AN ADDRESS ON THE TREATMENT OF WOUNDS 289 



in any degree to relax our efforts to carry out the strict antiseptic principle, 

 the strenuous endeavour so to deal with wounds as to prevent from first to 

 last the development in them of pathogenic organisms.^ The means by which 

 this object may be most surely and at the same time most conveniently attained 

 will, no doubt, vary greatly in the future in accordance witli our ever-ad\'ancing 

 science ; but whatever modifications we may admit in our methods, let us at 

 all events never be satisfied with any that does not yield results at least as 

 good as those which it is now in our power to secure. 



If we suffer ourselves to be drawn aside from the strict antiseptic principle, 

 we shall not only subject our patients to the risk of the old disasters, but we 

 shall be compelled to withhold from them the benefit of valuable procedures 

 which strict antiseptic management alone can warrant. Take as a single 

 example the case of a loose cartilage in the knee-joint. To remove it by free 

 incision is the most simple and satisfactory treatment, except' for the attendant 

 danger which was formerly so great as to be prohibitor\', but of which our present 

 means of carrying out the antiseptic principle have entirely disarmed it. If 

 such a procedure was ever ventured on without antiseptic means, the only 

 chance of success lay in accurate closure of the wound with a view to primary 

 union. On the other hand, under antiseptic management, I systematically 

 abstain from closing the wound completely, leaving a part unstitched for the 

 introduction of a drainage-tube, so as to guard against the inflammatory distur- 

 bance which might otherwise result from accumulation of fluid in the articular 

 cavity. In other words, I abstain from the onh' means which would have 

 afforded hope of success without antiseptic treatment, and I adopt means which, 

 without antiseptic treatment, must infallibly lead to disaster through septic 

 suppuration of the articulation. Here, then, I conceive we have a true touch- 

 stone of the truth of the antiseptic principle. The loose cartilage which I liold 

 in my hand was removed from the knee of a gentleman a fortnight ago. It lay 

 imprisoned in the angle between the anterior part of the articular surface of 

 the tibia and the femur. I extracted it by free incision ; and as the situation 

 was one which did not admit of convenient insertion of a drainas:e-tube into 

 the joint, I left the wound widely gaping throughout. That patient lias not 

 since experienced the slightest uneasiness, nor has there been an}- disturbance, 

 local or constitutional. 



And this leads me to make the general remark that under strict antiseptic 

 treatment union by first intention has no longer the imjiortance it used to possess. 

 As regards the essential points of avoidance of inflammation and fe\er, of pain 



' The tcnn 'pathogenic bacteria' has been iiUrudiiced by the Ceinuui pathologists to signiiy bacteria 

 which give rise to disease in the animal body by developing within it. 



