THE PRINCIPLES OF SURGERY xxxv
great essay on "The Contagiousness of Puerperal Fever" (1842) brought out the important fact that infection is carried by the hands of doctors and nurses from one patient to another. While this was primarily a contribution to obstetrics, the principle is quite as important in its application to surgery. While Holmes undoubtedly did not succeed in convincing many of the leading men of his day of the correctness of his conclusions, his most forceful writing undoubtedly did a great deal to promote greater care on the part of doctors and nurses to avoid carrying infection by their hands from the diseased patients whom they attended to others not so afflicted. No other writer up to that time had ever collected such a vast amount of data or presented it in anywhere near as convincing a manner. It undoubtedly had an important influence in paving the way for aseptic and antiseptic surgery.
Relatively few of those interested in the history of asepsis and anti- sepsis know that Nathan Smith advised the use of bichloride of mercury solution, ten grains to the pint, many years before it came into general favor as a substitute for carbolic acid in antiseptic wound treatment. Had this observation, published in the "Philadelphia Monthly Medical Journal of Medicine and Surgery," 1827, vol. i, attracted much attention in that day, the general introduction and use of antiseptic surgery would have come about forty years earlier than it actually did. As it did not attract very much notice, Smith was at least spared the harsh criticism and abuse which fell to Lister as a result of his suggestion to use carbolic acid. Lister deserves great credit for introducing the use of carbolic acid in the treatment of wounds. His observations at first were entirely empirical, and had not Pasteur soon shown the reason why carbolic acid is a valuable aid in wound healing, it is possible and even probable that the method would have fallen into disuse as did Smith's bichloride solution.
Although there are some who still regard the use of operating gloves unnecessary, probably the majority of successful surgeons of to-day consider the introduction of rubber operating gloves as one of the impor- tant advances in modern aseptic technic. There seems to be no quest ion that W. S. Halsted was the first to suggest the use of rubber gloves. The important question of their value in surgery is thoroughly discussed by Lockett ("Philadelphia Medical Journal," 1899, vol. iii). He gives the details of a series of experiments carried out in Keen's clinic, showing that the cotton gloves then advocated by Mikulicz and other continental surgeons are not reliable as a means of hand disinfection, and refers to Halsted's paper in the "Johns Hopkins Hospital Reports" (March, 1891, vol. ii). Curiously characteristic of the attitude of German writers, Klenim, in his "Leipzig Inaugural Dissertation," exhaustively reviews the subject of hand disinfection, giving careful references, yet he cretin
