AN ADDRESS ON THE TREATMENT OF WOUNDS 279 



Or, again, it seems to me conceivable that the normal serum mav oppose 

 an insuperable obstacle to the nutritive attractions of an individual bacterium, 

 but that this may be overcome by the associated action of several of the organ- 

 isms in close proximity ; after the analogy of the more energetic operation of 

 a concentrated solution of a chemical reagent. In this case the diffusion by 

 water would produce its effect by simply detaching and separating the bacteria 

 from each other. But whatever be the explanation, the fact remains. 



I have also made observations on the effects of exposure of uncontaminated 

 blood to air in different localities, and I have found that even the introduction 

 of considerable quantities of dust has not led to putrefactive change. 



Applying this knowledge to the discussion of ovariotomy performed without 

 antiseptic precautions, the question naturally suggests itself whether in manv 

 cases any septic organisms have really been introduced into the peritoneal 

 cavity, either from air or from water, in a condition capable of developing in 

 the effused serum. And thus we have suggested to us a further explanation 

 of the success of such operations. 



But the facts which have been elicited by the experiments referred to have 

 a far wider range of application than to the special case of ovariotomy. They 

 seem to indicate that the putrefaction so apt to occur in wounds not treated 

 antiseptically is due rather to septic matter in a concentrated form than to 

 the diffused condition in which it exists either in water or in air. They suggest 

 the highly important question, Is the spray really necessary ? In other words. 

 Is there sufficient chance of the air of an operating theatre or private room 

 containing septic matter which can prove effective in blood serum to make it 

 needful to regard the question of contamination from the atmosphere at all ? 

 If the answer must be given in the affirmative, and the choice must lie between 

 the spray and antiseptic irrigation during the operation at intervals varying 

 according to the discretion of the surgeon, with syringing of the cavity of the 

 wound after stitching, and syringing also at every dressing, then I should give 

 my voice decidedly in favour of the spray, as being more sure of attaining its 

 object and involving less irritation of the wound, and also (if carbolic acid be 

 the antiseptic used) much less risk of carbolic poisoning. At the same time 

 it must be distinctly borne in mind that the spray is, beyond all question, the 

 least important of our antiseptic means, and that the circumstance that a surgeon 

 does not happen to have a spray-producer at hand is no excuse wliate\'er for 

 his abandoning the attempt to obtain aseptic results. But if the apparatus 

 for the spray is at my disposal, I for my part do not as yet dare to abandon it 

 By the careful use of our jiresent means, the spray included, we ha\o arri\ed. 

 1 think I may venture to say, at absolute security of attaining tlie great object 



