The President's Address. By G. S. Woodhead. 209 



forefront of his treatment of a cavity, whilst he never feared, in 

 spite of his dislike to a surface lesion, to make free incision where 

 fluid had accumulated in connective tissue and other spaces and 

 could not be got rid of without such incisions ; just as to-day a 

 chronic or even certain acute forms of hydrothorax are treated 

 almost as a matter of routine by the drawing off of the fluid that 

 has accumulated in the thoracic cavity, the relief to the pressure 

 within the thoracic cavity apparently being followed by a renewed 

 activity of the lymphatic system in the immediate neighbourhood 

 of the collected fluid, and by a comparatively rapid absorption or 

 transportation by the lymphatics of the fluid that had accumu- 

 lated and become stagnant in them. 



Antiseptics may be used to prevent the access of germs to a 

 wound, to kill the germs that have made their way into dead 

 tissues, to help in the removal of dirt of all kinds and the accom- 

 panying germs, and of as much dead tissue as possible, and I am 

 satisfied that by their use for these purposes the best surgical 

 results will, in the long run, be obtained, whether at the front, at 

 the base, or in the General Hospitals. 



During the last month or two much has been written and 

 talked about "frostbite." Now I am satisfied, from what I have 

 seen and read, that many cases of so-called frostbite are not frost- 

 bite at all, but are the result of a stasis or accumulation in the 

 lower limbs of the nutrient fluids that should be constantly 

 circulating. Such cases correspond far more closely with a con- 

 dition recognized by veterinary surgeons as occurring in horses that 

 stand for long periods in their stalls, during lengthy sea voyages, 

 for example. This condition appears to be the result of (1) impaired 

 circulation of the blood, (2) interference with the circulation of 

 the lymph, and (3) damage to the tissues induced by imperfect 

 nutrition and diminished excretion of waste matter from the tissues. 

 The heart unstimulated by exercise exerts less propulsive power 

 than when the animal is undergoing active exercise, the arterial 

 flow slackens, and the blood is not driven through the capillaries 

 either so rapidly or so readily. Again, the muscles of the lower 

 limbs, not being called upon to contract, the veins lying between 

 them are not submitted to the pressure that results from healthy 

 muscular contraction. As the valves in the veins allow the blood 

 to pass in one direction only, the blood after passing through the 

 capillaries is driven towards the heart whenever muscular com- 

 pression is applied, but when the muscles do not contract this 

 factor in keeping up circulation is wanting. This same lack of 

 contraction leads to a similar stasis in the " valved " lymphatic 

 vessels, and neither blood nor lymph is changed so frequently as 

 under normal conditions ; and the fluid kept long in contact with 

 tissues, deprived of its nutritive properties, and receiving an 

 excess of effete material, no longer supplies sufficient material for 



