AN ADDRESS ON THE TREATMENT OF WOUNDS 291 



familiar with antiseptic practice know that it is a common thing to see the 

 organization of the blood-clot proceed under the protection of the superficial 

 layer of coagulum to complete healing without a particle of suppuration, a scar 

 being found when the superficial layer is detached. 



Time would not permit me to refer to all that has been communicated 

 by those who have taken part in this discussion. I cannot, however, forbear 

 making a passing allusion to the extremely remarkable results which have been 

 related by Professor Esmarch as obtained by his permanent dressing — results 

 so surprising that they would be incredible were it not for the perfect trust- 

 worthiness of the authority that vouches for them. And I would ask those 

 who advocate mere cleanliness, as distinguished from antiseptic practice, how 

 they can reconcile their views with facts such as these ? What can be more 

 dirty, in the ordinary acceptation of the term, than a wound left covered up 

 with the same dressing for weeks together, the original blood and serum remain- 

 ing upon it intact under this ' Dauer-Verband ' ? Yet it is surgically clean 

 because it is aseptic. On the other hand, the aesthetically cleanlv water 

 dressing is surgically dirty, because it contains elements which give rise to 

 septic changes in wounds. 



One other point which has been referred to in connexion with this debate 

 is of so much importance that I cannot but notice it. The old objection has 

 been revived that antiseptic treatment leads the surgeon to concentrate his 

 attention upon local measures, to the neglect of general hygienic arrangements 

 and a due consideration for the constitutional state of the patient before subject- 

 ing him to operation. I do not think that this charge is at all warranted by 

 facts. For my own part, I have from the first used antiseptic treatment even 

 for superficial wounds and sores, not so much for the sake of the individual 

 cases (which I knew did well, as a rule, under water dressing) as for the express 

 purpose of preventing them from contributing elements of general unhealthiness 

 to the hospital ward. And if I have sometimes allowed the beds under my 

 charge to be more crowded than is in accordance with the views of modern 

 hygiene, it has been only after such a condition, originally brouglit about by 

 accidental circumstances, had proved as a matter of fact consistent with perfect 

 healthiness of the patients. The septic element being suppressed, less space 

 was found to be essential to salubrity. 



As to the other part of the charge — viz. that antiseptic treatment leads 

 to a less careful selection of patients for operation than ought to be made, it 

 seems to me to be refuted by the success which confessedly attends the practice. 

 If, indeed, the charge were well founded, and wc^ did reaUy operate upon patients 

 whose constitutions rendered them unfit subjects for such interference, good 



