208 Transactions of the Society. 



as possible. When, however, it comes to be a question of wounds 

 received on the battle-field, the bruising, the torsion, the infiltration 

 of filth, must result in the death of some of the tissues and great 

 damage to others, and these dead tissues, offering a nidus for the 

 growth and multiplication of the micro-organisms that have been 

 introduced from without from whatever source, cannot be further 

 damaged, whilst the micro-organisms contained in them may be 

 destroyed by the action of a powerful antiseptic; the same micro- 

 organisms, if left alone and at rest in their nidus, giving rise to 

 septic and putrefactive foci, which ultimately may carry off the 

 patient. [ hope to have an opportunity of studying more carefully 

 the observations of those working at the front, but I am convinced 

 that the whole method of treatment of wounds, both at the front 

 and at the base, will resolve itself into the use of the two methods 

 suggested by Lister in the cases above mentioned, and the more 

 closely his principles are followed, whatever antiseptics may be 

 used, and however they are applied, the better will be the results 

 obtained. 



Lister, though a great master of detail, always worked along 

 lines of great principles. He appeared to realize from the first 

 that in all suppurative and septic processes two main factors were 

 involved — the number, resistance, activity or invading power of 

 the micro-organisms on the one hand ; the vitality, nutrition and 

 resisting power, either general or specific, of the tissues on the 

 other. Dead tissues and fluids, especially when present in large 

 masses, he looked upon as food easily ingested and assimilated by 

 active micro-organisms ; whilst healthy, active tissues he depended 

 upon for the destruction of large numbers of weakly micro-organisms 

 and of smaller numbers of more active and virulent micro-organisms. 

 Dead tissue in itself might be harmless, but as a nidus for the 

 multiplication and growth of micro-organisms, and therefore as a 

 coign of vantage from which other tissues might be attacked, it was 

 ever a source of danger, and should be removed as soon as possible. 

 He also realized that accumulations of fluid, whether active or 

 passive in any part, must always interfere with the nutrition, and 

 therefore with the vitality, of the tissues in the immediate neigh- 

 bourhood of the channels or spaces in which that fluid accumulated ; 

 whilst, as he was fond of demonstrating to his classes, there was, 

 in all this, a vicious cycle completed by the malnutrition of the 

 tissues leading to further accumulations of fluid, which fluid, 

 having given up its nutrient elements and received in their stead 

 a surfeit of effete matter, was no longer capable of helping to 

 nourish the surrounding tissues. It was for this reason that Lister. 

 though a most conservative surgeon, insisted on the removal of 

 sloughs, dead tissue, separated fragments and extravasated blood 

 from open and contaminated wounds, and even from wounds which 

 were likely to be easily contaminated. Drainage he placed in the 



