ME:\rBERS OF THE BRITISH MEDICAL ASSOCIATION 265 



that there is about an eighth of an inch of cicatricial margin ; yet there is no 

 pus — there is not even any granulation. How the tissue which is thus formed in 

 an organizing blood-clot differs histologically from that of granulations, I have 

 not had time to investigate. But that it differs from granulations functionally 

 is certain, and that in two ways. First, it has not nearly the same tendency to 

 contract that granulations have ; and, secondly, instead of forming pus under the 

 influence of the very slightest stimulus, as granulations do, this tissue resembles 

 normal textures in requiring protracted stimulation to induce it to granulate and 

 suppurate. Now, cicatrization in an open wound without granulation is some- 

 thing new ; it never happened in the world's history without antiseptic means. 



We ma}^ now dispense with the drainage-tube in this case ; and having 

 removed it from the tubular cavity in the coagulum in which it lay, I will cut 

 out with scissors a piece of the tube of blood-clot. You observe blood oozes 

 freelv from it. What was once blood-clot bleeds when wounded. It has become 

 organized and vascularized up to the surface. 



If there had been a dressing of carbolic gauze applied next the wound, and 

 changed daily, we should have had a very different appearance. It seems to 

 be a difficult thing for me to write the English language so as to make m}^ mean- 

 ing intelligible. I find the opinion still often attributed to me, that carbolic acid 

 stops suppuration by some sort of specific agency. On the contrary, I have 

 pointed out, from my earliest experience in the subject, that antiseptic treat- 

 ment threw remarkable light upon the subject of suppuration, by showing that 

 an antiseptic itself, while it prevented putrefaction, stimulated to suppuration ; 

 so that you have what I have termed 'antiseptic suppuration',^ if the antiseptic 

 continues to act upon the tissues for a certain length of time. If we had not 

 interposed this layer of prepared oiled silk to protect the wound from the 

 stimulating action of the carbolic acid in the gauze, we should have had a granu- 

 lating and suppurating sore long ago. The blood-clot itself in its superficial 

 layers serves as an additional protection to that which lies beneath ; but if 

 the blood-clot, which must be regarded as a kind of tissue, is stimulated by an 

 antiseptic, its superficial parts are converted in time into granulations which 

 suppurate. The interposition of the oiled silk ' protective ' shields the clot 

 more or less completely from this stimulating agency, and, provided that you 

 can allow a considerable period to elapse between the times of changing the 

 dressing, so as to avoid the frequent washing of the clot with the stimulating 

 antiseptic lotion, you may often see cicatrization proceed to its completion 

 without any granulation occurring. In the present case, it is five days since 

 the dressing was last changed, and it might have been loft longer without risk 



' See p. 1 5 J. 



LISTER II T 



