ILLUSTRATING THE ANTISEPTIC SYSTEM OF TREATMENT 149 



antiseptic salt urges the superficial cells of the granulations to develop pus- 

 corpuscles. 



If the sore is treated with water dressing, the serum first exuded putrefies 

 in the lint, and the products of putrefaction, being acrid salts, cannot fail to 

 stimulate the surface of the granulations ; and accordingly superficial suppura- 

 tion is induced without any appearance of inflammation, just as under the 

 influence of the antiseptic. Thus, in their effects upon a granulating sore, an 

 antiseptic and a putrid dressing are alike : both excite superficial suppuration 

 by direct chemical stimulation of the granulations. But in their operation on 

 a recent wound there is this all-important difference between them, that the 

 antiseptic stimulates only the surface to which it is applied, and every drop 

 of discharge which it induces dilutes it and renders it less stimulating ; but 

 putrefaction being a fermentation, the self-propagating ferment spreads through- 

 out all the recesses of the wound, wherever extravasated blood, or serum, or 

 portions of dead tissue afford nidus and pabulum for its development, and its 

 products become more and more acrid the longer it continues in operation. 

 Antiseptics, then, though they do produce suppuration when applied con- 

 tinuously to a recent wound, are superficial in their action and utterlv trivial 

 compared with the deep and virulent effects of putrefaction, which, indeed, 

 often causes death by irritation and blood-poisoning before suppuration has 

 had time to be established. 



These conclusions may be exhibited in a diagrammatic form as follows : — 



Causes of Sttppuration. 



Abnormal \ ( Through excited nervous ) r n 



,. , ,. A \ ,. f Inflammatory. 



stimulation i ( action I 



of the 1' j From the direct action of ] a. Putrefactive. 



tissues, ) ^ "( stimulating salts ) b. Antiseptic. 



This scheme, though not strictly exhaustive,^ applies to almost all circum- 

 stances met with in surgery ; and it will be found to conduce to clearness to 

 speak of suppuration as inflammatory, putrefactive, or antiseptic, according to 

 the circumstances in which it occurs.^] 



If the use of the protective be so advantageous, you may naturally inquire 

 why I do not employ it at the first dressing. The reason is twofold. In the 



' The group a ought to include the products of other ferments besides those of putrefaction. For 

 I am satisfied that inodorous ferments sometimes occur in the animal fluids, and produce salts which 

 stimulate to suppuration. Also viruses inducing suppuration are very probably of the same essential 

 nature (ferments), though some at least are odourless, as in the case of erysipelas. Again, the group /), 

 to be complete, should include salts which, though not the products of putrefaction, cannot be said 

 to be antiseptic, such as dilute chloride of sodium, i!v:c. 



' Any special case, not falling under the scheme, tiiay be called according to its special nature ; 

 thus we may speak of erysipelatous suppuration, variolous suppuration, «S:c. 



