S94 Sir Rickman John Godlee [March 12, 



It ^Yill not, however, do to brush the argument aside in this way 

 without examining it and answering it. I therefore submit for your 

 consideration a suggestion as to what happens in a case successfully 

 treated antiseptically, that is, one that heals without suppuration. 



AVe do not know for certain in what form the anaerobic spore- 

 bearing organisms are introduced into a wound. I, at all events, do 

 not know of scientifically conducted observations upon the subject. 

 But it is clear that they must be either in the form of bacteria, or 

 spores, or both, probably embedded in decaying organic matter in 

 the soil. If the antiseptic reaches them it destroys the bacteria, 

 together with ' the other septic organisms. But possibly, or let us 

 say probably, it has not sufficient time before becoming too diluted 

 to kill the spores, though it may for a while inhibit their power of 

 development. There, then, these spores lie dormant between a thin 

 layer of carbolized slough and a mass of more or less carbohzed blood 

 clot. If sepsis is avoided, the phagocytes at last invade both the 

 slough and the clot, and healing takes place without suppuration. 

 What is the fate of the spores ? 



We must suppose that, when the carbolic acid has disappeared, 

 as they are embedded in a warm, airless nidus, they germinate, but 

 only to find themselves surrounded by active phagocytes which, if 

 they form a suitable pabulum, destroy them. And so the matter 

 ends so far as the wound is concerned. 



This, I maintain, is a reasonable hypothesis and a sufficient 

 answer, and fortunateh it is rare indeed, if it ever happens, for 

 tetanus to occur after a wound has healed without any suppuration 

 at all ; and, moreover, the abolition of tetanus in civil practice has 

 coincided with the reduction in the number of suppurating wounds. 



As a further support of the argument, let us now consider the 

 case of the bacteria and spores of tetanus or gas gangrene lying 

 together in an untreated wound, or in one to which less powerful 

 antiseptics are applied, antiseptics not strong enough to destroy the 

 pus-producing organisms. They find themselves, therefore, amongst 

 extensive septic sloughs and decomposing blood-clots in which the 

 phagocytes, if they can penetrate at all, have their time fully occu- 

 pied with myriads of other organisms, which first weaken and then 

 overpower them. Is it to be wondered at that lockjaw and gas 

 gangrene affect a certain proportion of such cases ? On the contrary, 

 the marvel is that these complications are not more frequent. 



For, after all, though tetanus and gas gangrene are ghastly 

 things, and make a great impression because the laity knows about 

 them, these diseases are not by any means the most deadly or the 

 most frequent. Probably 40 per cent of the wounds at one part of 

 the campaign were infected with tetanus, but, up to date, there have 

 been reported only HoT cases, of which only '1 have occurred since 

 January 20. And it must be remembered that there are effectual 

 ways of dealing with both diseases — tetanus by the piophylactic 



