itself, but sometimes occurs along with the ordinary pyogenic bacteria, in which cases there results a mixed infection. It is capable, however, alone of causing spreading gangrene, an extremely dangerous condition, and one which nearly always terminates fatally. Ernst has described a case of fatal septic endometritis following abortion, in which at the autopsy the walls of the uterus were found to be gangrenous and contained bubbles of gas; there were necrotic nodules surrounding cavities filled with gas which were scattered throughout the liver and heart muscle; large numbers of these bacilli existed wherever the presence of gas was demonstrable. Another case of general infection with the bacillus aérogenes capsulatus following abortion, associated with general subcutaneous emphysema 28 ASEPTIC SURGICAL TECHNIQUE. and accumulations of gas in the blood-vessels all over the body, was fully reported in this country in 1894 (Steward, Baldwin, and Graham), and the organism is now recognized as being of considerable pathogenic importance. In order to isolate this bacillus anaérobic methods have to be employed. It varies in length from seven to nine micro-millimetres, is encapsulated, non- motile, and sometimes forms spores. Pelvic abscesses are sometimes found which contain gas, and in such cases the possibility of the presence of this bacillus should always be taken into consideration. When, after an abdominal section, the patient has died without having exhibited the characteristic symptoms of septicemia, the death has not usually been attributed to septic infection, but rather has been supposed to be due to “heart-failure,” shock, pneumonia, suppression of the urine, or some other more or less satisfactory cause. But when a patient dies even less than twelve hours after an operation we cannot positively exclude sepsis as the cause of death until the fact has been proved by an autopsy made by a competent pathologist and bacteriologist. Autopsies are on record at which none of the local lesions which attend septic inflammation were demonstrable to the naked eye. The examination of cover- slips, however, made from a small amount of fluid in the pelvic cavity, showed that organisms were present in large numbers, and tubes of nutrient agar-agar inoculated with the same fluid gave the characteristic growths. ASEPSIS. 29 Experiments have shown that the poisoning resulting from a peritoneal infection is sometimes so intense as to cause death before the appearance of any marked local reaction in the peritoneum. In the fatal cases in which it has been impossible to secure a complete autopsy, even where during life the ordinary symptoms of such a condition were absent, we have not the right to state positively that death was not due to septic infection. It is undoubtedly more comforting to the operator to attribute a fatal result to any cause other than this, since he is naturally unwilling to think that his technique has been faulty. Those surgeons who are best able to judge are perhaps most ready to admit the possibility of infection of the wound through some slip during the operation, since it is they who realize the manifold ways in which such an accident might occur. In practising asepsis we aim at bringing about that condition in which there is complete absence of septic material,—a condition which, of course, can be insured only by excluding all pathogenic micro-organisms from the site of operation. By this we do not mean to say that in the most complete asepsis to which we attain there is always a sterile wound; on the contrary, as we have already stated, it is probable that most fresh wounds contain a certain number of organisms, but these are either non-virulent or are present in too small numbers to give rise to the phenomena of sepsis. 30 ASEPTIC SURGICAL TECHNIQUE. The maintenance of an aseptic condition is certainly one of the most important points to be aimed at in formulating a technique of operative surgery. It is true that an ideal technique which will be aseptic from a bacteriological stand-point, and which will protect our wounds so as to prevent the ingress of even a single bacterium, is scarcely ever possible, at least at the present day; but those who control their technique by bacteriological experiments, and strive in every way to approach as nearly as possible such an ideal, constantly aiming at perfect cleanliness in their work, will undoubtedly obtain better results than those who have no such standard. In practising antisepsis we employ the various means which have been devised for destroying bacteria or for so inhibiting them in their action as to render them incapable of giving rise to infection. The agents which are employed to bring about this condition are known as antiseptics and disinfectants. Strictly speaking, antiseptics must be classed separately from disinfectants, the latter term applying only to those agents which kill pathogenic or putre- factive organisms, and which may consequently be termed true germicides, the former to the agents which arrest putrefaction or fermentation, but do not necessarily destroy the micro-organisms. A deodo- rant does away with bad odors, and does not necessarily have either disinfectant or antiseptic powers. While the bacteriologists have shown us that infection rarely takes place from the air, they have also demonstrated that it is most frequently brought about by contact. We can thus readily understand the comparative uselessness of the carbolic spray, and the importance of preventing the introduction of bacteria on the instruments or the hands of the operator and his assistants. The association of laboratory with operative clinical experience must continue; we have learned much, but there is a promise of still greater progress to be reached in this way. While deprecating the adoption of methods based solely upon laboratory experiments, experience having too often shown the inexpediency of such a procedure, I would insist most strongly upon the necessity of the harmonious working together of the surgeon and clinician with the bacteriologist, believing that each and all will in this way gain new facts and new points of view. But in our enthusiasm for asepsis and aseptic methods we must not by any means lose sight of the importance of a perfected mechanical technique. Besides depending upon the presence or absence of the seed,—the bacteria,—the question of infection or immunity is influenced to a great extent by the condition of the soil,—the tissues and fluids of the individual. Our more modern knowledge of wounds and wound-infection should by no means tend to make us belittle the skill of the surgeon, and at the same time it should stimulate him to increase his operative precision. a} ASEPTIC SURGICAL TECHNIQUE. Linear incisions, the avoidance of any rough handling of the tissues and of the use of irritating fluids in the wounds, the filling of dead spaces with substances having their origin in the body (serum, moist blood-clot, known to have definite germicidal power), the abbreviation of the time required for operations, the maintenance of hygienic surroundings, and the adoption of every means for strengthening the vital resistance of the patient—all contribute largely to a surgeon’s success.
Key Takeaways
- Identify and consider the possibility of post-operative infections, especially those caused by Bacillus aérogenes capsulatus.
- Perform thorough autopsies to confirm septic infection when patients die shortly after surgery.
- Maintain strict asepsis during operations to prevent bacterial contamination.
Practical Tips
- Regularly clean and sterilize surgical instruments before use to minimize the risk of introducing bacteria into wounds.
- Use antiseptics and disinfectants appropriately, understanding their limitations in preventing infection.
- Maintain a sterile environment for surgeries to reduce the risk of post-operative infections.
Warnings & Risks
- Do not rely solely on carbolic sprays as they are ineffective against bacteria introduced through contact.
- Be cautious when attributing deaths shortly after surgery to causes other than sepsis without thorough investigation.
- Understand that even with aseptic techniques, some bacteria may still be present in wounds.
Modern Application
While the specific techniques and terminology have evolved since 1916, the core principles of maintaining sterility and preventing post-operative infections remain crucial. Modern surgeons continue to use advanced sterilization methods, antibiotics, and aseptic practices to ensure patient safety. Understanding these historical techniques provides valuable context for modern survival preparedness, especially in emergency settings where sterile conditions may be limited.
Frequently Asked Questions
Q: What is the significance of identifying Bacillus aérogenes capsulatus in post-operative infections?
Bacillus aérogenes capsulatus can cause severe and potentially fatal infections, such as spreading gangrene. Its identification through autopsies helps confirm septic infection when patients die shortly after surgery.
Q: Why is it important to maintain strict asepsis during surgeries?
Maintaining strict asepsis prevents the introduction of bacteria into wounds, reducing the risk of post-operative infections and complications. This is crucial for ensuring patient safety and successful outcomes.
Q: How can modern surgeons apply the concept of 'asepsis' in their practices?
Modern surgeons can apply the concept of asepsis by using advanced sterilization methods, employing strict hand hygiene protocols, and maintaining sterile environments. These practices help prevent infections and ensure patient safety.