290 AN ADDRESS ON THE TREATMENT OF WOUNDS 



and danger, it is a matter of absolute indifference whether primary union occurs 

 or not. Nay more, as in the case just referred to, if we wish to make doubly 

 sure of preventing all inflammatory disturbance, it is sometimes well to avoid 

 stitching, and the tension which may become associated with it. There is at 

 present in King's College Hospital a man on whom^ I operated three weeks 

 ago for ununited fracture of the humerus, cutting down on the fragments and 

 uniting them by a suture of thick silver wire after sawing off their extremities. 

 Now, in a case of this kind some years ago in which I applied stitches to the 

 wound, although a good-sized drainage-tube was used, a certain amount of 

 inflammatory disturbance occurred, which I could only attribute to want of 

 "ufflcient exit for the abundant sanguineous oozing that took place from the 

 osseous surfaces. This disturbance led not merely to some deep-seated suppura- 

 tion, but to necrosis of a portion of one of the fragments, which greatly retarded 

 the cure. Hence I have since abstained from anything like close stitching 

 after such operations, and in the patient referred to the wound was left gaping 

 widely. At the next dressing it was found occupied by blood-clot, which has 

 subsequently become organized, and at the same time has contracted so much 

 that the cicatrix, already nearly complete, promises to be little more than linear. 

 Meanwhile there has been no uneasiness, redness, or swelling, and no febrile 

 disturbance, and if any imperfect pus whatever has been formed, it has been 

 only from the surface of the organized coagulum as a result of slight unavoidable 

 stimulation by the antiseptic used in the dressing. And here we have, as 

 I believe, another touchstone of the antiseptic principle, showing that it is true, 

 and gives results both new and important. For without effective antiseptic 

 means of some kind or other such a course of such a wound would, I believe, 

 be impossible. The impermeable protective layer applied next the wound 

 under the antiseptic gauze prevented evaporation, and maintained a constant 

 state of moisture of the surface of the clot. Now, a moist dressing other than 

 an antiseptic one could not have failed to occasion putrefaction of the exposed 

 coagulum and suppuration of the cavity of the wound.^ Yet, all who are 



* In an animal like the donkey the reparative energies of the tissues would appear to be greater 

 than in man, as is indicated by the well-known faciUty with which healing by scabbing is obtained in 

 veterinary practice. Yet, in the donkey's jugular, it was only the parts of the coagulum near the wall 

 of the vein that had escaped putrefaction. Even in such an animal, therefore, an exposed clot covered 

 with water dressing would putrefy, with the exception of the parts next the tissues ; and these would 

 granulate and suppurate. Under a dry dressing, indeed, even in man, healing without suppuration 

 has been sometimes seen in open wounds of considerable extent, especially when the affected part has 

 been kept completely at rest and supported by methodical compression, as insisted upon by M. Alphonse 

 Guerin and Mr. Gamgee. Here the dry dressing appears to have an antiseptic influence by causing 

 an inspissated state of the serum in the dressing, for it has been shown by Naegele that bacteria are 

 unable to develop in concentrated organic solutions. Such results of mere dry dressing cannot, however 

 be reckoned on with anything like certainty. 



