212 BIOLOGICAL PROBLEMS 



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divided opinion between them. The first is the anti- 

 septic school, of Listerian tradition, the other is the 

 44 physiological " school of Sir Almroth Wright. Of 

 both ideas there are many current modifications which 

 do not need to be entered upon in detail here, except 

 in so far as they directly concern our present subject. 

 It will suffice to say that under both headings there 

 are two main sub - divisions, those of irrigation 

 methods and of packing methods. Treatment by 

 antiseptics, however applied, has behind it the weight 

 of long experience, but nevertheless it breaks down 

 in the greater majority of cases when confronted with 

 the deeply established infections of war wounds. The 

 practical experience of surgeons in France and else- 

 where has shown that antiseptics can only be relied 

 upon in conjunction with surgical excision of the 

 damaged tissues, a procedure which is at once more 

 mutilating and more dangerous than anyone would 

 wish. Moreover, in very deep wounds, or if important 

 organs are involved, excision may be anatomically 

 impossible; and even in the best of cases, if no 

 freshly-lit infection of the new surfaces takes place, 

 the procedure is cumbersome, and convalescence is 

 more or less delayed; in the most severe cases very 

 much more than less. 



If excision be admitted as a practice, then "Carrel- 

 Dakin " irrigation with hypochlorous acid, or packing 

 with B.I. P. P. (the bismuth-iodoform-paraffin paste of 

 Morison) may, with reservations, produce a satisfac- 

 tory final result; but the reservations are very con- 

 siderable, and it is safe to say that no antiseptic exists 

 which is truly non-irritant and efficacious in such a 

 degree as to diminish them. 



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Wright's method depends upon simple irrigation 

 with hypertonic saline, without the application of any 

 antiseptic. The basis of this practice is the belief 



