276 AN ADDRESS ON THE TREATMENT OF WOUNDS 



surfaces, as well as those of the woiind, would be more or less irritated by it, 

 and in proportion to this irritation would effusion be increased and absorbing 

 power enfeebled, till such time as the temporary effect of the carbolic acid had 

 subsided ; and if, in spite of the antiseptic means, active septic matter had 

 been introduced, putrefaction and septicaemia would be the natural result. 



At the same time, I believed that the day would come when strict antiseptic 

 treatment would prove valuable in ovariotomy. Especially did I anticipate 

 that it would permit early operation for small tumours instead of the patient 

 being kept waiting in anxiety, as used to be the case, till the tumour should 

 have attained large dimensions. And in point of fact I think, judging from 

 the records that have come to us from various quarters, and especially from 

 Germany, that strict antiseptic treatment has rendered very great service to 

 ovariotomy ; that it has made the surgeon more independent of healthy sur- 

 roundings, and also has made less essential the excessively minute care during 

 the operation, and the close attention after it which we have all so much admired 

 in the practice of Dr. Keith. Thus surgeons generally have been brought, by 

 the use of antiseptic means, much more nearly towards the high level of Wells 

 and Keith. Even Keith, on at length adopting strict antiseptic measures with 

 an improved spray, for a while surpassed himself by an unbroken series of eighty 

 successful cases. Yet, wonderful as this achievement was, it was only a difference 

 in degree from his former experience, and assuredly no absolute proof of superi- 

 ority of the new means employed. Of late I understand he has abandoned the 

 spray for reasons which I had not the opportunity of hearing him explain when 

 this subject was discussed at the Congress, and I am informed that he continues 

 to have admirable results, which cannot surprise us when we remember what 

 he had arrived at in his early period without adopting antiseptic measures.^ 



But how, it may naturally be asked, can the success of ovariotomy per- 

 formed without the use of antiseptic means be reconciled with the truth of the 

 antiseptic principle ? The answer is, I believe, to be found partly in certain 

 peculiarities of the abdominal cavity, and partly in circumstances common to 

 wounds in general. One great peculiarity of operation-wounds within the 

 abdomen, as compared with those in ordinary situations, is that already referred 

 to — viz. that the plasma from the cut surface is poured out into a large cavity 

 lined with a serous membrane disposed to absorb it as fast as it is effused. Thus 

 without drainage or any outlet whatever for discharge being provided, the 



^ It is important to bear in mind that Dr. Keith always paid the most scrupulous attention to 

 cleanliness ; and among the elements of that cleanliness he included what was a very important anti- 

 septic precaution — namely, the purification of the sponges which he used by boiling them ; impure 

 sponges being undoubtedly a very fertile source of septic contamination, while protracted boiUng is 

 a most effectual means of destroying septic ferments. 



