OF TREATMENT IN SURGERY 6i 



a wounded lung should have such totally different effects from that entering 

 through a permanently open penetrating wound from without, was to me a com- 

 plete mystery till I heard of the germ theory of putrefaction, when it at once 

 occurred to me that, though we could not suppose the gases of the atmosphere 

 to be in any way altered in chemical composition by passing through the trachea 

 and bronchial tubes on their way into the pleura, it was only natural that they 

 should be filtered of germs by the air-passages, one of whose ofhces it is to arrest 

 inhaled particles of dust, and prevent them from entering the air-cells. In 

 truth, this fact in practical surgery, when duly considered, affords as good 

 evidence in support of the germ theory of putrefaction as any experiment that 

 can be performed artificially. 



Another remarkable example of the same thing, though brought about by 

 different circumstances, occurred recently in my practice at the infirmary. 



Case of Penetrating Wound of the Thorax and Abdomen. — On the ist of 

 October last, a butcher, aged i8, was admitted on account of a most serious 

 wound of the chest, inflicted by a comrade who, angry at having a dirty bladder 

 thrown at him by the patient, threw in return his knife, \\dth a blade nine inches 

 long, and keen-edged, half of which buried itself in the patient's infra-axillary 

 region, between the ninth and tenth ribs. He himself drew out the knife, 

 which was followed by a fearful gush of blood. Being accustomed to see blood 

 flow, he said * there was a spout of four inches before the fall '. He was im- 

 mediately taken to the hospital, where my then house surgeon, Mr. Hector 

 Cameron, found him blanched, his clothes drenched with blood, which was still 

 pouring from the wound, venous in colour, and with a tendency to regurgitate 

 during inspiration, implying that it proceeded from a wound in the lung, which 

 was further indicated by the occurrence of haemoptysis. There was also pro- 

 truding from the external wound a piece of omentum five inches long, showing 

 that the knife had passed through the diaphragm into the abdominal ca\'ity. 

 No time was to be lost, as death from haemorrhage was imminent ; and Mr. 

 Cameron judged it best to plug the wound, but at the same time to introduce 

 an antiseptic as in compound fracture, in order to destroy any atmospheric 

 germs that might have been drawn in during inspiration. With tliis object, 

 after cutting off the protruding piece of omentum, which he kept to show me, 

 he soaked a piece of lint with a solution of carbolic acid in four parts of boiled 

 linseed oil, and by means of dressing-forceps passed it as far as he could in every 

 direction in the pleural cavity, repeating the application several times. He 

 then took two strips of lint steeped in the same solution, each about a foot 

 long and an inch in breadth, and pushed them into the pleura, one upwards, 

 the other downwards, as far as possible consistently with keeping their ends 



