 
 ficiently attest i^value. 
 
197' 
 
 In a letter recently written to the author upon the sub- 
 ject of antisepsis by Prof. G. W. Broome, of St. Louis, 
 he most aptly says: 
 
 "Any physician may see and appreciate the great 
 value of dry dressings in surgical cases. I may go a 
 little further and venture the prediction that the scien- 
 tific surgery of the near future will not even include the 
 now widely used irrigating vessels in the instrumenta- 
 rium of the surgeon at all. Instead of irrigations the 
 asepticity of a wound will be secured and maintained 
 by dry sponging. In suppurating cases acepsis will be 
 established by destroying the medium in which the 
 pyogenic micro-organisms grow and multiply by the 
 same means. The availability of any antiseptic is en- 
 hanced in proportion to the degree of its inhibitory 
 power. The inhibitory function can be performed per- 
 fectly in a dessicated field only. Dessication can only 
 be secured by means of dry, together with hygroscopic 
 dressings. A suppurative inflammation with the pres- 
 ence of pus wherever found in the human body, must 
 be treated by dry sponging, not by irrigation; so that it 
 will only be a little while until the application of pow- 
 ders possessing such power will be a universal practice 
 among progressive surgeons. 
 
 "Latterly, I have been using *Sennine' to dust over 
 laparotomy wounds and have found it superior in many 
 essential particulars to other antiseptic powders P 
 
 Silver Nitrate. — AgNOj. Also called Argentic nit- 
 rate and ^^Lunar Caustic'*^ — the latter term being a relic 
 of the days of alchemy, when the element silver was 
 
198 
 
 known by the name and zodiacal sign of Luna. It is a 
 crystalline substance, soluble in water and possessing 
 the property, in the presence of moisture and heat, of 
 staining organic matter black — this property is made 
 use of in the so-called indelible inks. 
 
 This silver salt has marked antiseptic properties. 
 Miquel and Behring, while laboring under the impres 
 sion that corrosive sublimate was the best germicide, 
 placed it next in efficiency to corrosive sublimate — in- 
 deed, even superior to that much-vaunted agent in the 
 presence of albumin. 
 
 The experiments of Behring seemed to demon- 
 strate that in a solution of the strength of 1:10,000, 
 anthrax spores were destroyed in forty-eight hours. 
 The chief objections are the disagreeable property of 
 indelibly staining organic matter and the fact that its 
 germicidal efficiency is much impaired by the presence 
 of chlorids — that of sodium (NaCl) for instance, which 
 is present in appreciable quantities in such fluids as the 
 urine. This is owing, as has been previously explained, 
 to the formation of comparatively inert and insoluble 
 silver chlorid. 
 
 Skatol. — Koch has proven that this substance, even 
 in excess, in water has no germicidal power as far as its 
 action upon anthrax spores is concerned. 
 
 Smoke. — This substance possesses inhibitory proper- 
 ties which have been known for ages; these properties 
 have been made use of in the preservation of meats. 
 The preservative properties of smoke are due to the 
 pyroligneoi;s acid and creosqte which are cpntained 
 
199 
 
 therein, although in small quantities. Beu and Petri 
 have shown that salted and smoked meats have contain- 
 ed bacteria undestroyed for six months; after that time, 
 however, they usually failed to give any evidence of 
 vitality. Hence we may conclude that smoke only ex- 
 ercises germicidal power upon long exposure either to 
 its action or to that of its active principles. 
 
 SoDic Carbonate. — NajCOj. This substance is more 
 commonly termed Soda or Washing Soda, It is too 
 familiar a compound to need extended description. 
 Kitasato found that typhoid bacilli were killed in from 
 four to five hours by a 2. 47 per cent solution and that 
 the spirilla of cholera were also destroyed by a 3.45 per 
 cent solution. 
 
 SoDic Chlorid. — NaCl. This substance is better 
 known as Salt — common salt. It is supposed by the 
 laity, and indeed by many physicians, to possess valua- 
 ble antiseptic properties. This is far from the truth, 
 however; saturated solutions failed to destroy any bac- 
 teria (except the spirillum of cholera, which was killed 
 in a few hours) even after prolonged exposure to its 
 action. Experiment has demonstrated the fact that 
 saturated solutions are utterly powerless to destroy or 
 sterilize cultures of the tubercle bacillus even in two 
 months exposure. Miquel has determined that the sub- 
 stance is antiseptic in the proportion 1 :6. 
 
 SoDic Hydroxid. — NaOH. Better known as Caustic 
 Soda, This substance has about the same germicidal 
 activity as the analogous potassium salt (See potassio 
 hydroxid). Miquel has determined that it is antiseptic 
 in the proportion 1:56. 
 
200 
 
 SoDic Di-iODO-SALiCYLATE. — This substance usually 
 occurs in white acicular crystals. It possesses antisep- 
 tic properties and has been used chiefly as a dusting 
 powder in the treatment of parasitic diseases of the skin. 
 Its use seems to be somewhat limited thus far. 
 
 SoDic Di-THTo- SALICYLATE. — This substauce occurs as 
 a grayish- white powder which is very hygroscopic and 
 is also soluble in water in the proportion 1;1 — that is, 
 equal parts. This sulphur derivative of the sodium salt 
 of salicylic acid has antiseptic properties; it has been 
 used locally, as in ozena, and has also been used inter- 
 nally in the treatment of gonorrheal rheumatism and 
 rheumatic fever. When so administered the usual dose 
 is 3 grains given about twice per diem, 
 
 SoDic Paracresotate. — NaCgHyOj. This salt of 
 paracresotic acid occurs usually as a fine, white crystal- 
 line powder with a bitter taste; it is somewhat soluble 
 in warm water (about 1 :24). It is said to possess anti- 
 septic as well as antipyretic properties and is said to 
 have given successful results when used. The usual 
 dose is 1-20 grains, but as an antiseptic it is given in 
 doses of 1-8 to 1-4 of a grain. 
 
 SoDic SozoiODOLATE. — NaCgHjIgOHSOs. This com- 
 pound occurs in the form of well-defined but colorless 
 prisms. The substance is spoken of as an antiseptic; its 
 chief uses so far have been in the treatment of syphilitic 
 ulcers (as a substitute for iodoform), in diseases of the 
 bladder and also in catarrhal affections of the nasal 
 mucous membrane. The salt may be used locally as a 
 dusting powder or in solutions of the strength of one 
 
201 
 
 per cent or else in the form of an ointment of about ten 
 per cent strength. 
 
 SoDic Sulphite.— -NajSOj. Sternberg obtained en- 
 tirely negative results from the use of this sodium salt 
 of sulphurous acid. For a long time the sulphites and 
 the hyposulphites enjoyed popularity as germicides of 
 reputed value; but recent researches indicate that they 
 are utterly devoid of germicidal power and hence the 
 sanguine expectations of PoUi of Milan have not been 
 realized in this direction. They do not seem to have 
 any material effect upon the process of fermentation and 
 as fermentation without the presence of bacteria is an 
 impossibility, the inference is obvious. 
 
 SoDic SuLPHocARBOLATB. — NaC«H5S04.2H,0. This 
 is the sodium salt of sulphocarbolic acid, and is ob- 
 tained as a white soluble salt by dissolving sodic car- 
 bonate in sulphocarbolic acid. It is closely allied in 
 chemical nature as well as antiseptic activity to the zinc 
 salt of the same acid. (See sulphocarbolic acid, also 
 zinc sulphocarbolate.) 
 
 Sodic Tetbaboratk. — This term is only properly ap- 
 plied to common borax, which is the sodium salt of 
 tetraboric acid. However a different substance is 
 erroneously described under this name by Squibb, Cerna 
 and other writers. This spurious tetraborate is de- 
 scribed as a compound resulting from the mixture and 
 application of. heat to equal parts of borax, boric acid 
 and water; upon cooling a neutral compound is said to 
 result. It is a well known fact that boric acid yields 
 metaboric acid upon the application of heat to boiling. 
 
202 
 
 It is exceedingly probable then that the action of heat 
 upon the mixture results in the formation of sodic 
 metaborate, which crystallizes out from the resulting 
 liquid, water being simply a vehicle. The reaction 
 could be expressed thus: 
 
 Borax. Boric Acid. Sodlc Metaborate. Metaboric Add. 
 
 Na^BiO^+H.BO.-f heat — 2NaB0.i + 3HB0,. 
 
 This so called "tetraborate," which is probaly a meta- 
 borate, occurs in hard, transparent and clustered crys- 
 tals with a neutral reaction npon litmus. It is some- 
 what soluble in water and is said to possess antiseptic 
 properties which are similar to if not greater than those 
 of borax and boric acid. Water at the ordinary tem- 
 perature dissolves about sixteen per cent, of the sub- 
 stance, and it is this saturated aqueous solution which 
 is used locally in medicine. Menz iinds that it has the 
 disadvantage, however, of forming hard crusts on surgi- 
 cal dressings; these hard crusts are objectionable be- 
 cause irritating to abraded surfaces. This is undoubt- 
 edly due to crystallization by evaporalion of the aqueous 
 menstrum of the solution used. Thus far the substance 
 hss received little*recognition. 
 
 SoDic Thiophbn suLPHONATB. — This substancc is a 
 thiophen derivative of the sodium salt of sulphonic 
 acid, and is represented by the chemical formula C4H8 
 S.NaSOs. It usually occurs as a white, crystalline 
 powder which has been used chiefly 'as a dusting 
 powder in various diseases of the skin; it is said to be 
 superior, for such use, to beta-naphthol. 
 
 Sodic Thio-sulphatb. — Na,S,0,. This is the sub- 
 
208 
 
 stance commonly and erroneously termed the hyposul- 
 phite. Hypo-sulphurous acid is HjSO,, and its sodium 
 salt would be Na,S08 — the only correct chemical formula 
 for eodic hyposulphite. The substance commonly called 
 the hyposulphite or "hypo" is really the sodium salt of 
 thio sulphuric acid H,S,Oj. 
 
 The so-called hyposulphite has been vested with anti- 
 septic powers in the minds of physicians ever since the 
 day of the extravagant claims of Polli of Milan — indeed 
 even earlier. The experiments of Arloing, Cornevin 
 and Thomas prove it, however, to be utterly devoid of 
 germicidal power. Miquel has determined that it is 
 antiseptic in the pproortion 1:3 — this indicates feeble 
 powers. (See sodic sulphite.) 
 
 SoLUTOL. — This substance belongs to the same class 
 of bodies as creolin, cresin, lysol, saprol, solved, etc. 
 It is a combination of cresol (cresylic acid) and sodic 
 cresylate; it contains about sixty per cent, of cresylic 
 acid, one-fourth of which is free and the remaining 
 three-fourths being combined with sodium to form the 
 cresylate. Cresol itself is insoluble, and sodic cresylate 
 is therefore used to render it soluble, otherwise it would 
 be practically useless. We may therefore consider 
 solutol to be an alkaline solution of sodic cresylate in 
 excess of so called cresylic acid (cresol.) In this re- 
 spect it is markedly similar to, indeed almost identical 
 with cresin, which see. 
 
 It makes a very effective preservative for cadavers, 
 and hence may be service in the dissecting room. It is 
 also of great use for the disinfection of closets, sinks, 
 
204 
 
 infected bed clothing, infectious sputa or other such 
 discharges, etc. Its caustic and strong alkaline nature, 
 precludes its use in surgery, either as an application or 
 even in surgical dressings. It has played no part in the 
 medical literature of the past year. 
 
 SoLVEOL. — This substance is analogous to solutol, 
 being a solution of cresylic acid (cresol) in sodic creso- 
 tate. It usually occurs as a dark liquid with a little 
 odor and a neutral reaction; it is soluble in water 
 While slightly caustic and irritant it is not as markedly 
 so as solutol. It is also not so greasy as either creolin 
 or lysol. It is usually used in strengths of one-half to 
 one per cent, being slightly irritant in such proportion. 
 Hueppe seems to think that it is superior to carbolic 
 acid, but this opinion does not seem to be upheld by the 
 surgical world, at least it has been unable to supplant 
 carbolic acid in surgery. 
 
 SozAL. — This substance is the aluminum salt of para- 
 phenyl-sulphonic acid (also termed sozonic acid). It is 
 somewhat allied to Alumnol, the aluminum salt of naph- 
 thol-sulphonic acid. It occurs in the form of crystals, 
 which have an astringent taste and a slight odor of car- 
 bolic acid; it is soluble in water and does not seem to 
 decompose very readily. It has been recommended for 
 use in surgical dressings, although it is but a feeble anti- 
 septic. If one may judge from its disappearance from 
 medical literature, it seems to have practically passed 
 from use. 
 
 SozoiODOL. — This substance is also termed Di-iodo- 
 
205 
 
 para-phenyl-sUlphonic acid, Squibb gives the following 
 method for its preparation: 
 
 "About two parts of crude carbolic acid are added 
 very slowly to one part of strong sulphuric acid. The 
 reaction raises the temperature to about 110°C. and 
 continues for two or three days, when para-phenyl-sul- 
 phonic acid (sozonic acidj is formed. Any excess of 
 carbolic acid is removed and then iodine is added to 
 form this sozo-iodolic acid (sozo-iodol)." 
 
 It occurs in acicular prisms which are free from odor 
 and readily soluble in alcohol, water and glycerine. It 
 has been employed as a local antiseptic in diseases of 
 the skin and naso-pharynx; also in venereal diseases 
 and wherever iodoform is applicable. It is used locally 
 as a dusting powder, or in gauze, or in collodion, or in 
 solution in strengths of 5 to 20 per cent. The aluminum, 
 ammonium, lead, potassium, sodium, zinc and mercury 
 salts of this acid are employed more frequently than the 
 acid itself. The sodium salt seems to be the most 
 favored derivative thus far; it occurs in bright, some- 
 what prismatic acicular crystals, which are odorless and 
 employed either in substance or else in 5 to 10 per cent, 
 aqueous solutions. Guttmann reports thirty cases of 
 pertussis in which nasal insufflation of the substance 
 gave good results. 
 
 Witthauer has employed the mercurial salt in powder, 
 emulsion and ointment with what appears to be good 
 effect. 
 
 Draer claims that preparations of this substance, and 
 of the free acid and mercurial salt in particular, possess 
 
206 
 
 marked disinfectant action when brought into contact 
 with cholera spirilla, and also that sufficient strength of 
 solution and length of exposure is able to completely 
 prevent their growth. This, however, Hueppe directly 
 contradicts. Suffice it to say that the substance is not 
 growing in favor. 
 
 Stbresol. — This is the name for an antiseptic var- 
 nish introduced into therepeutics by Berlioz. It is re- 
 commended for use in diphtheria and in certain skin 
 affections. Two formulas for the substance are given, 
 the first of which is from Blanc. 
 
 
 Grms. 
 
 Gum Lac, 
 
 - 5. 
 
 Gum Benzoin, - - - • 
 
 5. 
 
 Balsam Tolu, .... 
 
 . 5. 
 
 Cryst. Phenol., 
 
 1.5 
 
 Alcohol sufficient to dissolve. 
 
 
 11. 
 
 Grms. 
 
 Purified Gum Lac, 
 
 - 270 
 
 Purified Gum Benzoin, 
 
 . 10 
 
 Balsam Tolu, 
 
 10 
 
 Cryst. Pheno 
 
 180 
 
 Oil of Cassia, . . - - 
 
 6 
 
 Saccharin, 
 
 - 6 
 
 Alcohol sufficient to make 1 litre. 
 
 
 No clinical reports have been received 
 
 in regard to 
 
 this preparation as yet; it is therefore impossible to de- 
 
 cide its status. 
 
 
207 
 
 Styracol. — This substance is the cinnamio ether of 
 guaiacol, and is produced by heating cinnamyl chlorid 
 and guaicol together. It has the chemical formula 
 C5H5,C,H4,OCH,,CH:CH.CO.O. It occurs as a crystal- 
 line needle-like powder. It was suggested as a local 
 antiseptic, also internally in pulmonary tuberculosis, in 
 diseases of the gastro intestinal tract, in chronic vesi- 
 cal catarrh, and in gonorrhea. Experience has hardly 
 justified these expectations, however, and like many 
 others of its therapeutic brethren it seems to have died 
 the death. 
 
 Styron — This substance is a compound of Peruvian 
 balsam and liquid storax. It has been used locally in 
 ulcerations, and has been suggested for administration 
 in cholera. It has been employed in the spray in a 
 strength of four per cent.; in solution in the strength 
 of eight per cent., and for introduction into serous 
 cavities, such as those of the chest and abdomen, in 
 solutions of varying strengths from 1:200 down to 1:50. 
 
 It is but little heard of recently. 
 
 SuLPHAMiNOL. — Alto termed Thio-oxy-di phenyl-amiu^ 
 It is obtained by the action of sulphur upon the salts of 
 meta-oxy-di-phenyl-amin. It occurs as a light, pale- 
 yellow, odorless and tasteless powder, which is insolu- 
 ble in water but freely soluble in the alkalies, acetic 
 acid and alcohol. Its solutions retain the pale-yellow 
 color. It seems to possess the power of checking the 
 formation of pus to some degree, and this is considered 
 by some its chief claim to recognition in therapeutics; 
 although its antiseptic power, if it has any at all, is 
 
208 
 
 very weak. It has been. used in powder in wounds, and 
 has been insufflated into the nasal fossae and sinuses of 
 that region with some apparent benefit. It has been 
 recommended in gastro-intestinal disorders on the sup- 
 position that the digestive fluids decompose it into car- 
 bolic acid and sulphur. However, it is used chiefly as 
 a local application, as are also its derivatives sulph- 
 aminol-creosote, suiphaminol-eucalyptol, sulphaminol 
 guaiacol and sulphaminol-menthol. When admin- 
 istered internally it is usually given in single doses of 
 four grains, or daily doses of fifteen grains. 
 
 Wojtaszek conducted a series of experiments upon 
 rabbits in order to test the claims of the advocates of 
 sulphaminol. After such experimentation he concludes 
 that "sulphaminol is devoid of any physiological action. 
 As regards its alleged antiseptic properties, they also 
 seem to be about «/7." 
 
 Squibb says that the substance has not been in gen- 
 eral use during the past year, and that even during the 
 year before last few reports concerning it appeared in 
 medical literature. 
 
 SuLPHOCAEBOLic AciD. — HCeH5S04. Also termed 
 Phenol-sulphonic acid^ Sozolic acid and Aseptol. It is 
 formed by the action of concentrated sulphuric acid 
 upon phenol (carbolic acid). Icthyol is sodium or 
 ammonium icthyo-sulphonate, a derivative of this acid; 
 it is a natural product, however. The acid itself is not 
 so much used in medicine, its derivatives being in com- 
 moner use; the chief of these are the sodium and zinc 
 salts (which see). 
 
209 
 
 SuLPHUME. — This substance has been also called, 
 "Pure Liquid Sulphur" (!) It is nothing more nor less 
 than an aqueous solution of the higher sulphids or sulph- 
 hydrids of sodium and potassium saturated with sulphur, 
 with traces of the sulphids of calcium and magnesium. 
 It is very ingenuously but not ingeniously recommended 
 by the manufacturer for skin diseases, open sores and 
 ulcers, ulcerated throats, diphtheria "and other affec- 
 tions." It is almost totally devoid of germicidal power, 
 however. 
 
 Sulphur Di oxid. — SO,. This substance is errone- 
 ously termed ''^Sulphurous acicT'* and ^''Sulphurous acid 
 gas?'* It is produced by the burning of sulphur — that 
 is, by its oxidation, thus: 
 
 S + O, = SO,. 
 
 It is very extensively used for purposes of fumiga- 
 tion, but has little or no use in medicine or surgery 
 proper. 
 
 Sternberg (1880) found that this substance, which is 
 a gas, disinfected dried vaccine virus exposed for twelve 
 hours on ivory points to the action of an atmosphere 
 containing one volume of the gas. The liquid virus, 
 however, exposed in a watch-glass, was disinfected by 
 one- third of this amount. 
 
 Sternberg (1885) found that pus micrococci were 
 killed by an exposure for eighteen hours to the action 
 of a dry atmosphere containing twenty volumes of the 
 gas (SO2) — four volumes per cent failed. Experimental 
 data force us to the inevitable conclusion that this sub- 
 stance, like chlorin, is much more active as a germicide 
 
210 
 
 in the presence of moisture. Moisture, as is the case 
 with chlorin also, causes a bleaching action as well as 
 an antiseptic one. An aqueous solution of the gas will 
 give true sulphurous acid (H^SO.,) thus: 
 SO, + H,0 = H^SOs. 
 
 The presence of moisture is essential to this substance 
 (SO3) if germicidal power is to be exercised by it. In- 
 deed, in the pure state anhydrous sulphur di~oxid does not 
 destroy spores^ even when the gas is liquefied by pressure. 
 Moisture is essential. 
 
 Thinot(1890) has come to the conclusion that the 
 specific germs of tuberculosis, glanders, farcy of cattle, 
 typhoid fever, cholera and diphtheria are destroyed by 
 an exposure of twenty-four hours to an atmosphere con- 
 taining the gas developed by the combustion of sixty 
 grains of sulphur for every cubic metre. 
 
 The American Public Health Association in directing 
 the use of this substance as a disinfectant recommends 
 that the infected articles be "exposed for twelve hours 
 to an atmosphere containing at least four volumes per 
 cent of this gas in the presence of moisture?'* 
 
 Sulphuric Acid. — This substance is too familiar to 
 need description — suffice it to say, in this regard, that its 
 chemical formula is HjSO^. 
 
 Koch (1881) found that anthrax spores grew after ex- 
 posure to a one per cent solution for twenty days. 
 
 Sternberg (1885) demonstrated that a four per cent 
 solution failed to destroy the vitality of the spores of 
 the Bacillus suhtilis in four hours. 
 
 Seitz found that the dejecta of typhoid patients, when 
 
§11 
 
 mixed with equal parts of the disinfecting solution, 
 were sterilized by a five per cent solution in three days. 
 The evidence in the case forces us to the conclusion that 
 sulphuric acid possesses considerably less germicidal 
 power than carbolic acid. 
 
 Sulphurous Acid. — H^SOs. Sternberg (1885) found 
 that micrococci were destroyed in two hours by 1 :2000 
 by weight of sulphurous anhydrid (SO^) added to water. 
 He also demonstrated that pus cocci fail to grow in an 
 aqueous solution of the strength 1 :5000. 
 
 De la Croix determined that one gramme of sulphur 
 di-oxid when added to two thousand parts of bouillon 
 prevented the development of putrefactive bacteria and 
 finally destroyed their vitality after a time. 
 
 Kitasato found that typhoid bacilli were killed .28 per 
 cent and cholera spirilla by .148 per cent in five (?) 
 hours. 
 
 Tannic Acid. — Ci4Hio09. This substance, also called 
 TanniUy is too f amilar to physicians to need description. 
 It is more commonly used as a tonic, hemostatic and 
 styptic but experiments demonstrate that it possesses 
 more or less antiseptic activity, A twenty per cent so- 
 lution failed, after two hours exposure, to destroy the 
 spores of Bacillus anthracis and Bacillus subtilis, Ab- 
 bott however demonstrated that a solution of the 
 strength 1:400 (.25 per cent) destroyed micrococci. 
 Kitasato found that 1.66 per cent destroyed the typhoid 
 bacillus in ^\q hours and 1.5 per cent effected the same 
 result in the same time in the case of cholera spirilla. 
 
212 
 
 Miquel has determined that it is antiseptic in the pro- 
 portion of 1:207. 
 
 Taetaric Acid.— H,C,H,Oe or C2H,. (OH),. (COOH),. 
 This substance, which is manufactured from grape- 
 wine deposits (argol), is used in medicine and the arts. 
 It is sufficiently common to need no description. The 
 substance seems to be about equal to tannic acid in an- 
 tiseptic activity. 
 
 Abbott found that micrococci were killed in two 
 hours by a solution of the strength 1:400, As was also 
 the case where tannic acid was used, a twenty per cent 
 solution failed to destroy the spores of Bacillus anthra- 
 cis and Bacillus subtilis. Hansen has shown however 
 that its germicidal power is limited to a comparatively 
 small number of species — indeed whole species of micro- 
 organisms are not only unaffected by tartaric acid but 
 even actually favored by it. 
 
 Terebenb. — CijHig. This substance is supposed to 
 be a modification of terpene, produced by the distilla- 
 tion of oil of turpentine with sulphuric acid; it is sup- 
 posed to contain camphene, cymene, terpilene and bor- 
 neol. It is a light yellow liquid with the odor of fresh- 
 ly-cut pine wood, or the odor of thyme. It is somewhat 
 soluble in ether and alcohol but practically insoluble in 
 water. It is said to be an agreeable antiseptic, a five 
 per cent solution is said to have made a very serviceable 
 surgical dressing. It has been used by inhalation in 
 bronchial affections and in pulmonary tuberculosis. 
 
 It may be used internally in capsules or in emulsion 
 
213 
 
 in doses of 4 to 6 minims; or externally in five per cent 
 solutions. 
 
 Tbepinb. — CioH[i8(OH)8. Aq. The hydrate of terpine 
 is obtained by the action of alcohol, nitric acid and oil 
 of turpentine upon each other. It occurs in white, odor- 
 less, rhombic crystals with a faintly aromatic taste. It 
 is soluble in alcohol and boiling water but only moder- 
 ately so in cold water, benzene, turpentine and carbon 
 disulphid. It has antiseptic and expectorant properties, 
 it is said. It has been recommended for use in bronchi- 
 tis and whooping-cough. It is given in doses of 2 to 
 grains, preferably in tablets or in alcoholic or syrupy 
 mixtures. 
 
 Thallinb. — C9HioN(OCH3). This substance is also 
 termed Tetra-hydro-para-methyl-oxy-chinolin and Tetra- 
 hydro-para-chinonisoL It is formed by heating acrolein 
 and para-amido-anisol together with some oxidizing 
 agent. At ordinary temperatures it is a liquid which 
 forms, when cooled, a yellowish-white, crystalline pow- 
 der with a bitter, saline taste and a peculiar somewhat 
 aromatic odor. It is soluble in water; its two chief 
 salts, the sulphate and the tartrate, which are used in 
 medicine, are soluble in water and slightly so in 
 alcohol. Wood speaks very briefly but also very un- 
 favorably of the substance. It has been used in gonor- 
 rhea, in one and a half per cent injections and two per 
 cent bougies, with apparent success. 
 
 Thilaninb. — This substance is a sulphuretted lanolin 
 produced by the action of sulphur upon lanoline and 
 containing about three per cent of sulphur. It is a yel 
 
214 
 
 lowish-brown substance resembling vaseline and devoid 
 of irritating properties. It has been used locally in 
 dermatology, being designed to replace ichthyol and 
 thiol. 
 
 Fox, after experience with the medicament, concludes 
 that it possesses no single advantage over the remedies 
 commonly used. It is objectionable, however, on ac- 
 count of its color, odor and high price. It seems to 
 have received little or no attention during the past year 
 and has probably passed out of use. 
 
 Thiol. — Thiol is a mixture of sulphuretted hydrocar- 
 bons, it is an artificial substance designed as a succeda- 
 neum for ichthyol; this latter substance is obtained by 
 the distillation of a bituminous oil, it contains ammon- 
 ium and probably also sodium ichthyo-sulphonate, — it 
 is used chiefly in dermatology, having no active germi- 
 cidal properties though said to have the power of arrest- 
 ing the growth of bacteria. Thiol occurs in two forms; 
 one, a liquid, which exists as a thin, brownish extract 
 slightly heavier than water and is not the purified pro- 
 duct, it is therefore cheaper and oftener used; the other 
 occurs as a fine brown powder, or else in scales. It is 
 soluble in water, especially in the presence of glycerin. 
 The substance is chiefly used by dermatologists and 
 gynecologists. Reports as to the results of its use in- 
 dicate that it is free from odor and irritating properties, 
 does not cause bleeding from raw and eroded surfaces, 
 promotes absorption of effusions — and indeed has such 
 advantages over ichthyol itself that it bids fair to dis- 
 place the latter substance. Thiol may be given intern- 
 
216 
 
 ally in doses of one and a half grains; locally it may be 
 applied as a dusting powder, or else in ointment or else 
 in solutions of 10 to 60 per cent strength. 
 
 Thiophbn.— C4H4S. This substance is a sulphur de- 
 rivative of benzene. Indeed Meyer has pointed out the 
 fact that it occurs in all of the commercial benzenes de- 
 rived from coal-tar. It may be isolated by agitation 
 with one-tenth volume of concentrated sulphuric acid. 
 The substance occurs as a clear, colorless and volatile 
 oil which is insoluble in water. 
 
 Thiophen itself has been but little used in medicine, 
 but its derivatives, lead and sodium thiophen-sulphonate 
 (which see) and thiophen di-iodid, have been favorably 
 reported on from Kaposi's clinic in Vienna. 
 
 Thiophen di-iodid (C4H,IjS) occurs in beautiful, small, 
 crystalline tablets which are volatile at ordinary temper- 
 atures and which are also insoluble in water; the com- 
 pound has been used as a substitute for iodoform, being 
 employed in all conditions in which iodoform would be 
 considered indicated. Hock, of Vienna, says that its 
 use in the powder in surgical dressings seems to retard 
 the formation of pus and to prevent the occurrence of 
 of exuberant granulation. It is used in the form of a 
 dusting powder, or else in gauze. Its freedom from ob- 
 3ectionable odor and its non-toxic and non-irritating 
 properties have been demonstrated by clinical experi- 
 ence. 
 
 Thioebsorcin. — CeH4(0S),. This substance results 
 from the combination of resoroin, sodic hydroxid, sul- 
 phur and hydrochloric acid. The product occurs in the 
 
216 
 
 form of a flocculent, grayish white, non-irritating, taste- 
 less and odorless powder which is insoluble in water 
 but slightly soluble in alcohol and ether. It has been 
 suggested and employed as a substitute for iodoform 
 and has been used as a dusting powder, especially in 
 the treatment of ulcers of the leg. 
 
 Thymol. — CjoHigOH. This substance is obtained 
 from the volatile oils of thyme and other plants. 
 It occurs in large, transparent plates or in acicular crys- 
 tals which are insoluble in water but soluble in the 
 fatty and essential oils. It has been used by inhalation 
 in pertussis and various pulmonary affections; it has 
 also been employed internally in various gastro-intesti- 
 nal diseases and in rheumatism. It is said to have given 
 good results in the treatment of wounds, skin diseases 
 and various affections of the mouth. 
 
 This product was introduced into medicine by Ranke 
 of Halle, in 1878, and was much lauded on account of 
 its comparative freedom from poisonous and irritating 
 properties, but clinical experience has^in nowise war- 
 ranted the brilliant expectations, they have not been 
 fulfilled. A five per cent solution does not destroy 
 anthrax spores, even in fifteen days' exposure to its 
 action, as has been demonctrated by Koch; but their 
 development is somewhat restrained by 1:80,000 he 
 states. Yersin found that the substance itself required 
 three hours to destroy the tubercle bacillus. Behring after 
 careful investigation, pronounces that it possesses four 
 times less germicidal power than carbolic acid, and yet 
 Ranke fondly believed it to be a formidable rival of the 
 
217 
 
 latter. Miquel has determined that it is antiseptic in 
 the proportion of 1:1340. 
 
 Tin Chlorid. — This substance, in one per cent solu- 
 tion and acting for two hours, destroyed the bacteria of 
 of putrefying bouillon, but an .8 per cent solution failed 
 to accomplish this. 
 
 Tobacco Smoke. — Tassinari demonstrated that to- 
 bacco smoke possesses the power of restraining the de- 
 velopment of bacteria — especially certain species, as 
 Friedlaender's bacillus and the spirilla of cholera, which 
 fail to develop after exposure for half an hour to an 
 atmosphere of tobacco smoke. 
 
 TuMBNOL. — This is a comparatively new compound 
 which is produced by the treatment of the unsaturated 
 hydrocarbons of mineral oils with sulphuric acid, and 
 is closely allied to ichthyol. It occurs as a dark-brown 
 fluid which Neisser, of Breslau, seems to consider an 
 efficacious compound. He says that the substance and 
 its compounds, whose action seems to be chiefly super- 
 ficial, owe their virtues to their strong reducing proper- 
 ties rather than to the sulphur in their composition, 
 which latter is true in the case of ichthyol. It has been 
 recommended in pruritus, moist eczemata, etc. It has, 
 however, no antiparasitic or germicidal powers and 
 hence is of no service in erysipelas. But little has been 
 heard of the substance in this country as yet. 
 
 Valerianic Acid. — HCjHjjOj or better C4H,.C00H. 
 This acid is an oily, colorless, liquid with a penetrating 
 and characteristic odor; it is but slightly, soluble in 
 water but is soluble in alcohol. It is found in valerian 
 
218 
 
 atid angelica root but is generally prepared by the oxi- 
 dation of amyl alcohol. Koch found that a live per 
 cent solution failed to destroy anthrax spores even after 
 five days' exposure. 
 
 Xylol.— CgHio- Also termed Xylene and Di-methyl- 
 benzene. This substance, as its chemical formula indi- 
 cates, is a hydrocarbon and resembles benzene. It is 
 said to possess antiseptic properties and application has 
 been made of this fact, especially in the treatment of 
 variola. The dose, when adminsstered internally, is 
 30 to 45 grains given in wine. 
 
 Zinc Chlorid. — ZnClg. This substance, which is 
 used in concentrated solution as an escharotic or caustic, 
 also possesses antiseptic powers. Koch found that it 
 had little or no effect upon anthrax spores, however, 
 for such spores germinated even after thirty days im- 
 mersion in a five per cent solution. A five per cent 
 solution successfully destroyed the spoies of Bacillus 
 subtilis, A two per cent solution destroyed pus cocci 
 in two hours while a .5 per cent (1:200) solution de- 
 stroyed the Micrococcus Pasteuri in the same time. 
 Miquel has determined that the substance is antiseptic 
 in the proportion of 1 :526. 
 
 Zinc-Mbrcuric Cyanid.— Hg(CN),.4Zn(CN),. This 
 substance occurs as a white powder which is practically 
 insoluble in water. It has been highly recommended 
 as a non-irritating antiseptic but its use has not become 
 general. Until recently it was the favorite antiseptic 
 used by Sir Joseph Lister, the "Father of Antiseptic 
 Surgery"; more recently, however, he has repudiated all 
 
219 
 
 antiseptics with the exception of carbolic acid — this he 
 deems the antiseptic /«r excellence. The chief objection 
 to zinc mercuric cyanid is its feeble germicidal power, 
 owing what virtue it possesses to its inhibitory power. 
 (See "Mercury.") 
 
 Zinc Sozoiodolatb. — This substance is the zinc de- 
 rivative of sozoiodol (which see). It occurs in the form 
 of acicular crystals which are soluble in water in the 
 proportion of 1 :20. It has been used in acute and 
 chronic blenorrheas and also in acute inflammatory con- 
 ditions of the naso-pharynx. In gonorrhea it is em- 
 ployed in aqueous solutions of strengths of .5-1.5 per 
 cent, to which either laudunumn or salicylate of bis- 
 muth may be added. 
 
 Zinc Sulphate. — ZnSO^. This substance occurs in 
 crystals or crystalline masses which are readily soluble 
 in water. The product is used chiefly as a mineral 
 astringent or an irritant emetic. Some physicians have 
 attributed antiseptic or germicidal powers to it. Koch 
 found that anthrax spores germinated even after ten 
 days immersion in a five per cent solution. Micrococci 
 from an acute abscess resisted the action of ten to 
 twenty per cent solutions even after exposures of two 
 hours — the Micrococcus tetragenus was killed however. 
 A careful consideration of all of the experimental data 
 at our command leads us to the conclusion that the 
 substance has very feeble, if any, germicidal power. 
 
 Zinc Sulphocarbolatb. — This substance is the zinc 
 salt of sulphonic acid, also termed sulphocarbolic or 
 phenyl-sulphuric aci4. (See sulphoo^rbolic acid). This 
 
220 
 
 salt was at one time highly vaunted as an intestinal 
 antiseptic. Koch found that a five per cent solution 
 failed to destroy anthrax spores even after five days 
 exposure — the eodium compound was equally worthless, 
 even when applied for a greater length of time. 
 
 Zinc Sulphydroxid. — Zn(SH),. Theoretically this 
 substance is the hydroxid in which the oxygen of the 
 radical hydroxyl has been displaced by sulphur. Zinc 
 sulphydroxid occurs as a white solid which readily de- 
 composes in the dry state and is therefore frequently 
 preserved by immersion in water. It has been employed 
 both internally and externally. Its use in external 
 treatment has been chiefly in such conditions as psori- 
 asis, eczema and various dermatoses of a vegeto-para- 
 sitic character. It can be used externally in the form 
 of an ointment of the strength of ten per cent. Inter- 
 nally it is administered in doses of one-half to two 
 grains, usually in pill form. 
 
 VIII. — Their Use and Value in General 
 Medicine. 
 
 What have the principles of general antisepsis done 
 for general medicine? Have not their far-reaching in- 
 fluences been felt even here? To-day the modern sci- 
 ence of bacteriology is about to revolutionize modern 
 medicine and its principles — indeed we seem upon the 
 eve of a dawn of the elaboration of a specifiic and radi- 
 cal treatment for disease, infectious diseases at least. 
 In some cases this seems to have been accomplished al- 
 
 'C 
 
221 
 
 ready while in others a vast stride has been made in 
 such direction by the demonstration, isolation and study 
 of the various specific organisms upon which the etio- 
 logy of these diseases seem dependent. While much 
 has been accomplished in this field, it is chiefly in the 
 sphere^ of preventive medicine, of praphylaxis, that the 
 harvest has proven richest and most abundant. In the 
 case of pulmonary tuberculosis, one of the most fatal as 
 well as common of all diseases, the specific cause of the 
 disease has been discovered, isolated, cultivated and 
 studied. This has led to the demonstration that infec- 
 tion in many cases is largely due to the dessication and 
 dissemination of tuberculous sputa as an impalpable 
 powder, 
 
 A proper appreciation of the infectious and dang- 
 erous nature of the sputum has led to its destruction or 
 sterilization. The result of this has been seen in some 
 localities, where extended observations were made, in a 
 reduction of the death- rate of the disease. When we 
 consider the extent of the disease and its essentially 
 fatal character, we can readily appreciate the fact that 
 even a slight reduction in the mortality is as significant 
 as important, indicating as it does the possibility of 
 more than a slight saving of human life the world over. 
 While the disease itself is by no means thoroughly 
 amenable to treatment, yet its inception has been to 
 some extent avoided by the destruction or sterilization 
 of the infectious discharges (sputa) from those thus 
 affected. Moreover attempts at internal and local treat- 
 ment of the diseased condition, although hardly brill* 
 
222 
 
 iantly encouraging, have not been altogether devoid of 
 result. Of course in all treatment it must constantly 
 borne in mind that the destructive action of the blood 
 and tissues upon parasitic organisms is appreciably 
 decreased by conditions of mal-nutrition and depressed 
 vitality; or by surroundings unfavorable to the most 
 healthy development of the body and its organs and 
 tissues. By improving nutrition and placing the patient 
 in the most favorble hygienic conditions which are per 
 se least favorable to micro-organic development, we in- 
 crease the germicidal power of the blood and tissues 
 and their toxicity for tubercle bacilli as well as other 
 bacteria. 
 
 To hygiene, to quarantine, to sanitary science, anti- 
 sepsis and bacteriology (its logical outcome) have prov- 
 en of the utmost value — indeed upon this rock are they 
 now founded. Typhoid fever, Asiatic cholera and vari- 
 ous other epidemic and infectious diseases have had 
 their virulence comparatively circumscribed by rigid 
 adherence to the dicta of antisepsis, especially by the 
 complete disinfection of stools and other infectious dis- 
 charges from those afflicted. This has been of decided 
 value; when one is unable to control an infectious dis- 
 ease itself, it is of the utmost importance and value to 
 be able to control the spread of the disease. It is diffi- 
 cult to estimate the absolute value of such power, be- 
 cause such value depends upon the casualties and fatali- 
 ties averted, therefore it must remain an unknown yet 
 indubitable quantity or factor. To what did we owe 
 our freedom from the terrible scourge of cholera a few 
 
223 
 
 years ago but to the prompt institution of rigid sanitary 
 and hygienic — that is, antiseptic — precautions? Indeed 
 scientifiic men are so familiar with the abundant and 
 practical results of the application of antiseptic princi- 
 ples in preventive medicine that is hardly seems necess- 
 ary to do more than direct attention to them. Certainly 
 they are as manifest as the successes of the use of anti- 
 septics in various traumatisms and in the treatment of 
 localized infectious conditions where accessible to local 
 treatment, 
 
 Moreover bacteriology, the legitimate offspring of 
 antisepsis, has also added greatly to the precision of 
 diagnostic skill and science. What nosological chain 
 of evidence is now complete and positive, in tuberculosis, 
 that is devoid of a demonstration of the presence of the 
 specific bacillus in the morbid secretion? What diag- 
 nosis of Asiatic cholera is a completed scientific entity 
 at the present day unless the presence of the character- 
 istic spirilla in the alvine discharges has been demon- 
 strated? How indeed may we clearly and positively 
 differentiate between diphtheria and several other in- 
 fectious, inflammatory, membranous or pseudo -membran- 
 ous diseases of the naso-pharynx except by a bacter- 
 iological demonstration of the presence or absence of 
 the Klebs-Loeffier bacillus? 
 
 In the earlier days of even modern antisepsis sub- 
 stances were frequently employed which later and riper 
 experience has proven devoid of value. The beginning, 
 of all systems are necessarily crude, it is the oft-repeated 
 story of per aspera ad astra. In the utter absence of 
 
224 
 
 precise knowledge concerning the nature of the infect- 
 ing agent, or germ, or its habits as well as habitat, it 
 was not surprising to find the sanitarian devoting him- 
 self to futile efforts at destruction of imaginary foes 
 with weapons almost as imaginary. For this same rea- 
 son he frequently neglected to attack the much more 
 material and infectious pathogenic principles of such 
 things as tuberculous sputa or typhoid or choleraic ex- 
 creta. We have now learned however that even if 
 pyogenic and pathogenic bacteria do exist in the air 
 (which is not to be doubted) the spray, as Stimson has 
 amply shown, is thoroughly incapable of effecting their 
 destruction. By far the greater danger of infection 
 lies in the transfer of germs directly to the wound sur- 
 face or other focus of infection by means of infected 
 hands, instruments or dressings. Indeed in many cases, 
 formerly, the physician or surgeon was himself the un- 
 suspected and unconscious source of infection. Now 
 however everything unsterilized is looked upon as a 
 possible source of infection. 
 
 The vital resistance of bacterial organisms to various 
 agents differs within certain limits for the various 
 species; some exhibiting special susceptibility to ftpecial 
 agents, for example that of the septic micrococcus to 
 alcohol and of the Bacterium termo to boracic acid. 
 There is therefore certainly some rational basis for the 
 supposition that the various pathogenic germs may like- 
 wise exhibit similar susceptibilities to various agents 
 administered medicinally with a view to the destruction 
 of such germs, or rather to a prevention of their devel- 
 
226 
 
 opment. The antiseptic value of the substances so 
 tested depends largely, indeed entirely upon their 
 power to prevent the multiplication and proliferation of 
 bacteria. This does not necessarily imply germicidal 
 power, which it would hardly be within the bounds of 
 reason to expect in internal administration. Indeed 
 Sternberg has claimed that it is possible that the virture 
 of mercuric chlorid and iodid in syphilis may be due to 
 the restrictive power of even the small quantities of the 
 drug exhibited. It woul'l be impossible to introduce 
 sufficient to kill the germ but he thinks it plausible at 
 least that a sufficient quantity may be ingested to re- 
 strict its growth and development. Some agents which 
 do not actually kill micro-organisms nevertheless pos- 
 sess considerable restrictive power and by virtue of this 
 property become valuable antiseptics, this is especially 
 true of boracic acid. 
 
 Clinical experience has demonstrated the value of 
 various antiseptics which have been used experimentally 
 in the treatment of various diseases in which there was 
 reason to even suspect the presence of specific organ- 
 isms. Indeed there are few practitioners who have not 
 employed these agents internally for the cure of various 
 forms of disease. In some instances their effect has 
 been more or less prompt and satisfactory; in others 
 probably only negative results have been attained while 
 in a third class perhaps only toxic and untoward devel- 
 opments have arisen. In view of this diversity and 
 varience in both results and opinions perhaps a discus- 
 sion of the proper uses and limitations of antiseptic 
 
226 
 
 remedial agents, however brief or imperfect, may not 
 be entirely out of place. Let us look at our facts in the 
 light of the developments, established by both experi- 
 ment and experience, of the past few years. It has been 
 demonstrated beyond doubt that most of the infectious 
 diseases at least are due to (a) specific organisms or (b) 
 substances produced by the action of specific organisms; 
 and that most, if not all, of these diseases are accom 
 panied by more or less pyrexia. In many of these cases 
 the specific organism has been isolated and determined, 
 as is the case with the following: 
 
 Morbid Conditions. 
 Suppuration. 
 
 Gonorrhea." 
 Anthrax. 
 
 Tuberculosis. • 
 Leprosy. 
 Glanders. 
 Typhoid fever. 
 Tetanus. 
 Influenza. 
 Diphtheria. 
 Specific croupous pneu • 
 monia. 
 
 Asiatic cholera. 
 Relapsing fever. 
 Epidemic dysentery. 
 Erysipelas 
 
 Micro Organisms. 
 The various pus cocci 
 such as /Staphylococcus pyo- 
 genes aureus^ alhuSjCitrns and 
 the Streptococcus pyogenes. 
 The gonococcus of Neisser. 
 Bacillus anthracis. 
 " tuberculosis, 
 " leproe. 
 " mallei, 
 " typhosus. 
 " tetani, 
 " inftuenzce. 
 " diphtherice, 
 Diplococcus pneumonicB. 
 
 Spirillum cholercB, 
 Spirochaete Obermeieri. 
 Ameba dyseritericB. 
 Streptococcus erysipelatis. 
 
Then too certain other diseases such as variola, rubeo- 
 la, scarlatina, yellow fever, typhus fever, syphilis, Ori- 
 ental plague and several intestinal diseases are also in- 
 fections in nature and doubtless have specitiic organisms 
 which have not as yet been isolated. Let us glance 
 briefly at these conditions. 
 
 In the case of suppuration the virtue and value of 
 antisepsis is peculiarly marked. In a properly conducted 
 treatment of a localized and accessible condition the 
 formation of pus is now practically as rare as it was 
 formerly common. Indeed as Gerster says, at the pres- 
 ent day infection and suppuration in a fresh wound are 
 due to technical faults or else errors of commission 
 or omission on the part of the professional attendant in 
 charge. 
 
 Anthrax and glanders are more commonly confined 
 to the lower animals and hence have little interest 
 to us in a consideration of the method and results of 
 antiseptic treatment. 
 
 In the more modern and successful treatment of gon- 
 orrhea the tendency is to the use of irrigant antiseptic 
 solutions of boracic acid, mercuric chlorid, potassic 
 permanganate and hydrogen peroxid. In such cases 
 the results given have been more than satisfactory. In- 
 deed sterilization of the lower genito-urinary tract has 
 been accomplished, it is even claimed, by the internal 
 administration of such remedies as oil of wintergreen or 
 boracic acid. Johnson had proven the appearance of bo- 
 racic acid in the urine ten minutes after its administra- 
 tion by the mouth. 
 
228 
 
 In the case of influenza, variola, rubeola, scarlatina, 
 yellow fever, typhus fever and relapsing fever little or 
 no benefit has been ascribed as yet to internal antiseptic 
 medication, except in the case of influenza which some 
 claim is distinctly modified by the inhalation of vapor- 
 ized volatile antiseptics. In scarlatina also antiseptic 
 inunctions in the latter stage have lessened the chances 
 of infection of those coming in contact with the patient. 
 
 Epidemic dysentery, so long beyond the control of 
 the physician, has at last been found more or less amen- 
 able to antiseptic rectal injections, especially of aqueous 
 solutions of argentic nitrate. 
 
 Diphtheria is now recognized as an infectious disease 
 of a local nature whose general symptoms are due to 
 secondary absorption of the products of vital activity 
 on the part of the germ. Its treatment is essentially 
 antiseptic, being directed against the germ lodged in 
 the membrane. The results of such treatment are so 
 obvious that we need hardly do more than refer to them. 
 The same is also true of erysipelas, whose streptococcus 
 seems to be specially susceptible to the influence of 
 carbolic acid. In Asiatic cholera it has been noticed 
 that the spirilla are especially susceptible to the effect 
 of the mineral acids, even in dilute solutions. Advant- 
 age has been taken of this fact in the treatment of the 
 disease and it has also been combined with intestinal 
 irrigation. 
 
 In the case of tetanus Dr. Schwarz, of Padua, cured a 
 boy of the disease by means of the injection of an anti- 
 toxin which bad been prepared by Tizzoni and Cattani 
 
229 
 
 from the specific bacillus. Schwartz likewise refers to 
 three other similar cases which had been treated by 
 Italian physicians in a similar manner with the success- 
 ful result in each case. Fraenkel had a similar experi- 
 ecce in diphtheria. 
 
 It is now established beyond doubt that typhoid fe- 
 ver is caused by a specific organism introduced from 
 without. Eberth found the bacillus present in the 
 spleen, lymphatic glands and portions of the intestinal 
 tract in twelve out of twenty-three cases, Koch in fifty 
 per cent and Meyer in sixteen cases out of twenty. 
 Lucatello reproduced the disease in ten out of thirteen 
 cases by inoculation with blood from the . spleen of a 
 diseased animal. Neuhaus found the bacillus in the 
 rose maculae in nine out of fifteen cases. The chief seat 
 of the disease is in the intestinal tract. It hardly seems 
 rational to claim to be able to kill the germ under such 
 surroundings, but can we not sweep the fecal matter 
 from the bowel and by the use of proper antiseptics 
 prevent the development and proliferation of the germ 
 within the intestinal tract? The experiments of Fort- 
 chinskey are interesting in this connection. He used 
 from ten to fifteen grain doses of boracic acid in two 
 hundred and forty cases of typhoid fever during an 
 epidemic; he was successful in two hundred and thirty- 
 one cases — about ninety-six per cent. He claims that 
 in the first three or five days fever and diarrhea dimin- 
 ished, tympanitis almost disappeared and the stools be- 
 came normal in character. 
 
 It is hardly necessary at the present time to offer 
 
230 
 
 proofs of the existence of ptomaines and toxalbumins, 
 this has long since been done by many competent and 
 reliable observers. Indeed such substances may be real 
 causative factors in disease or in the causation of dan- 
 gerous and disagreeable symptoms. Such ptomaines or 
 toxalbumins may originate either externally or inter- 
 nally, in either event their ingestion and absorption are 
 more or less promptly followed by various acute pheno- 
 mena resembling ordinarily the profound symptoms of 
 acute alkaloidal poisoning. In many cases the disease 
 may be primarily local but soon becomes constitutional, 
 a result of the secondary absorption of the products 
 eliminated by the germ in its life history. And the 
 manifestations of this secondary or systemic infection 
 are often more alarming and more dangerous than those 
 of the primary local infection. After this general in- 
 fection has taken place the local use of antiseptics is 
 useless except in the attainment of a purely local result. 
 The disturbing element is no longer circumscribed, it 
 has now penetrated within the portals of the circulation 
 whither we can hardly follow it, for the agent which by 
 its toxic power has paralyzed the nervous system and 
 threatens every function is quite beyond thh reach of 
 germicides — it is amenable to no antiseptic. The cause 
 is not an organism whose vitality may be destroyed, it 
 is a definite compound whose physiological effects must 
 be combated or whose chemical autonomy must be de- 
 stroyed. After ptomaines, leuoomaines or toxalbumins 
 are formed they can hardly be antagonized by germi- 
 cides, the germ must be destroyed before elaborating 
 
 p- 
 
231 
 
 the substances. In other cases perhaps the germ itself 
 may enter the circulation, leaving the site of primary 
 infection; it is then inaccessible and proof against at- 
 tacks of this nature. If in this latter case the future treat- 
 ment of infectious disease is to be directed to specific 
 germs rather than to the resulting phenomena we shall 
 be forced to rely not upon mechanical destroyers but 
 upon proteids or alkaloids which are either chemically 
 or physiologically antagonistic, as well as to institute 
 treatment with a view to an increase of the vital resistive 
 power of the tissues and fluids. Here is the field of the 
 medicine of the future. Germicides are only of value 
 in so far as they destroy germs and prevent future 
 elaboration of toxic products. Clearly then the infer- 
 ence is obvious — action must be taken sufficiently early 
 to destroy the germ and render impossible secondary 
 infection by absorption of toxic products. 
 
 In such diseases as are dependent upon secondary in- 
 fection our main reliance as yet is to be placed in those 
 remedies and measures which support and stimulate 
 the vitality of the patient and promote his nutrition — 
 "<?a rohuVy fer auxUium^ 
 
 It can be positively stated that fermentative or putre- 
 factive micro-organisms do not exist actively in the in- 
 testinal tract when its secretions are normal. Kurlow 
 and Wagner have proven conclusively that constant or 
 specific microbes do not exist in the stomach and 
 that those which do enter it with the ingesta are only 
 accidental abd temporary residents for they cannot live 
 in the normally acid contents of that organ. In their 
 
opinion the normal gastric juice is indeed an exceed- 
 ingly strong germicidal agent and when in full and nor- 
 mal activity destroys all others than the most prolific 
 and tenacious germs, such as the bacilli of tuberculosis 
 and anthrax; certain staphylococci also seem to be able 
 to withstand its action. So Nature provides, as it were, 
 a Cerberus to guard the portals of the alimentary tract or 
 rather indeed to fortify its whole course, just as in her 
 beneficence she has conferred germicidal properties up- 
 on the blood, certain fluids, and the cellular elements, 
 or their constituents, of certain organs. 
 
 If then the normal intestinal and gastric juices possess 
 such desirable and valuable attributes may we not con- 
 clude that the vast majority of cases of infectious dis- 
 ease of such tract are direct results of a vitiation of or 
 deficiency in the quality of each secretion? If such be 
 the case then scientific therapeusis demands the de- 
 struction and elimination of infectious material by the 
 institution of normal processes elaborating normal se- 
 cretions as well as, if not more than, the direct antagon- 
 ism of antiseptics themselves. Antiseptics may be of 
 decided value however when they have the power of 
 ridding depressed vitalities of the incubus of germ life. 
 While large numbers and varieties of micro-organ- 
 isms do exist normally in the digestive tract they are 
 ordinarily incapable of injurious action because they are 
 rendered inert by the normal digestive fluids. But the 
 moment, however, that such normal secretions, become 
 perverted, vitiated or arrested the germs already there, 
 or those introduced with the ingesta, are placed under 
 
233 
 
 conditions favorable to their development and as a con- 
 sequence fermentative changes ensue. Once instituted 
 who can foresee the result? Will it be simply a case 
 of primary and local infection or will it result in a more 
 complex and dangerous secondary and systemic infec- 
 tion? This depends entirely upon the nature of the 
 germ or germs and also the facilities present which are 
 favorable or unfavorable to successful and undisturbed 
 development. When only a single local infection 
 supervenes it may be and is possible by the use of 
 proper antiseptic measures and the administration of 
 proper antiseptic remedies in sufficient quantities to 
 limit or arrest the morbid condition. Not always by 
 destroying the organisms themselves, but by instituting 
 a train of conditions unfavorable to their snbsequent 
 growth and development. This must, however, remain 
 little else than palliative and temporary in effect so long 
 as the secretions of the digestive tract are at fault and 
 allowed to remain so. Furthermore we can anticipate 
 little else than unsatisfactory results as long as we ex- 
 pect a small amount of antiseptic, such as is hardly more 
 than sufficient to sterilize a superficial ulceration, to 
 promptly,' thoroughly and sufficiently disinfect the whole 
 intestinal tract with its many square feet of mucous 
 membrane, to say nothing of the accumulated infected 
 secretions and excretions. Catharsis, elimination and 
 irrigation must precede and mechanically prepare and 
 make clean the way for the antiseptic which is to fol- 
 low—that is, a minimum amount of work should be left 
 for it. 
 
234 
 
 IX. — Thbib Value and Use in Surgery. 
 
 The primary elucidation of the principles of antisepsis 
 originated with the surgical branch of the healing art 
 and it is but natural that we should look to this depart- 
 ment of medical science for subsequent development 
 and improvement. Have our expectations been realized 
 or has Time, with ruthless hand, swept all record from 
 the history of progress? Nearly three decades ago the 
 principles of antisepsis first came into practical use in 
 surgery and the subsequent history of those principles, 
 from the very first period of their inception, has been 
 one of continual and uninterrupted progress. Within 
 the past few years the results of bacteriological research 
 have completely revolutionized surgical pathology and 
 surgical methods. A large majority, if not all, of the 
 acute and chronic inflammatory processes and lesions, 
 as well as wound complications, which are brought to 
 the attention of the surgeon are due to micro organisms. 
 For this reason it is necessary and expedient that the 
 importance of bacteriology as an integral portion of the 
 science and art of modern surgery be given due and 
 proper recognition. These recent advances in surgical 
 pathology, involving surgical methods as they did, laid 
 the very foundation for those brilliant achievements of 
 modern surgery which read like the pages of a medieval 
 romance. The debt which modern surgery owes to 
 bacteriology and bacteriological research is peculiarly 
 great, for to it must be accredited a large measure of 
 
235 
 
 the success attendant upon its later years. The knowl- 
 edge which has been derived from the systematic inves- 
 tigation of disease, impelled by the aid afforded by bac- 
 teriology, has opened new fields of usefulness and mater- 
 ially extended the sphere as well as increased the utility 
 of the surgeon himself. Indeed to such good effect 
 that many conditions formerly and vainly treated by 
 medication are now speedily and successfully obviated 
 by the art of the surgeon. 
 
 In the olden days operations were performed, it is 
 true, upon the various cavities, cranial, thoracic and ab- 
 dominal; but such cases, for reasons which are now ob- 
 vious, were so speedily and uniformly terminated by 
 death from septic causes that intrepid indeed must be 
 the heart and hand which dared stand undaunted in the 
 very face of assured disaster. The values of antisepsis 
 and asepsis were less than vaguely known and appre- 
 ciated and though such conditions were at times some- 
 what imperfectly obtained this was rather the result of 
 chance than design. The bravery and no less the suc- 
 cess of a McDowell under these conditions, with a howl- 
 ing mob on one side and a fearful operation with a still 
 more fearful outlook as to mortality on the other, was 
 little else than marvelous and phenomenal. This ex- 
 ceedingly hazardous chance of success has been entirely 
 obviated by modern methods; the sanctum of the human 
 body is now devoid of any sanctum sanctorum within 
 which it is forbidden the invading hand of the surgeon 
 to enter — the very centers of life and function are ap- 
 proached with little or no fear of untoward consequences. 
 
236 
 
 This confidence is not the child of audacity but the off- 
 spring of confidence and success. Abdominal surgery 
 has sprung into bud and blossom beneath the kindly in- 
 fluence of modern aseptic and antiseptic methods. The 
 thoracic cavity is invaded and no ill result is anticipated. 
 Cranial surgery is now a sturdy youngster though only 
 of some seven or eight summers. Cerebral localization 
 is the logical outcome of modern methods of research 
 and the spirit instituted has stimulated cerebral surgery 
 to renewed strength. All of these triumphs were possi- 
 ble only upon one contingency-r-complete and thorough 
 antisepsis, which of course includes asepsis. 
 
 But the greatest achievement of modern surgery is 
 not so much in the triumphs of either abdominal or 
 cerebral surgery; nor indeed of any one or more partic- 
 ular classes of operations. This lies in the method which 
 has brought every organ within the domain and under 
 the influence of the surgeon— it forms the very founda- 
 tion upon which the superstructure rests. The victory 
 and success of that method manifests itself no less in 
 recovery from the simplest operation than in that from 
 laparotomy or craniotomy or the extirpation of a cere- 
 bral tumor without the formation of pus or the develop- 
 ment of pyrexia. So great is the importance of this 
 method that the introduction of antisepsis marks the 
 dawn of modern surgery. The value of the service 
 which Lister had rendered mankind was exemplified 
 when Queen Victoria conferred knighthood upon him. 
 This was honor, this was glory — but the unfading and 
 imperishable glory of Sir Joseph Lister's life is to have 
 
237 
 
 ushered in an era which has snatched life from death 
 in that it has so markedly reduced the mortality of man- 
 kind in so far as death by unnatural septic means is con- 
 cerned. He recognized and appreciated the fact that 
 wound infection is dependent upon the presence and in- 
 fluence of micro organisms. But he did much more 
 than this, for he adopted measures of treatment based 
 upon this truth; he not only recognized the evil and ap- 
 preciated its source but also formulated a systematic 
 method of combating these microscopic yet omnipotent 
 as well as omnipresent foes of the surgeon. His fame 
 will rest safely and securely upon the establishment of 
 these fxxndsimeniskl J^rincip/es even if every detail of his 
 original method be supplanted by better ones. Indeed 
 this has taken place to some extent already and will 
 probably continue to do so. The original spray and 
 dressing Lister has n#w discarded himself, explaining 
 that these were but the essential crudities which occur 
 in the development and perfection of any system. But 
 Xhe J>rinciples upon which they were founded remain ab- 
 solutely unaltered and unshaken in every particular; 
 for of a truth, the elapse of time and the accumulation 
 of experience all bear testimony to, as well as strength- 
 en, their unassailable position. The antiseptic and 
 aseptic methods depend no less upon the researches of 
 bacteriology than upon clinical experience — indeed, in 
 the development of these methods both work together 
 hand in hand, the one announcing principles which the 
 other puts into practice. As Dr. Edwin Hamilton has 
 most aptly said: **The surgery of to-day seems ele- 
 
vated on a tripod of three solid enduring feet — they are, 
 anesthetics, antiseptics and experimental research." 
 
 The stage of controversy as to the value of the 
 methods of antisepsis and asepsis has long past, for, 
 with the exception of a very limited number of individ- 
 uals the surgical world is unanimous in its unqualified 
 approval of the method which has yielded so many 
 brilliant results. Moreover those very few who affect 
 to dispute the efficacy of the principles make use of them 
 by different methods. Any procedure made with a 
 view to the exclusion of germs is metaphorically and 
 literally an antiseptic procedure. Lawson Tait who bit- 
 terly and maliciously assails not only Lister's methods 
 and principles but his very personality also, completely 
 sterilizes every instrument or dressing by the antiseptic 
 action of heat; his excellent results are due to a rigid 
 and thorough application of tlese principles — yet 
 he piously raises his hands to Heaven and renders 
 thanks that he is not as other men are. As Dr. 
 J. William White aptly says, the animus of his attack 
 is shown when Tait naively says that Lister has com- 
 pletely ignored him and his results for the past twelve 
 years. Bantock owes his results to precautions identi- 
 cal with those of Tait. Their mortality records are 
 low, it is true, — 4 per cent in Bantock's practice and 
 3.3 per cent in Tait's practice. But Thornton, a country- 
 man of Tait, working under the same conditions and in 
 the same field of work, has^ by a judicious combination 
 of antisepsis and asepsis, obtained the marvelonsly low 
 mortality record of 1.88 per cent — a distinct and signal 
 
239 
 
 gain over both Bantock and Tait, Bantock's mortality 
 being 122 4-9 per cent greater and Tait's 83 1-3 per 
 cent greater than that of Thornton. These results have 
 also been attained by Price and others of our own 
 country. 
 
 The clinical and bacteriological proof that suppura- 
 tion, pyemia, septicemia, erysipelas and other similar 
 complications are due to the presence and influence of 
 micro organisms is practically absolute. Lister has 
 said: "The germ theory of putrefactioq is the founda- 
 tion of the whole system of antiseptic surgery, and if 
 this theory is a fact, it is a fact of facts that the antisep- 
 tic system means the exclusion of all putrefactive or- 
 ganisms." This theory is founded upon a mass of cor- 
 related and substantiated facts, experimental, clinical, 
 physiological, pathological and bacteriological in char- 
 acter; these are sufficient to establish it upon a firm and 
 substantial basis. But the time for controversy is past; 
 thQ principles are indubitably established — the only de- 
 batable ground is as to the selection of methods of carry- 
 ing out those principles and as to the perfection of 
 details. The constant and thorough researches of pa- 
 tient and trustworthy investigators have but confirmed 
 Lister's statement in every degree. The clinical proof 
 is equally strong. The statistics of all operations, 
 major and minor, in the preListerian period as con- 
 trasted with those of the past two decades, establish 
 the fact that those septic diseases which were rife in 
 private, but more especially hospital practice have al- 
 most entirely disappeared. Formerly these diseases 
 
240 
 
 slew thousands and tens of thousands, but now the mor- 
 tality from these causes is almost nil and the diseases 
 themselves have been almost entirely banished. Form- 
 erly surgeons attempted to produce suppuration and to 
 prevent primary union; modern surgery teaches us to 
 secure primary union and to prevent the occurence of 
 suppuration — indeed the formation of pus is looked up- 
 on as a tangible cause for reproach to the surgeon in 
 charge. Compound fractures, which were formerly 
 among the most dangerous of accidents, are now scarcely 
 more so than simple'ones. The rate of mortality con- 
 sequent upon amputations and abdominal sections has 
 fallen nearly to zero. Formerly recovery in such cases, 
 especially in abdominal section, was hoped for and fond- 
 ly hailed as an evidence of superior skill on the part of 
 the surgeon. At the present day recovery is not simply 
 hoped for but confidently expected as a matter of course 
 — the operator not only deserves success but he also 
 commands it. 
 
 The history of the development and establishment of 
 this great theory which has so profoundly influenced 
 the progress not only of surgery but the whole of med- 
 ical science as well, is the result of the labor not of one 
 but of hundreds of the world's choicest intellects; it 
 constitutes one of the brightest of all the chapters in 
 the record of human progress. It belongs to no one 
 nation exclusively but is the common property of the 
 civilized world, for it has been at once an evolution and 
 a revolution in the complete consummation of which 
 all nations have shared. lu Germany and France 
 
241 
 
 Schwann and Pasteur demonstrated that putrefaction is 
 due to the presence of micro-organisms. In Scotland 
 and England Lister applied this fact to surgery, demon- 
 strating that the statements of Schwann and Pasteur 
 hold true also in the case of living flesh. In the United 
 States, Austria and Germany further applications and 
 perfections of technique have been attained; while in 
 the United States, France, Germany, Great Britain, 
 Italy and Russia immense strides have been made in the 
 direction of the development of bacteriology and surgi- 
 cal pathology. 
 
 But let us glance briefly at some of the benefits 
 which the principles of antisepsis, which naturally 
 include those of asepsis, have conferred upon humanity. 
 
 In the period of 1864 to 1866 inclusive, Lister op- 
 erated in the city of Glasgow. The mortality in this 
 series of operations of all kinds was 45.7 per cent; these 
 deaths were largely due to septic complications and dis- 
 eases. In the period of 1867 to 1869 inclusive he began 
 gradually to employ his antiseptic methods and the 
 mortality sank remarkably — to iS per cent! This meant 
 that whereas pervious to the use of his antiseptic 
 method only slightly more than one-half of his patients 
 survived, under its use about six sevenths survived. He 
 began to improve the details of his system and moved 
 to Edinburgh. During the period of 1871 to 1876 in- 
 clusive he treated five hundred and fifty- three grave 
 surgical cases with a mortality from septic conditions 
 reduced to — .36 per cent! Thus in twelve years his 
 mortality rate dropped from 45 7 per cent to .36 per 
 
242 
 
 cent; without antisepsis it was 127 times as great as with 
 it. This diminution is so startling and so striking that 
 when we remember that the different results were ob- 
 tained by the same operator upon the same class of pa- 
 tients for practically the same injuries or diseases, they 
 seem, ipso facto^ not only conclusive but little short of 
 the marvelous. 
 
 Somewhat later the methods of Lister and those cur- 
 rent before the introduction were subjected to compari- 
 son. He, with antiseptic precautions, and Spence, with- 
 out antiseptic precautions, worked in the same hospital 
 upon the same class of patients for practically the same 
 conditions. Spence lost three times as many patients as 
 Lister. * In deaths from infectious disease Lister had a 
 mortality record of .33 per cent, while that of Spence 
 was 2.4 per cent, or nearly eight times as great as that of 
 Lister! 
 
 But these results were not peculiar to the practice of 
 Lister, the originator of the system; they were corrobo- 
 rated and confirmed by every impartial observer and 
 operator. Nussbaum has distinctly and expressly stated 
 that in the forty years experience in his clinic, under 
 himself as well as his predecessors, deaths from wound 
 diseases and wound complications were so common, 
 prior to the introduction of antiseptic methods, that 
 even those patients with the slightest injuries frequently 
 succumbed to them. He furthermore stated that dur- 
 ing this same period erysipelas and abscesses were mat- 
 ters of daily occurrence, that 80 per cent of all wounds 
 and sores were attacked by hospital grangrene and that 
 
243 
 
 nearly all cases of compound fracture terminated in 
 death. But immediately upon the introduction of the 
 antiseptic method all of these diseases suddenly disap- 
 peared and healing by first intention, previously almost 
 unheard of in his serviee^ became the rule instead of the 
 exception. His statistics also show that while for six- 
 teen years previously hospital gangrene, erysipelas, 
 pyemia and septicemia had never been absent from the 
 wards of the Munich General Hospital they suddenly 
 vanished upon the introduction of antiseptic methods of 
 wound treatment. 
 
 Volkmann states that in his practice the mortality in 
 compound fractures was above 40 per cent. Immedi- 
 ately before he adopted antiseptic methods he had 
 twelve cases of compound fracture, every one of which 
 was terminated by death from septicemia or pyemia. 
 He had become so discouraged by the alarming mortali- 
 ty from septic causes, the prevalence of gangrene, ery- 
 sipelas, pyemia, septicemia, etc., that he declared his in- 
 tention of closing his hospital. As a dernier ressort he 
 tried the methods of Lister. From that time until the 
 year 1881 he had in all 135 cases of compound fracture 
 with not a single death from septic causes! — 133 out of the 
 135 completely recovered; of the remaining two, one 
 (a drunkard) died of delirium tremens^ the other of fatty 
 embolism of the lungs within two hours — before treat- 
 ment had been fairly instituted. This means that only 
 one death was directly due to compound fracture and 
 even then by an unfortunate accident which can hardly 
 be averted. In his practice previously, with a mortali- 
 
244 
 
 ty of more than 40 per cent, he would have lost 58 pa- 
 tients. This means that in his experience with antisepsis 
 in compound fractures up to the year 1881 he had saved 
 57 lives which would have otherwise been needlessly 
 sacrificed. Contrast the mortalities — more than 40 per 
 cent on the one hand, .'74 per cent, three-quarters of one 
 per cent, on the other. That is, this mortality without 
 antisepsis was nearly fifty-eight (58) times as great as 
 his mortality with it. What a parallel! The figures 
 speak more forcibly than words. It is needless to say 
 that Volkmann did not close his hospital, far from it — 
 he became one of the sincerest admirers of Lister and 
 one of the staunchest advocates of his system. 
 
 Monsieur le Docteur Briquot shows in his statistics 
 that the mortality in the French hospitals after major 
 operations had been 52.5 per cent before the introduc- 
 tion of antiseptic methods, but that the introduction of 
 antisepsis lowered the death rate below 11 per cent. 
 In the Pennsylvania Hospital there were 116 cases of 
 compound fracture treated in the period 1839 to 1851. 
 In these, excluding those requiring amputation, there 
 were 51 deaths — a mortality of 44 per cent. In the 
 New York Hospital, during the same period, there were 
 12G cases treated; in these, excluding amputations, there 
 were 68 deaths — a mortality of 48.4 per cent. In the 
 surgical clinics of Vienna and Zurich, during the period 
 1860 to 1876 and prior to the use of antisepsis here, there 
 were reported by Billroth 180 cases of compound fract- 
 ure with a mortality, excluding amputation, of 41 per 
 cent. In the Obuchow Hospital of St. Petersburg, 106 
 
245 
 
 cases gave a mortality of 68 per cent. In Guy's Hospi- 
 tal, London, there were, during the period 1841 to 1861, 
 208 cases with 50 deaths — a mortality of 24 per cent. 
 It is but justice to whom justice is due to say that I have 
 obtained many of the statistics above quoted, from a 
 masterly and scholarly article upon antisepsis by no less 
 an authority than the well-known surgeon of Philadel- 
 phia, Dr. J. William White. An analysis of the 736 
 cases would give us an average mortality of 45 per cent 
 before the use of antiseptic principles and methods; this 
 corresponds with the statement of Volkmann that in his 
 practice the mortality in compound fracture was more 
 than 40 per cent. Upon the introduction of antiseptic 
 methods it fell immediately to 4 per cent. That is, 
 whereas in the 736 cases quoted more than 331 were 
 terminated by death, such results under antiseptic pre- 
 cautions would only occur in about 30 out of the whole 
 number of 736 cases. At the present day, with the im- 
 provements in methods, the mortality is still lower; 
 now death is far more rare than it was formerly com- 
 mon. Dennis recently reported 516 cases of compound 
 fracture in which there was 'absolutely no death from 
 septic causes. 
 
 Dr. Thomas G. Morton in one of his Pennsylvania 
 Hospital reports writes as follows: 
 
 ^^From the spring of 1875 to the same^period in 1879, a 
 period of four years, there were performed 108 ampu- 
 tations upon 100 patients. Of this number 17 died. 
 Five of these deaths took place within the first thirty- 
 six hours following the admission of the patient, and in 
 
246 
 
 each instance from recurring or continuous shock. * * 
 
 * We are greatly pleased to be able to report that dur- 
 ing the past ^ve years there has not occurred in the sur- 
 gical experience of the hospital a single case of pyemia. 
 
 * * * We believe that this result is due to the very 
 perfect system of forced ventilation by the fan, the 
 scrupulous cleanliness of the wards, and the free use of 
 carbolic acid in our dressings." 
 
 It is of passing interest to note that by the year 1886, 
 nearly eight years ago, the value of antiseptic measures 
 had even forced its attention upon crowned heads, for in 
 that year the King of Servia issued the following proc- 
 lamation: 
 
 "Whereas it is irrefutably proved by science that the 
 so-called antiseptic trsatment of wounds yields more 
 beneficial results than all other methods, we are pleased 
 to order that henceforward the said antiseptic plan of 
 treatment be solely employed in all the hospitals of our 
 kingdom, and that corrosive sublimate and iodoform be 
 used until our further disposition." 
 
 Dr. J, Knowsley Thornton, the President of the 
 Medical Society of London, in addressing that body, said : 
 "I am not ashamed still to use the spray and all the pre- 
 cautions which have advanced my results in ovariotomy 
 to 1.88 per cent mortality (as against Bantock's 4 per cent 
 and Tail's 3.3 per- cent) and I find increased practice and 
 a steady adherence to methods which have yielded me 
 good results in the past, increase in like ratio my suc- 
 cess in all abdominal operations. Every operator of 
 prominence improved his results enormously as soon as 
 
247 
 
 he adopted Listerism; then having learnt how to be surgi- 
 cally clean, he has found for himself ways of attaining 
 this end with more or less success by methods differing 
 from those of Lister. The sum and substance of it all 
 is, that if we had never had Lister to teach us true clean- 
 liness, we should never have used antiseptics, flushings 
 or drainage tubes to attain it. The great advance is 
 due to the antiseptic system, the minor details are 
 merely the different ways of attaining the same end — 
 asepticity. Time alone will show what is worth retain- 
 ing and what we may safely cast aside." 
 
 At least ninety per cent of the surgeons of the present 
 day recognize the value of the modern methods of op- 
 erative and wound treatment. When we consider the 
 formidable array of statistics, the conclusions drawn 
 therefrom and the lessons which they teach, it seems 
 established beyond all cavil, question or doubt that 
 thousands of lives have been saved every year by judi- 
 cious application of the principles of Lister that would 
 have been sacrificed by an application of those methods 
 which were in vogue prior to the introduction of anti- 
 septic surgery. If such an abundant measure of success 
 has attended the treatment of accidental and infected 
 wounds, how much greater should it be in operative 
 work; here the wounds are inflicted by the surgeon him- 
 self and under conditions which afford an opportunity 
 of cleansing away most of the infectious material from 
 the site of the operation. Thus the surgeon is enabled, 
 as Fowler aptly says, "to apply the ounce of prevention 
 rather than be compelled, as in accidental wounds, to 
 use the pound of cure." 
 
248 
 
 It is now clearly the legal as well as moral duty of 
 every individual who attempts the practice of surgery 
 to prevent the access of germs to the wounds of his pa- 
 tient by every means within his power. It is not a 
 mere matter of choice, it is incumbent upon him, it is 
 obligatory or else he must expect to bear the stigma of 
 merited reproach. By proper care in the exercise of 
 absolute surgical and bacteriological cleanliness this 
 can be secured. As Qerster has said in his "Aseptic 
 and Antiseptic Surgery." 
 
 "The fear of suppuration with its dreadful conse- 
 quences does not stay now the hand of the surgeon as 
 of old, when an operation was always considered a for- 
 lorn hope and a last resort. Strangulated hernise, for 
 instance, are not allowed to gangrene as often as for- 
 merly, and herniotomy is readily resorted to, as it is 
 well known that the dangers of an aseptic herniot- 
 omy done on a healthy gut are diminutive in compari- 
 son to the certain and enormous danger of strangulation 
 itself. 
 
 By the conviction that a fault of omission may be 
 followed by irremediable mischief, the sense of respon- 
 sibility is stirred up to vigilance, which again breeds 
 self-reliance and firmness of purpose in advising and 
 carrying out incisive measures, made clearly necessary 
 by a well-recognized danger to life or limb. And an 
 additional degree of responsibility is imposed by the 
 very safety of aseptic operations. 
 
 It can not now be successfully denied that the sur- 
 geon's acts determine the fate of a fresh woundi and that 
 
its infection and suppuration are due to his technical faults 
 of omission or commission, 
 
 * * * But he who becomes a master, to whom the 
 primary healing of a fresh wound remains not a curi- 
 osity but becomes a matter of course, will not doubt 
 the great change that has come over surgery." 
 
 If it was possible by the aseptic methods to secure a 
 complete and absolute exclusion of the germ from the 
 wound surface then the use of antiseptic substances 
 would be entirely unnecessary. But this ideal condition 
 is neither completely nor easily obtained for the opera- 
 tor is continually liable to forget or neglect some minor 
 detail or precaution which renders inutile all of the 
 care hitherto taken; we must conjoin these precautions 
 with the proper use of heat and antiseptics if we would 
 secure further and proper protection. It seems strange 
 to many how slight a discrepancy or flaw or lack of pre- 
 caution may disturb the entity and success of aseptic 
 methods; indeed it is exceedingly difficult to convince 
 the majority of physicians (even those making use of 
 proper precautions) that the touch of the completely 
 sterilized finger or instrument to a non- sterilized ob- 
 ject, such as one's own body or clothing or an assistant's 
 clothing or a door-knob or an unsterilized instrument or 
 dressing may vitiate the entire operation and seriously 
 endanger success by the introduction of even a few 
 microbic germs within the wound. For we must con- 
 stantly bear in mind the remarkable fecundity of these 
 lower forms of life, how a few solitary germs may 
 within a very short space of time become many, many 
 millions! 
 
260 
 
 We frequently hear of such discussions as "Asepsis 
 vs. Antisepsis," or are greeted by the news that aseptic 
 surgery is displacing antiseptic surgery — just as though 
 these were two diametrically opposed systems or meth- 
 ods. Aseptic surgery undoubtedly marks an important 
 advance in the attempt to perfect surgical detail, but it 
 is none the less antiseptic surgery. Antisepsis is that 
 condition which is opposed to sepsis or putrefaction; it 
 makes no difference whether the condition is obtained 
 by destruction, inhibition or exclusion of the germ- 
 putrefaction is prevented and that is the central and 
 essential idea of antisepsis. The object of antiseptic 
 surgery is to secure an aseptic condition in a wound. 
 There is no opposition between asepsis and antisepsis, 
 one is the logical outcome of the other. Although 
 thorough and complete asepsis is the ideal of every sur- 
 geon at the present day yet it is no less equally certain 
 that the time has not arrived when we can afford to 
 dispense with antiseptics. It is undoubtedly a fact that 
 aseptic methods should be reserved for sterile or steril- 
 ized wounds and not only to sterile wounds but to those 
 in which we have reason to anticipate little or no dis- 
 charge, with the accompanying risk of subsequent infec- 
 tion and putrefaction of such discharges. In all other 
 cases chemical antiseptics are necessary; in infected 
 wounds asepsis is an impossibility. Indeed in a large 
 proportion of those cases which come beneath the con- 
 trol of the surgeon we need chemical sterilization ©f 
 wounds and dressings as much as we ever did. There 
 is as yet no good reason deduced for casting aside ut- 
 
251 
 
 terlyHhe weaker chemical solutions which are in use at 
 the present time. Undoubtedly all antiseptic solutions 
 which are sufficiently strong as to appreciably compro- 
 mise the vitality of the tissues must be discarded; but 
 those disagreeable effects upon the hands of the opera- 
 tor and the tissues of the patient are usually only en- 
 countered when solutions of too great strength are 
 used — such as 1:1,000 of mercuric chlorid or 1:20 of 
 phenol. This objection, as White says, applies with 
 much less force to solutions of 1:2,500 of the one and 
 1 :40 of the other; these latter solutions experience has 
 proven to be practically just as effective. 
 
 However, we must not forget that surgical disinfec- 
 tion has progressed not so much by the introduction of 
 new and multitudinous antiseptics as by a better under- 
 standing of the modes in which they act efficiently and 
 the conditions which impair such efficient action. 
 
 In the vast majority of cases organisms gain access 
 to wounds by means of direct contact — that is, the germ 
 is actually and materially conveyed to the seat of infec- 
 tion. Nevertheless the possibility of infection from 
 the matter floating in the air is not to be overlooked 
 altogether, although the chances of infection from this 
 source are certainly slight; careful experimentation has 
 demonstrated that ordinarily the organisms exist in 
 this medium in so slight a degree as to hardly merit 
 serious consideration. This may be due to the antisep- 
 tic action of light in combination with that of the at- 
 mosphere, which antiseptic properties we have men- 
 tioned in preceding papers; or it may be due to the fact 
 
252 
 
 that the organic elements as well as the inorganic ele- 
 ments of the atmosphere may be deposited finally as 
 dust. Certainly settled dust, especially that of hospi- 
 tals, is comparatively rich in germs. In the collections 
 beneath the nails, especially of surgeons and physicians, 
 and in the rich soil of the epidermis, in the clotted 
 blood and dried infectious discharges upon instruments 
 we find an abundance of micro-organisms, pyogenic and 
 pathogenic. Indeed in operative work their presence 
 in the epidermis and their non removal or non-destruc- 
 tion is one of the commonest and most potent causes of 
 infection; then also the contact of non sterilized ob- 
 jects, whether they be the hands of the operator or of 
 the assistants, or whether they be the instruments and 
 surgical dressings used, furnish other palpable foci of 
 infection. Or else absence of sterilization or imperfect 
 sterilization favor the development of those organisms 
 and substances which ultimately find their way into the 
 wound itself where they encounter in abundance pabu- 
 lum sufficient for their subsequent sustenance and by 
 their presence and injurious action prejudice the natural 
 operations of repair. It is much easier to destroy these 
 organisms outside of the wound, or body, than in it, and 
 in a proper appreciation of this fact lies confidence of 
 perfect success. These conditions then demand the 
 thorough preparation and sterilization of the surface of 
 the patient, more especially in the vicinity of the site 
 of the proposed operation; and not only a thorough 
 sterilization of the epidermis itself but also of every» 
 things absolutely everything^ which is in any way likely 
 
253 
 
 to come in contact with the wound area. There should 
 be, if possible, absolutely no avenue by means of which 
 infection can reach such area. Chemical sterilization 
 is still important— even indispensable in some fields of 
 modern surgery; but as concomitant and valuable fac 
 tors we also have certain mechanical measures of purifi- 
 cation which form an essential part of aseptic prepara- 
 tion properly so-called. No one link in the chain is to 
 be overlooked. Demosthenes once said that there were 
 three requisites for perfect oratory, namely, action, 
 action and action. So also there are three essentials in 
 perfect antisepsis, namely, thoroughness, thoroughness 
 and THOROUGHNESS. The thickened epidermis about 
 the wound edge is a favorite nidus for germs; they col- 
 lect, and warmth and moisture aid in their subsequent 
 development. Not only must the germ be thoroughly 
 killed or excluded but the possibility or subsequent in- 
 fection must also be forseen and guarded against. For 
 instance, in even an ideal aseptic and antiseptic opera- 
 tion in which there is much subsequent discharge or 
 oozing there is danger of infection and subsequent de- 
 composition of these discharges; they must, if possible, 
 be absorbed and sterilized and for this purpose dry 
 dressings are frequently valuable. As Gerster says: 
 "The dryer the operation the dryer the course of heal- 
 ing" and also that "dry absorbent dressings, favoring 
 rapid evaporation, are most useful in the treatment of 
 extensive aseptic wounds." Indeed in an extensive cor- 
 respondence with the leading surgeons of America, 
 Great Britain, France and Germany I find the dry dress- 
 
264: 
 
 ing almost universally endorsed; the moist dressing be- 
 ing used in infected areas and the dry dressing being 
 almost exclusively used in aseptic operative procedures. 
 Experiments upon animals, as we have previously 
 shown, have demonstrated the fact that when micro- 
 organisms were introduced into the circulation and any 
 portion of the body was injured, that is where there 
 was a local depression of vitality, that there developed 
 a subsequent invasion of such injured tissues by the 
 microorganisms — that is, there was a sort of inter- 
 nal invasion. The virulence of such germs, or their 
 capacity for virulent action, was modified in certain de- 
 grees according to the length of time they remained in 
 the circulation; their number and vitality being evi- 
 dently lessened the longer they remained in contact 
 with the blood — that is, within certain definite limits. 
 For instance, this power of the blood is definite and 
 limited and in the case of invasion by large numbers of 
 germs would be exhausted before securing complete 
 destruction of all the germs. In this latter case, when 
 the blood has lost its germicidal power it becomes a good 
 culture medium and the germ then thrives rather than 
 dies. Yet if limited numbers of these self same micro- 
 organisms be injected into perfectly healthy non injured 
 animals not only is such injection followed by negative 
 results but the destruction of the germs is prompt. 
 This demonstrates then that certain tissues have a cer- 
 tain amount of inherent germicidal power within cer- 
 tain limits; also that the healthy organism fB frequently 
 able to cope, unaided, with disease. But when the 
 
266 
 
 health and the properties resultant thereon are dis- 
 turbed or when the germ invades in large and over- 
 whelming numbers it then becomes necessary to afford 
 such aid as will reinforce these antagonistic properties 
 which are peculiar to health. It is incumbent upon us 
 to prevent infection, as far as is possible; this means 
 that we should so protect the parts from contact with 
 micro-organisms that their entrance within the systemic 
 portals, or even their lingering at the gates as it were, 
 would be an utter impossibility. If they once succeed 
 in reaching the tissues, though every effort be made to 
 destroy them lodged, as they are, in the vital strong- 
 holds, it is possible that though partly devitalized they 
 may ultimately renew their life with as much vigor and 
 be fully as capable of harm as before. In order to 
 overcome this possibility we must prevent their access 
 — indeed, as Gerster says: "Prevention has become 
 the watchword of modern practice, and it can be said 
 that, by the successful employment of the preventive 
 methods of the present day, surgery has become a con- 
 servative branch of the healing art." After the germ 
 has once gained entrance, and a foothold, not only may 
 it be difficult either to dislodge it or kill it but in our 
 zealous efforts in the latter direction we may even 
 seriously impair the vital activity of the cellular con- 
 stituents of the adjacent tissues, producing almost as 
 much harm as the germ itself. The acme of success 
 lies in preventing development — not in allowing it and 
 then cutting it short subsequently, but in rendering it 
 an utter impossibility. The acme of success lies in 
 prevention. 
 
256 
 
 In closing this brief and somewhat imperfect resume 
 of the triumphs of antisepsis in the surgical art we can 
 not refrain from quoting that magnificent apostrophe 
 which Arpad Gerster has so eloquently uttered: 
 
 "Having passed in review the present status of anti- 
 parasitic surgery, we see that although incisive changes 
 have befallen the means employed, the principles upon 
 which the discipline was grounded remain unshaken. 
 The living spark of truth has survived the pedantry 
 and over-zeal of the advocates, as well as the sneers and 
 contempt of the opponents of the new departure. Its 
 blessings have soothed and removed untold suffering and 
 misery — have saved I might say, millions of lives. For 
 all this humanity is indebted to one man, whose intel- 
 lect pierced the deadly mists that overhung the practice 
 of surgery. That to the activity of the surgeon, though 
 it still remains surrounded by grave responsibilities, 
 was added a vastly increased element of pleasure, the 
 gaudium certamtnis against disease and death — for this 
 gift to his fellow-surgeons we are indebted to Sir Joseph 
 Lister." 
 
257 
 
 X. — Their Value and Use in Obstetrics and 
 Gynecology. 
 
 The influence of antisepsis and asepsis was far-reach- 
 ing. It pervaded wholly all of the various fields of 
 medical science; it not only revolutionized surgery and 
 left its decided impress upon the general practice of 
 medicine but also very notably affected obstetrics and 
 gynecology. No sooner had the benefits of Lister's 
 teachings been fully demonstrated than obstetricians 
 and gynecologists began the application of similar 
 methods and principles in the lying-in chamber and op- 
 erating room. This was done anxiously and expectant- 
 ly at first but the ultimate fruit of success was the 
 establishment of supreme confidence. In obstetrics, as 
 well as in the other fields of the medical art, sepsis is 
 the chief general condition dependent upon the presence 
 of micro-organisms. The technical use of this term 
 implies not only the actual presence of such micro or- 
 ganisms but also the various accompanying forms of in- 
 toxication which result from certain forms of necrobio- 
 sis or destruction of the minuter and cellular elements 
 of the tissues. It is not necessary to uphold this state- 
 ment by lengthy argument, for it has been indubitably 
 proven — indeed the occurrence of sepsis and septic con- 
 ditions is now universally admitted to be due to the 
 presence of certain and particular forms of germ life. 
 Of the conservative and other various phenomena in- 
 duced by their presence, suppuration is at once the most 
 
268 
 
 common and most obvious. The commonest of the 
 pyogenic or pus-forming germs are the Staphylococcus 
 Pyogenes aureus , albus and citrus and the Streptococcus 
 pyogenes. 
 
 These germs by their presence induce septic condi- 
 tions, ergo^ prevent their access to and subsequent inva- 
 sion of the tissues and the occurrence, development and 
 consequences of sepsis, in its various forms, are also 
 prevented. This also is universally acknowledged. 
 However much we may disagree in our opinions as to 
 the use or virtue of any particular antiseptic substance 
 we must and do all agree unanimously as to the extreme 
 virtue of the principle. There is not the slightest doubt 
 but that it is infinitely better for the parturient woman 
 not only to render such patient absolutely clean, domes- 
 tically, surgically and bacteriologically, but also to ex- 
 clude all septic influences from the puerperal chamber. 
 Of course ideal conditions in this respect are hardly 
 possible to attain and it is infinitely easier to write this 
 than to do this; but it is possible to attain a relative 
 freedom from such infectious influences by the exercise 
 of absolute care and patience — "patience is bitter but its 
 fruit is sweet." It may cost the physician some incon- 
 venience and trouble, but is the life and health of the 
 patient to be bartered for the convenience of the pro- 
 fessional attendant? 
 
 The means by which disinfection is accomplished are 
 legion. Probably the best means of sterilization of in- 
 struments and dressings is by the use of the antiseptic 
 and germicidal power of moist heat; this is readily at- 
 
259 
 
 tained by the use of the Arnold and other forms of 
 sterilizers which are now made for the use of the phy- 
 sician and surgeon. Sterilization of instruments and 
 dressings materially decreases the chances of infection 
 as far as the armamentarium per se is concerned. But 
 we must also be mindful of the fact that there are other 
 avenues by means of which infection may gain access 
 and these are of equal, if not greater, importance — 
 namely, the patient's own body and the operator's 
 hands, as has been shown in a previous paper. Kelly, 
 Robb and Ghriskey, of the Johns Hopkins University, 
 have proven by rigid and ample experimentation that 
 the Staphylococcus pyogenes alhus^ and sometimes aureusy 
 are present in enormous numbers on the hands and 
 about the nails of all physicians and surgeons. This is 
 but natural when we consider how often they come in 
 contact with infectious material. The possibility of 
 direct transmission of infection by the hands of the 
 physician first seemed to suggest itself in the occur- 
 rence of puerperal septicemia under conditions which 
 seemed to indicate such a cause. Of this fact there are 
 recorded many lamentable instances. This origin of 
 the disease was pointed out by Gordon toward the lat- 
 ter part of the last century; he said that he himself 
 **was the means of carrying the infection to a great 
 number of women" and aleo traced the spread of the 
 disease in the same way in the practice of certain mid- 
 wives. As Play fair remarks, in some remarkable in- 
 stances this unhappy property of carrying contagion 
 has clung to individuals in a way that formerly seemed 
 
most mysterious and led to the supposition that the 
 whole system had become saturated, as it were, with 
 some subtle and volatile poison. One of the strangest 
 cases of this kind was that of Dr. Rutter, of Philadel- 
 phia, which caused much discussion. He had forty five 
 cases of puerperal septicemia in his own practice in one 
 year, while none of his neighbors' patients were at- 
 tacked. It is related that, in order to "rid himself of 
 the mysterious influence which seemed to attend upon 
 his practice, he left the city for ten days, and before 
 waiting on the next parturient case had his hair shaved 
 off and put on a wig, took a hot bath, and changed 
 every particle of his apparel, taking nothing with him 
 that he had worn or carried to his knowledge on any 
 former occasion; and mark the result. The lady, not- 
 withstanding that she had an easy parturition, was 
 seized the next day with childbed fever, and died on 
 the eleventh day after the birth of the child. Two 
 years later he made another attempt at self purification, 
 and the next case attended fell a victim to the same 
 disease." Meigs, in commenting on the case, refused to 
 believe that Dr. Rutter carried the poison, but rather 
 thought that he was '^merely unhappy in meeting with 
 such accidents through God 's providence," and asks, 
 "Did he distil a subtle essence which he carried with 
 him?" It appears, however, that Dr. Rutter was the 
 subject of a form of ozena which was sufficiently severe 
 to disfigure him in time, from its effect upon the con- 
 tour of his nose, as Harris says. It is, of course, obvi- 
 ous that under these peculiar circumstances his hands 
 
261 
 
 could never have been free from pyogenic organisms 
 and septic matter. This is of peculiar interest because 
 it shows how obscure may be the source of infection 
 and how thorough must be the preparation which would 
 obviate its transmission to a patient. This is only one 
 of many, many thousands of similar cases — that is, 
 similar in the fact that the infection was directly trans- 
 mitted. 
 
 Not only may contagion dwell within or upon the 
 person of the physician, as in the case just cited, but 
 Kelly, Robb, Ghriskey and others have proven that 
 pyogenic organisms are to be found in quantity upon 
 the hands and beneath the nails of every physician and 
 surgeon — at least, this occurred in the case of every 
 single one of a large number who were examined. Not 
 only were these germs found in quantity but it was also 
 demonstrated that washing and scrubbing the hands 
 with brush, soap and water, even as long as twenty-five 
 minutes, was utterly inadequate to remove all of the 
 germs. Nevertheless such washing and scrubbing by 
 mechanically removing detachable epithelial and sub- 
 ungual debris which are constantly loaded with germs 
 materially reduces the chances of infection. In sixty- 
 five experiments upon physicians who scrubbed the 
 hands freely, from ten to twenty five minutes, with 
 strong brown soap and hot water frequently changed, 
 fifty-six (that is, all but nine) yielded numerous colonies 
 of pyogenic organisms; in almost every case these germs 
 were specimens of Staphylococcus pyogenes albus and in 
 some cases Staphylococcus pyogenes aureus. The remain- 
 
262 
 
 ing nine owed their escape to the inhibitory influence of 
 mercuric chlorid which had been used as far back as the 
 previous day. In seven additional experiments which 
 were made upon nurses, positive results were obtained 
 in every case, developing variously forty, sixty, six 
 hundred and myriads of colonies of Staphylococcus pyO' 
 genes albus and a few of aureus. As the experimenters 
 remark, it was known in each instance that the test v^ras 
 about to be made and all endeavored by unusually vig- 
 orous efforts to earn the credit of "no growtb." 
 
 Kelly further remarks that solutions of corrosive 
 sublimate (mercuric chlorid or bi chlorid of mercury) 
 even as strong as 1:500 are ;?^/ germicidal after immer- 
 sion of the* hands from two to five minutes. The mer- 
 cury salt acts either by mechanically coating some por- 
 tion of the coccus or else chemically combining with it, 
 thus only inhibiting further growth until the salt is pre- 
 cipitated or otherwise removed. Kelley says: *'This I 
 have repeatedly shown to be true following both the 
 ordinary practice of immersion of the hands from two 
 to five minutes in 1:500 and 1:1000 solutions after a pre- 
 liminary washing for ten minutes with soap and water, 
 and again after carefully following out Fuerbringer's 
 method, now so generally adopted. The latter method 
 was distinctly shown to be inefficient in almost every 
 instance. It is briefly the following: 
 
 Clean the nails with a pointed steel. 
 
 Scrub the hands, especially the nails, one minute with 
 soap and hot water and a sterile brush. 
 
 Immerse the hands in alcohol (not under eight per 
 
263 
 
 cent) for one minute; immediately transfer hands, still 
 wet with the alcohol, to a freshly-prepared solution of 
 mercury bi-chloride, 1;500, for one minute, when they are 
 supposed to he sterile. 
 
 I exhibit in my hands four tubes carrying cultures which 
 failed to develop after sterilizing by this method, illu- 
 sively showing an apparent sterility, for here on the 
 other hand, are cultures taken from the same fingers 
 after precipitating the bichloride with a sterile ammonium 
 sulphide solution ^ and these show innumerable colonies P 
 
 These results are striking and are but confirmed by 
 the late experiments exploding the old classic belief in 
 the inordinate germicidal power of mercuric chlorid, 
 which has been heretofore placed so inexactly and so 
 inaccurately high. He further says: **It is a remarka- 
 ble fact, of great practical importance, that this inhibi- 
 tory effect of the bichloride holds over on the hands for 
 twenty four hours. In two instances of men who had 
 been away from the hospital for from four to six weeks, 
 the ammonium sulphide produced the characteristic 
 dark stain on the fingers, showing the presence of bichlo- 
 ride. Here is the source of error explaining the nine 
 negative results in the hands of my staff after simple 
 soap and- water cleansing. We did not then know of 
 this property of the sublimate. 
 
 Four experiments were made also with a four per 
 cent solution of lysol; all yielded colonies. 
 
 Three experiments with peroxide of hydrogen also 
 furnished abundant colonies." From this we infer then 
 that really positive results were obtained not only in 
 
264 
 
 the case of the experiments upon the hands of nurses 
 but also in the sixty-five experiments upon the hands of 
 physicians; the nine apparent negative results being due 
 to extraneous inhibition and not due to the scrubbing. 
 We also conclude that mercuric chlorid, lysol (four per 
 cent) and peroxide of hydrogen are useless as far as 
 absolutely sterilizing the hands is concerned; the first, 
 however, has strong inhibitory properties. Kelly favors 
 the use of trimming and cleaning the nails, scrubbing 
 the hands thoroughly with brown soap and hot water 
 and subsequent immersion in a saturated solution of 
 potassic permanganate followed by neutralization and 
 deoolorization by immersion in a saturated solution of 
 oxalic acid; he claims that this thoroughly sterilizes the 
 hands. Certainly such procedures are upheld by a large 
 number of experiments in which no colonies developed 
 subsequent to their use, even immediately after the 
 demonstration of countless colonies after the use of 
 soap and water. Also in the very low percentage of 
 cases in which germs developed, in this latter case the 
 occurrence of colonies being small and such as found 
 consisting of small and definite numbers of micro or- 
 ganisms. Potassic permanganate and oxalic acid are 
 not only harmless to the hands but afford the most effic- 
 ient germicidal method of sterilizing the hands — in- 
 deed, Kelly goes so far as to say .that soap and water 
 and potassic permanganate and oxalic acid are the only 
 true germicides for such use and therefore the best we 
 have to day. He further says that mercuric chlorid, al- 
 though dangerous on wounds on account of its property 
 
265 
 
 of coagulating and causing necrosis of albuminous tis- 
 sues, has valuable properties of inhibiting, not destroying^ 
 those germs with which it comes in contact. 
 
 The physician must not only free himself from infec- 
 tion but the patient and her attendants, as well as her 
 surroundings, must also be kept absolutely clean. The 
 physician should exercise due care and discretion in 
 making vaginal examinations and after delivery should 
 pay immediate attention to lesions of the genital tract. 
 Antiseptic and aseptic precautions have so materially 
 lowered the death rate from child-birth that it becomes 
 incumbent upon every obstetrician to make use of those 
 means and every precaution which guarantee increased 
 safety, at least. The elementary principles involved in 
 the practice of modern midwifery may be tersely, 
 though not comprehensively summed up as follows: 
 
 1. The patient must be made absolutely clean in all 
 of her surroundings. The room, as well as the bed it- 
 self, must be clean and free from infectious principles 
 — that is, as far as is practicable. Cleanliness must be 
 insisted upon; it is not expensive — fresh air and clean 
 water cost but little. 
 
 2. The accoucheur must render himself as aseptic as 
 possible; also all instruments or dressings which are to 
 be used. The instruments and dressings may be steril- 
 ized by moist heat; the hands by the liberal use of the 
 brush, soap and water, the use of the nail brush and the 
 subsequent use of some germicidal solution — preferably 
 that of potassic permanganate and oxalic acid as has 
 been previously described. The physician must make 
 no examination until he is absolutely certain that he 
 
263 
 
 can convey no infection to his patient thereby; indeed, 
 he must avoid all examinations which are not absolutely 
 necessary. 
 
 3. The child must receive immediate attention when 
 born, so that there may be no danger of sepsis — opthal- 
 mic or otherwise. This precaution will not only en- 
 tirely avert the occurrence of opthalmia neonatorum 
 but of other infantile affections dependent upon the 
 early occurrence of sepsis. 
 
 A strict adherence to the dictates of such a policy, 
 while not entirely eliminating death from obstetric 
 practice will certainly materially decrease it. It may 
 be argued that many cases thrive and progress to a 
 favorable termination without the adoption of any pre- 
 ventive measures whatever. This will readily be 
 granted; but it cannot be denied that many more cases 
 progress thus favorably under such precautions than 
 without them. It is then the duty of the physician to 
 spare himself no necessary precaution for the ultimate 
 safety of the patient whose life and health is intrusted 
 to his keeping and when he accepts the issue he also 
 accepts this responsibility. 
 
 The benefits of antiseptic treatment in the various 
 hospitals and lying in institutions have been so signal, 
 so apparent, so enormous, that all criticism has been 
 disarmed and silenced and every doubt as to value 
 and expediency has vanished. This is happily true of 
 hospitals, but a condition of things obtains in private 
 practice which is not altogether to the credit of those 
 who neglect proper precautions. Nearly twenty years 
 ago ^the mortality in the various lying-in institutions 
 
267 
 
 was so great that the International Congreps of Physi- 
 cians and Surgeons, then in session at Brussels, adopted 
 resolutions asking for the abolition of such. The 
 prevalence of puerperal septicemia in hospitals or insti- 
 tutions in which lying-in women are congregated had 
 been constantly observed, both at home and abroad; 
 this was accompanied in a vast majority of cases by a 
 most appalling death rate. The disease when once de- 
 veloped spread rapidly from one patient to another 
 until infection was general in spite of all that could be 
 done. In the years 1760, 1768 and 1770 the disease 
 prevailed to such an extent in London that in some of 
 the institutions nearly all of the patients died. It is 
 stated of the Edinburgh Infirmary, in this connection, 
 that in the year 1773 "almost every woman as soon as 
 she was delivered, or perhaps about twenty-four hours 
 after, was seized with it, and all of them died^ though 
 every method was used to cure the disorder." The 
 lying-in institutions of the Continent were conducted 
 upon a much larger scale but the death rate was equally 
 large here, even in some of the very best of such insti- 
 tutions. In the Maison d^ Accouchemenfs of Paris, during 
 many different years, the death rate rose so high that 
 one out of every three patients delivered died — on other 
 occasions as many as ten out of fifteen women delivered 
 died. These frightful results were not peculiar to any 
 one institution nor to any one class of institutions — all 
 seemed beneath the ban. In Vienna in 1823, 19 per 
 cent of the cases died; in 1842, 16 per cent. This con- 
 dition of affairs progressed until in Berlin in the year 
 1862 hardly a single patient escaped death and the hos- 
 
268 
 
 pital was therefore eventually closed. It was upon a 
 basis of such fact that the action of the Brussels Con- 
 gress was predicated. Now the conditions are entirely 
 reversed, the mortality in private practice being greater 
 than that of the hospitals, although by no means alarm- 
 ing. The reason for this is obvious. In the hospital or 
 lying-in institution every precaution is taken; not only 
 are all instruments and dressings sterilized, as well as 
 the hands of the operator, but the whole institution and 
 its wards have been kept in as good a condition of asep- 
 sis as is possible under the circumstances. The nurses 
 are properly trained and instructed and a systematic 
 and thorough preparation has been made for an earnest 
 extermination of danger from septic causes. In the 
 home of the patient all of these conditions, even fre- 
 quently with the exercise of proper care, do not always 
 obtain. The channels by which infection is subtly 
 transmitted or brought within the portals are many and 
 except in illness (and not always then) no systematic 
 effort is made to exclude it. To reproduce the results 
 attained in the hospital or to reproduce the conditions 
 which surround the patient in the hospital we must 
 practically reproduce the hospital itself — or at least its 
 discipline. 
 
 At the present day, as we have said, the mortality of 
 private practice is greater than that of hospital practice. 
 It is now between eleven and twelve years since anti- 
 septic methods of treatment were introduced in the 
 New York Maternity Hospital and the result there, as 
 elsewhere, has been a uniform and enormous decrease 
 in not only the occurrence of disease from septic causes 
 
but in a most significant reduction of the mortality. 
 Garrigues says that during the nine years preceding the 
 introduction of such methods, (1875 to 1883), 3,504 
 women were confined in the institution, 146 of whom 
 died — that is, 4.17 per cent. During the last six 
 months before the change was made, 237 women were 
 delivered, 19 of whom died— that is, 8 per cent. Of 
 these nineteen, seventeen succumbed to sepsis — that is 
 7.17 per cent. During the last month before the intro- 
 duction of antiseptic methods the total mortality reached 
 20 per cent and that from sepsis or infection 15.69 per 
 cent. The results following the use of antisepsis he 
 tabulates as follows: 
 
 
 
 Si 
 
 < 
 n 
 
 H 
 
 H 
 
 00 
 
 DEATHS. 
 
 PER CENT. 
 
 Year. 
 
 Total. 
 
 From 
 Sepsis 
 
 Total 
 Mortality. 
 
 From Sepsis. 
 
 
 
 
 
 
 1884 
 
 532 , 
 
 8 
 
 4 
 
 1.53 
 
 0.76 
 
 1885 
 
 537 
 
 3 
 
 
 
 0.56 
 
 0.00 
 
 1886 
 
 446 
 
 5 
 
 1 
 
 1.12 
 
 0.23 
 
 1887 
 
 389 
 
 5 
 
 1 
 
 1 30 
 
 26 
 
 1858 
 
 377 
 
 3 
 
 
 
 0.79 
 
 0.00 
 
 1889 
 
 314 
 
 1 
 
 
 
 32 
 
 00 
 
 1890 
 
 345 
 
 4 
 
 1 
 
 1 13 
 
 029 
 
 1891 
 
 240 
 
 1 
 
 
 
 43 
 
 0.00 
 
 
 3170 
 
 30 
 
 7 
 
 0.90 
 
 0.19 
 
270 
 
 These figures are significant; they reveal the fact that 
 during the years 1885, 1888, 1889 and 1891 there were 
 absolutely no deaths from sepsis in this institution, and 
 at no time in the years tabulated did the mortality from 
 sepsis run above .76 per cent and in one-half of the 
 time was .00 per cent! The mortality in the nine years 
 preceding the introduction of antiseptic methods was 
 nearly 500 per cent (5 times) greater than the same 
 during the eight years following the introduction of 
 such methods of treatment. The deaths from septic in- 
 fection were reduced to one fifth of one per cent! Con- 
 trast this condition with that of pre Listerian days. In 
 the last six months of the non-antiseptic method in the 
 New York Maternity Hospital the mortality from sep- 
 tic causes was 7.17 per cent or more than 35 out of 500; 
 this was reduced by antisepsis to less than 1 out of 500. 
 These mortalities give startling comparisons but the re- 
 sults from antiseptic methods are substantiated by 
 Garrigues by the following statistics: 
 
 The Sloane Maternity Hospital of New York was 
 founded comparatively recently; in the report of the 
 first thousand cases only six deaths were reported— only 
 one of these from sepsis. This would give a general 
 mortality of six-tenths of one per cent (0.6 per cent) and 
 a mortality from septic causes of one-tenth of one per 
 cent (0.1 per cent). 
 
 Pippingskoeld of Helsingfors during the period of 
 1884 to 1887, with an average of 650 deliveries per 
 annum, had a mortality of 0.29 per cent. 
 
 Mermann of Manheim had nearly 700 cases before a 
 
271 
 
 single death occurred, and that one was due to rupture 
 of the uterus. 
 
 Carl von Braun of Vienna in 1004 consecutive cases 
 met with only two deaths. 
 
 Obstetrics and gynecology owe a lasting debt to sur- 
 gery for the benefits of improved surgical methods 
 and the development of great skill in operative tech- 
 nique as well. Indeed to the specialist in surgery are 
 now relegated many of the operative procedures of both 
 obstetrics and gynecology. Cesarian section, ovario- 
 tomy, hysterectomy, laparotomy for tubal pregnancy 
 and other causes, and other kindred measures are now 
 properly surgical operations. For their successful ob- 
 viation we are indebted largely to surgical progress and 
 the application of the results to such forms of treatment. 
 Indeed we find that the influence of modern surgery has 
 largely modified many of the ordinary obstetrical gyne- 
 cological procedures. 
 
 By far the most formidable septic condition which 
 confronts the obstetrician is puerperal septicemia. The 
 condition is, or was rather, unhappily too common to 
 need a description of its incubation, symptoms and the 
 various phenomena which attend its course. The in- 
 fluence which antiseptic measures have had upon its 
 development has already been fully considered statisti- 
 cally. Hermann gives the following etiological factors 
 in the production of a puerperal infection: 
 
 1. External infection, caused by pathogenic cocci. 
 This can be prevented by subjective antisepsis. 
 
 2. Auto infection, as understood by Semmelweiss, 
 which may be divided into. 
 
272 
 
 {a) Ptomaine intoxication or putrid infection caused 
 by microorganisms. It cannot be combated and vaginal 
 injections are useless. Prevention is the necessity. 
 
 (^) Pathological germs which have been lying dor- 
 mant and are brought into action by the birth. These 
 we find in cases of old exudations, pyo- salpingitis and 
 old abscesses of the glands of Bartholini. In these 
 cases vaginal injections are also usually useless. 
 
 3. Vaginal infection caused by pathogenic germs 
 which have found their way into the vagina before labor 
 began. 
 
 In all of the branches of modern medicine the watch- 
 word is prevention. This is probably the only method 
 by which the development of all varieties of puerperal 
 infection may be prevented. A perfectly ideal manage- 
 ment of all puerperal cases may not be theoretically at- 
 tained, although practically sufficient to prevent the de- 
 velopment of dangerous or even other than the mildest 
 symptoms. In very many lying-in institutions very 
 rigid rules are laid down with a view to the prevention 
 of the possibility of transmission of infectious material 
 to the patient either on the hands of the attendants or 
 on instruments, napkins, etc., and these have met with 
 most satisfactory results. Until recently a few practi- 
 tioners ridiculed the use of such precautions which were 
 certainly strongly indicative of a proper recognition of 
 the danger and also an earnest endeavor to remove it. 
 Local antisepsis has accomplished most valuable and 
 fruitful results which are by no means to be underesti- 
 mated. Many experiments and attempts have been 
 
373 
 
 made to apply a system of antiseptic medication by the 
 internal use of antiseptic subetances but these have, as 
 yet, been unfruitful. While local antisepsis has yielded 
 brilliant results, the outlook in puerperal infection, as 
 far as the virtues expected from internal administration 
 of antiseptics are concerned, is certainly, as yet, not 
 very bright. 
 
 XL — The Essentials of Antisepsis and Asepsis. 
 
 Thanks to the certain and infallible foundation af- 
 forded modern surgery by the antiseptic method of 
 wound treatment and to the subsequent uniform adhe- 
 sion and healing of wounds when so treated, the tech- 
 nique of operative surgery has received a most extra- 
 ordinary and tremendous stimulus during the past 
 quarter of a century. This was but natural for anti- 
 sepsis and asepsis put within the hand of the surgeon a 
 never- failing aid and reared up for him an ever- reliable 
 foundation of confidence; and upon this positive founda- 
 tion it was the function of modern surgery to rear a 
 superstructure of brilliant work and of still more bril- 
 liant and indeed unparalleled results. With thorough 
 and conscientious precautions, there is not at the pres- 
 ent time any portion of the human body which is en- 
 tirely without the pale of the dominion of the surgical 
 sceptre — the scalpel. There is within the organism no 
 veiled sanctum sanctorum to stay the hand of the sur- 
 geon in a progression which erstwhile would have been 
 
274 
 
 deemed profanation. The cranial cavity and its con- 
 tents no longer constitute a noli me tangert. The tho- 
 racic and abdominal cavities, and the joints as well, are 
 invaded, under proper precautions, with absolutely no 
 fear of evil consequences; they are now approached 
 with a well-merited boldness of such a nature as would 
 have stamped the effort in former times as the offspring 
 of either madness or criminality. The only bugbears 
 which can and do frighten the modern surgeon are his 
 own personal technical sins, from which the avenging 
 Nemesis should afford him no protection. Not only 
 are these facts, and their proper appreciation, of the ut- 
 most value in purely reparative work but they are also 
 of equal importance in their bearing upon diagnosis of 
 surgical and other affections. Formerly surgery was a 
 dernier ressort; it was resorted to only when all other 
 means of relief or reparation had failed and when the 
 chances for future failures were in consequence but in- 
 creased. Now, however, we may operate not only for 
 relief but also for information, for purposes of diagno- 
 sis, in order to lay a positive foundation upon which to 
 build proper measures of relief, whether surgical or 
 otherwise. Indeed it may well be said that at the 
 present time the most radical surgery is pre eminently 
 the most conservative in its results. These conditions 
 necessarily and materially amplify the scope of opera- 
 tive skill and technique; but they also entail a double 
 duty — thorough antisepsis, or asepsis, and thorough 
 technique down to the minutest details. 
 Nevertheless the element of undoubted safety which 
 
275 
 
 has been added to most operations has engendered 
 some curious conditions. Clumsy and bungling opera- 
 tors who, under former methods, had hitherto achieved 
 but a slight modicum of success, now accomplished even 
 brilliant results, simply through use of antisepsis, while 
 in other cases operators of even marvelous manual and 
 technical dexterity signally failed, simply through lack 
 of these proper precautions. Not that antisepsis and 
 asepsis encouraged carelessness or that a premium was 
 placed upon crudity — far from it! The brilliant, aston- 
 ishing and classic triumphs of modern surgery were 
 only possible by a combination of what Gerster fittingly 
 terms "technical skill, the cunning of hand and brains, 
 with the conscientious practice or a thorough-going 
 cleanliness." The advantage then lay, not in the en- 
 couragement of careless work but in the fact that even 
 in spite of it the former technical bungler was given a 
 chance of success despite his operative bungling, while 
 the truly skilled were vouchsafed an attainment of re- 
 sults which were hardly within the province of even 
 their most sanguine expectations. Yet, on the other 
 hand, this does not alter the fact that neglect of surgi- 
 cal cleanliness invites a Nemesis whose retribution is 
 not more swift than certain in its nature. It is none 
 the less true, as has been said, that the barbaric neglect 
 of cleanliness and lack of attention to hemorrhage, the 
 rough methods, the tearing and the slashing frequently 
 necessitated by lack of anesthesia in former days has 
 now been preceded by more exact and cleahly modes of 
 operating. Dissection is based upon proper technical 
 
276 
 
 and anatomical knowledge, hemorrhage is controlled 
 and the operative field thus kept dry, tissues are prop- 
 erly retracted and the course of the knife pjade plain to 
 the eye of the surgeon; cleancut incisions are made, if 
 possible, which altogether materially increase or aid 
 that natural and inherent tendency to repair. Indeed, 
 with the ideal surgeon, his knowledge is as clean and 
 sharp as his knife. 
 
 Not only is it positively incumbent upon the surgeon 
 to care for his patient, by proper surgical skill and tech- 
 nique, during the operation to which he has been sub- 
 jected, but it is also his duty to care for the conditions 
 which surround that equally critical period, the stage of 
 repair and recovery, Not only must the patient be 
 properly protected against the injury and danger of 
 wound infection during the course of an operation but 
 just as thoroughly, just as effectively during convales- 
 cence — the duty in this respect does not terminate un- 
 til the condition and its consequences have either term- 
 inated or else the relation of physician and patient be 
 kept no longer intact. This means the institution of a 
 rapid, progressive and undisturbed process of repair and 
 healing of every operative wound — not by methods 
 which are fantastic, not by means which are impossible, 
 not by methods which are not accessible to every phy- 
 sician and gurgeon, not by an enormous expenditure of 
 time, money and worry, but by the simple exclusion of 
 all possible means of infection. Experience has amply 
 taught us that every wound, with proper care and atten- 
 tion, may be caused to adhere and uniformly progress 
 
277 
 
 to a state of consummated repair, provided that the ex- 
 clusion of micro organisms and their products from the 
 affected tissues be secured. When we consider the 
 protean forms in which the masked infection may assail 
 favorable foci, it means naught else than the exercise 
 of that eternal vigilance which is said to be the price of 
 liberty. Unless destroyed or removed, micro- organisms 
 cling to all objects which come in contact with the 
 wound — this is true of even the band of the surgeon 
 himself. Therefore the care and foresight of the opera- 
 tor must not only be constant but also universal. Does 
 this mean trouble? Does this mean expenditure of 
 time? Yes, but it is economy of both. It does not re- 
 quire the one-half of either which will be required upon 
 the occurrence of septic developments later, due to the 
 criminal carelessness and neglect of the surgeon who 
 has culpably exposed the life or health of the patient 
 who has trustingly placed both in his care. More often 
 than not when such occurs, when sepsis develops, it is 
 frequently too late to purchase life or health by the ex- 
 penditure of any amount of either time or trouble. Nor 
 can the proper expenditure of time and trouble in the 
 early days of the cage be compared to the mortification 
 and remorse which arises and overwhelms when it final- 
 ly dawns upon the professional attendant that his self- 
 ish regard for his own comfort has been allowed to 
 jeopardize, even sacrifice, the life of his patient. It is 
 again but the old, old story of the stitch in time which 
 saves nine — only in this case applied with ten-fold force. 
 The question is now no longer a debatable one — it 
 
278 
 
 stands firraly grounded apon an unassailable and unim- 
 pregnable foundation of eternal and established truth, 
 of snoh strength as scientific dogma has heretofore 
 seldom witnessed. 
 
 Slightly more than twenty five years ago Lister first 
 demonstrated the importance of a proper consideration 
 of atmospheric dust and the chance of consequent infec- 
 tion of atmospheric origin. The possibility of this he 
 clearly demonstrated, although we know at the present 
 time that the danger of a more material infection from 
 instruments, dressings, hands, nails, etc., is infinitely 
 greater. Nevertheless it is always a matter of greater 
 safety when an operation can be performed in a clean 
 room with smooth walls, where the possibility of stir- 
 ring up dust, in any manner, from floor, walls, ceiling, 
 furniture or ornaments has been reduced to a minimum 
 if not entirely removed. Based upon facts which were 
 themselves firmly founded upon ample clinical experi- 
 ence, and based upon Pasteur's masterly demonstration 
 of the origin and nature of the causes of decomposition 
 in general, Lister instituted a method, a systematic 
 method, for the purpose of combating the operation of 
 such causes in the living fiesh of the hospital ward and 
 sick-room. He first demonstrated that decomposition 
 in wounds only supervenes upon contact with something 
 introduced from without; that upon exclusion of all 
 possible chance of infection from without no decompo- 
 sition occurred. The splendid results which immediate- 
 ly followed an appreciation of this fact, and their sub- 
 stantiation by the results obtained by VolkmanOi 
 
279 
 
 Schede, Thiersch, Socin and others beside Lister him- 
 self, led to more extended investigations, demonstra- 
 tions and enunciations upon the part of the latter. Fol- 
 lowing this came the demonstration by Lister that the 
 causes of infection introduced from without were essen- 
 tially organic in nature since they were destroyed by 
 such measures as effected the destruction of organic 
 matter in general. Finally he established the fact that 
 such organic sources of infection introduced from with- 
 out were capable of development and reproduction — 
 that is, that they were endowed ^ith life — they were 
 living organisms. 
 
 Pasteur has demonstrated that certain germs in cer- 
 tain media uniformly produce certain new compounds 
 — in this manner he not only explained butyric fermen- 
 tation but even gave a minute description of the germ 
 which was its cause. Other investigators also were at 
 work; Billroth made researches into the nature of the 
 specific material of wound infection. By far the most 
 important of these investigations were made toward the 
 latter part of the seventh decade of the present century 
 by Robert Koch. He extended the generalizations of 
 Lister and Pasteur, determining that in wounds or even 
 in their absence certain varieties of decomposition were 
 only produced, as in the case of liquids contained with- 
 in glass flasks, as a result of the presence of certain or- 
 ganisms. And from this germ of truth developed and 
 upon this important determination is founded the germ 
 theory of disease — that among infectious diseases each 
 distinct group of pathological conditions, which we 
 
280 
 
 term a disease, is directly caused or promoted by the 
 presence and action of a specific and peculiar micro or- 
 ganism. 
 
 After positive demonstration of this point it became 
 self-evident that one of the most important points in 
 the treatment of infectious diseases was the prevention 
 or modification of the morbid processes by exclusion of 
 all such micro-organisms, or else the institution of con- 
 ditions unfavorable to their growth and proliferation. 
 The first attempt in this direction, after the promulga- 
 tion of the doctrines of antisepsis, was made by Lister 
 himself. He attempted to prevent wound infection of 
 atmospheric origin by the use of the spray, enveloping 
 operator and patient within an atmosphere impregnated 
 by vaporized solutions of carbolic acid, which was sup- 
 posed to penetrate dust particles and infectious matter 
 floating in the atmosphere and render it innocuous. It 
 has been demonstrated, by Stimson among others, that 
 it is not only unnecessary but that it is indeed impossi- 
 ble to attain the object sought, at least by such means 
 as the spray. It is even claimed that its use is posi- 
 tively injurious when compared with the results given 
 by improved methods, because it creates a more or less 
 violent agitation of the dust particles, dragging them 
 over the exposed wound surface in spite of the fact that 
 the temporary and incomplete contact of such particles 
 with the spray is utterly insufficient to destroy or arrest 
 the development of any infectious germs associated with 
 such dust particles. Therefore the employment of the 
 spray if not actually dangerous is certainly useless to 
 
281 
 
 say the least. It is but justice to Sir Joseph Lister to 
 say that he has long since discarded its use himself and 
 even condemns it now; nevertheless, although its appli- 
 cation was faulty the principles upon which its use were 
 predicated remain absolutely unchanged in every single 
 essential detail. We now know that the chance of at- 
 mospheric infection is no less positive in character, 
 though not nearly so great as formerly imagined. Tyn 
 dall has positively and beautifully demonstrated that 
 air becomes freed from dust by allowing the heavy par- 
 ticles to settle. He demonstrated that if a beam of sun- 
 light is allowed to pass through an empty closed vessel 
 its path is evidenced as a bright streak because of the 
 reflection of light by the dust particles. But if the ves- 
 sel is laid at rest for a time, negative results are attain- 
 ed, the path of light disappears because the dust par 
 tides which formerly reflected the light have sunk to the 
 bottom and no longer float in the atmosphere of the 
 vessel. Tyndall thus describes the experiment: 
 
 "Build a little chamber, and provide it with a door, 
 windows and window shutters; let an aperture be made 
 in one of the shutters through which a sunbeam can 
 pass; close the door and shutters so that no light shall 
 enter save through this aperture. The track of the sun- 
 beam is at first perfectly plain and vivid in the air of 
 the room. If all disturbance of the air be avoided, the 
 luminous track will become fainter and fainter, until at 
 last it disappears absolutely, and no trace of the beam 
 is to be seen. What rendered the beam visible at first? 
 The floating dust of the air, which, when thus illumi- 
 
282 
 
 nated and observed, is as palpable to the sense as dust 
 or powder placed in the palm of the hand In the still 
 air, the dust gradually sinks to the floor, or sticks to the 
 walls and ceiling, until finally, by this self-cleansing 
 process, the air is entirely freed from mechanically sus- 
 pended matter." 
 
 By further experiment he also proved that a dustless 
 atmosphere is always disassociated from infection of 
 atmospheric origin, that "in all these cases you find the 
 dust invariably producing its crop of bacteria, while 
 neither the dustless air nor the nutritive infusion, nor 
 both together, are ever able to produce this crop, your 
 conclusion is simply irresistible that the dust of the air 
 contains the germ of the crop which has appeared in 
 your infusion. I repeat that there is no inference of 
 experimental science more certain than this one." 
 
 These facts are made use of; dust particles are now 
 removed by ventilation or by washing walls and furni- 
 ture and finally allowing the remaining dust to settle, 
 when it may be removed by flushing walls and floor 
 with sterilized or antiseptic solutions. For this reason 
 most operating rooms are now constructed of highly 
 polished and impervious materials, such as marble, 
 which admit ready removal of dust by such means. 
 Kuemmel has shown that a dustless operating room can 
 be obtained in a well appointed hospital and Neuber 
 has shown that most excellent results can be obtained 
 in operations under such conditions— even without the 
 use of antiseptic solutions, provided the hands, instru- 
 ments, dressings, etc , be thoroughly sterilized. But 
 
283 
 
 such ideal surroundings cannot always be secured, in- 
 deed it is almost impossible outside of the hospital with 
 its special equipment for just such purposes. It is prac- 
 tically impossible to escape dust in inhabited localities, 
 no matter how cleanly the domicile — indeed, the gen- 
 eral practitioner will have to do most of his surgical 
 work; such as it is, in more or less dusty surroundings. 
 Therefore we are forced to employ irrigation to remove 
 the chance or opportunity for such accidental infection. 
 Gerster says: "But even a constant and powerful 
 stream of fluids will not be able to dislodge all the par- 
 ticles of dust that may have settled down upon and in- 
 sinuated themselves into the nooks and crevices of a 
 wound. Hence it is desirable to employ a liquid that, 
 aside from its non irritant quality, will have the prop- 
 erty of extinguishing the noxious effects of those parti- 
 cles of dust that can not be washed away by the irriga- 
 tion, but remain imbedded in the tissues. This is 
 chemical sterilization,''^ 
 
 While these things which confront us are conditions 
 and not theories, yet, as we have previously stated, of 
 vastly greater importance and of vastly greater fre- 
 quency is that form of infection termed contact infec- 
 tion. This may be caused in myriads of ways, by the 
 mere contact of unsterilized objects of any kind, whether 
 such be the instruments, the sponges, the dressings, 
 pledgets, or the hands of nurse or assistant, or even of 
 the operator himself. To guard against such* form of 
 infection not only must the wound or site of operation 
 be as thoroughly sterilized as possible but all objects 
 
284 
 
 brought into contact with the wound, or with objects 
 which are to be brought into contact with the wound, 
 must be thoroughly sterilized as well. Infection by all 
 channels, whether direct or indirect, must be thoroughly 
 excluded. Upon this point we lay greatest stress, for 
 only in such manner can thorough antisepsis or asepsis 
 be secured. It is a trite old adage, but one well worthy 
 of repetition here, that **Wtiat is worth doing at all is 
 worth doing well." Of nothing is this so true as of 
 antiseptic and aseptic procedures, because the sin of the 
 surgeon becomes two-fold — the sin of omission of thor- 
 ough sterilization develops directly into the sin of com- 
 mission of infection. And woe to the unfortunate oper- 
 ator in such a case — who will shrive him from his sin? 
 Is he excusable for ignorance? Is he excusable for care- 
 lessness? Granting these facts, are we not forced to 
 face the issue? 
 
 Such conditions as we have described do undoubtedly 
 exist — do we possess a remedy ? Is it within our power 
 to efficiently and thoroughly sterilize or disinfect every- 
 thing which is liable to come into contact with the 
 wound? The reply of Kocher to this question could 
 hardly be more emphatic: **This question is to be an- 
 swered unhesitatingly in the affirmative as regards 
 pledgets, dressings, sutures and instruments, and a phy- 
 sician is no longer permitted to sin against the demands 
 of absolute sterilization of the objects named or to ex- 
 cuse defects in the antiseptic treatment of wounds by 
 untoward external conditions." 
 
 By what means can we secure antisepsis and asepsis? 
 
285 
 
 There is a large number of drugs possessing disinfect- 
 ing power and with each moment the list increases in- 
 terminably. Foremost among all of these agents stands 
 carbolic acid, the substance to which antisepsis owes its 
 birth; \}iq protege of Lister, cast aside but only to be re- 
 ceived back again with ten-fold welcome when a riper 
 experience had but served to confirm his first views. 
 Suffice it to say that carbolic acid is used exclusively by 
 Lister, Annandale and other eminent operators. Mer- 
 curic chloride (corrosive sublimate)|was formerly held in 
 high favor but the experiments of Geppert, Tavel, Vic- 
 querat, Zimmerman, Kelly, Welch, Robb, Ghriskey, 
 McClintock and others all uniformly demonstrate that 
 the germicidal value of the medicament was much over- 
 rated — indeed, it is now considered to possess little if 
 any germicidal power, certainly less than that of car- 
 bolic acid, although its inhibitory power is high. Many 
 operators have abandoned its use for carbolic acid and 
 from a voluminous correspondence with many of the 
 most prominent surgeons of America, Germany, France, 
 England and Austria, I learn that many who use the 
 sublimate restrict it to cleansing the skin in the vicinity 
 of a projected operation. 
 
 The sterilizing agent par excellence for instruments 
 and dressings is heat. Satisfactory sterilization of 
 gauze, ligature and instruments can be secured by ex- 
 posure for comparatively short periods to moist heat at 
 a temperature at or slightly above that of boiling water. 
 At temperatures of 266° Fahrenheit, and above, all mi- 
 cro-organisms and their spores present in permeable ob- 
 
286 
 
 jects are abeolutely destroyed in a very few minutes. 
 At many of the surgical clinics in this country and in 
 Europe the steam or hot water sterilizer has become one 
 of the most important adjuncts to the armentariura of 
 the surgeon. The best, simplest and most accessible 
 substitute for steam is boiling water. It was David- 
 sohn who taught us to sterilize instruments by boiling. It 
 was he who demonstrated that even the boiling of in- 
 struments for five minutes, in covered vessels charged 
 with water, was followed, not once, not twice, but 
 invariably by perfect sterilization of the objects so 
 treated. This may be continued for a longer time if 
 desired, indeed the longer the better, within certain 
 limits. We may feel assuredly confident, however, 
 that we are using properly sterilized instruments when 
 they have been immersed for half an hour in boiling 
 water; but the great drawback to such boiling, especially 
 when prolonged, was that all steel instruments were in- 
 variably rusted and ultimately ruined. To the ingenuity 
 of Schimmelbusch we are indebted for an expedient 
 which, though simplicity itself, effectually overcame all 
 objection on this score. He suggested the use of a one 
 per cent aqueous solution of sodic carbonate ("soda") 
 in place of water alone; this prevented the much-dreaded 
 rusting. The advantages of such methods of steriliza- 
 tion are immeasurable in many respects; probably one 
 of the most important is the simplicity of the process, 
 and the apparatus as well, to say nothing of the ease 
 with which the latter may be obtained and the former 
 applied almost anywhere. 
 
287 
 
 It is interesting to note that Tavel has demonstrated 
 that solutions of sodic chlorid (common salt) and of 
 sodic carbonate (soda) require much less boiling for com- 
 plete sterilization than simple water. Therefore the 
 addition of soda to water, as suggested by Schimmel- 
 busch, to prevent rusting of instruments, in the process 
 of sterilization is not only beneficial in such respect but 
 also actually hastens and perfects sterilization. Tavel 
 has shown that a solution of 0.75 per cent of salt and of 
 0.25 per cent of calcined soda is absolutely sterile after 
 fifteen minutes' boiling (killing various spores, among 
 others those of the bacillus of anthrax and of the hay 
 bacillus); this solution also keeps very well, only a few 
 mould fungi developing at the end of an exposure of 
 several weeks, it is claimed. Gauze compresses, pledgets 
 and silk Tavel claims to have rendered absolutely sterile 
 by boiling them half an hour in the solution. He fur- 
 thermore demonstrated that such solution was unirri- 
 tating to wounds and to the peritoneum and hence, in 
 his opinion, formed an excellent non irritating and ab- 
 solutely sterile solution, when so boiled, which seemed 
 to be especially adapted for purposes of aseptic irriga- 
 tion. 
 
 Perhaps it might behoove us to give some con- 
 sideration to a few of those points, purely technical in 
 nature, by means of which success is attained — per aspera 
 ad astra. 
 
288 
 
 Cleansing op the Patient and Sterilization of the 
 Wound Area and Vicinity. 
 
 Many surgeons give, where practicable, one or more 
 warm baths preceding the operation. In the early days 
 of antisepsis Volkmann thought that shaving and scrub- 
 bing of the skin in the neighborhood of the proposed 
 operation should precede all other measures with a view 
 to disinfection. There cannot be the slightest doubt, 
 in fact time has but comfirmed his practice, that the 
 powerful adjuvants of razor, soap, stiff brush and hot 
 water are of the most desirable nature. We know that 
 masses of filth, cutaneous debris and of p'^thogenic and 
 pyogenic micro-organisms cling to the epidermis and 
 especially in those regions most covered with hair; fur 
 thermore, such collections are permeated by the natural 
 sebaceous secretions of the cutaneous glands, such coat- 
 ing forming an effectual barrier against the penetration 
 of watery solutions of antiseptic medicaments, with 
 the probable exception of carbolic acid. Schimmel- 
 busch has demonstrated^the inhibitory effect of such 
 unctuous materials upon the action of chemical sterili- 
 zers in aqueous media. Therefore some means must be 
 used for the removal of such objectionable substances. 
 To effect this the area is shaved, if hairy, removing at 
 once mechanically a great number of organisms as well 
 as conditions favoring re -infection. Then thorough 
 scrubbing with potash or soft soap, hot water and a stiff 
 bristle brush sweeps away with rapidity and facility, 
 grease, filth, cutaneous debris and noxious micro-organ- 
 
289 
 
 ism^, leaving for the action of subsequently applied an- 
 tiseptics but a minimum amount of work to do. 
 
 Not only must we sterilize the wound area in the 
 manner just indicated but it is obligatory that we look 
 strenuously to the means by which we accomplish our 
 objects. Among the various articles used for such pur- 
 pose probably none is so exposed to infection and is 
 therefore so liable to become a dangerous though un- 
 conscious focus of infection as the surgical nail brush. 
 Schimmelbusch has made extended investigations and 
 experiments in the cleansing and sterilization of such 
 brushes. He has positively shown that the common 
 method of a single brief immersion, in even a strong 
 germicidal solution, is hardly more than merely per 
 functory in nature, it is entirely inadequate to destroy 
 the adherent pathogenic and especially the pyogenic 
 microorganisms and, moreover, inspires a confidence 
 which is entirely falc<e and which can be naught else 
 than baneful in eflPect. Upon examining the brushes so 
 treated in the Berlin clinic Schimmelbusch found them 
 to be especially rich in pyogenic bacteria; he also de- 
 mostrated that an immersion of at least ten minutes 
 duration and made in a strong mercuric solution was 
 absolutely necessary. This was true when the brushes 
 so sterilized were entirely free from the^ soap used in 
 scrubbing. But more frequently than not the brushes 
 are thrown back after use, fairly reeking with soapsuds 
 aud infectious material, the soap rendering the subli- 
 mate entirely inert and the infectious material convert- 
 ing what should be a haven of safety into a masked and 
 
290 
 
 uncertain, and therefore doubly dangerous focus of in- 
 fection. Therefore where sublimate sterilization of 
 brushes is employed it is imperative that all soap should 
 be cleansed from them before immersion in the subli- 
 mate solution, otherwise perfect sterilization cannot be 
 effected. On this account it is a source of great gratifi- 
 cation and congratulation to learn from the researches 
 of Schimmelbusch that simpler and far more reliable 
 means of sterilization are within the reach of every 
 j)hysician and surgeon. He has proven that the most 
 unclean Krush can be rendered absolutely and indubit- 
 ably aseptic by »iiSip\e boiling for five minutes in a one 
 per cent aqueous solution b/^S'.oda. 
 
 With such simple, effective and accessible means for 
 the sterilization of surgical nail brushe\s at our disposal 
 there cannot be the slightest shadow of am excuse for 
 neglect in this direction, nor indeed can the#:e be for 
 culpable neglect anywhere in the chain of antist^ptic or 
 aseptic procedures essential to every precise and scien- 
 tific operation. » 
 
 Cleansing and Sterilization of Instruments! 
 
 No one can doubt for an instant that the removal /)f 
 such debris as pus, blood, portions of animal fibres ancd 
 tissues and what not which inevitably cling to all in- 
 struments used in the course of an operation, should b/C 
 thoroughly attained before use of such instruments fc*r 
 operative work again. We do not think that even th e 
 most conservative adherents of the old fashioned metjti- 
 ods could or would gainsay the fact that such precaution 
 
291 
 
 is only proper and legitimate — nay, even demanded. 
 But what of the instrument which has come in contact 
 with infected tissues, instruments which have bathed 
 and reeked in the morbid discharges or tissues over- 
 whelmed by erysipelas, by tuberculosis, by syphilis or 
 by an infectious affection of any nature? Is the neces- 
 sity for purification of these instruments not greater, 
 incalculably greater, than in the case of instruments 
 which have traversed only perfectly normal and unin- 
 fected tissues? However, it has been demonstrated by 
 Schimmelbusch that even the most careful, thorough 
 and extensive scrubbing and washing of instruments 
 with hot water, soap and a stiff brush does not and can 
 not render them aseptic if they have been once infected. 
 To many, especially artery forceps and other purposely 
 roughened instruments, considerable and dangerous 
 quantities of harmful germs were found adherent. It 
 is necessary to do more than merely wash the instru- 
 ments, no matter how thoroughly the latter process is 
 conducted. Simplicity in an instrument is now, all 
 other things being equal, the most desirable quality. 
 The very best and certainly the very safest are the sim- 
 plest, those fashioned entirely of one piece of metal and 
 having no crevices and interstices to offer favorable 
 lurking places for infectious material. They should, 
 moreover, possess smooth and well-polished surfaces — 
 no grooved or otherwise roughened handles; they are 
 unnecessary, they are hard to clean thoroughly and 
 what is more they directly invite and favor collection 
 of infectious material and hence increase chances of 
 
292 
 
 septic infection in operative work.' As Gereter says: 
 "Another factor has to be considered. In the large 
 practice of our hospitals, where from three to five oper- 
 ations are performed at one session, the minute cleans- 
 ing of a large instrumentarium after each operation is 
 tedious, involving considerable time. We either had 
 to submit to this, or had to provide a disproportionately 
 large and costly set of duplicates and triplicates. As a 
 matter of fact, the latter thing was rarely resorted to, 
 and the cleansing of the bloody instruments being hur- 
 riedly and often inadequately done, main reliance was 
 placed upon the disinfecting power of our carbolic acid 
 bath. And as consideration for the assistants' hands 
 had gradually caused the abandonment of the stronger 
 for weaker solutions, frequent failures in securing 
 primary union were the result of these evasive attempts." 
 
 How different and how much more certain are the 
 conditions at our disposal at the present time! All that 
 we need is a covered vessel containing a one per cent 
 aqueous solution of boda; after boiling the instruments 
 therein for ^ve minutes we may empty them into steril- 
 ized water or, better, a 1:20 or 1:30 solution of carbolic 
 acid. They are thoroughly sterilized and are ready for 
 use. In many hospitals cold sterilized soda solution is 
 kept at hand to be poured over the hot instruments upon 
 placing them into the tray. Sterilized water is also 
 frequently employed for the same purpose. 
 
 We may then sum up the requisites for thorough 
 sterilization of instruments to be used in operative work 
 as follows: 
 
293 
 
 a. A thorough preliminary cleansing with a stiff 
 brush and plenty of soap and hot water. 
 
 b. After such preliminary cleansing all instruments 
 are to be boiled for at least five minutes in a covered 
 vessel containing a one per cent aqueous solution of 
 soda. All instruments, complex in nature, which for 
 any reason cannot be subjected to thorough preliminary 
 cleaning, or which have been exposed to specially viru- 
 lent infection, should for caution's sake^be boiled for 
 haU an hour. 
 
 c. After such sterilization is completed the instru- 
 ments should be placed in a tray of three or four per 
 cent carbolic acid solution to guard against infection 
 before use. 
 
 Note. — All instruments dropped during an operation 
 shouli be left untouched unless re-sterilized. 
 
 Preparation and Sterilization of Dressings. 
 
 The dry preservation of dressing materials sterilized 
 and impregnated with phenol or sublimate must be en- 
 tirely rejected. Not that these substances possess no 
 value but that such sterilization is but ephemeral at best 
 in the case of dressings which are not used within a 
 reasonably short time after subjecting them to such 
 means of sterilizition. Phenol is more or less volatile 
 and sublimate is rendered inert by long continued con- 
 tact with organic matter. Sterilization can only exist 
 as long as these agents are present in active form. 
 Kocher says that positive demonstrations show that 
 such is not the case with dry dressings chemically 
 
29i 
 
 sterilized, unless the materials are applied directly to 
 the wound from the antiseptic solution. We cannot be 
 sure that such dressings have not become re-infected 
 after the antiseptic agent has volatilized or become 
 inert. 
 
 When we consider the large quantities of fabrics 
 handled by the large number of persons required by 
 the folding, immersing, wringing, unfolding, drying, 
 refolding, cutting and final storing or preparation for 
 shipment; when we also consider the fact that the work- 
 men are necessarily devoid of the technical knowledge 
 of asepsis and the minutae of conditions required by the 
 surgeon in aseptic work, we must be forcibly struck by 
 the chance of possible accidental contamination. Neces- 
 sarily the manufacturer's standard is one more or less 
 commercial in nature, the essential requisite to him is 
 profit and yet he must also meet competition; therefore 
 the work must be conducted by individuals to whom 
 the requirements of surgical accuracy are matters of 
 utter indifference, if indeed they be not also matters of 
 utter ignorance. It is obligatory, it is essential that we 
 assure ourselves beyond a peradventure that all dress- 
 ings are actually sterilized before employment in wound 
 dressing. We surely cannot credit such an ideal to all 
 dry dressings supplied by manufacturers. Not that 
 their use should be forbidden but that they should not 
 be accepted as sterilized when such evidence is based 
 solely upon the ipse dixit of the manufacturer; he is 
 surely not going to make derogatory remarks about his 
 own products, and even where he is thoroughly consci- 
 
295 
 
 entious the chances of infection, both while in his hands 
 and afterwards, are utterly beyond his ken. Therefore 
 if we do employ such dressing materials we should 
 make assurance doubly sure by re sterilization. No 
 better directions for such process can be given than 
 those offered by Dr. (ierster in a recent paper on 
 ^'Aseptic and Antiseptic Details in Operative Surgery;" 
 we quote him verbatim: 
 
 "For purposes where a reliable dressing has to be 
 procured, extempore boiling in a soda or potash solution 
 of about 1| per cent for ten minutes is incomparably 
 the simplest and most practical manner of getting an 
 absorbent and aseptic material. In this procedure we 
 recognize at once the familiar ways of the laundry, the 
 eminently aseptic results of which have been demon- 
 strated beyond any reasonable doubt by Behring in the 
 Berlin Hygienic Institute. Thus cotton or linen stuff, 
 to be found in every household, can be readily rendered 
 serviceable for surgical purposes by a short boiling in 
 soda or potash lye. Well wrung out, it can be immedi- 
 ately used, and will dry rapidly in situ under the influ- 
 ence of the body heat and exposure to the air." 
 
 Sterilization by means of hot air has also been sug- 
 gested and employed but, as Gerster says, has not re- 
 ceived consideration because of the necessity of costly 
 and complicated apparatus. Then, also, there can be no 
 question but that the methods of sterilization by em- 
 ployment of moist heat are vastly more efficacious and 
 vastly more simple than those by dry heat. These ob- 
 jections, therefore, do not obtain against the employ- 
 
296 
 
 ment of steam for purposes of disinfection or steriliza- 
 tion. 
 
 Preparation and Sterilization of Ligatures and 
 Sutures. 
 
 It must be obvious that infection of wounds may hap- 
 pen through the medium of improperly prepared liga- 
 tures and sutures, or where incompletely sterilized or 
 even non-sterilized gauzes or other bibulous or porous 
 materials are introduced into wound areas — even though 
 for the purpose of absorption of discharges and conse- 
 quent local drainage. Suppose, for example, that infec- 
 tious material has been introduced by means of a suture; 
 we have then transplanted into the wound an absolute 
 and positive focus of incubation, proliferation and in- 
 fection. The micro-organisms find in the injured tis- 
 sues, altered secretions and morbid discharges highly 
 appropriate media for development. We have here 
 conditions most favorable for a progressive, lasting and 
 spreading infection. 
 
 For such purposes as ligation and suturing, silk, cat- 
 gut and silkworm gut are the materials most frequently 
 employed. Well prepared catgut of suitable sizes may, 
 at times, be used for both. Probably one of the best 
 methods for effectively and conveniently sterilizing cat- 
 gut is that recommended by Kocher: 
 
 Wash the commercial article in ether and then im- 
 merse it for twenty-four hours in good oil of juniper 
 berry; it may then be transferred and kept ready for use 
 in a 1:1000 solution of sublimate, the medium of solu- 
 
297 
 
 tion being absolute alcohol. The absolute alcohol, of 
 course, hardens the catgut, making it firm but flexible. 
 When it is desirable to prevent a too ready absorption 
 the article may be especially hardened, after steriliza- 
 tion and subsequent washing in alcohol, by immersion 
 in a 1:20 solution of carbolic acid containing thirty 
 grains of potassic di-chromate to the quart. An immer- 
 sion of forty-eight hours duration will cause the sub- 
 stance to resist absorption for a week or ten days. 
 
 Silk may be boiled, as Czerny, of Heidelberg, directs, 
 in a 1:20 carbolic acid solution for one hour, or else im- 
 mersed for twenty-four hours in a solution of corrosive 
 sublimate in alcohol (1:100) and then kept for subse- 
 quent use in absolute alcohol. 
 
 Silkworm-gut is easily threaded and moreover makes 
 an excellent suture material. It may be prepared in the 
 same manner as silk. A preliminary soaking, before 
 use, in carbolic acid solution is said to render it more 
 pliant and supple. 
 
 Ligature materials, after chemical sterilization, should 
 be wound upon spools of glass or other easily sterilized 
 material and preserved by immersion in antiseptic solu- 
 tion from which, when desired for use, they should be 
 directly transferred to the wound. This latter proced- 
 ure is allowable because the amount of adhering phenol 
 or sublimate is small and of no importance as far as fear 
 of toxic effects may be concerned; indeed the practice 
 so far from being reprehensible is probably of decided 
 advantage in that it effectually eliminates the^ chance 
 of accidental infection at the time of its employment. 
 
298 
 
 In the Billroth Clinic in Vienna, the silk is preserved 
 in closed vessels in five per cent aqueous solution of 
 carbolic acid; the silver wire in carbolic glycerin of ten 
 per cent strength; the catgut in sublimate alcohol of one 
 per cent strength; all are put into a two and a half per 
 cent carbolic acid solution before use and are handed 
 out of this. In order to make sure of avoiding any in- 
 terchange, the instruments which are used in phlegmon, 
 etc., are kept in a special wooden box by themselves 
 and are conspicuously differentiated from the rest by 
 means of their handles. 
 
 Preparation and Sterilization of Sponges. 
 
 These articles, in many quarters, have been supplanted 
 by pads or compresses of absorbent cotton or gauze, be- 
 cause of the cheapness and comparatively easier 
 methods of disinfection of the latter. Indeed many op- 
 erators of distinction have altogether abandoned the use 
 of marine sponges. Dr. W. W. Keen writes me thus: 
 "I have practically abandoned marine sponges, and use 
 sponges made of dry bichloride or sterilized gauze, 
 rolled into balls about the ordinary size." In the clinic 
 of Billroth in Vienna the use of sponges in laparotomy 
 was discarded in 1887; at the present time sponges have 
 been almost entirely supplanted, even in other opera- 
 tions, by sterilized gauze compresses of various sizes. 
 Gerster also says: 
 
 "The large flat sponges so generally used in laparoto- 
 my have been abandoned by me for three years as ex- 
 pensive, and not as handy as small, well-sterilized com- 
 
299 
 
 presses of plain, absorbent gauze, which, to prevent un* 
 folding and fraying, are firmly tied with silk at one end. 
 The surgeon is nowhere so cramped for lack of space 
 as at his operations in the bottom of the pelvife^. A 
 sponge used for packing away intestines needs constant 
 pressure to prevent its expansion and encroachment up- 
 on available space. A pad of gauze held down for a 
 short while will become packed, and will retain its 
 shape and position even if released from digital pres- 
 sure." 
 
 Nevertheless for some purposes sponges, properly 
 prepared, are peculiarly adapted and, as they are used 
 by some surgeons yet, it may not be out of place to give 
 some space to their consideration. Among other meas- 
 ures which have been suggested is boiling; such a 
 method is foolish in the extreme, because the process of 
 sterilization by boiling robs the sponge entirely of those 
 very properties which render it valuable, materially im- 
 pairing its absorptive powers, its softness and its elas- 
 ticity. 
 
 Many operators bleach their sponges before using 
 them, this is not essential but adds to the appearance. 
 A good and reliable method of preparing and steriliziog 
 sponges is as follows: 
 
 a. Free the sponge from calcareous materials by dry 
 beating and then immerse for about fifteen minutes in 
 dilute hydrochloric acid. Then wash in cold water un- 
 til all traces of the acid have been removed. 
 
 b. After removal of calcareous matter, as directed, 
 allow the sponges to stand a couple of days in water. 
 
300 
 
 This will allow proliferation or germination of spores 
 — the fully developed microbe being much more sus- 
 ceptible to chemical sterilization than the spore.. After 
 such standing the sponge is more thoroughly and effect- 
 ually sterilized. 
 
 c. Thoroughly knead the sponge by hand with green 
 soap and plenty of hot water for several minutes. 
 Rinse away completely all traces of soap. 
 
 d. Immerse in a five per cent solution of carbolic 
 acid. An immersion of twenty-four hours, after such 
 treatment as has been described, is said to render 
 sponges absolutely sterile. 
 
 After squeezing the sponges until free from excess of 
 sterilizing solution, they may be preserved in steril- 
 ized air-tight jars until needed for use. Before using 
 they should be immersed for awhile in a five per cent 
 solution of carbolic acid. 
 
 Sponges once used may be re-sterilized by the same 
 process; in case of saturation with blood they should be 
 well washed in tepid water until all traces of blood have 
 been removed. 
 
 Sublimate should never be used for sterilization of 
 sponges— contact renders it inert, especially in the 
 presence of light and heat. 
 
 As a rule sponges are only used in operations requir- 
 ing rapid absorption of blood or secretion and more 
 especiallyjin those^casesjwhere total arrest of hemorrhage 
 is only possible by rapid completion of the operation. 
 They are especially of service, fastened to sponge or 
 artery foroeps, in certain operations about the face, the 
 
301 
 
 vagina, etc. They are also of great service in the rapid 
 cleansing and preliminary tamponade of the intestinal 
 canal in abdominal work. 
 
 PREPARA.TION AND STERILIZATION OF THE HaNDS. 
 
 Of equal importance for the attainment of success is 
 sterilization of the hands of the operator, his assistants 
 and his nurses. Kuemmel and Fuerbringer have both 
 shown that enormous quantities of pathogenic and pyo- 
 genic organisms are constantly lodged upon the hands 
 and especially beneath the finger nails of even the clean- 
 est of individuals, — this is particularly true of physi- 
 cians and surgeons, as well as of all others directly ex- 
 posed to infectious materials. No amount of washing, 
 or scraping, or trimming of nails can absolutely remove 
 these germs, more especially those lodged beneath the 
 nails. To facilitate digital examination the finger is 
 frequently lubricated with some oleaginous substance; 
 this collects in the space beneath the nail, so also do the 
 various germs with which the examining finger neces- 
 sarily comes in contact; they are finally crowded into 
 and stored away in the space beneath the nail, firmly 
 ensconced in the greasy collection and thereby effect- 
 ually protected against penetration and action of anti- 
 septic solutions. Therefore certain preliminary meas- 
 ures of cleaning are necessary, as in the case of the 
 sterilization of the skin of the patient in the vicinity of 
 the wound. 
 
 The hands, forearms and nails of operator, assistants 
 and nurses should be thoroughly washed and scrubbed 
 
ao2 
 
 in soap and hot water with a stiff bristle brush for five 
 or ten minutes. The nails should then be trimmed and 
 scraped, especially in the subungual space, and re- 
 scrubbed. Kuemrael recommends green or potash soap 
 for this purpose; this is an excellent suggestion as to 
 the detergent action of the soap is added the antiseptic 
 action of the usual excess of alkali in such soaps. 
 
 For the sake of safety it is better that an operator, or 
 his assistants, should not wear rings during an opera- 
 tion; they should be taken off before the hands are 
 scrubbed and remain off until the operation is entirely 
 completed. It would also be wise to caution nurses, as 
 Gerster suggests, against the wearirg of bangles, rings 
 or bracelets. One thing should be thoroughly impressed 
 upon all assistants and nurses — whenever a non-steril- 
 ized object of any kind is touchad, no matter what its 
 nature, it is imperative that the hands be sterilized 
 anew. 
 
 But as to the method of sterilization. Thanks to the 
 use of steam and boiling water we have attained abso 
 lute security in the disinfection of inanimate objects. 
 Unfortunately, however, such absolute precision has not 
 been attained in the sterilization of the hands, of the 
 skin of the patient or of his tissues — nevertheless such 
 is a necessity in the antiseptic and aseptic methods of 
 wound treatment. We cannot hold our hands in the 
 streaming stream, nor can we immerse them for ^\e 
 minutes in the boiling soda solution and certainly we 
 cannot subject our patient to such measures. Hence for 
 the preparation of hands and skin we are forced to the 
 
303 
 
 adoption of a combination of mechanical and chemical 
 sterilization. Bacteriological examinations by Tavel 
 and Vicquerat show that the hands are usually rendered 
 sterile by the method suggested by Fuerbringer. But 
 this is by no means always reliable notwithstanding the 
 great degree of confidence which it enjoys, for if the 
 operator has been exposed to infection (a condition in 
 which sterilization of the hands becomes more impera- 
 tive than ever), the method does not succeed in effect- 
 ing sterilization. In order to test this Kocher opened 
 a large abscese and purposely soiled himself with the 
 discharges. In spite of thorough application of the 
 method of Fuerbringer, colonies of staphylococci subse- 
 quently developed. Kelly at Johns Hopkins University 
 and Welch of the same institution have both proven 
 that the method is unreliable — and especially in those 
 cases when its use would be most desirable. They have 
 given a great deal of attention to this subject and have 
 suggested a more exact and certain method of manual 
 sterilization which was fully discussed in a previous 
 paper. For the details of this most recent and most 
 successful method of sterilization of the hands see the 
 paper "Antisepsis in Obstetrics." 
 
 Irrigation. 
 
 Upon this subject of irrigation a war of words has 
 been waged /r^ and con. Nevertheless it is too import- 
 ant to be dismissed without some adequate notice, — by 
 some it has been damned while by others it has been 
 canonized. 
 
304 
 
 All operative work is preceded by certain essential 
 and preliminary measures, such as the securing of a 
 dustless atmosphere, thorough cleansing of the skin of 
 the patient and of the hands of operator, assistants and 
 nurses, thorough sterilization of instruments, sponges, 
 dressings, etc. Were these preliminary measures al- 
 ways uniformly and ideally successful then irrigation 
 would be unnecessary. Unfortunately this is not alto- 
 gether so, but as we progress towards the attainment of 
 that ideal state the need of irrigation becomes more and 
 more restricted. But as long as there is a chance for a 
 flaw, as long as there is even ground for suspicion, just 
 so long is irrigation an absolute necessity. 
 
 It is usually impossible to secure a perfectly dustless 
 atmosphere for operative work; therefore in order to re- 
 move infectious material, whether from air or morbid 
 substances derived from the organism itself, irrigation 
 is usually employed. Moreover ^we must not forget the 
 chances of accidental infection by inattention, they can 
 hardly be excluded but are to a certain extent antici- 
 pated or guarded against by irrigation. Indeed in many 
 instances irrigation is most valuable, bridging over what 
 would be culpable gaps in an otherwise complete and 
 faultless procedure. Suffice it to say that in regions 
 which can be rendered aseptic with difficulty it is an in- 
 dispensable adjunct to the surgeon. 
 
 Irrigation may be either aseptic or antiseptic in na- 
 ture — aseptic when simple, bland, sterilized solutions 
 are employed; antiseptic when the irrigating fluids are 
 vehicles of antiseptic or germicidal agents. The vir- 
 
305 
 
 tues of irrigation may therefore be ascribed to either a 
 chemical action or the mere mechanical cleansing effect 
 of the stream injected against or over the tissues — or 
 may be ascribed to a combination of both. It is inter- 
 esting in this connection to note the experiments of 
 Zimmerman and Tavel. In their experiments small 
 pieces of meat were infected with detinite micro-organ- 
 isms; it was subsequently found that attempts at steril- 
 ization of such infected particles were by no means 
 always successful, even though the fragments of meat 
 were immersed in a 0.1 per cent acid sublimate solution 
 from one to five minutes. On the other hand, steriliza- 
 tion was easily effected under the same conditions when 
 infected strips of blotting paper were used in place of 
 the fragments of meat. If then this contact of the 
 strong antiseptic solution was insufficient to effect 
 sterilization we can hardly hope to secure better results 
 from the momentary contact in the case of wound irri- 
 gation. In practical work microorganisms are not 
 usually found in surroundings which are ideal as far as 
 the application of antiseptic principles is concerned. 
 We do not find them disassociated from organic mate- 
 rial. As Gerster says, they are not met with in the 
 shape of thin, watery emulsions but are found imbedded 
 in dense masses of what Lister appropriately called 
 "lumps of dirt," in conglomerations of grease and epi- 
 dermis, in powerful plugs of sticky slime, pus and blood 
 clot. Therefore let us first emphasize the paramount 
 antiseptic value of the homely methods employed for 
 cleansing dirty surfaces, comprised in the term mechani- 
 
306 
 
 cal purification; and secondly point out how infinitely 
 more they accomplish than any form of chemical disin- 
 fection by watery germicidal solutions alone. Both 
 should be combined. Still, as Kocher points out, Zim- 
 merman obtained quite an important difference in de- 
 gree by his disinfection, since a lesser number of colon- 
 ies developed and these did so more slowly and at a 
 later time, their virulence having been weakened. 
 Therefore Lister, considering every wound to be theo- 
 retically more or less infected, washed it with 0.2 per 
 cent sublimate solution at the end of an operation; he 
 has lately, however, discarded all other antiseptics in 
 favor of carbolic acid. Many surgeons modify this 
 process of antiseptic irrigation by final flushing of the 
 wound area with a 0.75 per cent sterilized salt solution 
 in order to wash away all trace of the antiseptic. 
 
 Irrigation is now rarely employed in aseptic wounds, 
 it is not only unnecessary but may even prove, as has 
 been declared in some instances, actually harmful; it is 
 therefore to be restricted to conditions or wounds which 
 are not in a thoroughly aseptic condition, such as those 
 in the neighborhood of the orifices of the body or in the 
 vicinity of accidentally infected or actually suppurating 
 areas. Gerster says: ^^A notable exception to this rule 
 is the abdominal cavity^ wherein irrigation is never to be 
 employed. This statement seems to condemn a widely 
 spread practice, and some courage is needed to express 
 it unreservedly. * * * How entirely useless, nay, 
 pernicious, the effects of flushing the peritoneum are in 
 cases of active septic infection, as, for instance, in the 
 
307 
 
 presence of fetid fecal abstcesses due to intestinal per- 
 foration, has been abundantly demonstrated to myself 
 and to other surgeons here and abroad by numerous un- 
 successful attempts. And there is nothing more certain 
 than that, on account of its complex character, the peri- 
 toneal cavity cannot be completely washed clean; that 
 germicidal solutions cannot be used in a sufficient 
 strength to be effective, and that finally an inert or weak 
 solution will only help to spread the elements of infec- 
 tion to previously unaffected areas. The substance of 
 these assertions was essentially confirmed by experi- 
 mental research on animals." 
 
 As to opening large cavities of the body, it seems 
 that no proof has been as yet offered that successful re- 
 sults cannot be attained by the employment of proper 
 precautions both before and after an operation, even 
 though antiseptic irrigation be discarded. Indeed it 
 may well be said, as has been done, that most opera- 
 tions within the peritoneal cavity afford no very rigid 
 test of the absolute value of the aseptic or antiseptic 
 measures therein employed. The condition of the 
 serous membranes and cavities, especially when exposed 
 to infection through various channels, is by no means a 
 proper and infallable guide for other injured tissues 
 under the same conditions, such for example as muscu- 
 lar or areolar tissue. The tolerance of the peritoneum 
 is well known and seems almost incredible; therefore 
 technical faults committed during abdominal operations 
 are much oftener undetected and unpunished by septic 
 developments than is the case in those similarly in- 
 
308 
 
 Gurred in extra-peritoneal operations. Because of this, 
 Kocher and many other surgeons now restrict them- 
 selves, in abdominal operations, to antiseptic precautions 
 before and after the operation rather than during its 
 course, and discard antiseptic irrigation trusting the 
 care of the wound during the operation to asepsis and 
 to the inherent resistive power of normal tissue. 
 Numerous experiments seem to demonstrate that the 
 serous membranes are remarkably tolerant of infectious 
 materials or else digest them with relative facility, 
 thereby rendering them harmless, perhaps, as has been 
 suggested, by the assistance of serous transudation. 
 But this remarkable tolerance, as has been shown by 
 Walthard and Tavel, exists only so long as the endothel- 
 ium remains intact. The injured tissues encountered in a 
 traumatism are by no means in this favorable condition ; 
 therefore the tolerance of the peritoneum should never 
 be allowed the function of a cover beneath which to 
 hide imperfect, careless and slipshod work. In lapa- 
 rotomy as well as elsewhere — indeed if not more eo — the 
 employment of thorough, rigid and conscientious anti 
 sepsis and asepsis is obligatory, it is naught else than a 
 duty. As has been said, once overstep the limit of 
 peritoneal tolerance and the danger usually becomes 
 irretrievable — the life of the patient usually terminat- 
 ing by a septic peritonitis for which there is no redress. 
 
 Drainage. 
 
 Many of the remarks made as to irrigation apply with 
 equal force to drainage of wounds. As Gerster most 
 
309 
 
 tersely says: "Imperfect cleanlinegs, copious irriga- 
 tion and abundant drainage represent the links of a 
 chain forged by necessity. A faultless asepsis has 
 often enabled us to do away with both irrigation and 
 drainage." 
 
 One of our best auxiliaries in securing the rapid heal- 
 ing of wounds is to render development and prolifera 
 tion of infectious material an impossibility — although 
 we also must be mindful of the fact that such conditions 
 do not and cannot obtain in perfectly aseptic wounds. 
 It must be remembered that normal healthy human tis 
 sues, and especially those through which the blood and 
 lymph are circulating freely and properly, constitute 
 very poor media for micro organic development, — in- 
 deed there can be very little doubt but that such tissues 
 are endowed with more or less inherent germicidal pow- 
 er, as we have shown in a previous paper. But the stag- 
 nation and subsequent alteration of blood or serum of- 
 fer excellent culture media and therefore it becomes a 
 duty to institute, in other than aseptic wounds, such 
 processes as will tend to prevent the accumulation of 
 altered secretions or morbid discharges in the wound 
 area. This we can secure in two ways; that is, either 
 by exact coaptation of well-nourished wound margins or 
 else, where this is not possible, by removing secretions 
 and conducting them without the wound area. This 
 last condition may be secured by the open method, the 
 method of secondary suture or else by drainage direct. 
 In the first, the open method, healing will be slow; in 
 the second or method of secondary suture, employed 
 
310 
 
 and modified by Bergmanti, Nussbaum, Spengler and 
 Heifericb, tbe wound is left open for one or two days 
 and then closed by sutures — it is claimed to unite the 
 advantages of the open method and that of exact coap 
 tation; the third method is that of drainage by means of 
 drainage tubes or gauze. These tubes are seldom al- 
 lowed to remain in the wound longer than forty eight 
 hours, except in case of grave infection. 
 
 Theoretically we may say positively that drainage is 
 useless in a perfectly aseptic wound. If the wound is 
 aseptic the secretions following an operation or an in- 
 jury contain nothing capable of causing sepsis, they will 
 be absorbed with no disagreeable consequences and with 
 no disturbance to either the wound or the general health 
 of the patient. But in the event of exposure of large 
 surfaces and irregular wounds a slight contamination is 
 usually to be foreseen and expected, as well as met by 
 proper means; these are usually afforded by proper 
 drainage tubes allowing facile discharge of all possible 
 elements of future decomposition and infection. 
 
 Small superficial wounds, where complete approxima- 
 tion of the wound surfaces can be secured, do not need 
 drainage. But deeper wounds, such as may be adapted 
 for either complete or partial primary union, must be 
 drained so that secretions may not accumulate after 
 union and compression have been instituted. In these 
 cases drainage by tubes is probably preferable. Drain- 
 age is also indispensable in all acute, progressive, sup- 
 purative processes where an egress may thus be pro- 
 vided for pus, sloughing tissue and morbid discharges. 
 
311 
 
 Probably nothing is in every way better adapted for 
 such purposes than the pure black gum or caoutchouc 
 tubing cut into proper lengths and preserved in an up 
 right position in a 1:20 carbolic acid solution. 
 
 It can be engraven upon the memory that properly 
 prepared aseptic rubber tubes are seldom, indeed we 
 may say never, capable of causing irritation. Any in- 
 creased discharge or other untoward phenomenon is due 
 to infection introduced within the wound by some 
 means, usually by means of the tube itself. In aseptic 
 wounds the function of the drainage tube is gone at the 
 end of about twenty- four hours because oozing has usu- 
 ally terminated by that time; although it is more fre- 
 quently kept in until the change of the first dressings in 
 order to avoid the disturbance of wound and dressings 
 consequent upon the removal at an earlier period. 
 
 But we repeat, in perfectly aseptic wounds drainage 
 is unnecessary, unless discharge is excessive. Gerster 
 goes even beyond this, he says: **Even in operations 
 where we are not absolutely certain of the aseptic con- 
 dition of our wound we can often dispense with the use 
 of drainage tubes, and not incur any serious risk. Berg- 
 mann first demonstrated that a wound of doubtful asep 
 ticity can yet be made to heal by primary adhesion. 
 He passed his suture points through the edges of the 
 wound and all its recesses down to the bottom with 
 iododoform gauze. Over this was placed the usual outer 
 dressing. Through the capillary action of the gauze 
 copious oozing of serum was encouraged, which in about 
 sixty hours lost its sanguinolent character, whereupon 
 
312 
 
 the packing being extracted the suture points left in situ 
 were closed, and the wound was seen to heal in a man 
 ner little differing from primary union. Undoubtedly, 
 much of the success of this plan of packing and secon- 
 dary suture is to be attributed to the iodoform, which 
 has triumphantly withstood various attacks upon its re- 
 putation." 
 
 Still another modification of this form of drainage is 
 now extensively employed in abdominal surgery, where, 
 on account of much unavoidable denudation or acciden- 
 tal infection, copious oozing is to be expected. Mikulicz 
 was the first one to employ the iodoform gauze packing 
 successfully in the abdominal cavity, and his plan has 
 met with widespread and deserved acceptance. First, 
 it does away with the use of the drainage tube, and sec- 
 ondly, its contact with the peritoneum causes Just 
 enough adhesive irritation to insure after its removal 
 rapid agglutination of the raw surfaces. Immediate 
 closure of the wound can be practised after the extrac- 
 tion of the packing. 
 
 Thanks also to Schede's method of treatment under 
 the moist ^blood crust we have, as it were, the choice of 
 a middle course between the open treatment and drain- 
 age. Kocher says of it: "When the immediate coap- 
 totion of the wound margins is impossible it utilizes the 
 blood effused into the wound to fill the cavity. The 
 wound is allowed to fill with blood, the edges are but 
 partially united by sutures, and the rest is covered witli 
 impermeable tissue. Where neither primary nor sec- 
 ondary suture is possible this method is much preferable 
 
313 
 
 to the simple open wound treatment, with reference to 
 the duration of the healing, by favoring the cicatrizing 
 process." 
 
 But more frequently than not all of these agents and 
 means which we have described are applied in operative 
 work where the wound is made by the surgeon himself 
 and most of the conditions are directly under the con- 
 trol of the operator; hence it is more possible to secure 
 asepsis, to prevent an intense or prolonged infection. 
 There are times as well when one must operate under 
 other than these favorable circumstances, when exten- 
 sive micro-organic invasion of the tissues has already 
 occurred or else when such invasion cannot well be 
 avoided, or when the site of the operation is also the 
 focus of an infection which is either intense in nature or 
 long in duration. In such cases we have to vary the 
 treatment with the conditions to be met; more frequent- 
 ly when such wounds are not aseptic we can secure very 
 good results by the use of antiseptic irrigation of the 
 wound area, the application of moist chemically steri- 
 lized compresses or other dressings which are frequently 
 changed unless specially contra-indicated; then the 
 wound can be sutured after the infectious matarial has 
 been eliminated and the line of union, in fact the whole 
 of the wound area, dusted with a dry antiseptic powder 
 dressing. 
 
 Moselig von Moorhof, by the use iodoform in 1880, 
 introduced anew form of wound treatment. Iodoform, 
 per se^ is a comparatively bland and inert body; but con- 
 tact with decomposing organic matter effects its own de- 
 
314 
 
 composition, liberating free and elementary iodiu by 
 which the ptomaines and toxalbumins are fixed and in- 
 cidentally further micro-organic development arrested, 
 as De Ruyter has shown. Both of these effects are due 
 to the presence of the liberated iodin rather than to 
 iodoform itself. This peculiar effect is only possible in 
 the presence of decomposition and such products as 
 ptomaines and toxalbumins. But the latter are directly 
 the result of vital activity on the part of bacterial organ- 
 isms, any condition in which they are found must neces- 
 sarily be septic in nature; therefore iodoform would be 
 practically and antiseptically inert in an aseptic wound. 
 It is for this reason that Kocher says that iodoform has 
 no place in the aseptic treatment of wounds. In wounds 
 appropriate for the aseptic treatment he further says 
 that its employment is senseless; on the contrary, the 
 wound may be directly infected by its application. But 
 it is the most active of all drugs for counteracting be- 
 ginning and advanced decomposition and hence is to be 
 used on wounds where decomposition must be expected 
 from insufficient asepsis. Bergmann's mode of using 
 the drug has been shown by the investigations of De 
 Ruyter to be the best — namely, to pour into the wound 
 a solution of iodoform (ten parts) in ether (twenty parts) 
 and alcohol (eighty parts). 
 
 Dry Pulverulent Dressings. 
 All modern wound or other surgical dressings have in 
 view one primal, or rather a two-fold object, namely 
 the exclusion of germs or their destruction or inhibition 
 when access has already taken place. 
 
315 
 
 Albuminoid substances, such as the blood, serum and 
 various tissues of the body, will decay or become putrid 
 under certain conditions. The active causes of such de- 
 composition are micro-organisms; for the growth and 
 development of such organisms certain definite condi- 
 tions, or combinations of conditions, must pre-exist, for 
 micro-organisms are no less amenable to vital and nat- 
 ural laws than the higher and more complex organisms, 
 up to man himself, — as Browning says: 
 
 "From life's minute beginnings, up at last 
 To man, the consummation of His scheme." 
 
 Certain conditions must exist or the germ dies. For 
 the growth and development of micro-organic life we 
 may say that at least three conditions must co exist; 
 these are (a) a certain definite temperature, {b) the 
 presence of more or less moisture and (c) the presence 
 of pabulum. Absence of any one will result in inhibi- 
 tion of vital activity if not in actual death of the germ. 
 In the absence of the two first conditions growth and 
 development are inhibited; absence of the last, or ab- 
 sence of all three conditions induce the ultimate death 
 and destruction of germ life. 
 
 As far as temperature is concerned we have previously 
 shown that few if any germs are really actually destroyed 
 by even extreme depression of temperature while ex- 
 treme elevation invariably effects such result. Indeed 
 exposure for even a few minutes to moist heat at the tem- 
 perature at which water boils (100° Centigrade or 212° 
 Fahrenheit) will not only destroy almost every known 
 
316 
 
 variety of pyogenic and especially pathogenic germ 
 life but their spores as well. The most favorable tem- 
 perature for their growth is from 95° to 100° Fahren- 
 heit, that is, about the normal bodily temperature. It 
 must be obvious that the application of a sufficient de- 
 gree of heat to the body for the purpose of effecting 
 sterilization would seriously impair and indeed destroy 
 the vitality of the very tissues to whose normal and 
 physiological development we are endeavoring to con- 
 tribute. True the germ would be destroyed, but so also 
 would the tissues to whose preservation and conserva- 
 tion our energies were supposed to have been directed. 
 Obviously then neither elevation nor depression of tem- 
 perature can be made use of in wound treatment, or in 
 the sterilization of any infected area of the human 
 body. Such, however, is splendidly adapted to the dis- 
 infection of instruments, bandages, dressings, etc. 
 
 As far as the second proposition is concerned, the 
 presence of more or less moisture, this can be somewhat 
 controlled. For this very reason absolutely ^/^ opera- 
 tions, as Gerster and other eminent operators agree, 
 are much more rapid in their processes of repair and 
 healing because of the aseptic condition consequent up- 
 on such absence of moisture. This is the chief virtue 
 of the galvano-cautery, the thermo cautery, in operative 
 work; that the high degree of heat not only promptly 
 destroys all germs present but also thoroughly dessi- 
 cates the tissues of the wound with which the knife 
 comes in contact, forming an absolutely dry and imper- 
 vious eschar beneath which the process of repair pro- 
 
317 
 
 oeeds in an almost ideal manner, because of the ab« 
 sence of micro organic interference with such normal 
 process. 
 
 Gerster says in his classic work upon ** Aseptic and 
 Antiseptic Surgery:" "Small or comparatively small 
 wounds, admitting of an exact coaptation of the deeper 
 as well as their superficial parts by suture, are exquis- 
 itely tit for this method of treatment. Plastic opera- 
 tions about the face may serve as a fair type. 
 
 '^Certain finely powdered substances, as iodoform or 
 subnitrate of bismuth, have the quality of rapidly in- 
 spissating blood and serum to a dry crust. Accordingly, 
 after the hemorrhage has been controlled and the 
 wound closed by suture, a quantity of the substance 
 chosen is dusted over the sutures. No further dress- 
 ings are applied. The escaping bloody serum forms a 
 paste with the powder, which by its sterilizing property 
 prevents decomposition, while the paste remains moist. 
 Free access of air will hasten exsiccation; and the dry, 
 hard crust once formed will securely prevent further 
 ingress of dust into the wound. In cases where the 
 powder is washed away by profuse oozing, the dusting 
 has to be repeated every half hour after the operation, 
 until the object — the formation of a dry crust — is ac- 
 complished " 
 
 Professor Friederich von Esmarch, Professor of Sur 
 gerv to the University of KitO, in a copy of his Hand- 
 buck uer Kriegchirurgischen Technik which he recently 
 sent me, mentions iodoform, bismuth subnitrate, naph- 
 thalin, zinc oxid, iodol, sozo-iodol, dermatol, aristol, 
 
318 
 
 di iodo-thio-resorcin, sulphaminol and salol among the 
 antiseptic powders for use as dry dressings. Of these 
 Gerster prefers the first two. The chief objections to 
 iodoform are, first, its disgusting, inevitable, persistent 
 and nauseating odor; second, its feeble germicidal ac- 
 tivity, possessing none until its decomposition liberates 
 free iodin; third, it produces marked toxic effects in 
 certain persons (elderly perspns seem specially predis- 
 posed) — these toxic effects it seems to manifest espe- 
 cially upon the central nervous system and therefore its 
 employment should be surrounded by great care and ac 
 curate dosage. It is almost indispensable, however, in 
 the treatment of accessible tubercular areas and has, as 
 has been mentioned, given very good results in septic 
 wounds. As to the subnitrate of bismuth its chief ob- 
 jection is the comparative weak germicidal power. 
 Broome, Bernays, Mastin, Martin, Senn, Marks, the 
 author himself and a host of others have found a com- 
 bination of phenol and boric acid to be a superior dry 
 dressing. This combination (a most excellent prepara- 
 tion of which is furnished in Sennine) possesses in a 
 marked degree the superior antiseptic virtues of its 
 constituents — indeed even Lister himself now declares 
 the supremacy of carbolic acid over every other germi- 
 cide. The pulverulent and non-irritating properties of 
 Sennine give it valuable exsiccating and inspissating pow- 
 ers which are absolutely indispensable in adrydres-ing. 
 Its antiseptic qualities give it valuable inhibiting and 
 steril izing properties; should hypersecretion by any chance 
 supervene it is thus enabled to completely sterilize the 
 
319 
 
 morbid discharges which would otherwise form a most 
 fertile and undesirable nidus for micro-organic develop- 
 ment. As a well-known authority upon antiseptics and 
 asepsis has said: "Capillary attraction, exerted by a 
 dry absorbent dressing, is perfectly adequate to drain 
 an aseptic wound of its serous discharges and the rapid 
 drying and crusting of these dressings is just the thing 
 we want to seal a sweet wound against the possibility 
 of subsequent infectiofi from without." And just here 
 is where the function, power and advantages of such 
 dressings as Sennine are most desirable; complete steril- 
 ization, and the presence of the antiseptic dessicant, ab« 
 solutely insure against subsequent infection. 
 
 We know that the excellent antiseptic value of our 
 highly absorbent dressings depends as much upon their 
 valuable qualities of promoting and hastening rapid 
 evaporation as upon their chemical properties. We 
 have employed exsiccation or dessication as a means of 
 preservation for ages; for centuries men have empiri 
 cally cured and preserved perishable food products in 
 the same manner and the testimony of experience is 
 sufficient to attest the efficacy of the process. We have 
 discussed in detail the effect of exsiccation upon micro- 
 organisms in a previous paper (Paper VII). It is also 
 interesting to note in this connection that Schlange has 
 shown that cultures, on moist pads of cotton, of the 
 bacillus of green pus were aggressively prolific when 
 evaporation was checked; but such proliferation was 
 immediately stopped upon exposing the pads freely to 
 the air and thus allowing them to become dry through 
 
320 
 
 loss of moisture. Moreover, Schimmelbusch distinctly 
 claims, with the best of reasons, that the efficacy of 
 highly absorbing and rapidly drying dressings, even 
 though containing moderate amounts of schizomycetes^ is 
 far greater than is the case with materials which lack 
 such valuable properties even though they be faultlessly 
 impregnated. 
 
 We have now reached the consideration of the third 
 condition, namely, the presence ^f pabulum. Normal 
 healthy tissue is antagonistic to the growth and devel- 
 opment of germs; so also are normal healthy secretions. 
 Ergo^ healthy tissues and secretions do not contain mi- 
 cro-organic pabulum. Normal, healthy intra vascular 
 blood possesses marked germicidal powers, probably 
 due, as Vaughan suggests, to the contained nuclein or 
 nucleins; but when such blood, drawn from the vessels, 
 is allowed to stand it rapidly loses its usual alkaline re- 
 action and becomes acid in character and in reaction 
 upon litmus; concomitant with this loss of alkalinity is 
 its loss of germicidal power, indeed such blood under 
 these conditions is not only devoid of all germicidal 
 power but even affords an excellent culture medium. 
 80 also, altered and morbid discharges form good cul- 
 ture media in which micro-organisms develop and flour- 
 ish because they find ample pabulum therein. To pre- 
 vent the occurrence of this condition we must either 
 prevent discharge from the wound or else if such occurs 
 prevent its subsequent infection. This may frequently 
 be done by means of absorbent drying powders which 
 inspissate such discharges and keep the wound dry and 
 
321 ' 
 
 hence nearly aseptic. The presence of an antiseptic or 
 inhibitory agent in such dressings will prevent the de- 
 velopment of micro organisms altogether. If hyperse- 
 cretion results, infection is almost certain to occur un- 
 less the discharges be thoroughly and efficiently steril- 
 ized and antiseptized. The functions of an ideal dress- 
 ing are two-fold (a) to inspissate moderate discharges 
 by absorption and subsequent evaporation of the liquid 
 portion of such discharge and thus present a dry field in 
 which micro-organic development is inhibited, or {d) 
 when such discharge becomes profuse to prevent infec- 
 tion by charging such secretions with antiseptics, or if 
 infection has supervened to effect sterilization by the 
 same agency. Many dry dressings possess only the first 
 quality, the best possess the second as well — among 
 these we might mention salol, naphthol, Sennine, and 
 to a certain extent, iodoform. These, with the possi- 
 ble exception of Sennine, have a comparatively low 
 solubility in the wound discharges and hence possess 
 very limited powers of penetration of wound recesses. 
 Sennine by virtue of its greater solubility has powers 
 which are more marked in this respect and hence it may 
 be classed among the very best of all dry dressings for 
 all purposes. The known hygroscopic properties of car- 
 bolic acid give this product of carbolic and boracic acid 
 the inspissating power which is so desirable in a dry 
 dressing; being a powder its power of absorption is in- 
 creased mechanically to some extent by virtue of a mod- 
 ified form of capillary attraction. To this is added the 
 marked antiseptic, bland and non-irritating properties 
 
of boric acid and the marked germicidal power of car- 
 bolic acid which has been almost entirely robbed, by 
 the combination, of its usual irritating qualities. Hence 
 in this substance we have the two-fold function of an 
 ideal antiseptic dry dressing fulfilled in a manner almost 
 ideal in itself. These facts are fully borne out by a 
 comparatively extended clinical experience, in addition 
 to the strong scientific foundation upon which they are 
 reared. 
 
 The present is distinctively an age of dry dressings 
 and from the present outlook the future is to be more 
 so, if not, indeed, exclusively an age of dry dressings. 
 In order to gather definite information upon this point 
 the writer has for the past six months or more been in 
 communication with the leading surgeons of the world; 
 from this correspondence he has gleaned a symposium 
 of their respective opinions upon the value of dry dress- 
 ings in general. In each case the surgeon expressed 
 the opinion knowing that it was to be used as his own 
 expression upon the subject, for so he was informed. 
 
 Thomas Annandale, Kegius Professor of Clinical 
 Surgery, University of Edinburgh: "I prefer dry dress- 
 ings in all cases except where owing to large cavities 
 and other conditions drainage is required." 
 
 Thomas Bryant, London, England: **I always use 
 dry absorbent dressings for fresh wounds. * * * I 
 finally dust the wound before closing it, with a powder 
 composed of one part of iodol and four parts of pow- 
 dered boracic acid." 
 
 Victor Horsley, London, England: *'I use dry dress- 
 
ings wherever possible and avoid hemorrhage as much 
 as possible." 
 
 W. W. Keen, Professor of the Principles of Surgery 
 and Clinical Surgery, Jefferson Medical College, Phila- 
 delphia; Surgeon to Saint Agnes' Hospital, Philadel 
 phia, Pa.: "I almost always use dry dressings, antisep- 
 tic or sterilized, rarely wet." 
 
 Nicholas Senn, Professor of the Principles of Surgery 
 and Clinical Surgery, Rush Medical College, Chicago; 
 Surgeon-General, Illinois National Guard; Surgeon in- 
 Chief, Saint Joseph's Hospital, Chicago; Attending Sur- 
 geon, Presbyterian Hospital, Chicago, ID.: "I prefer 
 dry dressings in all operations for aseptic conditions; in 
 all other cases I rely on solutions of carbolic acid or 
 sublimate. In operations for open tubercular lesions I 
 give iodine solution the preference." 
 
 Roswell Park, Professor of Surgery to the Medical 
 Department of the University of Buffalo; Surgeon to 
 the Buffalo General Hospital; Consulting Surgeon to the 
 Fitch Accident Hospital: "I would say that more and 
 more as the months go by I am in favor of dry operat- 
 ing and dry surgical dressings, and esteem that opera- 
 tion to be the nearest approach to the ideal in which 
 there is the least possible amount of fluid of any kind 
 present, either blood or antiseptic solution. In fact I 
 do not even use hydrogen peroxide now as I used it 
 5nce." 
 
 William Hunt, Surgeon to the Pennsylvania Hospital, 
 Philadelphia: "I have been an earnest advocate of dry 
 dressings almost since I entered the profession. One 
 
324 
 
 of my earliest papers was in advocacy of them. I have 
 never had any occasion to recede from such recommen- 
 dations. Thanking you for the opportunity of answer- 
 ing queries like yours, I am very truly yours," etc. 
 
 C. H. Mastin, Mobile, Alabama: **I use dry dress 
 ings in small wounds and in fact in all wounds where I 
 can get exact coaptation. Here I use indifferently 
 Bismuth, Aristol and sometimes Iodoform, but its odor 
 is objectionable, and I do not think it possesses any ad- 
 vantage over Aristol, Kurophen or Boric Acid. I might 
 add I use more Boracic Acid for small wounds, than 
 anything else. Where I am unable to get exact coapta- 
 tion, I am forced sometimes to use moist dressings. As 
 a rule I prefer dry dressing, first covering with the 
 selected articles (Boric Acid, Bismuth, Aristol or such 
 articles as I prefer at the time), then several folds of 
 gauze, (Iodoform, Mercuric, Boric, Eucalyptus or simple 
 dry gauze) cotton, gauze and then bandage." 
 
 D. W. Yandell,Profe8Sor of the Principles of ISurgery 
 and Clinical Surgery to the Medical Department of the 
 University of Louisville, Kentucky: "I like dry surgi- 
 cal dressings where I can use them on perfectly dry sur 
 faces which I can keep dry by complete drainage." 
 
 Theo. A. McGraw, Professor of Surgery to the De- 
 troit Medical College; Surgeon to Saint Mary's Hospi- 
 tal; Surgeon to the Harper Hospital, Detroit, Michigan: 
 "I aim to keep my wounds aseptic and am fond of the 
 dry method of operating." 
 
 Augustus C. Bernays, St. Louis Missouri: "I con- 
 sider that the dry treatment of wounds is the ideal 
 
325 
 
 method in all cases where an aseptic operation can be 
 performed, where there is no sepsis before the operation 
 and where there is no infection during the operation. 
 
 "Recently an excellent powder for the dry treatment 
 of wounds has been put before the profession in a most 
 convenient form under the name of 'Sennine.'" 
 
 Frederic H. Gerrish, Surgical Instructor to the Fort- 
 land School of Medicine; Professor of Anatomy to the 
 Medical Department of Bowdoin College: "I use car- 
 bolic solution for the instruments and sublimate solu- 
 tions for hands and the field of operation, first scrubb 
 ing these with hot water and soap Dry iodoform on 
 the wound, and above this a voluminous dressing of sub- 
 limate gauze have served me so well for so many years 
 that I feel little disposition to abandon them for any 
 new things which I have yet seen." 
 
 E. H. Bradford, Instructor in Clinical Surgery to 
 Harvard Medical School; Visiting Surgeon to the Bos- 
 ton City, Children's and Samaritan Hospitals: "I pre- 
 fer dry dressings in aseptic surgery in all cases where 
 the wound is aseptic." 
 
 George Wiley Broome, Professor of Surgery and 
 Dean of the Woman's Medical College, St. Louis; Sur- 
 geon to the Woman's Hospital, St. Louis. In a recent 
 letter to the writer Doctor Broome said: 
 
 "Any physician may see and appreciate the great 
 value of dry dressings in surgical cases. I may go a 
 little further and venture the prediction that the scien- 
 tific surgery of the near future will not even include the 
 now widely used irrigating vessels in the instrumen- 
 
326 
 
 tarium of the surgeon at all. Instead of irrigations the 
 asepticity of a wound will be secured and maintained 
 by dry sponging. In suppurating cases asepsis will be 
 established by destroying the medium in which the 
 pyogenic micro organisms grow and multiply, by the 
 same means. The availability of any antiseptic is en- 
 hanced in proportion to the degree of its inhibitory 
 power. The inhibitory function can be performed per- 
 fectly in a dessicated field only. Dessication can only 
 be secured by means of dry, together with hygroscopic 
 dressings. A suppurative inflammation with the pres- 
 ence of pus, wherever found in the human body, must 
 be treated by dry sponging, not by irrigation, so that it 
 will only be a little while until the application of pow- 
 ders possessing such power will be a universal practice 
 among progressive surgeons. 
 
 **Latterly I have been using *Sennine' to dust over 
 laparotomy wounds and have found it superior in many 
 essential particulars to other antiseptic powders P 
 
 In a recent paper entitled "Some Fresh Points in the 
 Technique of Celiotomy^ Extra Peritoneal Abdominal 
 Hysterectomy and Ideal Myomectomy," read before the 
 St. Louis Medical Society and published, April 7, 1894, in 
 the Weekly Medical Review of St. Louis, he says 
 further: 
 
 "I am strongly partial to dry dressing and dry spong 
 ing. I believe that one of the greatest achievements 
 of scientific surgery belongs to the future in this partic- 
 ular direction. When practical surgeons become more 
 familiar with the life, habits, growth g,nd developmept 
 
of the pyogenic microbes, then they will learn to ap* 
 preciate more fully the importance of an early and ab- 
 solute abandonment of the practice of irrigation and I 
 furthermore wish to make this declaration now: that 
 ideal surgery can, in the near future, contemplate the 
 act of the irrigation of wounds and cavities only in the 
 light of a revolt against the science of regeneration. I 
 mean this statement for a sweeping one covering all 
 cases, and especially pus cases, those very ones that 
 are looked upon to-day as presenting the ideal condition 
 for irrigation, dry sponging is the fresh point therefore 
 that I wish to show, whether it be for a pyocelia or a 
 suppurative otitis media, I care not which. Dry spong- 
 ing and dry dressing will be the practice of the future. 
 Dry sponging is more rational in every respect than the 
 irrigating method or wet sponging. Dry dressings by 
 means of powders have proven more satisfactory be 
 cause of their inhibitory power. 
 
 "The relative value of these powders is a subject I do 
 not care to discuss further than to mention the very 
 great value of iodoform in all tubercular processes and 
 boracic acid and phenol in combination as an ideal an- 
 tiseptic and dessicant. 
 
 "You know that iodoform was first introduced to the 
 profession by Mosetig Moorhof in the year 1880 and is 
 composed of alcohol, iodine, carbonate of potash and 
 water and its real merit, as an inhibitory agent depends 
 upon its slow decomposition and the liberation of iodine. 
 The latter acting in two different ways. The one is the 
 antiseptic property of iodine destroying germ life, the 
 
^28 
 
 other is the chemical property of iodine to eliminate the 
 toxines rendering them insoluble and therefore unab- 
 sorbable and thus innocuous to the system. The hygro- 
 scopicity of the impalpable powder of boracic acid is 
 too widely known to require explanation, and since the 
 father of antiseptic surgery still clings to the use of 
 carbolic abid I need scarcely consume your time in com- 
 mending the inestimable value of a combination in 
 powder form of boracic acid and phenol. These have 
 been happily incorporated under the name of ^Sennine' 
 and I know of nothing superior as a topical dressing to 
 prevent parasitism and thus secure the early and rapid 
 healing of a surgical woutid." 
 
 In order to obtain the very latest and most reliable 
 views upon these subjects, the author has been in con- 
 stant correspondence with many eminent medical gen- 
 tlemen for some time. The correspondence has been 
 peculiarly valuable, instructive and edifying — indeed, it 
 is a source of very great regret that space does not per- 
 mit the publication of the correspondence in full. The 
 author is deeply indebted for the uniform courtesy and 
 patience with which he has been indulged by these pro- 
 fessional gentlemen, the demands upon whose valuable 
 time must have been multifarious. In almost every 
 single instance there has been a marked display of that 
 true scientific brotherhood in which each lends his aid 
 freely and willingly to a brother investigator — indeed, 
 the correspondence has brought out in a remarkable de- 
 gree that indissoluble tie of brotherhood and unity 
 which binds the medical gentlemen of all ages, races 
 
 d climes. 
 
329 
 
 Professor Doctor Vincent Czerny, Professor of Sur- 
 gery to the University of Heidelberg: — "I use, almost 
 exclusively, gauze and wadding that has been sterilized 
 with streaming steam. Both are first boiled in a 0.6 
 per cent, salt solution and then sterilized in steam. 
 The catgut is sterilized in 1 per cent, bichloride solu- 
 tion. For disinfection of the hands we use Fuer- 
 bringer's method. For disinfection of wounds we use 
 the following: Iodoform gauze and cloth which has 
 been sterilized and dipped in 10 per cent, iodoform- 
 ether solution. For moist bandages we generally use 
 1 per cent, of aluminic acetate." 
 
 Professor Doctor Carl Gussenbauer, Professor of 
 Surgery to the University of Prague: — *'In an 
 swer to your question I would say that the asep- 
 tic and antiseptic methods are in use in my clin- 
 ic. Asepsis is secured by sterilization of the in- 
 struments and of the materials used for ban- 
 daging. For antiseptic purposes I use the corrosive 
 bichloride of mercury (1:1000), and for the intestine 
 salicylic or boracic acid. For dry bandages and for the 
 tamponade of wounds which have been infected, and 
 also in cases of tuberculous accumulations, I use iodo- 
 form. For moist bandages, when treating cases of 
 acute purulent inflammation, I use the acetate of alum- 
 inum. For ligatures I use catgut, and for stitching, 
 carbolized silk thread. 
 
 "We have recently made some other experiments 
 with different antiseptics, but have found nothing more 
 satisfactory than those mentioned. I hope that thepe 
 few brief indications will be of service to you." 
 
330 
 
 Professor Doctor Friederich vod Esmarch, Professor 
 of Surgery to -the University of Kiel: — In answer to 
 my letter, Professor Esmarch, who is without doubt the 
 greatest military surgeon of the world, sent me a copy 
 of his Handbuch der Kriegschirutgischen TechniJc. This 
 work was offered in competition for the large prize to 
 be awarded by the German Empress for the best work 
 on the technique of military surgery. A jury consist- 
 ing of Professor Doctor B. von Langenbeck, of Ber- 
 lin; Professor Doctor Billroth, of Vienna, and Profes- 
 sor Doctor Socin, of Basle, awarded the prize to this 
 work of Esmarch. It is undoubtedly one of the great- 
 est, if not the greatest, work on military surgery in any 
 language. In it Esmarch describes and prescribes in 
 detail various preparations of phenol, sublimate, zinc 
 chlorid, boric acid, aluminic acetate, salicylic acid, 
 chromic acid, thymol, potassic permanganate, benzoic 
 acid, iodic tri-chlorid, tri chlor phenol, chlorin, alum, 
 aseptin, sulphates of zinc and copper, zinc sulpho car- 
 bolate, aseptol, eucalyptol, oil of juniper, hydrogen 
 peroxid, absolute alcohol, iodoform, bismuth subnitrate, 
 naphthalin, zinc oxid, sozo iodol, derraatol, aristol, di- 
 iodothio-resorcin, sulph aminol, salol, etc , as antisep- 
 tics in the form of solutions or as dry dusting powders. 
 
 Doctor Thomas Annandale, Regius Professor of 
 Clinical Surgery to the University of Edinburgh: — 
 ^^ First — In all cases of aseptic wounds, operative or 
 otherwise, carbolic solution (1 :40) is used and the sur- 
 face of the wound well douched with it. Before clos- 
 ing the wound all fluids are pressed out, and then a 
 
331 
 
 piece of muslin which has been kept in a carbolic sola 
 tion (1:40) is applied next the wound, having the fabric 
 previously well- squeezed so as to leave it just damp. 
 Over this one or more layers of wood wool or corrosive 
 wool, according to the probable amount of serous or 
 other discharge, are applied and all are kept in position 
 by a 9>oiX> flannel bandage. 
 
 The dressing is not interfered with until— 
 
 a. Any discharge shows through the dressing. 
 
 b. Any rise in temperature. 
 
 c. Irritation or swelling felt by the patient in the 
 part. 
 
 Second — Septic wounds are treated by thorough wash- 
 ing with carbolic solution (1:20); by the free use of 
 iodoform; by the application of charcoal poultices, in 
 which 1 have great faith; and, in the case of the limbs, 
 the antiseptic bath is used when possible." 
 
 Doctor John Chiene, Professor of Surgery to the 
 University of Edinburgh: — "Thorough preparation of 
 the skin of the patient, surgeon and assistants with 
 soap, water, turpentine and methylated spirits, followed 
 by 1:20 carbolic acid. Instruments boiled and then laid 
 in 1:20 carbolic acid. Dry corrosive sublimate dress- 
 ings; swabs, not sponges, of gauze, or wool enclosed in 
 gauze (as shown me by Mr. Cotterill, Assistant Sur- 
 geon, Edinburgh Royal Infirmary); rarely use drainage 
 tubes, careful pressure taking the place of drainage, 
 taking great care to arrest haemorrhage at the time of 
 the operation." 
 
 Dr. Thomas Bryant, London, England: "I always 
 
332 
 
 use dry dreBsings for fresh wounds and of these I prefer 
 the wood wool tissue, that is wood wool mercuriated 
 and enclosed between two layers of gauze. 
 
 "I employ warm or hot water stained of a cherry 
 color with the tincture of iodine to saturate the sponges 
 I use in operations; and always apply to the surface of 
 a wound, before its dressings are applied, a sponge 
 wrung out in very hot iodine water to stop capillary 
 oozing. I finally dust the wound before closing it, with 
 a powder composed of one part iodol and four parts 
 powdered boracic acid. 
 
 **I usually suture my wounds with fine chromicized 
 catgut or silk rendered aseptic by boiling in carbolic 
 water and preserved on a metal winder in pure alcohol. 
 
 "Iodoform gauze I apply to the surface of the wound 
 beneath the wood wool tissue. I, in all deep wounds, 
 introduce a drainage tube of rubber for one or two days 
 and rarely dress wounds for the first three days, if there 
 are no indications for interference. 
 
 "In large wounds I use a simple strip of plaster ap- 
 plied between the sutures to keep the edges in apposi- 
 tion. Most of my wounds heal by *quick union.' " 
 
 Dr. Victor Horsley, London, England: "I use steri- 
 lized water. Five per cent carbolic solution for my in- 
 struments after sterilization by boiling. For disinfec- 
 tion of the hands 1:500 perchloride of mercury. In 
 cases of any doubt I irrigate with weak solutions of mer- 
 cury, 1:1000 to 1:4000. 
 
 "I use dry dressings wherever possible and avoid hem- 
 orrhage as much as possible." 
 
333 
 
 Dr. Reginald Harrison, Surgeon to Saint Peter's 
 Hospital; Hunterian Professor of Pathology and Sur- 
 gery, Royal College of Surgeons; London England: 
 **Amonget the uses of antiseptics must Jbe included 
 their applications to operations involving the urinary 
 apparatus. Recent researches, based upon bacteriologi- 
 cal observations, show that the urine is capable of be- 
 ing acted upon in the course of its excretion as to render 
 the occurrence of rigors and fevers following lesions 
 and abrasions of the urethra, as after internal urethrot- 
 omy, divulsion, or the use of catheters and bougies, 
 either rare or innocuous. This process is usually re- 
 ferred to as sterilization of the urine and was first put 
 into prominence by Dr. E. R. Palmer of Louisville, Ky., 
 chiefly with the use of boracic acid administered inter- 
 nally as a preliminary to the operation of internal ure- 
 throtomy: For this purpose, as well as for other oper- 
 ations of a like nature, for two or three days previously 
 I usually administer from five to ten grains of boracic 
 acid in water every four hours. My results in thus 
 preventing rigors and fever correspond with those of 
 Dr. Palmer. This action of boracic acid is probably 
 due to its being eliminated largely by the urine and 
 there acting as a protective against bacterial develop- 
 ment and propagation. Quinine, salol and hyposulphite 
 of soda act much in the same way. In uncomplicated 
 cases of purulent cystitis the last mentioned chemical 
 m half-drachm doses administered three or four times a 
 day in water will often speedily clear the urine of pus 
 and all traces of bacteria. Copaiba, sandal wood, sali- 
 
334 
 
 cylic acid and cubebs have a similar, though probably 
 feebler action on the urine as antiseptics. Amongst 
 local antiseptics, solutions of quinine and perchloride of 
 mercury are amongst the best for washing out the blad- 
 der. The former may be used in the proportion of two 
 grains to. the ounce of water and the latter not stronger 
 than 1:6000. Carbolic acid as an injection for washing 
 out the bladder often causes intense irritation when 
 used in sufficient strength to act as a bactericide. 
 
 "These are the drugs I usually employ as antiseptics 
 in lesions and purulent conditions involving the urinary 
 tract." 
 
 Dr. W. W. Keen, Professor of the Principles of Sur- 
 gery and of Clinical Surgery to the Jefferson Medical 
 College of Philadelphia; Surgeon to Saint Agnes' Hos- 
 pital, Philadelphia, Pa : "I have no especial antiseptic 
 formulae or I would gladly give them. I employ com- 
 monly carbolic acid and bichloride solutions. I almost 
 always use dry surgical dressings, antiseptic or sterilized, 
 rarely wet. I have practically abandoned marine 
 sponges and use sponges made of dry bichloride or ster- 
 ilized gauze rolled into balls about the ordinary size." 
 
 Dr. Nicholas Senn, Professor of the Principles of 
 Surgery and of Clinical Surgery to tjue Rush Medical 
 College of Chicago; Surgeon-in-chief to Saint Joseph's 
 Hospital of Chicago; Attending Surgeon to the Presby- 
 terian Hospital, Chicago, 111.: "I prefer dry dressings 
 in all operations for aseptic conditions. In all other 
 cases I rely on solutions of carbolic acid or sublimate. 
 In operations for open tubercular lesions I give iodine 
 solution the preference." 
 
386 
 
 Dr. Arpad J. Gerster, Professor of Surgery to the 
 New York Polyclinic; Surgeon to the Gernaan Hospital, 
 New York City; Surgeon to Mount Sinai Hospital, New 
 York City: "I have no favorite antiseptic formulaB. 
 The ones I use you will find mentioned in the last edi- 
 tion of my book on the same subject and in a pamphlet 
 mailed to your address to day which contains also an 
 exposition of the principles governing the use of dry 
 and moist dressings." 
 
 Dr. Gerster has been so freely quoted in the preced- 
 ing pages and his work is so well-known that his opin- 
 ions may be easily inferred. 
 
 Dr J. William White, Professor of Clinical Surgery 
 to the University of Pennsylvania, Philadelphia, Pa : 
 
 ''My dressings are as follows: 
 
 *'Skin cleansed with 
 "(^) Soap and water. 
 "(^) Alcohol. 
 *'(^) Carbolic acid 1 :40. 
 "(^) Sublimate 1:1000. 
 
 "Fponges are placed in a solution of 1:50 carbolic 
 acid in 1:2000 sublimate. As little sponging or irriga 
 tion as possible, except in cases where operative area is 
 always infectea. Then a douche of 1:20 carbolic acid 
 in 1:1000 sublimate. Drainage tubes usually dispensed 
 with in clean wounds. 
 
 "Permanent dressings of two varieties: 
 
 "1. (a) Iodoform dusted thickly over edge of wound 
 and over skin for some distance. 
 
 "(^) Moist crumpled iodoform gauze. 
 
336 
 
 "(^) Moist crumpled sublimate gauze. 
 "(//) Sublimate gauze bandages. 
 
 "2. Double cyanide dressing as recommended by 
 Lister with his latest modifications. 
 
 "Results about equally good with these two methods. 
 
 "In most general clinical work and in the majority 
 of all operative work a mild but thorough antisepsis 
 with a minimum of sponging, irrigation, etc., is to be 
 preferred." 
 
 Dr. John Ashhurst Jr., Professor of Surgery and of 
 Clinical Surgery to the University of Pennsylvania; 
 Surgeon to the Pennsylvania Hospital; Surgeon to the 
 Children's Hospital of Philadelphia, Pa.: "I beg to 
 say that an account of the antiseptic measures which 1 
 employ may be found in the sixth edition of my *Prin- 
 ciples and Practice of Surgery' recently published by 
 Messrs. Lea Brothers and Co., of this city." 
 
 Dr. Ashhurst therein recommends "antiseptics diluted 
 with good common stnse?'* 
 
 Dr. J. M. Barton, Surgeon to the Jefferson Medical 
 College Hospital; Surgeon to the Philadelphia Hospital: 
 "I am in the habit of using at my clinics at the Jef- 
 ferson College Hospital and the Philadelphia Hospital, 
 where I have experienced assistants, aseptic measures in 
 most of my operations, first sterilizing the parts, the 
 sponges and the hands of the operator and assistants 
 with some of the well known antiseptics, usually bi- 
 chloride of mercury (1:1000), and preparing the instru- 
 ments by boiling. 
 
 "During the operation boiled water alone is used, and 
 
337 
 
 the wound is dressed with dry gauze sterilized by heat. 
 When we cannot expect to remove the blood-stained 
 gauze at the end of twenty four hours, as when an open 
 wound ig packed with it, iodoform gauze is used. 
 
 "In out of- town operations, where I cannot have my 
 usual assistants, I rarely attempt aseptic work, but be- 
 fore, during and particularly after an operation, I use a 
 strong solution of bichloride of mercury freely to the 
 wound. The instruments and the towels surrounding 
 the seat of operation are sterilized with a 5 per cent, 
 solution of carbolic acid. 
 
 "I have put up in dozens, bottles each containing one 
 ounce and a half of carbolic acid and one ounce of alco- 
 hol. One of these I carry with me to each of my pri- 
 vate operations and empty into a quart of warm water, 
 making a 5 per cent, solution, in which the instruments 
 lie, in their tray, until the patient is under ether. Tow- 
 els are then wetted in the solution, which removes it 
 from the instruments, and the towels are used to sur- 
 round the site of the operation and to cover the instru- 
 ment table. 
 
 "The addition of the alcohol causes the carbolic acid 
 to fully and quickly dissolve in the water. 
 
 "Dry dressings, sterilized by heat, are carried with 
 me and applied while the parts around the wound are 
 still wet with the mercurial solution. 
 
 "When the wound is open and infected, I use wet 
 dressings, usually gauze wet with the mercurial solu- 
 tion, being careful to fully cover the dressing with mac- 
 intosh to prevent evaporation strengthening the solution 
 and causing blistering." 
 
338 
 
 Dr. William Hunt, Surgeon to the Pennsylvania 
 Hospital, Philadelphia, Pa.: "I have no favorite form 
 u'se for antiseptic procedures; varying strengths of cor- 
 rosive chlorides, carbolic acid and hot water meet all 
 the requirements according to my experience." 
 
 Dr. Roswell Park, Professor of Surgery to the Med- 
 ical Department of the University of Buffalo; Surgeon 
 to the Buffalo General Hospital; Consulting Surgeon to 
 the Fitch Accident Hospital, Buffalo, N. Y.: "My fa- 
 vorite application to the parts to be operated on, and 
 which I have applied for at least twenty-four hours pre- 
 viously, when opportunity permits, is of green soap 
 with 5 per cent, of lysol or of hydronapthol, perhaps a 
 little glycerin being added to the whole mass. This I 
 have applied on compresses, with rubber tissue outside 
 to prevent evaporation . 
 
 *'In my portable operating outfit, which I carry to all 
 country operations, I take a saturated alcoholic solution 
 of hydronaphthol for use upon instruments, ligaturee, 
 etc , to be used during the operation. These I place in 
 boiling water and add to it a little of the alcoholic so- 
 lution. The hot water takes up so much of it as it can, 
 making thereby a saturated watery solution, and the 
 rest is simply wasted, the loss, however, being insignifi 
 cant. 
 
 "I am now using for almost all cases, as a means of 
 sterilizing the operator's and assistants' hands, ordinary 
 flour of mustard, * * * the process being about as 
 follows: 
 
 "With a nail brush the hands are thoroughly scrubbed 
 with green soap, then it is rinsed off. A teaspoonful 
 
339 
 
 or so of the flour of mustard is then put on the hands 
 with a little water and thoroughly rubbed into all 
 creases and parts about the finger nails, and thus manip 
 ulated for three or four minutes. The result is the 
 most perfect sterilization of the hands, with the least 
 immediate after disturbance of the skin that can possi- 
 bly be produced by any means known to me. You will 
 remember that the oil of mustard is one of the most 
 powerful antiseptics known; in fact, all of the aromatic 
 oils share this property with it. Qaite recently I have 
 seen cinnamon recommended in the same way, and I 
 have no doubt that powdered cinnamon would be as 
 good as mustard, but not so easily procured. One ad- 
 vantage of the latter is that it is at hand in almost every 
 household. It is more than an ordinary antiseptic. 
 * * * Mustard can always be recommended as a de- 
 odorizing agent when the hands have become contam- 
 inated with any foul-smelling material. For my own 
 part, I shall have no fear in going at once from the dead 
 room to the operating table, providing my clothing car- 
 ried nothing, if I could resort to this means of disin- 
 fection and sterilization. 
 
 "It is, in my estimation, extremely desirable to have 
 a good combined styptic and antiseptic. For this pur- 
 pose I most highly recommend to you a 5 per cent, so- 
 lution of antipyrin. This I have used for several years, 
 after having first carefully tested it as an antiseptic. In 
 solution of this strength it is a fairly powerful germi- 
 cide, and if once carefully prepared with sterilized wa- 
 ter, and kept protected from ordinary atmospheric con- 
 tamination, can be used with impunity so far as danger 
 of infection is concerned. As a styptic it is more pow- 
 erful than any' medicinal substance with which I am 
 familiar. I have used it on and in the brain, on and in 
 the abdominal viscera, have injected it into the bladder^ 
 have used it in the nose, in fact, in any and every place 
 where oozing has given me any trouble, and have 
 
340 
 
 learned to have a firm faith in its valuable properties. 
 In my clinic I have always at hand a spray bottle from 
 which it can be sprayed upon any oozing surface, and it 
 is used almost daily. To many others, at home and 
 abroad, I have demonstrated its properties in this direc- 
 tion, and have never known it to give anything but sat- 
 isfaction." 
 
 Dr. C. H. Mastin, Mobile, Alabama: "As to anti- 
 septic formulae, I rarely, if ever, confine myself to any 
 one special formula. Sometimes I "use mercuric bi- 
 chloride, sometimes hot water, and now and then 
 Thiersch's boro-salicylic lotion; this last I prefer in ab- 
 dominal sections. When I use mercuric bichloride, I 
 use it as the case may be from 1,000 to 12,000 strength. 
 
 "I never use ^protective' unless in those cases where I 
 resort to a moist dressing, and then I use oiled silk, 
 waxed paper, or thin rubber. I do not see any special 
 advantage of Lister's mackintosh over any one of the 
 substitutes I have mentioned. Before all operations I 
 have the skin clean, using green soap with brush to 
 scour it thoroughly, then mercuric bichloric, 1:1000, 
 1:2000 or 1:5000, as the case may seem to require; then 
 wash it off with boiled water and alcohol or ether. / 
 attempt to clean the parts. In other words, I render them 
 as near aseptic as possible, and rely more on this than 
 the antiseptic lotions, chemicals, etc., which are so ex- 
 tensively used." 
 
 Dr. Theo. A. McGraw, Professor of Surgery to the 
 Detroit Medical College; Surgeon to St. Mary's Hos- 
 pital; Surgeon to the Harper Hospital, Detroit, Mich : 
 *'I have little faith in antiseptics ^^^<?)^/y<?r/r^^j'/«^- 
 tic purposes, I aim to keep my wounds aseptic, and am 
 fond of the dry method of operating. Usually before 
 operating, I have the skin shaved with soap and water, 
 then with ether, and finally with a 2 per mille solution 
 of corrosive sublimate." 
 
 Dr. Frederick H. Gerrish, Surgical Instructor to the 
 
341 
 
 Portland School of Medicine; Professor of Anatomy 
 to the Medical Department of Bowdoin College: "I 
 use carbolic solution for the instruments, and sublimate 
 solution for the hands and the field of operation, first 
 scrubbing them with hot water and soap. Dry iodoform 
 on the wound, and above this a voluminous dressing of 
 sublimate gauze have served me so well for so many 
 years that I feel little disposition to abandon them. 
 Results have been so satisfactory with this treatment 
 that I shall continue to follow the plan until there ap- 
 pears more reason than at present lor a change." 
 
 Dr. D. W. Yandell, Professor of the Principles of 
 Surgery and of Clinical Surgery to the Medical De- 
 partment of the University of Louisville, Ky.: "The 
 three antiseptics that I use in my practice are corrosive 
 sublimate, iodoform and carbolic acid. The first and 
 last I use in varying degrees of strength; the second 
 usually in powder or on gauze. I do not use corrosive 
 sublimate in abdominal sections." 
 
 Dr. E. H. Bradford, Instructor in Clinical Surgery to 
 the Harvard Medical School; Visiting Surgeon to the 
 Boston City, the Children's and the Samaritan Hospi- 
 tals, Boston, Mass.: "I can only say that I make use of 
 very simple antiseptics. Corrosive sublimate (1:1000 — 
 1:3000), iodoform in powder, aristol in powder, and 
 peroxide of hydrogen of various strengths. Carbolic 
 acid is used, of course, and for ointments, aristol and 
 vaseline." 
 
 Dr. J. McFadden Gaston, Professor of Surgery lo the 
 Southern Medical College, Atlanta, Ga.: "In septic 
 conditions, my reliance has been chiefly upon the fol 
 lowing, giving preference in accordance to the case in 
 the order named: — 
 
 "Labarraque's solution, with the addition of perman- 
 ganate of potash. 
 
 "Lugol's solution, diluted with varying quantities of 
 boiled water. % 
 
342 
 
 Carbolic acid, ODe ounce; glycerine, three ounces and 
 boiled water, one pint (more or less, to suit the case). 
 
 "Spirits of turpentine, one ounce; camphor, one 
 drachm, for first applications and afterwards, with ad- 
 dition of like quantity of olive oil. 
 
 "Peroxide of hydrogen is often employed as prepara- 
 tory to other measures. 
 
 "My use of corrosive sublimate is limited to cleans- 
 ing the skin in the field of operations." 
 
 Dr. Henry R. Wharton, Demonstrator of Surgery to 
 the University of Pennsylvania, Philadelphia, iPa.: 
 '*I fear I have no special antiseptic formulae. I use bi 
 chloride solution (1:2000 or 1:4000) and, in special cases, 
 boiled water for the irrigation of wounds. I use large- 
 ly, in antiseptic dressings, the modified moist method; 
 that is, applying next to the wound a few layers of 
 gauze, wrung out in bichloride solution, over this a pad 
 of dry bichloride gauze, and over this a pad of bichlo- 
 ride cotton and a bandage. I also frequently use dry 
 sterilized gauze, and think my results with it are equally 
 good." 
 
 Dr. J. E. Michael, Surgeon to the University Hospi- 
 tal; Consulting Surgeon to the Presbyterian Eye, Ear 
 and Throat Hospital, Baltimore, Md.: — "My method is 
 to have the surface of the field of operation thoroughly 
 cleansed with soap and water, then treated with ether 
 or alcohol and recleansed, after which I have the part 
 covered with a moist dressing of 1:1000 or 1:2000 bi- 
 chloride solution for several hours prior to operation. 
 I do not believe there is any necessity for applying an 
 antiseptic solution to fresh tissues during an operation, 
 but place my main reliance upon cleanliness and thor- 
 ough disinfection of the seat of operation, as well as of 
 hands, instruments and all other matter likely to come 
 in contact with the wound. 
 
 "My dressings are mainly simple sterilized gauze or 
 iodoform gauze. In obstetric practice, save in the pre- 
 
343 
 
 veDtive preparation of the external parts involved, upon 
 the lines laid down above, I make no use of antiseptics 
 in normal cases. In instrumental and manipulative 
 cases I depend upon douches of sublimate solution of 
 the strength of 1:1000 to 1:10000, depending upon the 
 parts involved." 
 
 Dr. George Wiley Broome, Dean of the Woman's 
 Medical College; Professor of Surgery to the Woman's 
 Medical College; Surgeon to the Woman's Hospital, 
 St. Louis, Mo. (See his remarks quoted under the dis- 
 cussion of "Dry Pulverulent Dressings"). 
 
 Dr. A. C. Eernays, Professor of Anatomy, Woman's 
 Medical College, St. Louis, Mo.: "The following are 
 some of my favorite formulae: 
 
 I^ Collodii, flgiv. 
 
 Hydrargyri bichloridi, - - gr.i. 
 
 M. 
 
 S. To be used with a brush over stitches and in- 
 cision so as to seal wound. 
 
 B$ Acidi Borici. 
 
 Bismuthi subnitrici, - • aa 5^3 • 
 
 M. 
 
 S. To be dusted on the incision very profusely so 
 as to cover up the stitches. 
 
 "Recently an excellent powder for tbe dry treatment 
 of wounds has been put before the profession in a most 
 convenient form under the name of Sennine." 
 
 The author himself will add that he has secured with 
 the dry dressing which Dr. Bernays mentions (Sennine, 
 a combination of phenol and boric acid) most excep- 
 tional results in cases amenable to dry treatment — in- 
 deed, in one case of accidental incised wound of the 
 hand in which he was himself his own patient, the pro- 
 cess of repair was naught less than an ideal one. These 
 results, as we have previously noted, have been corrob- 
 orated by a large number of eminent medical gentle- 
 men. 
 
344 
 
 We may summarize some of these statements and re- 
 searches as follows, bearing in mind that this is by no 
 means complete otherwise: 
 
 Carbolic Acid. — Gussenbauer, Esmarch, Lister, An- 
 nandale, Senn, Barton, White, Chiene, Horsley, Ger- 
 rish, Gaston, Hunt, Keen, Yandell, Bischoff, Bar, 
 Fritsch, Winckel, Lucas Cbampionniere, Kocher, Gers- 
 ter, etc. Used exclusively by: Lister, Chiene, Annan 
 dale, Horsley. Bischoff, Fritsch, Winckel, Lucas-Cham- 
 pionniere, and others. 
 
 Corrosive Sublimate. — Czerny, Gussenbauer, Es 
 march, Keen, Barton, Hunt, White, Bernays, Michael, 
 Wharton, Bradford, Gerrish, Gaston (only for the pur- 
 pose of cleansing the skin in the vicinity of operation), 
 Senn, McGraw, Yandell, Harrison, Gerster, Mastin, 
 Kocher, etc. Used exclusixely by: McGraw, Michael 
 and Wharton. 
 
 Iodoform. — Esmarch, Czerny, Gussenbauer, Michael, 
 Bradford, Gerrish, Yandell, Barton, White, Mastin, 
 Gerster, Kocher, etc. 
 
 Sennine — Broome, Yarnall, Bernays, Heine Marks, 
 Mastin, Martin, Morse, Buchanan, etc. 
 
 BoRACic Acid. — Harrison, Mastin, Bernays, Kocher, 
 Buchanan, etc. 
 
 loDiN. — Senn, Bryant, Gaston, etc. 
 
 Bismuth Subnitrate. — Esmarch, Kocher, Bernays, 
 Mastin, etc. 
 
 Hydronaphthol.— Park, Flower, etc. 
 
 Salol —Esmarch, Harrison, etc. 
 
 Hydrogen Peroxid — Bradford, Gaston, etc. 
 
 Aristol — Bradford, Mastin, etc. 
 
 loDOL. — Esmarch, Bryant, etc. 
 
 Mustard. —Park . 
 
 Antipyrin. — Park, etc. (Used as an antiseptic 
 styptic.) 
 
 Double Cyanid of Zinc and Mercury. — White, etc. 
 
AUTHORS. 
 
 Abbot, 95, 140, 152, 184, 211, 212 
 Adet de Roseville, 29. 
 Agrigentum, 11. 
 Allen, 119. 
 
 American Public Health Associa- 
 tion, 210. 
 Anel, 24. 
 
 Annandale, 285, 322, 330. 
 Anthoine, 150. 
 Arcaeus, 17. 
 Aristotle, 18. 
 
 Arloing, 118, 122, 179, 203. 
 Arnold, 259. 
 Ashhurst, 336. 
 
 Bantock, 238. 
 
 Barton, 336. 
 
 Baumgarten, 43, 63. 
 
 Bataille, 97, 
 
 Bayard, 27, 120. 
 
 Baxter, 122, 123. 
 
 Beauperthius, 29. 
 
 Beck, 170. 
 
 Behring, 67, 70, 71, 75, 76, 146 
 
 150* 157, I5^» 198,216,295. 
 Bell, 26, 27. 
 Bellosti Augustin, 23. 
 Bergmann, 31, 54, 310, 3"» SU- 
 
 Berkley, 28. 
 Berlioz, 206. 
 
 Bernays, 191, 318, 324, 3+4. 
 Besclin, 149. 
 Beu, 199. 
 Bilgner, 24, 27. 
 Billroth, 244, 279, 330. 
 Binz, 25. 
 Bitter, 70. 
 Blanc, 206. 
 Blondus, Michel, 14. 
 Blount, 98. 
 Blunt, 91. 
 Blythe, 122. 
 Bochefontaine, 25. 
 Boer, 100. 
 Bolton, 121, 123. 
 Booerhave, 24. 
 Bourget, 182. 
 Boyle, Robett, 20. 
 Bradford, 325, 342. 
 Braun,27i. 
 Braunschweig, 59. 
 Brieger, 51, 56, 80, 104. 
 Brignot, 244. 
 Brodnax, 199. 
 
 Broome, 196, 197, 318, 325, 326 
 344- 
 
U6 
 
 drowning, 315. 
 Brugnatelli, 56. 
 Bruno, 13. 
 Bryant, 322, 331. 
 Buchholtz, 108, 109, 113. 
 Budd, 33. 
 
 Buechner, 53, 59, 60, 63, 67, 70 
 72, 76, 158. 
 
 Cadcac, 87, 118, 149, 162. 
 
 Cadet de Gassicourt, 53. 
 
 Caignard de la Tour, 6, 28, 29, 32 
 
 Callender, 185. 
 
 Calvert, 32, 33, 120, 122, 123. 
 
 Cannon, 43. 
 
 Cattani, 75. 76, 79, 80, 228. 
 
 Chaumette, 27, 120. 
 
 Chautard, 156. 
 
 Cerna, 10 1, 103. 
 
 Cheyne, 84, 121. 
 
 Chiene, 331. 
 
 Christmann, 70, 151. 
 
 Christmas, 166, 170. 
 
 Cohn, 41. • 
 
 Colasanli, 147. 
 
 Colbatch, 21, 27. 
 
 Col de Villars, 24. 
 
 Cornevin, 118, 122, 179, 203. 
 
 Cozzolini, 164. 
 
 Cunningham, Lewis and D., 66 
 
 84. 
 Curtmann, 100. 
 Czerni, 297, 329. 
 
 Dann, 53. 
 Darzens, 172. 
 
 Davainne, 30, 32, 122, 123. 
 
 Davidsohn, 286. 
 
 D*Egineta, 13. 
 
 Delacroix, i6, 97, 129, 211. 
 
 De la Tour, 6, 34. 
 
 Delavan, 98. 
 
 Demosthenes, 253. 
 
 Dennis, 245. 
 
 De Ruyter, 314. 
 
 De Vigo, 14. 
 
 Desnos, 181. 
 
 D.sneuf, 184. 
 
 Doering, 177. 
 
 Donne, 29. 
 
 Dougall, 108, 122. 
 
 Douglass, 123. 
 
 Downes, 91. 
 
 Draer, 205. 
 
 Dubois, 172. 
 
 Duclaux, 168. 
 
 Dulerly, 171. 
 
 Dujardin-Beaumetz, 30, 127. 
 
 Duggan, 117. 
 
 Dumas, 120. 
 
 Dupre, 53, 54. 
 
 Dupuy, 53. 
 
 Duroy, 157. 
 
 Eberth, 42, 229. 
 Emmerich, 70, 71, 75, 148. 
 Empedodes, 11. 
 Empis, 184. 
 Erand, 98. 
 Esmarch, 317, 330, 
 Ezechias, 12. 
 
347 
 
 Faktor, 99. 
 
 Fassbender, 55, 
 Ferran, 154. 
 
 Feuerbringer, 262, 301, 303. 
 Fischer, 97, 122, 145. 
 Fisher, 128. 
 Fleck, 108. 
 Flint, 187. 
 •Fodor, 66, 70. 
 Foote, 165. 
 Forster, 104. 
 Fortchinskey, 229. 
 Fowler, 247. 
 Fox, 214. 
 Fraenkel, 76, 229. 
 Frisch, 87. 
 Fritsch, 182. 
 Fritze, 27. 
 
 Gaillard, 91. 
 
 Gaffky, 43- 
 
 Garrigues, 269. 
 
 Gaspard, 53. 
 
 Gaston, 342. 
 
 Gaulier, 48. 
 
 Gay Dussac, 28, 29. 
 
 Geister, 91. 
 
 Geppeit, 138. 
 
 Gerrish, 325, 341. 
 
 Gersier, 227, 248, 253, 255, 256 
 275,283, 292, 29s, 298, 302, 305 
 306,308,311,316,318,335. 
 
 Ghriskey, 136, 176, 259, 261, 285 
 
 Globig, 88. 
 
 Goldmann, 103. 
 
 Goldschmitt, 177. 
 
 Gordon, 259. 
 Gottstein, 161. 
 Graucher, 156. 
 Grohmann, 66. 
 Grube, 108. 
 Guareschi, 56. 
 Gubler, 184. 
 Guiboust, 27, 120. 
 Gschiedlon, 66. 
 Guinard, 162. 
 Gunning, 55. 
 Gussenbauer, 329. 
 Guttman, 145, 205. 
 Guyton, 128. 
 
 Hallibuston, 70. 
 Hallier, 25. 
 Halsted, 127. 
 Hamilton, 237. 
 Hansen, 41, 212. 
 Hardenbcrgh, 188. 
 Harder, 196. 
 Hardesty, 196. 
 Hare, 121, 188 
 Harris, 260. 
 Harrison, 333. 
 Haschimodo, 95. 
 Haukin, 56, 70, 71. 
 Helferich, 310. 
 Helmholtz, 29, 30. 
 Heister, 24. 
 Hemmer, 54. 
 Hennemann, 54. 
 Herbot, 25. 
 Hildebrandt, 60. 
 Hirne,;i27. 
 
34:8 
 
 Hitchmann, i88. 
 Hock, 215. 
 Hoffa, «;6. 
 Horsley, 322, 332. 
 Hoppe-Seiler, 122. 
 Huenefeld, 54. 
 Hueppe, 107, 204, 206. 
 Hueter, 40. 
 Hugge, 122. 
 Hunt, 323, 338. 
 Hunter, 26. 
 
 International Congress of Physi- 
 cians and Surgeons at Brussels, 
 267, 268. 
 
 Jaeger, 116, 176. 
 Jasuhara, 75, 76. 
 JeanneJ, 15. 
 Jenner, 74. 
 Johnson, 113, 227. 
 Jones Beuce, 54. 
 
 Kaposi, 215. 
 
 Karlow, 231. 
 
 Keen, 127, 298, 323, 334. 
 
 Kelly, 136, 176, 259,261, 262,264 
 
 285, 303. 
 Kern, 27. 
 Kerner, 53. 
 King o{ Servia, 249. 
 Kingzett, 188. 
 Kirchner, 130. 
 Kitasato, 75, 76, 80, 95, 99, 113 
 
 116, 132, 152, 161, 167, 171,173 
 
 i74» I75» 184, i99»2ii. 
 
 Klebbs, 42. 
 
 Klein, 96, 140. 
 
 Klemperer, 76. 
 
 Koch, 40, 41, 49, 56, 89, 90, 91, 95 
 96, 97, 99, 105, ic8, 116, 121 
 122,123, 129, 130, 133, 135' H9 
 153,157, 166, 167, 173,174,175 
 184, 193, 210, 216, 218, 219, 220^ 
 229, 279. 
 
 Koch, E., 188. 
 
 Kocher, 284, 293, 296, 303, 306 
 308, 312, 314. 
 
 Kolbe, 183, 184. 
 
 Kopp, 151. 
 
 Kresin, 145. 
 
 Kronacher, 148. 
 
 Kuemmel, 282, 301, 302. 
 
 Kuhn, 97. 
 
 Lafage, 150. 
 
 Lanfranc, 13. 
 
 Langenbeck, 28, 330. 
 
 Langenbuch, 157. 
 
 Laplace, 122, 142, 145. 
 
 Laser, 188. 
 
 Laveran, 42. 
 
 Lazerus, 64. 
 
 LeBoeuf, 20. 
 
 Leeuwenhock, 19, 28. 
 
 Lefort, 97. 
 
 Lemaine, 33, 120. 
 
 Leuret, 53. 
 
 Leviticus, 11. 
 
 Limpricht, 183. 
 
 Lindemann, 79. 
 
 Lisler, 4, 21, 27, 29, 34, 35» 3^, 37 
 
249 
 
 38, 39» 40, 4i,43» 112, 120, 125 
 126, 140, 142, 158, 163,218,241 
 278,279,285,305, 306,318. 
 
 Loeffler, 42. 
 
 Loew, 70. 
 
 Loewenthal, 186. 
 
 Lombard, 26. 
 
 Lomboso, 56. 
 
 Longard, 85. 
 
 Lucatello, 229. 
 
 Lukaschewitsch, 168. 
 
 108, 109, 113, 116, 122, 127,131 
 i35> H7» i53» 162, 164,167,173 
 i75» 176, 179' 198* 199,203,212 
 217, 218. 
 
 Morand, 52. 
 
 Morse, 195. 
 
 Morton, 245. 
 
 Moses, II. 
 
 Mosetig von Moorhoff, 313, 327 
 
 Mosso, 56. 
 
 Mueller, 25. 
 
 MacknofF, 59. 
 
 Magatus, 19. 
 
 Magendie, 53. 
 
 Maison d'Accouchments, 267. 
 
 Malet, 87. 
 
 Marks, i 6, 318. 
 
 Martin, 43, ^18. 
 
 Mastin 95, 318, 324, 340. 
 
 Mater y Hospital, New York 
 
 270. 
 Mayer, 25. 
 Mayow, 27. 
 
 McClintock, 70, 77, 96, 285. 
 McDowell, 235. 
 McGraw, 324, 341. 
 Meigs, 26 . 
 Menz, 202. 
 Meyer, 54, 215, 229. 
 Merk, 100. 
 Mermann, 270, 271. 
 Meunier, 118, 149. 
 Michael, 343. 
 Mikulicz, 312. 
 Miquel, 88, 97, 99, 100, 105, 107 
 
 Neisser, 41, 158, 217. 
 Nelaton, 97. 
 Nenki, 53, 55. 
 Neuber,.282. 
 Neudorfer 22, 143, 158. 
 Neuhaus, 225. 
 Newton, 3. 
 Nicati, 123. 
 Nicolaier, 43. 
 Nissen, 70, 93, 117. 
 Nold, 196. 
 Novy, 70, 77. 
 Nussbaum, 242, 310. 
 Nuttall, 66. 
 
 Oatman, 196. 
 Obermeyer, 41. 
 Ogata, 75, 76. 
 Ogston, 84, 184. 
 Ohmann-Dumesnil, 192. 
 Orfila, 53. 
 Orthenberger, 67. 
 Oswald i38. 
 
350 
 
 Palmer, 333. 
 
 Panum, 31. 54. 
 
 Paracelsus, 15. 
 
 Pare, 15, 26, 27. 
 
 Park, 100, i77»323»338. 
 
 Parmanus, 24. 
 
 Parisi, 25. 
 
 Parset, 84. 
 
 Pasteur, 30, 32, 33, 34, 35, 40, 41 
 
 42, 75, 241, 299. 
 Paul, 90. 
 Patt, 25. 
 Pekelhomig, 70. 
 Pepper, 12,44. 
 Perci, 26. 
 Personne, 127. 
 Perret, 1 50. 
 Pertij, 31, 
 Petri, 199. 
 Pfeiflfer, 43. 
 Pfiuhl, 116. 
 
 Pharmaceutische Zeitung, 178. 
 Pippingskoeld, 270. 
 Playfair, 259. 
 Pollender, 30. 
 Polli, 25, 31, 201, 203. 
 Portes, M., 179. 
 Prestley, 26. 
 Price, 239. 
 Pringle, 25. 
 Frosskauer, 128, I2Q. 
 Prudden, 87. 
 
 Quinke, 184. 
 Ranke, 216. 
 
 Raschig, 143. 
 
 Rayer, 30, 32. 
 
 Reiche, 186. 
 
 Reynier, 187. 
 
 Ribbert, 59, 84. 
 
 Richter, 26. 
 
 Riedlin, 100 149, 159. 
 
 Rietch, 123. 
 
 Robb, 136, 176, 259, 261, 285. 
 
 Roberts, 177. 
 
 Robin, 31, 160. 
 
 Rogerius, 13. 
 
 Rohe, 90, 129. 
 
 Rosenbach, 122. 
 
 Rosenthal, 113. 
 
 Roth, 59. 
 
 Roux, 76, 153. 
 
 Rutler, 260. 
 
 Salkowski, 108, 130. 
 Salmon, 79. 
 Schede, 279, 312. 
 Sthill, 97, 123, 145. 
 Schimmelbusch, 59, 286, 287, 289 
 
 290, 291, 320. 
 Schlange, ^19. 
 Schmidt, 54, 66. 
 Schmiedeberg, 31, 54. 
 Schroeder, 31. 
 Schroeter, 122. 
 Schulze, 28, 29, 30, 34. 
 Schumann, 53. 
 Schutz, 42. 
 
 Schwan, 29, 30, 34, 39, 40» 241. 
 Schwartz, 228. 
 Schweninger, 54. 
 
361 
 
 Scrivner^ 196. 
 
 beibel, 160. 
 
 Seitz, 210. 
 
 Selmi, 52, 55. 
 
 Semmelweiss, 271. 
 
 Senn, 318, 323, 334. 
 
 Sertuerner, 54. 
 
 Sevet, 120. 
 
 Shimwell, 155, 156. 
 
 Shmitt, 76. 
 
 Sivet, 27. 
 
 Sittmann, 67. 
 
 Socin, 279, 330. 
 
 Solis-Cohen, 114. 
 
 Solomon, 12. 
 
 SoDnenschein, 55. 
 
 Suergnersky, 107. 
 
 Spence, 242. 
 
 Spengler, 98, 310. 
 
 Squibb, 103, 107, 115, 124, 159 
 160, 165, 178, 205, 208. 
 
 Steffen, 104. 
 
 Steinmetz, 70. 
 
 Sternberg. 42, 63, 76, 87, 88, 91 
 100, 109, 112, 113, 122,123,127 
 ^33> 145, 152, i55» I59»i66, 174 
 ^75, i79» 184, 201, 209,210,211 
 225. 
 
 Stich, 54. 
 
 Stille, 98. 
 
 Stilling, 100. 
 
 Stimson, 123, 224, 280. 
 
 Tchourilow, 115. 
 
 Theophrastus, 8. 
 
 Thiersch, 185, 279. 
 
 Thinot, 210. 
 
 Thomas, 118, 122, 179, 203. 
 
 Thornton, 238, 246. 
 
 Tilanus, 158. 
 
 Tizxoni, 75, 76, 79, 80, 228 
 
 Tour, 6. 
 
 Traube, 66. 
 
 Trousseau, 53. 
 
 Tsuboi, 70. 
 
 Tyndall, 91, 287. 
 
 Unna, 180. 
 Ure, 29, 30. 
 
 Van Ermengem, 93, 132. 
 Vaughan, 56, 68, 69, 70, 71, 72, 73 
 
 77^ 78, 79, 80, 84. 
 Velpeau, 157. 
 Vicary, 17. 
 Vicquerat, 303. 
 Vifijo, 14. 
 Voelsch, 88. 
 Voit, 67. 
 
 Volkmann, 243, 278, 288. 
 Von Haller, 52. 
 Von Dusch, 31. 
 Von Kern, 27. 
 Von Mering, 104. 
 Von Walther, 27. 
 
 Tait, 238. 
 
 Tavel, 287, 303, 305, 308. 
 
 Tassinari, 217. 
 
 Wagner, 231. 
 Walb, 113. 
 Walthard, 308. 
 
352 
 
 Walther, 27. 
 
 Wharton, 343. 
 
 Wassermann, 80. 
 
 Weber, 54. 
 
 Weigert, 41, 6 g. 
 
 Weiss, 53. 
 
 Welch, 140, 176, 285, 303. 
 
 WelV35. 
 
 Westrumb, 54. 
 
 Weyl, 64. 
 
 White, 238, 245, 251,335. 
 
 Williams, 196. 
 
 Wiseman, 20. 
 
 Withauer, 205. 
 
 Wolffhuegel, 89, 90 
 
 Wojtaseek, 208. 
 Wood, 98, 127, 185, 213- 
 Wooldridge, 73, 77, 80. 
 Wurtz, 17. 
 Wysokowicz, 66, 84. 
 
 Yandell, 324, 341. 
 Yamall, 194. 
 
 Yersine, 88, 123, 145, 149, 171 
 216. 
 
 Zimmermann, 285, 305, 306. 
 Zirmssen, 124. 
 Zuelser, 55. 
 Zuntz, 70.