1915] on Back to Lister 393 



This is a di'eadful picture ; but all fighting is not trench fighting, 

 and we might have hoped not to be told that all wounds, except 

 bullet wounds, are septic, seeing that a few, at least, come under 

 treatment within a reasonable period, say twelve hours, after infliction. 



I have lieen helping Sir AVatson Cheyne to lead a crusade in 

 favour of applying to these dirt-infected wounds Lister's original 

 method of purification by means of undiluted carljolic acid. Xot 

 that I advocate it for civil practice, but because I think that the only 

 chance of destroying the organisms of tetanus and gas gangrene, and 

 the l)est way of dealing with streptococci, is to use the most potent 

 and safest antiseptic which is at the disposal of the surgeon for the 

 purpose. 



The suggestion met with the cordial approval of those who, like 

 myself, have employed this agent extensively. But it excited a 

 certain amount of loud criticism from others, who were chiefly im- 

 pressed by the fact that undiluted carbohc gas produces a certain 

 amount of sloughing. This criticism is easily met, because, if em- 

 ployed with the discretion that may be expected of reasonable people, 

 the slough is unimportant, superficial, and antiseptic — incomparably 

 less suited for the growth of micro-organisms than the extensive and 

 spreading sloughs which they themselves produce. Moreover, these 

 antiseptic sloughs do no harm, but are quickly absorbed if the wound 

 heals antiseptically. 



That is not the weak point in the argument. There is, however, 

 another, more difficult to answer, of which our opponents did not 

 make so much. Unfortunately, it cannot be denied that the spores 

 of the bacilli of tetanus resist the action of even undiluted carbolic 

 acid for a very considerable time. Moreover, my colleague. Dr. Thiele, 

 has shown that, if easily recognizable micro-organisms are injected 

 into the subcutaneous tissue, they enter the lymph channels, and may 

 pass into the circulation in the course of a few minutes, long before 

 there is a chance, if the same thing happens in contused wounds, of 

 getting at them with our antiseptics. 



Are we, then, to abandon this line of treatment, to fold our 

 hands in despair and say that it is useless to attempt to disinfect any 

 wound in civil or military practice to which spore-bearing or other 

 organisms may have gained access ? By no means. All Lister's 

 work cries out against such a conclusion. We must clear our minds 

 of the delusion that carefully planned experiments on guinea-pigs in 

 the laboratory are on all fours with unrehearsed experiments in 

 factories, or on wounded soldiers in the battlefield. Lister did un- 

 doubtedly succeed in stopping sepsis in compound fractures and in 

 banishing tetanus and hospital gangrene from his wards, and the 

 experience of generations of surgeons working with a saturated watery 

 solution of carbolic acid has confirmed his conclusions. Surely, then, 

 it may be possible to find a practical way of applying the principle to 

 military practice. 



