AN ADDRESS ON THE TREATMENT OF WOUNDS 287 



clavicle. He entrusted to me the duty of compressing the subclavian artery ; 

 and, as a preliminary measure, made a small incision penetrating through the 

 deep cervical fascia, so as to enable my thumb to be thrust through the mass 

 of clots in that situation, and reach the first rib, on which the vessel lay. He 

 then laid open the mass in the axilla by a free and rapid incision, and scooped 

 out with his hands enough of the clots to enable him to gain access to the arterial 

 trunk, and tie it above and below the place of its communication with the 

 aneurysmal cavity. Making no attempt to remove the rest of the coagula, 

 which indeed would have been quite impracticable, he simply brought the 

 cutaneous margins of the wound together by interrupted sutures, the ends of 

 the silk ligatures being left hanging out of the wound, in accordance with the 

 then universal practice ; and as this was before the days of antiseptic manage- 

 ment, no special treatment of that kind was of course employed, but a dressing 

 of dry lint for the first few da^^s, and water dressing afterwards. Considering 

 the well-known danger of dift'use suppuration, which without antiseptic treat- 

 ment used to attend free incision into a mass of extravasated blood, I was 

 astonished to see both the puncture above the collar-bone and also the main 

 wound heal in the kindest manner, without more suppuration from the latter 

 than must have attended a wound made in healthy tissues as a consequence 

 of the presence of the ligatures. The fact now ceases to be wonderful if we 

 take into account the circumstance that the outlying clots had been for 

 several days among the tissues, and had thus naturally acquired new living 

 elements which w'ould confer upon them the power of fencing themselves 

 against advancing putrefaction. 



Our principle seems, however, to find its widest application in aiding to 

 explain the possibility of union by the first intention without the use of any 

 antiseptic means, nay, in spite of the application of septic ones. For such is, 

 in truth, the apparently cleanly water dressing. As certainly as we remo\-e 

 it from a wound after the lapse of twenty-four hours, do we find that the diluted 

 blood serum which then soaks the lint has a putrid smell, implying that it 

 contains septic ferments such as would assuredly act eftectively upon blood 

 outside the body. And yet, in the not uncommon case of the occurrence of 

 primary union under such treatment, putrefaction fails to spread into the 

 wound ; for if it did so it would inevitably provoke suppuration. 



Long before I entertained the idea of the antiseptic principle I often con- 

 templated with wonder the behaviour of a thin layer of lymph or coagulum 

 between the surfaces of a healthy wound, as contrasted with that which the 

 same material would have exhibited, had it been placed in similar conditions 

 as to temperature and moisture, between two sheets of glass or gutta-percha. 



