DEMONSTRATIONS OF ANTISEPTIC SURGERY 257 



is a very uncertain and dangerous practice. But though it is true that wounds 

 of joints, whether accidental or intentional, may heal without disturbance under 

 ordinary treatment, yet it is certain, that if such wounds were kept open without 

 antiseptic means, disastrous consequences would be inevitable ; by keeping the 

 wound open we should take away the only chance there would be, without 

 antiseptic treatment, of the case ending without disaster. But, Gentlemen, 

 paradoxical as it may at first appear, with antiseptic treatment the more free the 

 wound, and the more widely it gapes, the more certain you are to avoid inflam- 

 matory disturbance in the joint ; simply for this reason, that you are the more 

 certain of a free discharge of the plasma effused into the interior. And if \-ou 

 avoid all tension from this cause, and at the same time exclude putrefactive 

 mischief, you have the joint left absolutely free from irritation. Before we 

 bring the patient in, I may say that I shall make the incision pretty free as 

 regards the skin, and carry it gradually down to the joint, so as to be able to 

 see and secure any small artery that may be divided. For if you simply plunge 

 the knife into the joint, and put in a drainage-tube, bleeding may take place 

 into the articulation from some deep vessel, and lead to considerable inconveni- 

 ence. Just as in Professor Andrew Buchanan's well-known experiment, hydro- 

 cele fluid is made to coagulate by the addition of a little serum from a blood-clot, 

 so if a very little blood finds its way into the knee-joint, the liquor sanguinis 

 effused from the synovial surface mixing with the globulin of the red corpuscles 

 forms a coagulable fluid and undergoes coagulation, and you have the knee- 

 joint filled with solid matter, which interferes with the rapidit}' of reco\'er\', 

 although in due time the accumulation disappears by absorption. 



[The patient being now brought in, Mr. Lister proceeded] — Here, then, 

 we have before us the distended knee-joint. You observe this peculiar limited 

 special bulging, which, together with the history, makes me suspect that the 

 joint is on the eve of suppuration. 



I have said that this case will be an example of the antiseptic treatment 

 in its simplest form. The antiseptic will not be introduced into the joint : it 

 will not be applied to the affected part at all. It will be merely employed 

 externally to prevent the access of septic mischief while we provide exit for 

 fluid from the interior. We shall first purify the skin with a strong (i to 20) 

 watery solution of carbolic acid, wiiich is best for detergent purjioses ; water 

 holding carbolic acid but slightly, and very readily giving it up to act upon 

 anything else. Carbolic acid has a remarkable penetrating propcrt\-. Ii blends 

 with oily substances and animal matters, and penetrates the hair and hair- 

 follicles, and therefore such a washing as I am now giving will render the skin 

 absolutely pure, surgically speaking. This is a very great point. 



