OF TREATMENT IN SURGERY 49 



decomposition, and therefore produce disturbance upon the-.tissues around them, 

 leading first to their gradual transformation into the rudimentary structure 

 whicli, when met with at the surface of a sore, is termed * granulations ', and 

 afterwards to the formation of pus by the granulations. But a dead portion of 

 tissue, if not altered by adventitious circumstances, is in its proper substance 

 perfectly bland and unirritating, and causes no more disorder in its neighbourhood 

 than a bullet or a piece of glass, which may remain imbedded in the living body 

 for an indefinite period without inducing the formation of pus ; while the dead 

 tissue differs from the foreign bodies alluded to in the circumstance that the 

 materials of which it is composed are susceptible of absorption. 



Antiseptic substances, being, like the products of decomposition, chemically 

 stimulating, will, like them, induce granulation and suppuration in tissues 

 exposed for a sufficient length of time to their influence ; but there is this all- 

 important difference, that an antiseptic merely stimulates the surface to which 

 it is appHed, becoming diluted and weakened by the discharge which it excites ; 

 but the acrid salts which result from putrefaction are perpetually multiplied 

 and intensified by self-propagating ferments, so that every drop of serum or 

 pus effused through their agency becomes a drop of poison, extending its baleful 

 influence both in the injured part and in the system generally. 



These pathological considerations indicate the after-treatment in com- 

 pound fracture, and explain the progress of the case. The antiseptic intro- 

 duced into the wound is soon washed out by the discharge or carried away by 

 the circulation, so that the blood and sloughs at first imbued with it become 

 unstimulating and amenable to absorption, while at the same time they are 

 prone to decomposition should any living atmospheric germs gain access to 

 them. The further treatment, therefore, must consist in maintaining an eflicient 

 antiseptic guard over the orifice of the wound until sufficient time has elapsed 

 to ensure complete consolidation of the injured parts. 



The sanious and serous discharge which occurs at the outset will give place 

 in a few days to a small amount of pus, if the wound is dressed in such a way 

 that the antiseptic continues to act upon the raw surface. This discharge, 

 due to the stimulating nature of the application, being merely superficial, and 

 involving no inflammatory or febrile disturbance, will occasion no anxiety to 

 one who understands its cause ; and I venture to repeat the caution given in 

 a previous communication,^ that the surgeon must on no account be induced 

 to explore the wound and pry into the source of the suppuration, so long as all is 

 going on well otherwise ; for such a course, by admitting germs into the interior, 

 may produce the most disastrous consequences in an otherwise promising case. 



' See p. 39 of this volume. 



LISTER II E 



