30 Colonel Sir Almroth E. Wright [March 9, 



WEEKLY EVENING MEETING, 

 Friday, March 9, 1917, 



Sir Jaaies Crichton-Browne, J.P. M.D. LL.D. F.R.S., 

 Treasurer and Vice-President, in the Chair. 



CoLOXEL Sir Almroth E. Wright, M.D. C.B. F.R.S. M.R.L, 

 A Consultant Physician to the British Army in France. 



The Treatment of War Wounds.* 



We are wont to classify the patients in our military hospitals into sick 

 and wounded. In reality all, or nearly all, are suffering from bacterial 

 infections. And in this lies the essential difference between the 

 sick and the wounded, that the sick are suffering from infections 

 spontaneously contracted, the wounded from infections induced by 

 mechanical injuries. My theme is the treatment of this latter class 

 of infections. They are distinguished by certain quite special features. 



In spontaneous infection we have to deal with microbes which have 

 fought their way into the body, and generally only a single species of 

 microbe will have done this. We have in wounds microbes mechani- 

 cally driven in, and every sort of microbe which exists in external 

 nature may thus be introduced. 



Furthermore, the disposition of the microbes in war wounds is 

 fundamentally different from that in ordinary surgical wounds. In 

 war wounds the infection is disposed in part upon lacerated raw 

 surfaces ; and in part it is carried deep into the substance of the 

 tissues. Moreover, the infected lacerated surfaces are left denuded 

 of skin and exposed to injurious external influences ; and the infec- 

 tion which is carried down into the tissues is left as a buried infection. 

 Now there is in ordinary surgical operations nothing at all comparable 

 to this. The surgeon would never leave cut surfaces naked and 

 exposed, or a buried focus of infection unopened. 



This will have brought it home to you how especially difficult 

 are the conditions which have to be dealt with in the infected war 

 wound. But let me, before embarking upon the question of their 

 treatment, first tell you something about the natural agencies by 

 which the inroads of microbes are combated. You are, of course, 

 aware that we are guarded against microbic infection by our blood 

 fluids and our white blood corpuscles. 



* [Supplemented by Additional Matter relating to Antiseptics and the 

 Method of Carrel, lleprinted from Lancet, June 23, 1917.] 



