42 ON THE ANTISEPTIC PRINCIPLE 



been after the second day, free from unfavourable symptoms, with pulse, tongue, 

 appetite, and sleep natural, and strength increasing, while the limb remained, 

 as it had been from the first, free from swelHng, redness, or pain. I therefore 

 persevered with the antiseptic dressing, and before I left, the discharge was 

 already somewhat less, while the bone was becoming firm. I think it likely 

 that in that boy's case I should have found merely a superficial sore had I taken 

 off all the dressings at the end of three weeks, though, considering the extent 

 of the injury, I thought it prudent to let the month expire before disturbing 

 the rag next the skin. But I feel sure that if I had resorted to ordinary dressing 

 when the pus first appeared, the progress of the case would have been exceed- 

 ingly different. 



The next class of cases to which I have applied the antiseptic treatment 

 is that of abscesses. Here, also, the results have been extremely satisfactory, 

 and in beautiful harmony with the pathological principles indicated above. 

 The pyogenic membrane, like the granulations of a sore, which it resembles in 

 nature, forms pus, not from any inherent disposition to do so, but only because 

 it is subjected to some preternatural stimulation. In an ordinary abscess, 

 whether acute or chronic, before it is opened, the stimulus which maintains the 

 suppuration is derived from the presence of the pus pent up within the cavity. 

 When a free opening is made in the ordinary way, this stimulus is got rid of ; 

 but the atmosphere gaining access to the contents, the potent stimulus of de- 

 composition comes into operation, and pus is generated in greater abundance 

 than before. But when the evacuation is effected on the antiseptic principle, 

 the pyogenic membrane, freed from the influence of the former stimulus without 

 the substitution of a new one, ceases to suppurate (like the granulations of 

 a sore under metallic dressing), furnishing merely a trifling amount of clear 

 serum, and, whether the opening be dependent or not, rapidly contracts and 

 coalesces. At the same time any constitutional symptoms previously occasioned 

 by the accumulation of the matter are got rid of without the slightest risk of 

 the irritative fever or hectic hitherto so justly dreaded in dealing with large 

 abscesses. 



In order that the treatment may be satisfactory, the abscess must be seen 

 before it has opened. Then, except in very rare and peculiar cases,^ there are 

 no septic organisms in the contents, so that it is needless to introduce carbolic 

 acid into the interior. Indeed, such a proceeding would be objectionable, as 

 it would stimulate the pyogenic membrane to unnecessary suppuration. All 



' As an instance of one of these exceptional cases, I may mention that of an abscess in the vicinity 

 of the colon, and afterwards proved by post mortem examination to have once communicated with it. 

 Here the pus was extremely offensive when evacuated, and exhibited vibrios under the microscope. 



