00 Colonel Sir Almroth E. Wright [March 9,. 



poteiicv ill li;ilf-;iii-li()iii', ;iii(l iL will, as I liave already liacl occasion to 

 ])oiiiL out, if not already (jnenclied by contact vvitli seruui, very 

 (juickly disap])ear from tlic wound. 



Turning" from the effect exerted upon microhes to the cU'ect ex- 

 erted upon tlie wound surface, let me recall to those of yon who have 

 seen it, that when a nuked tissue surface is treated with Dakin's fluid 

 (or for the matter of that with 5 per cent, salt solution) it is speedily 

 converted into a bright coral-red granulating surface. That means it 

 is converted into a defensi\'e surface excellently well provided with 

 new-foi"med blood-vessels from which active leucocytes and fully 

 potent lymph will emerge. I'hat is a physiological action to the 

 good. But there ai'c also other effects exerted. Leucocytes are 

 affected l)y Dakin's fluid. Ex])ei'iments show that it is destructive 

 to phagocytosis. When we add one part of the reagent to nine of 

 erxoafjvJar blood we I'educc; the ])hagocytic power of that ])lood by 

 more than one-half. AYe abolish ])hagocytosis when we add one part 

 of the I'eagent to four of 1)I()0(1. TIk; iluid elements of the discharge 

 also are altered in cliai'iicLer by Dakin's iluid. Let me remind you 

 here that we saw in oui' ex[)eriments on artificial sloughs that treat- 

 ment with Didcin's solution hinders the digestive processes whicii 

 bring about their separation. This stands in relation to the fact that 

 the reagent exerts upon try])sin, when albumen is not there to act as 

 a, buffer, a destructive action. We have here, as you perceive, a 

 ]»hysiological action which may ((uite well come into oper;iti(»n when 

 ii C()m])aratively clean but tryptic wound surface is flushed, Dakin's 

 fluid abolishes also the antitiT])tic power of the l)lood fluids. It 

 would seem, therefore, WMth one hand to give jn-otection, and with the 

 other hand to take it away. ]^ut what really does happen is, 1 

 suppose, that trypsin and antitrypsin alike are destroyed by the flush 

 and that afterwai'ds in the wound a new beginning is made. 



Let us follow up the train of thought here started. We may, I 

 think, profitably ask ourselves whether if put to our election between 

 maifitaining antiseptic action continuously at the expense of physio- 

 logical action, and alternating antise])tic with physiological action, we 

 should not do well to elect for the latter policy. And we may muse 

 whethei" it was not specially felicitous to have employed, as Carrel 

 has done, an antiseptic which is wry readily (|uenched and also 

 very volatile, and to have applied it disconlinuously. Had that 

 antise])ti(; been em])l()ye(l by a, method of continuous irrigation, 

 phagocytosis on the face of tlie wound would have been excluded, and 

 we might have; had in the cavity of the wound a lymph whose anti- 

 try] >tic power had been desti'oyed. 



]Uit I have already said enough about Dakin's fluid if you have 

 appreciated that it is a i)ooi' antiseptic : tluit it acts as a poison upon 

 leucocytes and blood fluids ; that its physiological action is a very 

 com])licated one ; and that its beneficial effects cannot be due simply 

 to its antiseptic action. 



