1917] on The Treatment of War Wounds 45 



is simply kept wet. Here, also, the microbes which have been incor- 

 porated in the clot wonld grow out. Then there would supervene 

 leucocytic emigration, and upon that would follow a breaking-down of 

 the leucocytes with a setting-free of trypsin ; and after that any and 

 every microbe would pullulate in the cavity of the wound and on the 

 devitalised wound surface. Finally, if treatment were still deferred 

 there would be reproduced in an aggravated form (for there would in 

 the open wound be a varied and more formidable infection) the evil 

 train of events which is associated with infection in a buried dead space. 

 AVhen you reflect that an open wound cavity filled with tryptic pus is 

 physiologically equivalent to an unopened abscess sac, you will see 

 that erosive action will enlarge and deepen its cavity ; that this will 

 enable the microbic infection to burrow everywhere deeper into the 

 walls ; and that bacterial poisons will be absorbed. 



All I have been saying in the last few minutes can be compressed 

 into this — An infected naked tissue surface becomes, if allowed to 

 dry, a desiccated slough -covered wound ; if simply kept wet, a tryptic 

 siqypurating ivound. And the bacteriological events can also be 

 expressed in a single sentence. A comparatively light infection, such 

 as we have in the man whose wounds have been properly opened up 

 and mechanically cleaned, is converted into a very heavy infection ; 

 and a purely surface infection into an infection invading the deeper 

 tissues. 



Problem of Preventing the Degeneration of the Wound 

 WHEN Treatment is Interrupted during Transport. 



Having realised what happens to the wound when untreated, we 

 have to think out how to keep wounds — whether originally com- 

 pletely open or opened by a surgeon— from falling during protracted 

 journeys from hospital to hospital into these desperately unwholesome 

 conditions. We have also to consider how to restore, as rapidly as 

 possible, wounds which have lapsed into distressing conditions either 

 through lying out untreated on the field or throtigh interruption 

 of treatment during lengthy transport. 



Suggestion that the wound could he sterilised at the outset, and could 

 he kept sterile hg leaving an antiseptic in the wound. — The first thought 

 of every man would probably be that the wound should be most 

 carefully disinfected at the outset. But what happens in burns shows 

 that to start in open wounds with a sterile surface avails nothing. A 

 burn is at the outset absolutely sterile, and quite notoriously — no 

 doubt the germs begin to arrive before the burnt surface has well 

 cooled off — it tends to become very rapidly intractably septic. We 

 may take it that the emigrating leucocytes are held back in the 

 superficial sloughs, disintegrate there, and corrupt the exuding lymph, 

 xlnd this cannot be prevented by any application of antiseptics. It is 

 just the same with war wounds. These become heavily infected even 



