The President's Address. By G. S. Woodhead. 207 



they are of the essence of the whole matter. There were greatly 

 damaged tissues in the wound, and the addition of the carbolic 

 acid, whilst but an insignificant factor in the devitalizing of the 

 tissues, by its presence enabled the operator to handle the parts 

 and treat them much more thoroughly than would have been 

 possible were sterile water only used. Moreover, the carbolic acid 

 was expected to exert a distinctly devitalizing action on any 

 bacteria that had been crushed into the wound ; and Col. Griffiths, 

 also one of Lister's disciples, maintains that the sterilizing influence 

 of the carbolic acid extends for some little distance from the sur- 

 face to which it is applied.* This is evident from the fact that 

 this substance is absorbed and appears in the urine so readily when 

 carbolic acid is applied too freely to large wounded surfaces. Here 

 we have one set of conditions. The second case is now almost 

 " classical." After the removal of a horny growth from the heel 

 of a patient, a tremendous gap was left, and Lister conceived the 

 idea of allowing the blood-clot to fill up this gap and so to form a 

 scaffolding into which blood vessels from the surrounding tissues 

 might make their way. He exposed and examined this blood-clot 

 from time to time, and although he used an antiseptic dressing he 

 was careful, as he pointed out, to keep as much of the antiseptic 

 out of the wound as possible. The antiseptic shield he applied 

 was to prevent the access of micro-organisms to the clot, not to 

 sterilize the clot itself. He was specially insistent on this point, 

 and, in another case that also clings to a place in my memory, he 

 demonstrated that an abscess opened and cleaned out, perhaps by 

 washing with carbolic acid, should always be left alone when once 

 the healing process has begun. He recommended, therefore, that 

 at this stage the antiseptic should be kept outside the abscess, and 

 its use allowed only as a shield against the access of organisms 

 that might set up putrefactive or other processes in the fluid 

 draining into the abscess cavity aud thus to the surface. Lister 

 anticipated and considered fully the two aspects of the present- 

 day controversy, and I am convinced that, as the outcome of 

 the present war, there will be a modification in the ideas and 

 practice of thoughtful surgeons. When comparatively healthy 

 tissue is incised, and closed cavities to which micro-organisms have 

 gained no access and around which the tissues are undamaged are 

 opened up, it is obviously unneccessary to introduce antiseptics 

 even of the least irritant type, as these antiseptics may, if acting 

 upon tissues but slightly weakened, lower their resistance to the 

 attacks of incurrent micro-organisms. They may even help the 

 micro-organisms in their attacks on the tissues. It is desirable, 

 then, to alter the surroundings of these weakened tissues as little 



'o k 



* This thesis has since been more fully elaborated by Sir W. Watson Cheyiie. 

 Fleet Surgeon Barrett Smith, and Mr. Arthur Edmunds, in the Journal of the 

 Royal Naval Medical Service, 1915, vol. i. p. 103. 



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