286 AN ADDRESS ON THE TREATMENT OF WOUNDS 



certain it is that the organization of lymph proceeds more rapidly in proportion 

 as the wounded tissues are in a more vigorous condition. Thus a wound on 

 the dorsum of the foot of a feeble old man, though strictly protected from septic 

 influence, heals very languidly ; while a cut in the lip of a child unites with 

 great rapidity. This, indeed, would seem a further argument in favour of the 

 tissues being the source of the new corpuscles. But be this as it may, the 

 lymph on the peritoneum becomes very rapidly thronged with new living 

 elements, and the same will be the case with a blood-clot, which differs from 

 recent lymph merely in containing the additional and probably entirely neutral 

 element of the red corpuscles. But in the meantime, as, in the ass's jugular, 

 the tissues of the vessel were irritated, as it would appear, by the acrid products 

 of putrefaction diffused around the septic parts of the clot, and penetrating 

 to those which were not really septic, so would the parts of the peritoneum 

 surrounding the clot in Douglas's space be excited to adhesive inflammation, 

 gluing the opposed surfaces together by lymph ; and again this lymph, becoming 

 rapidly organized through the high vital energy of the peritoneum, would oppose 

 an effectual barrier to the spreading of bacteric development should it extend 

 to the surface of the clot. At the same time the irritation caused by the putrid 

 products, where most intense, would induce copious effusion of plasma and 

 accumulation of putrid serum. In time this state of things would lead to limited 

 abscess, such as has been occasionally met with after ovariotomy, the discharge 

 of the putrid pus having in some instances been followed by the recovery of 

 the patient.^ 



But the power of organizing blood-clot or lymph to resist the advancing 

 development of putrefactive bacteria has, like the behaviour of the serum in 

 relation to putrefaction, a far wider range of application than to the explanation 

 of the success of ovariotomy performed without antiseptic treatment. It serves, 

 for example, as I believe, to explain a fact like the following : In Mr. Syme's 

 celebrated case of diffuse aneurysm of the axillary artery, treated by ' the old 

 operation ', the aneurysmal clots had not only enormously distended the axilla, 

 but reached backwards so as to raise the scapula, and upwards high above the 



* It is conceivable that, even without the intervention of a coagulum, a collection of serum in 

 Douglas's space, undergoing gradual putrefaction through the influence of some effective septic particle 

 introduced at the operation, and being prevented from diffusion through the general peritoneal cavity 

 in the first instance by a state of perfect repose of the patient, might by its irritation cause such adhesive 

 inflammation as would prove an effectual barrier against the spreading of bacteric development ; for 

 the putrescent serum would produce inflammatory disturbance not merely in the parts on which it 

 acted directly, but also by sympathy (through the nervous system) on parts in the vicinity. The serum 

 of the plasma effused through this agency would be absorbed by neighbouring healthy parts, leaving the 

 lymph to glue the peritoneal surfaces together, and, becoming rapidly organized, to operate as a vital 

 barrier against the advance of putrefaction. 



