288 AN ADDRESS ON THE TREATMENT OF WOUNDS 



The absence of putrefaction in the former case, as compared with its occurrence 

 in the latter, was plainl}^ due in some way or other to the influence of the hving 

 tissues, between which the putrescible lymph or blood-clot lay. Beyond this, 

 however, all was mystery. Afterwards, when the power of healthy living 

 tissues to oppose bacteric development became apparent to me, as exemplified 

 by the inabihty of bacteria to grow in the mucus of a healthy urethra,^ I attri- 

 buted the absence of putrefaction in the healthy wound to a direct control 

 on the part of its tissues over the septic bacteria. There is, however, a defect 

 in this explanation — viz. that, whatever be the nature of the controlling agency 

 of the tissues on the bacteria in their vicinity, it can hardly be conceived that 

 it is exerted beyond an extremely limited range ; so that in order that it should 

 be effective, a more accurate and close apposition of the cut surfaces would 

 seem necessary than actual experience shows to be required. And here our 

 new principle comes to our aid, when we learn that the clot itself, as it becomes 

 organized, acquires the defensive property which remained to be accounted for. 



The thinner the layer of the clot, the more rapidly, caeteris paribus, will 

 it be densely peopled throughout with the new corpuscles, which confer upon 

 it this defensive power ; and the process will also advance quickly in proportion 

 as the tissues of the cut surfaces are vigorous and active. And thus we have 

 the rationale of the rules of the older surgery in aiming at union by the first 

 intention — viz. to perform the operation as much as possible by clean cuts 

 with a sharp knife that shall injure the tissues as little as may be, apply the 

 cut surfaces closely together, at the same time providing an outlet for effused 

 blood and serum, and afterwards endeavour to avoid inflammatory disturbance, 

 which, in proportion to the degree in which it exists, enfeebles the vital powers 

 of the part affected. 



Yet sound as these maxims were in the then existing state of surgical science, 

 the best efforts of the surgeon were too often thwarted by ' unhealthy actions ', 

 as he termed them, of which he did not understand the cause, and which he 

 was consequently powerless to prevent. And we must not allow an exceptional 

 case like ovariotomy to blind our eyes to the truth that the disasters of surgery 

 in the past have been essentially caused by septic agencies."^ Simplification 

 of our means of procedure is no doubt in itself highly desirable, and I have 

 already indicated one direction in which it may possibly be attained. But the 

 safety of our patients incomparably transcends such a consideration, and it 

 would indeed be a grievous thing if our desire for simplicity should induce us 



^ See Transactions of the Royal Society of Edinburgh, vol. xxvii (see vol. i, p. 275). 



^ Under the term ' septic ' I of course include all unhealthy conditions due to the development of 

 micro-organisms, whether the changes which they occasion in the organic fluids and sohds be or be not 

 accompanied by putrefactive odour. 



