AN ADDRESS ON THE TREATMENT OF WOUxVDS 



Delivered before the Surgical Section of the International Medical Congress, London, August 1881.' 



[Lancet, 1881, vol. ii, pp. 863, 901 ; Transactions of the International Medical Congress, 



London, 1881, vol, ii, p. 369.] 



Mr. President and Gentlemen. — To those of you who know from personal 

 experience what antiseptic measures can do for surgery it may well seem strange 

 to find some who have taken part in this discussion still assigning them a secondary 

 place in the treatment of wounds. The explanation of this fact is, I believe, 

 to be found chiefly in the success — nay, the brilliant success — sometimes obtained 

 without the use of any antiseptic means whatever. This has been conspicuously 

 the case with abdominal surgery, and especially with ovariotomy. Ovariotomy, 

 indeed, has sometimes been spoken of as a touchstone of the efficacy of the 

 antiseptic treatment. The success which has attended antiseptic ovariotomy 

 has been regarded as a signal proof of the truth of the antiseptic principle. 

 Such, however, has never been my own view. Mr. Spencer Wells and Dr. 

 Thos. Keith achieved results which astonished the world before strict antiseptic 

 treatment was thought of : and when, several years ago, Dr. Keith expressed 

 to me an intention of performing ovariotomy antiseptically, I strongly dissuaded 

 him from his purpose. I knew his already brilliant success ; I felt that our 

 spray apparatus was as yet inadequate for the production of a cloud sufficiently 

 large to cover the whole field of operation, and sufficiently line to avoid needless 

 irritation ; and I was also aware that such operations are often both very pro- 

 tracted and very anxious, while in proportion to the duration and the anxiety 

 of an operation is the chance of the neglect of some apparently trivial yet 

 important element in the procedure. And if the antiseptic treatment were 

 attempted in ovariotomy and failed in its immediate object, I felt that it would 

 be not only nugatory but injurious. It seemed to me that in any case of ovario- 

 tomy performed without antiseptic measures there was a contest between eftusion 

 from the wounded surfaces and absorption of the effused serum by the uninjured 

 peritoneum. If absorption kept pace with effusion, there was no time for jnitre- 

 f active fermentation to take place in the effused liquid ; but it absorption 

 lagged behind and effusion predominated, the serum accumulated in the abdo- 

 minal cavity, and, ])utrefying, gave rise to septicaemia. Now, supposing an 

 antiseptic like carbolic acid to be employed in the operation, the peritoneal 



* In preparing these remarks for the press, .Mr. l.islcr has expanded the facts and arguments adduced 

 during the necessarily limited time at Ixis disposal in the discussion. 



