1917] on The Treatment of War Wounds 51) 



in physiological treatment of a surface infection is assiduity in re- 

 moving any leucocytes which may break down upon the face of the 

 wound. That is a question of maintaining intact the antitryptic 

 power of the lymph on the wound surface. 



A second method of procedure — I may call it the unreasonlwj anti- 

 septic procedure — is to employ an antiseptic, without laying stress 

 upon the assiduous cleansing of the wound surface and the mainten- 

 ance of good physiological conditions ; without inquiring whether the 

 antiseptic can, when brought into external contact with pus or an 

 infected tissue, penetrate into it ; and without asking whether the 

 antiseptic hinders phagocytosis, or destroys the antitryptic power of 

 the blood fluids, or permits or interferes with tryptic action. 



This unreasoning antiseptic procedure is constantly employed. It 

 has led to failure upon failure, and it would be a matter for wonder 

 if it did succeed. 



The third and last method of procedure I may call the combined 

 antiseptic and physiologicat procedure. If we want to find a method 

 of this sort we shall not find it by inquiring for it under this name. 

 What we have to seek is a method which proclaims itself an anti- 

 septic method and in this guise combats effectively, but perhaps not 

 with full comprehension, corruptive changes in the wound. 



The method of Carrel is, as 1 think, such a method. I would 

 propose to show that it is a comljined antiseptic and physiological 

 method ; then to survey the results obtained ; and finally to consider 

 how far the results should be credited to the antiseptic, and how far 

 to the physiological, element in the treatment. 



We have in Carrel's treatment two factors : («) Dakin's antiseptic, 

 or, as I should prefer to call it, Dakin's therapeutic agent ; and 

 (&) Carrel's procedure for washing and refreshing the wound surface 

 in the intervals between the complete dressings. Now each of these 

 factors acts not only by killing or removing microbes, but by making 

 the conditions in the wound unfavourable for microbial growth. Let 

 me, taking first Dakin's fluid, and then Carrel's washing procedtire, 

 try to make for you an inventory of their directly anti-bacterial, and 

 their physiological or indirectly anti-bacterial, effects. 



Dakin's Fluid. 



Dakin's fluid is, as I have shown you,* a very ineffective anti- 

 septic when it is brought into application upon microbes suspended 

 in serum. It is also, as I have shown you, an antiseptic which has 

 as good as no power of peneti'ating into albuminous fluids. It is 

 also an extremely volatile antiseptic. Yv'hen exposed in a shallow 

 dish at blood temperature I have found it to lose four-fifths of its 



"^ Vide supra, Experiments on Antiseptics. 



