5.S Colonel Sir Almroth E. Wright [March 9, 



set-back due to transport has been prevented or remedied, we have 

 confronting us the prol:>lem which, if treatment had been uninter- 

 rupted, would have presented itself earlier — the problem as to how to 

 treat a slight infection of a naked tissue surface. 



One procedure is to leave the wound to heal up from the bottom, 

 limiting oneself to such re-dressing as would prevent erosive diges- 

 tion. Bv this programme the patient would, when his wound is a 

 large one, be condemned to very many months of disability and also 

 of bacterial intoxication. For the fact has got to be faced that it is 

 all but impossible to maintain satisfactory conditions in a large 

 wound for months on end. 



The alternative programme is for the surgeon to close the wound 

 with the minimum delay. If the anatomical conditions permit, and 

 the bacteriological examination shows the wound surface to be practi- 

 cally uninfected, or if the wound is only a very few hours old and 

 the implanted microbes cannot yet have grown out, the wound can, 

 after removal of all dead and foreign matter, be immediately closed 

 — the surgeon, of course, standing by to reopen the wound if 

 symptoms of buried infection develop. If, on the other hand, 

 bacteriological examination shows that the wound surface is appreci- 

 ably infected, or the history of the case makes this practically certain, 

 we should, by closing the wound, be violating all the principle* of 

 surgery. AVe should be converting a surface infection into a buried 

 infection. The proper step to take with a wound which is appreciably 

 infected is to reduce the microbic infection to the point at which it is 

 negligible and then re-suture. 



Methods of DeaUmj with a Mkrobk Infection which Stands in th<- 

 Way of Secondary Sat are. 



The nricrobic infection may 1)e dealt with by any one of the 

 following procedures. 



In the /z'r.S'/! ^;/rt^;^ we can employ the physiological procedure. If 

 we elect to do this, wc think out clearly the requirements. For ex- 

 ample, it will be inap|)ropriate when dealing with a purely superrteial 

 streptococcic and staphylococcic infection to continue the application 

 of hypertonic salt solution. The effect of that would be, on the one 

 hand, to bold off phagocytes from the microbes (for strong salt 

 arrests emigration) ; and, on the other hand, to provide the staphylo- 

 coccus and streptococcus with lymph, a fluid in which they can grow 

 and disseminate themselves over the whole face of the wound. What 

 we want is an application which calls out leucocytes, and which will 

 restrain, or which at any rate will not activate, the lymph liow. 

 Physiological salt solution, and zinc sulphate in I per cent, solution, 

 and no doubt many other heavy metal salts in dilute solution, are the 

 sort of agents we require. But what is, above all, essential to success 



