Pasteur had glimpses of another world beyond the phenomena of fermentation—the world of virus ferments. Two centuries earlier, an English physicist, Robert Boyle, had said that he who could probe to the bottom the nature of ferments and fermentation would probably be more capable than any one of explaining certain morbid phenomena. These words often recurred to the mind of Pasteur, who had, concerning the problem of contagious diseases, those sudden flashes of light wherein genius is revealed. But, ever insisting on experimental proofs, he constrained his exalted imagination so as to follow calmly and patiently the road of experimental method. He could not bear the slightest error, or even hasty interpretation, in the praises addressed to him. One day, during the period of the most ardent polemics, in the midst of the struggle on spontaneous generation, a medical man named Déclat, who declared that Pasteur’s experiments were “the glory of our century and the salvation of future generations,” gave a lecture on “The Infinitesimally Small and their R?le in the World.” “After the lecture,” relates Dr. Déclat himself, “M. Pasteur, whom I only knew by name, came to me, and, after the usual compliments, condemned the inductions I had drawn from his experiments. ‘The arguments,’ he said, ‘by which you support my theories, are most ingenious, but not founded on demonstrated facts; analogy is no proof.’” Pasteur used to speak very modestly of his work. He said, in a speech to some Arbois students, that it was “through assiduous work, with no special gift but that of perseverance joined to an attraction towards all that is great and good,” that he had met with success in his researches. He did not add that an ardent kindness of heart was ever urging him forward. After the services rendered within the last ten years to vinegar{224} makers, silkworm cultivators, vine growers, and brewers, he now wished to tackle what he had had in his mind since 1861—the study of contagious diseases. Thus, with the consistent logic of his mind, showing him as it did the possibility of realizing in the future Robert Boyle’s prophecy, he associated the secret power of his feelings; not to give those feelings their share would be to leave one side of his nature entirely in the shade. He had himself revealed this great factor in his character when he had said, “It would indeed be a grand thing to give the heart its share in the progress of science.” He was ever giving it a greater share in his work.
His sorrows had only made him incline the more towards the griefs of others. The memory of the children he had lost, the mournings he had witnessed, caused him to passionately desire that there might be fewer empty places in desolate homes, and that this might be due to the application of methods derived from his discoveries, of which he foresaw the immense bearings on pathology. Beyond this, patriotism being for him a ruling motive, he thought of the thousands of young men lost to France every year, victims of the tiny germs of murderous diseases. And, at the thought of epidemics and the heavy tax they levy on the whole world, his compassion extended itself to all human suffering.
He regretted that he was not a medical man, fancying that it might have facilitated his task. It was true that, at every incursion on the domain of Medicine, he was looked upon as a chemist—a chymiaster, some said—who was poaching on the preserves of others. The distrust felt by the physicians in the chemists was of a long standing. In the Traité de Thérapeutique, published in 1855 by Trousseau and Pidoux, we find this passage: “When a chemist has seen the chemical conditions of respiration, of digestion, or of the action of some drug, he thinks he has given the theory of those functions and phenomena. It is ever the same delusion which chemists will never get over. We must make up our minds to that, but let us beware of trying to profit by the precious researches which they would probably never undertake if they were not stimulated by the ambition of explaining what is outside their range.” Pidoux never retrenched anything from two other phrases, also to be found in that same treatise: “Between a physiological fact and a pathological fact there is the same difference as between a mineral and a vegetable”; and: “It is{225} not within the power of physiology to explain the simplest pathological affection.” Trousseau, on the other hand, was endowed with the far-seeing intelligence of a great physician attentive to the progress of science. He was greatly interested in Pasteur’s work, and fully appreciated the possibilities opened by each of his discoveries.
Pasteur, with the simplicity which contrasted with his extraordinary powers, supposed that, if he were armed with diplomas, he would have greater authority to direct Medicine towards the study of the conditions of existence of phenomena, and—correlatively to the traditional method of observation, which consists in knowing and describing exactly the course of the disease—to inspire practitioners with the desire to prevent and to determine its cause. An unexpected offer went some way towards filling what he considered as a blank. At the beginning of the year 1873, a place was vacant in the section of the Free Associates of the Academy of Medicine. He was asked to stand for it, and hastened to accept. He was elected with a majority of only one vote, though he had been first on the section’s list. The other suffrages were divided between Messrs. Le Roy de Méricourt, Brochin, Lhéritier, and Bertillon.
Pasteur, as soon as he was elected, promised himself that he would be a most punctual academician. It was on a Tuesday in April that he attended his first meeting. As he walked towards the desk allotted to him, his paralyzed left leg dragging a little, no one among his colleagues suspected that this quiet and unassuming new member would become the greatest revolutionary ever known in Medicine.
One thing added to Pasteur’s pleasure in being elected—the fact that he would join Claude Bernard. The latter had often felt somewhat forlorn in that centre, where some hostility was so often to be seen towards all that was outside the Clinic. This was the time when the “princes of science,” or those who were considered as such, were all physicians. Every great physician was conscious of being a ruling power. The almost daily habit of advising and counselling was added to that idea of haughty or benevolent superiority to the rest of the world; and, accustomed to dictate his wishes, the physician frequently adopted an authoritative tone and became a sort of personage. “Have you noticed,” said Claude Bernard to Pasteur with a smile under which many feelings were hidden, “that, when a{226} doctor enters a room, he always looks as if he was going to say, ‘I have just been saving a fellow-man’?”
Pasteur knew not those harmless shafts which are a revenge for prolonged pomposity. Why need Claude Bernard trouble to wonder what So-and-so might think? He had the consciousness of the work accomplished and the esteem and admiration of men whose suffrage more than satisfied him. Whilst Pasteur was already desirous of spreading in the Académie Médecine the faith which inspired him, Claude Bernard remembered the refractory state of mind of those who, at the time of his first lectures on experimental physiology applied to medicine, affirmed that “physiology can be of no practical use in medicine; it is but a science de luxe which could well be dispensed with.” He energetically defended this science de luxe as the very science of life. In his opening lecture at the Museum in 1870, he said that “descriptive anatomy is to physiology as geography to history; and, as it is not sufficient to understand the topography of a country to know its history, so is it not enough to know the anatomy of an organ to understand its functions.” Méry, an old surgeon, familiarly compared anatomists to those errand boys in large towns, who know the names of the streets and the numbers of the houses, but do not know what goes on inside. There are indeed in tissues and organs physico-chemical phenomena for which anatomy cannot account.
Claude Bernard was convinced that Medicine would gradually emerge from quackery, and this by means of the experimental method, like all other science. “No doubt,” he said, “we shall not live to see the blossoming out of scientific medicine, but such is the fate of humanity; those that sow on the field of science are not destined to reap the fruit of their labours.” And so saying, Claude Bernard continued to sow.
It is true that here and there flashes of light had preceded Pasteur; but, instead of being guided by them, most doctors continued to advance majestically in the midst of darkness. Whenever murderous diseases, scourges of humanity, were in question, long French or Latin words were put forward, such as “Epidemic genius,” fatum, quid ignotum quid divinum, etc. Medical constitution was also a useful word, elastic and applicable to anything.
When the Vale de Grace physician, Villemin—a modest, gentle-voiced man, who, under his quiet exterior, hid a veritable{227} thirst for scientific truth—after experimental researches carried on from 1865 to 1869, brought the proof that tuberculosis is a disease which reproduces itself, and cannot be reproduced but by itself; in a word, specific, inoculable, and contagious, he was treated almost as a perturber of medical order.
Dr. Pidoux, an ideal representative of traditional medicine, with his gold-buttoned blue coat and his reputation equally great in Paris and at the Eaux-Bonnes, declared that the idea of specificity was a fatal thought. Himself a pillar of the doctrine of diathesis and of the morbid spontaneity of the organism, he exclaimed in some much applauded speeches: “Tuberculosis! but that is the common result of a quantity of divers external and internal causes, not the product of a specific agent ever the same!” Was not this disease to be looked upon as “one and multiple at the same time, bringing the same final conclusion, the necrobiotic and infecting destruction of the plasmatic tissue of an organ by a number of roads which the hygienist and physician must endeavour to close?” Where would these specificity doctrines lead to? “Applied to chronic diseases, these doctrines condemn us to the research of specific remedies or vaccines, and all progress is arrested.... Specificity immobilizes medicine.” These phrases were reproduced by the medical press.
The bacillus of tuberculosis had not been discovered by Villemin; it was only found and isolated much later, in 1882, by Dr. Koch; but Villemin suspected the existence of a virus. In order to demonstrate the infectious nature of tuberculosis, he experimented on animals, multiplying inoculations; he took the sputum of tuberculous patients, spread it on cotton wool, dried it, and then made the cotton wool into a bed for little guinea-pigs, who became tuberculous. Pidoux answered these precise facts by declaring that Villemin was fascinated by inoculation, adding ironically, “Then all we doctors have to do is to set out nets to catch the sporules of tuberculosis, and find a vaccine.”
That sudden theory of phthisis, falling from the clouds, resembled Pasteur’s theory of germs floating in air. Was it not better, urged Pidoux the heterogenist, to remain in the truer and more philosophical doctrine of spontaneous generation? “Let us believe, until the contrary is proved, that we are right, we partisans of the common etiology of phthisis, partisans of the spontaneous tuberculous degeneration of the{228} organism under the influence of accessible causes, which we seek everywhere in order to cut down the evil in its roots.”
A reception somewhat similar to that given to Villemin was reserved for Davaine, who, having meditated on Pasteur’s works on butyric ferment and the part played by that ferment, compared it and its action with certain parasites visible with a microscope and observed by him in the blood of animals which had died of charbon disease. By its action and its rapid multiplication in the blood, this agent endowed with life probably acted, said Davaine, after the manner of ferments. The blood was modified to that extent that it speedily brought about the death of the infected animal. Davaine called those filaments found in anthrax “bacteria,” and added, “They have a place in the classification of living beings.” But what was that animated virus to many doctors? They answered experimental proofs by oratorical arguments.
At the very time when Pasteur took his seat at the Academy of Medicine, Davaine was being violently attacked; his experiments on septic?mia were the cause, or the pretext. But the mere tone of the discussions prepared Pasteur for future battles. The theory of germs, the doctrine of virus ferments, all this was considered as a complete reversal of acquired notions, a heresy which had to be suppressed. A well-known surgeon, Dr. Chassaignac, spoke before the Académie de Médecine of what he called “laboratory surgery, which has destroyed very many animals and saved very few human beings.” In order to remind experimentalists of the distance between them and practitioners, he added: “Laboratory results should be brought out in a circumspect, modest and reserved manner, as long as they have not been sanctioned by long clinical researches, a sanction without which there is no real and practical medical science.” Everything, he said, could not be resolved into a question of bacteria! And, ironically, far from realizing the truth of his sarcastic prophecy, he exclaimed, “Typhoid fever, bacterization! Hospital miasma, bacterization!”
Every one had a word to say. Dr. Piorry, an octogenarian, somewhat weighed down with the burden of his years and reputation, rose to speak with his accustomed solemnity. He had found for Villemin’s experiments the simple explanation that “the tuberculous matter seems to be no other than pus, which, in consequence of its sojourn in the organs, has undergone varied and numerous modifications”; and he now im{229}agined that one of the principal causes of fatal accidents due to septic?mia after surgical operations was the imperfect ventilation of hospital wards. It was enough, he thought, that putrid odours should not be perceptible, for the rate of mortality to be decreased.
It was then affirmed that putrid infection was not an organized ferment, that inferior organisms had in themselves no toxic action, in fact, that they were the result and not the cause of putrid alteration; whereupon Dr. Bouillaud, a contemporary of Dr. Piorry, called upon their new colleague to give his opinion on the subject.
It would have been an act of graceful welcome to Pasteur, and a fitting homage to the memory of the celebrated Trousseau, who had died five years before, in 1867, if any member present had then quoted one of the great practitioner’s last lectures at the H?tel Dieu, wherein he predicted a future for Pasteur’s works:
“The great theory of ferments is therefore now connected with an organic function; every ferment is a germ, the life of which is manifested by a special secretion. It may be that it is so for morbid viruses; they may be ferments, which, deposited within the organism at a given moment and under determined circumstances, manifest themselves by divers products. So will the variolous ferment produce variolic fermentation, giving birth to thousands of pustules, and likewise the virus of glanders, that of sheep pox, etc....
“Other viruses appear to act locally, but, nevertheless, they ultimately modify the whole organism, as do gangrene, malignant pustula, contagious erysipelas, etc. May it not be supposed, under such circumstances, that the ferment or organized matter of those viruses can be carried about by the lancet, the atmosphere or the linen bandages?”
But it occurred to no one in the Academy to quote those forgotten words.
Pasteur, answering Bouillaud, recalled his own researches on lactic and butyric fermentations and spoke of his studies on beer. He stated that the alteration of beer was due to the presence of filiform organisms; if beer becomes altered, it is because it contains germs of organized ferments. “The correlation is certain, indisputable, between the disease and the presence of organisms.” He spoke those last words with so much emphasis that the stenographer who was taking down the extempore speeches underlined them.{230}
A few months later, on November 17, 1873, he read to the Academy a paper containing further developments of his principles. “In order that beer should become altered and become sour, putrid, slimy, ‘ropy,’ acid or lactic, it is necessary that foreign organisms should develop within it, and those organisms only appear and multiply when those germs are already extant in the liquid mass.” It is possible to oppose the introduction of those germs; Pasteur drew on the blackboard the diagram of an apparatus which only communicated with the outer air by means of tubes fulfilling the office of the sinuous necks of the glass vessels he had used for his experiments on so-called spontaneous generation. He entered into every detail, demonstrating that as long as pure yeast alone had been sown, the security was absolute. “That which has been put forward on the subject of a possible transformation of yeast into bacteria, vibriones, mycoderma aceti and vulgar mucors, or vice versa, is mistaken.”
He wrote in a private letter on the subject: “These simple and clear results have cost me many sleepless nights before presenting themselves before me in the precise form I have now given them.”
But his own conviction had not yet penetrated the minds of his adversaries, and M. Trécul was still supporting his hypothesis of transformations, the so-called proofs of which, according to Pasteur, rested on a basis of confused facts tainted with involuntary errors due to imperfect experiments.
In December, 1873, at a sitting of the Academy, he presented M. Trécul with a few little flagons, in which he had sown some pure seed of penicillium glaucum, begging him to accept them and to observe them at his leisure, assuring him that it would be impossible to find a trace of any transformation of the spores into yeast cells.
“When M. Trécul has finished the little task which I am soliciting of his devotion to the knowledge of truth,” continued Pasteur, “I shall give him the elements of a similar work on the mycoderma vini; in other words, I shall bring to M. Trécul some absolutely pure mycoderma vini with which he can reproduce his former experiments and recognize the exactness of the facts which I have lately announced.”
Pasteur concluded thus: “The Academy will allow me to make one last remark. It must be owned that my contradictors have been peculiarly unlucky in taking the occasion{231} of my paper on the diseases of beer to renew this discussion. How is it they did not understand that my process for the fabrication of inalterable beer could not exist if beer wort in contact with air could present all the transformations of which they speak? And that work on beer, entirely founded as it is on the discovery and knowledge of some microscopic beings, has it not followed my studies on vinegar, on the mycoderma aceti and on the new process of acetification which I have invented? Has not that work been followed by my studies on the causes of wine diseases and the means of preventing them, still founded on the discovery and knowledge of non-spontaneous microscopic beings? Have not these last researches been followed by the discovery of means to prevent the silkworm disease, equally deducted from the study of non-spontaneous microscopic beings?
“Are not all the researches I have pursued for seventeen years, at the cost of many efforts, the product of the same ideas, the same principles, pushed by incessant toil into consequences ever new? The best proof that an observer is in the right track lies in the uninterrupted fruitfulness of his work.”
This fruitfulness was evidenced, not only by Pasteur’s personal labours, but by those he inspired and encouraged. Thus, in that same period, M. Gayon, a former student of the Ecole Normale, whom he had chosen as curator, started on some researches on the alteration of eggs. He stated that when an egg is stale, rotten, this is due to the presence and multiplication of infinitesimally small beings; the germs of those organisms and the organisms themselves come from the oviduct of the hen and penetrate even into the points where the shell membrane and the albumen are formed. “The result is,” concluded M. Gayon, “that, during the formation of those various elements, the egg may or may not, according to circumstances, gather up organisms or germs of organisms, and consequently bear within itself, as soon as it is laid, the cause of ulterior alterations. It will be seen at the same time that the number of eggs susceptible of alteration may vary from one hen to another, as well as between the eggs of one hen, for the organisms to be observed on the oviduct rise to variable heights.”
If the organisms which alter the eggs and cause them to rot “were formed,” said Pasteur, “by the spontaneous self-{232}organization of the matter within the egg into those small beings, all eggs should putrefy equally, whereas they do not.” At the end of M. Gayon’s thesis—which had not taken so long as Raulin’s to prepare, only three years—we find the following conclusion: “Putrefaction in eggs is correlative with the development and multiplication of beings which are bacteria when in contact with air and vibriones when away from the contact of air. Eggs, from that point of view, do not depart from the general law discovered by M. Pasteur.”
Pasteur’s influence was now spreading beyond the Laboratory of Physiological Chemistry, as the small laboratory at the Ecole Normale was called.
In the treatise he had published in 1862, criticizing the doctrine of spontaneous generation, he had mentioned, among the organisms produced by urine in putrefaction, the existence of a torulacea in very small-grained chaplets. A physician, Dr. Traube, in 1864, had demonstrated that Pasteur was right in thinking that ammoniacal fermentation was due to this torulacea, whose properties were afterwards studied with infinite care by M. Van Tieghem, a former student of the Ecole Normale, who had inspired Pasteur with a deep affection. Pasteur, in his turn, completed his own observations and assured himself that this little organized ferment was to be found in every case of ammoniacal urine. Finally, after proving that boracic acid impeded the development of that ammoniacal ferment, he suggested to M. Guyon, the celebrated surgeon, the use of boracic acid for washing out the bladder; M. Guyon put the advice into practice with success, and attributed the credit of it to Pasteur.
In a letter written at the end of 1873, Pasteur wrote: “How I wish I had enough health and sufficient knowledge to throw myself body and soul into the experimental study of one of our infectious diseases!” He considered that his studies on fermentations would lead him in that direction; he thought that when it should be made evident that every serious alteration in beer was due to the micro-organisms which find in that liquid a medium favourable to their development, when it should be seen that—in contradiction to the old ideas by which those alterations are looked upon as spontaneous, inherent in those liquids, and depending on their nature and composition—the cause of those diseases is not interior but exterior, then would indeed be defeated the doctrine of men{233} like Pidoux, who à propos of diseases, said: “Disease is in us, of us, by us,” and who, à propos of small-pox, even said that he was not certain that it could only proceed from inoculation and contagion.
Though the majority of physicians and surgeons considered that it was waste of time to listen to “a mere chemist,” there was a small group of young men, undergraduates, who, in their thirst for knowledge, assembled at the Académie de Médecine every Tuesday, hoping that Pasteur might bring out one of his communications concerning a scientific method “which resolves each difficulty by an easily interpreted experiment, delightful to the mind, and at the same time so decisive that it is as satisfying as a geometrical demonstration, and gives an impression of security.”
Those words were written by one of those who came to the Académie sittings, feeling that they were on the eve of some great revelations. He was a clinical assistant of Dr. Béhier’s, and, busy as he was with medical analysis, he was going over Pasteur’s experiments on fermentations for his own edification. He was delighted with the sureness of the Pastorian methods, and was impatient to continue the struggle now begun. Enthusiasm was evinced in his brilliant eyes, in the timbre of his voice, clear, incisive, slightly imperious perhaps, and in his implacable desire for logic. Of solitary habits, with no ambition for distinction or degrees, he worked unceasingly for sheer love of science. The greatest desire of that young man of twenty-one, quite unknown to Pasteur, was to be one day admitted, in the very humblest rank, to the Ecole Normale laboratory. His name was Roux.
Was not that medical student, that disciple lost in the crowd, an image of the new generation hungering for new ideas, more convinced than the preceding one had been of the necessity of proofs? Struck by the unstable basis of medical theories, those young men divined that the secret of progress in hospitals was to be found in the laboratories. Medicine and surgery in those days were such a contrast to what they are now that it seems as if centuries divided them. No doubt one day some professor, some medical historian, will give us a full account of that vast and immense progress. But, whilst awaiting a fully competent work of that kind, it is possible, even in a book such as this (which is, from many causes, but a hasty epitome of many very different things spread over a very simple{234} biography), to give to a reader unfamiliar with such studies a certain idea of one of the most interesting chapters in the history of civilization, affecting the preservation of innumerable human lives.
“A pin-prick is a door open to Death,” said the surgeon Velpeau. That open door widened before the smallest operation; the lancing of an abscess or a whitlow sometimes had such serious consequences that surgeons hesitated before the slightest use of the bistoury. It was much worse when a great surgical intervention was necessary, though, through the irony of things, the immediate success of the most difficult operations was now guaranteed by the progress of skill and the precious discovery of an?sthesia. The patient, his will and consciousness suspended, awoke from the most terrible operation as from a dream. But at that very moment when the surgeon’s art was emboldened by being able to disregard pain, it was arrested, disconcerted, and terrified by the fatal failures which supervened after almost every operation. The words py?mia, gangrene, erysipelas, septic?mia, purulent infection, were bywords in those days.
In the face of those terrible consequences, it had been thought better, about forty years ago, to discourage and even to prohibit a certain operation, then recently invented and practised in England and America, ovariotomy, “even,” said Velpeau, “if the reported cures be true.” In order to express the terror inspired by ovariotomy, a physician went so far as to say that it should be “classed among the attributes of the executioner.”
As it was supposed that the infected air of the hospitals might be the cause of the invariably fatal results of that operation, the Assistance Publique[31] hired an isolated house in the Avenue de Meudon, near Paris, a salubrious spot. In 1863, ten women in succession were sent to that house; the neighbouring inhabitants watched those ten patients entering the house, and a short time afterwards their ten coffins being taken away. In their terrified ignorance they called that house the House of Crime.
Surgeons were asking themselves whether they did not carry death with them, unconsciously scattering virus and subtle poisons.{235}
Since the beginning of the nineteenth century, surgery had positively retrograded; the mortality after operations was infinitely less in the preceding centuries, because antisepsis was practised unknowingly, though cauterizations by fire, boiling liquids and disinfecting substances. In a popular handbook published in 1749, and entitled Medicine and Surgery for the Poor, we read that wounds should be kept from the contact of air; it was also recommended not to touch the wound with fingers or instruments. “It is very salutary, when uncovering the wound in order to dress it, to begin by applying over its whole surface a piece of cloth dipped into hot wine or brandy.” Good results had been obtained by the great surgeon Larrey, under the first Empire, by hot oil, hot brandy, and unfrequent dressings. But, under the influence of Broussais, the theory of inflammation caused a retrogression in surgery. Then came forth basins for making poultices, packets of charpie (usually made of old hospital sheets merely washed), and rows of pots of ointment. It is true that, during the second half of the last century, a few attempts were made to renew the use of alcoholized water for dressings. In 1868, at the time when the mortality after amputation in hospitals was over sixty per cent., Surgeon Léon Le Fort banished sponges, exacted from his students scrupulous cleanliness and constant washing of hands and instruments before every operation, and employed alcoholized water for dressings. But though he obtained such satisfactory results as to lower, in his wards at the H?pital Cochin, the average of mortality after amputations to twenty-four per cent., his colleagues were very far from suspecting that the first secret for preventing fatal results after operations consisted in a reform of the dressings.
Those who visited an ambulance ward during the war of 1870, especially those who were medical students, have preserved such a recollection of the sight that they do not, even now, care to speak about it. It was perpetual agony, the wounds of all the patients were suppurating, a horrible fetor pervaded the place, and infectious septic?mia was everywhere. “Pus seemed to germinate everywhere,” said a student of that time (M. Landouzy, who became a professor at the Faculty of Medicine), “as if it had been sown by the surgeon.” M. Landouzy also recalled the words of M. Denonvilliers, a surgeon of the Charité Hospital, whom he {236}calls “a splendid operator ... a virtuoso, and a dilettante in the art of operating,” who said to his pupils: “When an amputation seems necessary, think ten times about it, for too often, when we decide upon an operation, we sign the patient’s death-warrant.” Another surgeon, who must have been profoundly discouraged in spite of his youthful energy, M. Verneuil, exclaimed: “There were no longer any precise indications, any rational provisions; nothing was successful, neither abstention, conservation, restricted or radical mutilation, early or postponed extraction of the bullets, dressings rare or frequent, emollient or excitant, dry or moist, with or without drainage; we tried everything in vain!” During the siege of Paris, in the Grand H?tel, which had been turned into an ambulance, Nélaton, in despair at the sight of the death of almost every patient who had been operated on, declared that he who should conquer purulent infection would deserve a golden statue.
It was only at the end of the war that it occurred to Alphonse Guérin—(who to his intense irritation was so often confounded with another surgeon, his namesake and opponent, Jules Guérin)—that “the cause of purulent infection may perhaps be due to the germs or ferments discovered by Pasteur to exist in the air.” Alphonse Guérin saw, in malarial fever, emanations of putrefied vegetable matter, and, in purulent infection, animal emanations, septic, and capable of causing death.
“I thought more firmly than over,” he declared, “that the miasms emanating from the pus of the wounded were the real cause of this frightful disease, to which I had the sorrow of seeing the wounded succumb—whether their wounds were dressed with charpie and cerate or with alcoholized and carbolic lotions, either renewed several times a day or impregnating linen bandages which remained applied to the wounds. In my despair—ever seeking some means of preventing these terrible complications—I bethought me that the miasms, whose existence I admitted, because I could not otherwise explain the production of purulent infection—and which were only known to me by their deleterious influence—might well be living corpuscles, of the kind which Pasteur had seen in atmospheric air, and, from that moment, the history of miasmatic poisoning became clearer to me. If,” I said, “miasms are ferments, I might protect the wounded from their fatal influence by filtering the air, as Pasteur did. I then con{237}ceived the idea of cotton-wool dressings, and I had the satisfaction of seeing my anticipations realized.”
After arresting the bleeding, ligaturing the blood vessels and carefully washing the wound with carbolic solution or camphorated alcohol, Alphonse Guérin applied thin layers of cotton wool, over which he placed thicker masses of the same, binding the whole with strong bandages of new linen. This dressing looked like a voluminous parcel and did not require to be removed for about twenty days. This was done at the St. Louis Hospital to the wounded of the Commune from March till June, 1871. Other surgeons learnt with amazement that, out of thirty-four patients treated in that way, nineteen had survived operation. Dr. Reclus, who could not bring himself to believe it, said: “We had grown to look upon purulent infection as upon an inevitable and necessary disease, an almost Divinely instituted consequence of any important operation.”
There is a much greater danger than that of atmospheric germs, that of the contagium germ, of which the surgeon’s hands; sponges and tools are the receptacle, if minute and infinite precautions are not taken against it. Such precautions were not even thought of in those days; charpie, odious charpie, was left lying about on hospital and ambulance tables, in contact with dirty vessels. It had, therefore, been sufficient to institute careful washing of the wounds, and especially to reduce the frequency of dressings, and so diminish the chances of infection to obtain—thanks to a reform inspired by Pasteur’s labours—this precious and unexpected remedy to fatalities subsequent to operations. In 1873, Alphonse Guérin, now a surgeon at the H?tel Dieu, submitted to Pasteur all the facts which had taken place at the hospital St. Louis where surgery was more “active,” he said, than at the H?tel Dieu; he asked him to come and see his cotton-wool dressings, and Pasteur gladly hastened to accept the invitation. It was with much pleasure that Pasteur entered upon this new period of visits to hospitals and practical discussions with his colleagues of the Académie de Médecine. His joy at the thought that he had been the means of awakening in other minds ideas likely to lead to the good of humanity was increased by the following letter from Lister, dated from Edinburgh, February 13, 1874, which is here reproduced in the original{238}—
“My dear Sir—allow me to beg your acceptance of a pamphlet, which I send by the same post, containing an account of some investigations into the subject which you have done so much to elucidate, the germ theory of fermentative changes. I flatter myself that you may read with some interest what I have written on the organism which you were the first to describe in your Mémoire sur la fermentation appelée lactique.
“I do not know whether the records of British Surgery ever meet your eye. If so, you will have seen from time to time notices of the antiseptic system of treatment, which I have been labouring for the last nine years to bring to perfection.
“Allow me to take this opportunity to tender you my most cordial thanks for having, by your brilliant researches, demonstrated to me the truth of the germ theory of putrefaction, and thus furnished me with the principle upon which alone the antiseptic system can be carried out. Should you at any time visit Edinburgh, it would, I believe, give you sincere gratification to see at our hospital how largely mankind is being benefited by your labours.
“I need hardly add that it would afford me the highest gratification to show you how greatly surgery is indebted to you.
“Forgive the freedom with which a common love of science inspires me, and
“Believe me, with profound respect,
“Yours very sincerely,
“Joseph Lister.”
In Lister’s wards, the instruments, sponges and other articles used for dressings were first of all purified in a strong solution of carbolic acid. The same precautions were taken for the hands of the surgeon and of his assistants. During the whole course of each operation, a vaporizer of carbolic solution created around the wound an antiseptic atmosphere; after it was over, the wound was again washed with the carbolic solution. Special articles were used for dressing: a sort of gauze, similar to tarlatan and impregnated with a mixture of resin, paraffin and carbolic, maintained an antiseptic atmosphere around the wound. Such was—in its main lines—Lister’s method.{239}
A medical student, M. Just Lucas-Championnière—who later on became an exponent in France of this method, and who described it in a valuable treatise published in 1876—had already in 1869, after a journey to Glasgow, stated in the Journal de médecine et de chirurgie pratique what were those first principles of defence against gangrene—“extreme and minute care in the dressing of wounds.” But his isolated voice was not heard; neither was any notice taken of a celebrated lecture given by Lister at the beginning of 1870 on the penetrating of germs into a purulent centre and on the utility of antisepsis applied to clinical practice. A few months before the war, Tyndall, the great English physicist, alluded to this lecture in an article entitled “Dusts and Diseases,” which was published by the Revue des cours scientifiques. But the heads of the profession in France had at that time absolute confidence in themselves, and nobody took any interest in the rumour of success attained by the antiseptic method. Yet, between 1867 and 1869, thirty-four of Lister’s patients out of forty had survived after amputation. It is impossible on reading of this not to feel an immense sadness at the thought of the hundreds and thousands of young men who perished in ambulances and hospitals during the fatal year, and who might have been saved by Lister’s method. In his own country, Lister had also been violently criticized. “People turned into ridicule Lister’s minute precautions in the dressing of wounds,” writes a competent judge, Dr. Auguste Reaudin, a professor at the Geneva Faculty of Medicine, “and those who lost nearly all their patients by poulticing them had nothing but sarcasms for the man who was so infinitely superior to them.” Lister, with his calm courage and smiling kindliness, let people talk, and endeavoured year by year to perfect his method, testing it constantly and improving it in detail. No one, however sceptical, whom he invited to look at his results, could preserve his scepticism in the face of such marked success.
Some of his opponents thought to attack him on another point by denying him the priority of the use of carbolic acid. Lister never claimed that priority, but his enemies took pleasure in recalling that Jule............