AN ADDRESS ON THE TREATMENT OF WOUNDS 277 



serum is, under favourable circumstances, prevented from accumulating as it 

 would in ordinary wounds similarly treated, and opportunity is not afforded 

 for putrefaction. 



Another favourable result of the disposition of the parts is that even if 

 some accumulation of fluid does take place, the large size of the cavity, naturally 

 adapted for variations in capacity, prevents the occurrence of tension, which 

 is so common a cause of disturbance in ordinary wounds. More especially if 

 a large tumour has been removed, the part affected is left in a state of the 

 most perfect flaccidity and relaxation. 



A further peculiarity in favour of abdominal wounds is due to the high 

 vital power of the peritoneum. I recollect making a post mortem examination 

 in a case of strangulated hernia, where death had taken place \nthin forty- 

 eight hours of the operation, and finding it impossible to discover the site of the 

 incision by inspection from within the abdomen, so completely had the peritoneal 

 wound already cicatrized. This high degree of vital energy operates beneficially 

 in a manner which I shall be better able to explain when I have spoken of some 

 circumstances common to all wounds in their relations to septic agencies. 



At the Cambridge meeting of the British Medical Association last year, 

 I brought forward facts which showed that the serum of blood is not at all so 

 favourable a soil for the growth of micro-organisms as I had previously imagined.^ 

 If we take a glass of uncontaminated milk or urine, so arranged that if left 

 untouched it will remain for any length of time free from organisms, and add 

 to it a drop of ordinary water, we are sure to find in a few days evidence of bacteric 

 development in the liquid. Indeed, in the case of milk, which appears to afford 

 pabulum for almost all varieties of micro-organisms, I have shown that if a 

 dozen glasses of the liquid in a state of purity, in vessels suitably arranged to 

 prevent contamination from without, receive each one-hundredth of a minim 

 of tap water, most of the glasses will develop bacteria, though of difterent 

 species in the different vessels, showing how numerous and how various are the 

 micro-organisms really present in water.- Even the comparatively crude liquid 

 which we call 'Pasteur's solution', a mere solution of cane-sugar, tartrate of 

 ammonia, and earthy salts, in which many kinds of bacteria refuse to grow 

 at all, will be pretty sure to produce such organisms in a few days if a drop of 

 tap water is added to it. Now from these analogies, and knowing as wc do 

 to our cost that blood serum is but too liable to putrefactive fermentation. I had 



^ See vol. i, pp. 387 et seq. 



' See 'On the Lactic Fcnnentation ', Transactions of the Pathological Society of London, 187S 

 (printed in vol. i, p. 353). The results of such an experiment differ according to the season of the year. 

 In cold wintry weather, when bacteria might be expected to be less numerous, it may happen that but 

 few of the inoculated glasses show any change at all. 



