338 AN ADDRESS ON | 



pletely, with the Hne of union perhaps sealed hermetically with some antiseptic 

 varnish, and bitter was my disappointment at finding that the carbolic acid 

 used as our antiseptic agent induced by its irritation such a copious effusion of 

 bloody serum as to necessitate an opening for its exit ; hence came the drainage 

 of wounds. But if we can discard the application of an antiseptic to the cut 

 surfaces, using sponges wrung out of a liquid that is aseptic but unirritating, 

 such as the i to 10,000 solution of corrosive sublimate, we may fairly hope that 

 the original ideal may be more or less nearly attained. 



We have already made of late considerable approaches towards it. Our 

 wounds being no longer subjected to the constant irrigation of the spray, and 

 carbolic acid having given place to the less irritating, though more efficient, 

 solutions of corrosive sublimate, serous discharge is much less than formerly, 

 and less drainage is required. In many small wounds where we used to find 

 drainage imperative we omit it altogether, and in those of larger extent we 

 have greatty reduced it. Thus, after removing the mamma and clearing out 

 the axilla, I now use one short tube of very moderate calibre, where I used to 

 employ four of various dimensions. But it would be a grand thing if we could 

 dispense with drainage altogether ; without applying the very firm elastic 

 compression adopted by some surgeons, which, besides involving the risk of 

 sloughing of parts of low vital power, with the chance that it may after all fail 

 in its object, proves often extremely irksome to the patient. 



It remains for me to say a few words regarding the best form of external 

 dressing. Some surgeons have thought that simplicity and efficiency may be 

 combined in the maximum degree by the use of cotton- wool sterilized by heat. 

 But though it may be a simple thing to heat the wool appropriately by means 

 of suitable apparatus in a public institution, for the ordinary practitioner it would 

 be impracticable. And as regards efficiency, I need hardly remark that cotton- 

 wool, merely aseptic, can only exclude septic mischief when it is in the dry state. 

 When it is soaked to its external surface with a copious discharge, it must be 

 liable to become septic en masse. And however well we may succeed in the future 

 in diminishing or abolishing discharge from wounds made by the surgeon, there 

 must always remain cases in which it will occur in greater or less amount. 



Contused wounds, for example, into which dirty material of one kind or 

 another has been introduced before they are seen by the surgeon, must be purified 

 by the use of powerful antiseptic means, and must, for a while, discharge freely. 

 The same is to be said of cases in which we make the attempt, often with signal 

 success, to restore an aseptic condition in a part affected with septic sinuses. 

 Again, there are abscesses in which, in the present state of our knowledge, we 

 cannot avoid the occurrence of considerable serous oozing, and in which a 



