unless he refuses to be convinced by any argument that he finds himself unable to refute. Let us now examine further Dr. Girard's statements. He says: "During a sojourn abroad last winter my attention was particularly drawn to this innovation in surgery, as it had been introduced on the European continent but two years, and was the almost exclusive topic of conversation of the surgical profession there. It happened that my first intercourse was with some of the most decided and renowned opponents of the system, and I became acquainted with all the objections to it before I had witnessed its advantages and benefits. I received therefore the glowing accounts of Lister's disciples with an incredulous ear, and it was only by travelling from one Lister Hospital' to another, that belief in its superiority forced itself upon me. I became convinced that if it is not the only proper wound-treatment, it is the safest one, and renders conservative surgery possible beyond what had ever been believed. It would take volumes to describe all I witnessed, and I cite but a few examples. Who, before this, would have fearlessly opened the knee-joint for suppurative arthritis, as I saw done under the spray,' the patient recovering in a few days with a sound joint? Who would have expected an ovariotomy with general adhesions, in a woman seventy-five, to heal in eight days without a symptom of reaction, or a laparotomy for the liberation of an incarcerated peritoneal hernia in a moribund patient, healing in six days, or a resection of the ulna in nine. days. Hospitals which had been in use for centuries and had become hot-beds of infection, where the majority of operations formerly were followed by pyæmia, gangrene, and erysipelas, where everything had been tried to combat these evils, where treatment open,' occlusive,' by 'immersion,' compresses of chlorine water, carbolized water, even Lister's 'gauze' and paste' had failed, become entirely free from these complications as soon as Lister's system with all its precautions had been introduced. Prof. v. Nussbaum, Surgeon-General in the Bavarian Army, told me that formerly he operated in his hospital with the greatest reluctance, as nearly every case was sure to be followed by grave accidents, even the opening of a panaritium or the amputation of a finger, would cause pyæmia and death; wounds granulating in the most healthy manner, as soon as brought into his hospital, would become gangrenous and the patient would die, when a few days before he appeared to be on the eve of entire recovery. Now everything is changed. While during sixteen years in which he had charge of the Munich General Hospital pyæmia never failed a single month to make its appearance, until at last it seized eighty per cent. of the patients, since the introduction of Lister's system it has absolutely disappeared. The same is the experience of Professor Volkmann, of Halle." The limited space of this treatise does not allow me to enter more fully on the subject of Lister's treatment of wounds; neither does the object which I have sought to accomplish require it. My principal aim has been to call the attention of the surgical profession especially to these facts, viz:— I. That there are certain germs in the air, more particularly in the atmosphere of over-crowded hospitals, which, if permitted to enter wounds, give rise directly to living organisms, inflammation, and suppuration; and indirectly to all septic conditions which are found as wound-complications. 2. That the successful management of wounds depends principally on the ability of the surgeon to keep the wounds, under all circumstances and at all times, free from germs and living organisms; and therefore the value of any method of wound-treatment depends primarily on the degree of antisepsis which can be obtained by it. 3. That the occasional discovery of a few bacteria in a wound, which has been treated antiseptically, does not disprove the fact that these bacteria arise from germs; but may be satisfactorily explained in a variety of ways, especially by the existence of germs which have not been destroyed by the means employed. 1 Ibid. pp. 2, 3. 324 CHAPTER VII. THE APPLICATION AND MANAGEMENT OF VARIOUS FORMS OF AFTER TREATMENT. LISTER'S ANTISEPTIC. THE MATERIAL WATER It is even universally admitted by the surgical authors, who have not yet employed the antiseptic method, that no system of wound-treatment has ever given any better results; whilst those surgeons, who have abandoned all other methods, and now adhere strictly to Lister's system of wound-treatment, are enthusiastic in its praise, and confidentially declare that no other practice gives the same degree of safety to their patients. It is, therefore, unnecessary to enter here into any details intended to illustrate the superiority of this form of treatment. The Lister system of wound-treatment as now perfected meets in every particular the demands of the germ theory, and this is not true of any other form of dressing which has ever been recommended or employed. In all cases where this system has been employed in the treatment of wounds, it has been followed by complete asepsis; if otherwise, the surgeon himself, or, the material employed, must be held responsible for the results, and not the method. Dr. Robert F. Weir, of New York, says: "The chorus on this point is unanimous among surgeons who have sucessfully used it. Hagedorn, of Magdeburg, says that in every failure the surgeon himself is to blame, and not the method; and Lindpaintner, representing the experience of Munich with nearly a thousand cases treated antiseptically, states that it must be considered a precept that the minutest directions must be followed, and that he who does not get the result (desired) must certainly have made some mistake. This opinion is reiterated by all who have achieved success by the method, and the number of such is already large and increasing. A second condition, which really should have come first, is that they who use the method should at least provisionally accept the theory on which the dressing is based; they should, so to speak, act as if they saw germs on everything. This, however, is not so imperative as the one just spoken of. For,' remarks Lister, those who are unwilling to accept the theory in its entirety, and choose to assume that the septic material is not of the nature of living organisms, but a so-called chemical ferment destitute of vitality, yet endowed with the power of self-multiplication such a notion, unwarranted though I believe it to be by any scientific evidence, will, in a practical point of view, be equivalent to the germ theory, since it will inculcate precisely the same methods of antiseptic management. important that this should be clearly understood." " Let us now turn from these introductory remarks to the consideration of the various articles required for the proper application of the antiseptic dressing to amputation wounds. The only germ-destroying agent employed by Lister during the performance of an amputation is the carbolic acid. There are required three acid solutions, carbolized catgut ligatures, metallic sutures, protective, Mackintosh, and antiseptic gauze. The three carbolic acid solutions should be carefully prepared and properly labelled before the commencement of the operation. The solution commonly called 1-30, and which is intended for use with the steam atomizer should be filtered in order to avoid the stoppages in the delivery tube, which will otherwise occur. This 1-30 solution when mixed with the steam should form a spray of the strength of I-40, and it will therefore be observed that the strength of the solu tion intended for use with the atomizer should depend on the atomizer itself. The 1-20 solution is employed in cleansing New York Med. Journ., vol. xxvi. p. 563. the operator's hands, the parts contiguous to the point at which the amputation is to be performed, while all the instruments, drainage-tubes, and sponges which are to come in contact with the wound during the operation, ought to be kept in this solution at least half an hour before they are used, in order to render them thoroughly antiseptic. In my own practice of antiseptic surgery, I very seldom employ the sponge, and greatly prefer the use of the antiseptic gauze, after having dipped it in the 1-40 solution for all the purposes for which others commonly employ the sponge. The gauze possesses the advantage of being always at hand, and antiseptically prepared, and is never used but once and then thrown away. The 1-40 solution is employed in washing the fresh wounds, and may be injected through the drainage-tube after the closure of the flaps and the introduction of the metallic sutures. The surgeon after having carefully cleansed his hands with the 1-20 solution, will find it advantageous if he anoints them with an oleaginous mixture, which should contain one part of the acid to ten of the oil. The application of this mixture will diminish the benumbing, irritating, and roughening effects of the acid. All the aqueous solutions of carbolic acid, but more particularly the 1-20, will be improved by the addition of about six ounces of glycerine to each gallon of water. The glycerine is an excellent solvent of the acid, and consequently serves to hold it in solution, and at the same time renders it somewhat less irritating. Carbolized Catgut Ligatures.-These are the only ligatures which should ever be used in the practice of antiseptic surgery. The ligatures having been placed on the arteries in the usual way, then their ends are cut close to the knots which require no further attention from the surgeon. These ligatures are now made so satisfactory that no better means for the control of hemorrhage can be desired, and even torsion of the arteries seems likely to be entirely abandoned. Drainage Tubes.-Black rubber tubing is the material most frequently employed for these tubes, and will be found varying from the size of a small quill to that of the little finger; and it should be perforated with suitable openings which serve for the |