Page:The Evolution of Surgery.djvu/16

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The Evolution of Surgery.

Thus it is then that almost imperceptibly and year by year we of this generation have seen the outcome of Lord Lister's great work, and have seen results from it of which he himself could have had no conception. For surgical advance unquestionably owes itself to two great fundamental discoveries—anæsthesia and asepsis. Of anaesthesia I shall say nothing: I am thankful indeed that it came long before my day. Whether the future may hold for us a perfection in the methods of local or spinal anaesthesia which will entirely replace general narcosis or not, at least we have now means of relieving immediate pain and shock so perfect, and on the whole so safe, that we can always operate slowly, carefully and with precision. The hurried and "brilliant" surgery of former days is past for ever, and never again need we sacrifice accuracy to the fact that human agony could only be endured for a very limited period.

But as regards asepsis, the full value of Lister's work had not been realised in 1883 and the evolution of surgery in the five and twenty years of my personal experience has been mainly the development of this great advance—a development the lines of which I hope to be able to trace to-day.

It is, of course, notorious that life and limb are saved by preventing the diseases of wounds, and by the practical abolition of pyæmia, septicæmia, erysipelas, spreading gangrene and suppuration. But it would seem to me that the operative technique of surgery owes much of its progress to a less well recognised result of completely aseptic wound treatment. Apart from the graver infections almost every wound was formerly associated with at least some surrounding inflammation. Even in the slightest of cases there was an area of redness extending for about half an inch from the cut surface. This area presented some swelling, it was painful and tender and the tissues involved had lost