ON THE PRINCIPLES OF ANTISEPTIC SURGERY 347 



When first I witnessed the remarkable fact of the entire cessation of sup- 

 puration as a result of relieving abscesses of their contents and at the same time 

 preventing the access of micro-organisms from without, I inferred that microbes 

 could have nothing to do with the production of the pus, but that it was caused 

 by inflammation which, however it had originated, was kept up by the tension 

 of the pent-up liquid operating through the nervous system. This view has, 

 however, been disproved for both acute and chronic abscesses ; for the acute by 

 Ogston's observation that they invariably contain micrococci, w^hich experiment 

 has since proved to be truly pyogenic, and for the chronic by Koch's discovery 

 of the tubercle bacillus, which we now know to abound in the pyogenic mem- 

 brane and caseous material in such cases. Some other explanation is therefore 

 called for. As regards acute abscesses, if we consider what is the primary 

 difference made by a poultice, as compared with an antiseptic dressing, we see 

 that putrefaction is admitted by the former, while it is excluded by the 

 latter. And I conceive that the acrid products of putrefaction act injuriously 

 upon the pyogenic membrane and prevent destruction of the micrococci by 

 the natural antisepsis which is always disposed to operate, but, so long as the 

 abscess is unopened, is hindered by the disturbing influence of tension caused 

 by the rapidly accumulating pus. 



In chronic abscesses the slowly increasing contents cause but little tension. 

 But we know that a very slight degree of tension on the wall of a cavity con- 

 taining fluid is sufficient to keep up chronic inflammation in the sac and 

 surrounding tissues. This is well illustrated by the obstinacy of chronic bursitis 

 patellae so long as the bland serous contents remain in the sac ; and conversely 

 the rapid cure that takes place when provision is made antiseptically for the 

 escape of the fluid. Not only does the tendency to abnormal effusion of fluid 

 cease, but the inflammatory induration around the sac speedily disappears. 

 And as inflammation, in whatever degree, is always a cause of weakness of the 

 part affected by it, we can understand that, so long as a psoas abscess remains 

 unopened, the enfeeblement of the surrounding tissues, caused in the way referred 

 to, may place the tubercular vertebrae at a disadvantage in their combat with 

 the tubercle bacilli and prevent them from throwing off the disease as they would 

 have done before abscess had occurred, if the spine had been placed at rest in 

 the recumbent posture. If tension is relieved by antiseptic drainage, the tissues 

 are allowed to recover vigour and assert their supremacy. But if such an abscess 

 is poulticed after incision, though tension is removed, far worse causes of dis- 

 turbance come into operation. The pyogenic organisms, previoush" absent, 



are simultaneously scraped away and washed out. An antiseptic dressing is of course applied to the 

 sutured wound, wliicli may cither heal at once throughout or furnish a temporary leakage of serum. 



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