AN ADDRESS ON THE TREATMENT OF WOUNDS 285 



vicinity of the glass tube the red corpuscles were utterly altered, and accom- 

 panied by abundant bacteria of different kinds, some in active movement, the 

 piece of firm clot from near the wall of the vein showed the red corpuscles often 

 exactly like those of freshly drawn blood ; ^ while, if any bacteria were present, 

 they did not declare themselves to ordinary microscopic examination. 



Thus the experiment affords very striking proof of the power of an undis- 

 turbed healthy coagulum in the vicinity of living tissues to resist the develop- 

 ment of putrefactive bacteria, even when present in a highly concentrated form ; 

 while we have, as I believe, an explanation of this power in the multitude of new 

 living elements with which the clot w^as peopled.^ 



Turning now to the application of these pathological facts to ovariotomy, we 

 find that they seem to complete the explanation of the success which has 

 attended that operation performed without antiseptic precautions. Among the 

 points in Dr. Keith's earlier practice which most excited alike my admiration 

 and my astonishment was the way in which he diagnosed an accumulation of 

 fluid in the pouch of the peritoneum termed Douglas's space, and, drawing 

 off by puncture per rectum with cannula and trocar a quantity of putrid liquid, 

 saved his patient from impending death. I greatly admired the skill of this 

 practice ; but I was astonished at the pathological facts. How was the septic 

 process limited and prevented from spreading throughout the cavity of the 

 peritoneum ? This seems now to admit of interpretation. In such cases 

 septic matter must have been introduced during the operation in a form capable 

 of developing in the blood ; and if we suppose a portion of such effective septic 

 ferment imprisoned in the interior of a coagulum in the space referred to, this 

 clot, situated within the living body, may be conceived to oppose an obstacle 

 to the development of the putrefactive bacteria in its substance, as was the 

 case in the venous compartment of the ass's jugular. And here the high vital 

 energy of the peritoneum would come into play. We have seen how rapidly 

 a wound in the peritoneum may heal, and this rapid healing is, in other words, 

 the rapid peopling of the lymph in the wound with vigorous new living elements. 

 For, whatever view may be taken as to the source of these new corpuscles, 



' Tlic only cliange observed in the red corpuscles of this part of the clot was that in some cases 

 they had an abnormal purple colour, which I presume was due to products of putrefaction diftused 

 through the clot from the neighbouring putrefying parts. 



" The development of cells of new formation in organizing coagula \nthin the li\nng body, first 

 ascertained, so far as I am aware, by myself in 1864, has been the subject of various observations 

 of late years, especially by German pathologists, as, for example, Tillmanns. (Vide Centralblatt fur 

 Chirurgie, 1897, No. 46.) That this cell development may, under some circumstances, go on to genuine 

 suppuration is a fact I believe not hitherto published by any pathologist, though the truth of the 

 occasional conversion of coagula into pus has always seemed to mc sufViciontly apparent from the 

 naked-eye appearances of suppurative phlebitis and the beautiful experiments of Cruveilliicr. 



