Results of Ovariotomy before and after Antiseptics
Authors: T. Keith
Journal: BMJ (1878)

EVER since Mr. Lister showed me-now more than ten years ago-a large blood-clot organised in the wound of a compound fracture, I have followed his antiseptic treatment through its various stages in my daily surgical work.Time has only convinced me of its value.In those early days of antiseptics-I speak of ten or twelve years ago-it did not seemn-possible that-any method could be devised whereby the antiseptic principle could be properly carried out in the removal of abdominal tumours.Yet, in the hope that a certain amount of carbolic acid introduced into the abdominal cavity might prevent or retard the putrefaction of the red serum that is apt to stagnate in the pelvis after ovari- otomy, a two or three per cent.watery solution of carbolic acid was freely used in sponging and cleaning out the cavity; antiseptic ligatures, first of the finest silk and then of catgut, were used, and all instruments were rubbed with carbolic oil.Towels were soaked in the watery solution, and sometimes held against the wound, in the vain hope of keeping the air pure as it rushed in when the peritoneal cavity was opened.Carbolic acid was wasted in every possible way.The floor and walls of the room in which the operation was to be performed were sponged with it, and the air was charged with the vapour driven off by heat.For nearly three years-from I869 to 187I-this practice was more or less carried on.The results, which for that time had hitherto been good, did not improve, but rather the reverse, and, after two or three mysterious-looking deaths, in cases that should have done well, this carbolic-acid treatment was thrown aside.It had brought nothing but disappointmel-nt and vexation of spirit.For the next five years, th9ugh I continued to use it as usual in ordi- nary work, no carbolic acid whatever, nor any antiseptic, was made use of in my ovarian operations.Unable, though believing in it as much as ever, to carry out the antiseptic principle, and thus find protection from external agencies, I thought this operation one in which it would be better to trust to care and cleanliness alone.Sponges were simply wrung out in hot water, long boiled, and if any carbolic acid were used in the cleaning of them it was washed away before an operation was begun.Beyond a purgative, nothing of the so-called "preparation" of the patient was made.No restrictions were put upon visitors, except that they must not have come directly from a dissecting-room, or from visiting a case of erysipelas, and they were requested not to touch the sponges.These I always cleaned and took charge of myself.The friends who assisted me-all busy men in large obstetric and general practice-took no special precautions against infection.Sometimes, on putting the question, it was found that almost every kind of infec- tions disease had been already visited that moming; once only was there a suspicion that mischief was carried, for one of my friends him- self took severe erysipelas a few days after he had assisted me at an operation.The patient recovered after a slow attack of blood-poisoning.The regulations made in some hospitals, that every visitor must sign his name in a book, declaring that he has not for a week visited any case of infectious disease or attended a post mnortem examination, before being admitted into the operating-room, has always seemed to me to be meant for a sort of plaisanterie.For my own part, when a case goes wrong after an operation, I have seldom to look far beyond myself for the cause of failure-something done, something not done.This is a lesson hard to learn: we blame persons, things, accidents, and circumstances, rather than ourselves.p WU MUCLI.'MItcr EWO'OT turce orainary cases tnat woutu na-re got weii.