A FEW OPINIONS ON THE ANTISEPSIS QUESTION: IN SYMPOSIUM FORM.

The following opinions have been formulated by their signers, physicians of much experience and scholarly intelligence, in reply to a few questions on the subject of asepsis, antisepsis, and compatibility, or otherwise, of these methods with the homoeopathic rule:

I. DR. HELMUTH.

I am in a great hurry to-night, but can say that I am a firm believer in aseptic and antiseptic methods. I believe that it is common sense to say that, if we can exclude micro-organisms from a wound decomposition will not occur.

I do not understand how a carefully conducted aseptic or antiseptic treatment can in any way interfere with homoeopathic treatment. It don't in my practice; in fact, the medicines act better with patients undergoing such treatment.

It seems to me also that there has lately been a difference of opinion as to terms - What is asepsis? What is antisepsis? Yours truly,

WM. TOD HELMUTH.

II. DR. I. T. TALBOT.

BOSTON, March 31, 1892.

You are kind enough to ask my opinion concerning the value of aseptic and antiseptic methods of treatment. I consider them. the basis of the great advance made by operative surgery in the last twenty years.

Asepsis is, of course, the ideal condition when there is no poisonous condition in or about the patient; when the air, the clothing, the furniture, the room, the persons themselves, including the operator and assistants, are all free from any possibility of conveying poison to the patient undergoing an operation and placed in a position to absorb any virus brought in contact with the wound. But in the present condition of the world it requires the greatest care to remove those septic influences which are so constant, and asepsis is attained only by antisepsis.

That this is capable of great abuse, such as the undue use of toxic substances, so that in destroying the supposed virus the patient also may succumb, is quite possible, and the surgeon should use great judgment in his antiseptic methods.

We all know that soap and water, and abundance of fresh air, heat and cold, rank among the most powerful antiseptics, and should be used as far a practicable. But these are not always sufficient; hence the well-known fumigation of rooms with burning sulphur, the sulphurous acid penetrating into cracks and

crevices and hidden places where the other substances could not effectively reach.

Instruments, too, can be rendered septic by the high and long continued application of heat. The hands and person of the operator, and the part of the patient to be operated upon, can often be rendered aseptic by thorough washing; but sometimes even this is inefficient, and a more powerful antiseptic, like carbolic acid or bichloride of mercury, and other powerful so-called antiseptics, may be used with great benefit as well as entire safety.

The methods of using these substances advantageously the experience of the last ten years has done much to improve, and while the efforts of the profession, and particularly of surgeons, are directed to the study of the best methods of antisepsis I am sure we are moving in the right direction.

I do not see anything in such methods incompatible with homœopathy. In fact homoeopathy positively demands this, and it has been through the care of the surroundings of patients that homœopathy has done so much for the advancement of medical practice. If a patient is filthy the first duty of the homoeopath, before any pellets are given, is to remove the noxious surroundings. We use substances, soap and water, and even detergents, which, taken into the stomach, would act as poisons, but which upon the skin and upon the clothing of the patient are only healthful, and render the system more susceptible to the influence of the properly selected medicine; and I should as soon think of the effects of the weekly washing being incompatible with homoeopathy as are the results of properly applied antiseptics.

One may find fault with the methods and kinds of antiseptics used if he chooses, and show a better way, but I think it absurd in the extreme to find fault with the principle which, often as it has been applied, has shown such wonderful results for good. Yours sincerely,

No. 66 Marlborough st., Boston.

III. DR. CONRAD WESSELhoeft.

I. T. TALBOT.

One who ventures to reply to the questions propounded concerning the above subjects should be aware that he may find himself one of a symposium, within which accurate knowledge on the subject proposed will vary like the opinions expressed. Therefore the following is offered, in the hope that it will not deviate essentially from the finding of an intelligent minority.

In order to answer your questions correctly, concerning aseptic and antiseptic methods of treatment, I must premise that these methods apply not only to the general prevention of un

cleanliness, but that they are wholly directed to the exclusion of bacteria from the patient, whether surgical or medical.

To say, as some do, that antiseptic methods are equivalent to absolute cleanliness would not cover the ground, unless it is understood that cleanliness signifies the exclusion or destruction of noxious microbes. In this sense cleanliness, as far as possible absolute, should stand first and foremost in all hygienic measures in medicine and surgery.

As to your question, whether there is anything in such methods incompatible with homoeopathy, I should perfer to say medicine in general in the place of homoeopathy alone.

It will be found that, for obvious reasons, the answer to the question must be somewhat conditional.

Antiseptic measures are unavoidably associated with the application of certain substances which destroy or prevent the growth of microbes. Heat, such as the body can tolerate, is not sufficient for that purpose, and boiled water, as soon as it falls a little below the boiling point, very readily becomes re-infected. While pure water disinfected or sterilized by heat would be the most desirable antiseptic, experience teaches that it is not sufficient for the purpose, and hence mercuric bichloride, carbolic acid, iodoform, and many other more or less powerful drugs, are used, in a highly diluted state, in combination with water.

The question is well worth considering, whether these substances interfere with medicines administered internally; but, unfortunately, experience concerning this point is imperfect, though not wanting, and any opinion concerning it must therefore be somewhat theoretical.

Surgeons apply antiseptic measures to intact surfaces, that is, to the outer integument as well as to cavities. It is doubtful if fluids sterilized (made aseptic) by drugs, in very dilute state, would make such conditions produce serious or undesirable effects, provided the surfaces with which they come in contact are sound.

That such undesirable effects have followed the application of certain sterilized solutions (mercuric bichloride, carbolic acid,) to wounded tissues is admitted. The conclusion to be drawn is, that antiseptics interfere with internal medication under certain known conditions.

Possibly even a very dilute solution, say, of mercuric bichloride, would interfere with very dilute medicines administered internally; nor is it probable that their influence upon a brisk purgative or an opiate would be especially salutary.

If cases should occur where antisepsis and internal medication seem indicated, it is for the physician to decide which of the two is more necessary, and to omit the measure of less importance.

In most surgical instances the application of antiseptic dressings is of a local nature, not precluding internal medication by highly diluted medicines, say, from the first to the fifth decimal attenuation. Those who use "high potencies" believe them to be of such invincible strength that any consideration of their relation to antiseptics is unnecessary.

Antiseptic preparations, in the form of "internal" medicine, are not in use, on account of their danger; but as means of disinfecting rooms, clothing and utensils, they are indispensable, and do not interfere with internal medication.

In some quarters antisepsis has met with opposition, and has perhaps here and there lost ground; not because the underlying principle is unsound, but because, in various ways, it has been abused and misapplied, thus leading to a misunderstanding on the part of some. The market has been fairly overloaded with patented and unpatented antiseptics. In devising means of cleanliness the thing has been overdone in the form of nauseous and noxious greasy salves and plasters, which, by failing to fulfil their avowed purpose, irritate the patient and discourage the novice in medicine, who, in the bustle of the cleansing process, fails to see the true underlying intention and principle which in perfection, next to a safe and beneficent rule (s. s. c.) of applying medicines, is the greatest step medical science has ever taken in advance. Yours sincerely,

IV.

In reply I would say :

DR. CH. GATCHELL.

C. WESSELHOEFT.

(1). I believe that aseptic and antiseptic methods of treatment have been of inestimable value in preventing disease, in rendering it benign, and in saving human life. In the present state of knowledge upon the subject I would look upon a neglect to make use of such methods as little less than criminal upon the part of the practitioner of medicine, the accoucheur, or the surgeon. I do not believe that one can be too strict in their application. I have been acquainted with some who employ aseptic methods and yet regard antiseptic methods as being unnecessary and without value. Upon observing the practice of those who are of this opinion, it appears to me to be little more than a refinement of language to distinguish their asepsis from another's antisepsis.

My convictions upon the main subject have been formed after a study of the reports made by men of prominence in various hospitals, both in this country and abroad, and upon my own experience and observation in hospital practice.

(2). I see nothing in these methods incompatible with the practice of homoeopathy. Indeed, to make such claim would. require, I think, a very violent assumption.

Fraternally yours,

CH. GATCHELL.

V. DR. HORACE PACKARD.

In response to your request for remarks concerning the value of "aseptic and antiseptic" methods of treatment, I submit the following:

Aseptic means without sepsis.

Antiseptic means against sepsis.

Sepsis is now universally recognized as the cause of all putrefactive fermentation in surgical wounds.

All surgeons universally practice some sort of method directed against sepsis; hence their belief is in antiseptic surgery, and they practice according to the light which they have upon the subject, antiseptic surgery.

Aseptic surgery is a misnomer, and the term should never have been introduced into surgical literature. It is only a source of confusion, and leads many who are not thoroughly grounded on our present knowledge of wound infection, suppuration and putrefactive decomposition, to ignore the great truths which the herculean efforts of Lister have taught us. At best, with all the antiseptic methods, and the best antiseptic methods known to science, we can only approximate the ideal state of freedom. from sepsis.

The only question at issue, as I see it, is, whether in our antiseptic methods of treatment chemical antiseptics shall be used. That they are of value in freeing the field of operation from septic material, and in making the hands of the operator and his assistant clean, I can have no doubt. Experience has shown us that chemical antiseptics are not necessary in making instruments, dressings, or utensils sterile. We are able to accomplish all this by the aid of heat.

Neither are chemical antiseptics of value in a wound which is made with clean instruments and clean hands, and upon which clean sponges and dressings are used.

My estimate concerning the value of a rigidly executed antiseptic method of treatment, based on an intelligent comprehension of the laws of tissue repair, is incomputable.

I cannot see how the compatibility or incompatibility of homœopathic treatment in connection with such antiseptic methods of wound treatment can in any way arise. There is absolutely nothing known in homoeopathy that can stop the pro