1915] on Back to Lister 395 



administration of antitetanic serum, and gas gangrene by very free 

 incisions. 



No, the deadliest enemy is the ubiquitous Streptococcus, the foe 

 that kills more than shells and bullets. But as it is certahily killed 

 by undiluted carbolic acid or by a 5 per cent solution in water, there 

 is at least a chance that, so far as Streptococci are concerned, wounds 

 may be disinfected even in war, and if these and the other pyogenic 

 organisms are destroyed, there is, as I have shown, great reason to 

 suppose that sporing anaerobes like Bacillus tetani would have no 

 chance of growing.* 



But it may be said : " What about the organisms that have 

 •entered the lymph channel and the blood current ? What is tlie 

 good of trying to purify the wound if they have already given us 

 the slip ? '' "^ 



Let us see precisely what Dr. Thiele says, and remember that his 

 experiments are conducted by injecting cultivations of micro-organisms 

 sul)Cutaneously. He maintains : — 



(1) That they travel quickly to the nearest lymphatic glands, 

 where they are retarded, perhaps killed. 



(2) If not, they make their way along the thoracic duct to the 

 jugular vein and enter the blood stream, and by that channel are 

 conveyed, a few at a time, not in sufficient numbers to be detected 

 by the microscope, to the bone marrow, the spleen, and other paits 

 where groups of cells of the phagocyte class are ready to deal with 

 them. 



(3) If the enemy overpowers all these means of resistance they 

 may invade the blood in large numbers and cause general blood- 

 poisoning. 



(4) That some are quickly taken up by the blood without passing 

 through the lymphatics. 



I must again point out that, in spite of all these alarming facts, 

 general septicaemia probably never occurs if the wound heals without 

 suppuration. To take another simile from the war, the germs that 

 escape into the circulation are like enemy aliens, prisoners of war, or 

 the struggling Turks who crossed the Suez Canal. It is not they, 

 but the main body on the fighting line — that is, the wound — who 

 are engaged in manufacturing the deadly toxins. If they can be 

 annihilated, there is not much fear of mischief from the enemy in 

 our midst. It has never been suggested that germs which have 

 entered the circulation from the wound go back with their ill -begotten 

 progeny to make it suppurate. The argument, therefore, that it is 



* In using the word anaerobe I desire to own that I do not completely 

 understand its meaning. It certainly has been used in more than one sense, 

 and to-day bacteriologists are not agreed about the effect of oxygen on 

 anaerobes, their need for it, the sources from which they obtain it, and other 

 points. We cannot divide micro-organisms by a clear cut line into aerobes 

 and anaerobes. 



