348 ON THE PRINCIPLES OF ANTISEPTIC SURGERY 



are admitted, and along with them the microbes of putrefaction, the products 

 of which are at first absorbed by the sac and cause the primary toxic fever, but 

 soon by their irritation convert the pyogenic membrane into a huge granulating 

 surface which suppurates like an ulcer under water dressing. The tubercle bacilli 

 meanwhile are allowed to develop at will in the tissues enfeebled by this fresh 

 cause of disturbance. 



Even in abscesses with fetid contents antiseptic treatment is often rewarded 

 by brilliant success. I once opened an abscess in the lumbar region, giving 

 exit to a brown liquid, closely resembling thin faeces and with a smell like that 

 of putrid intestines in the dead-house. Being provided with an antiseptic 

 dressing, I applied it, and on changing it next day I was, I confess, surprised as 

 well as delighted to see nothing issue from the opening but a few drops of trans- 

 parent and odourless serum. Microscopic examination showed the original 

 contents to consist almost entirely of closely packed very slender bacilli in active 

 writhing movement ; of what species I know not. Healing took place rapidly 

 with a typically aseptic course. 



In that case I picture to myself the following series of events. The colon 

 was at some spot affected with inflammation not severe enough to cause death 

 of its tissues, but sufficiently intense to prostrate for the time the agency by 

 which, in a healthy state of the bowel, bacteria in the faeces are prevented from 

 passing through its walls. One or more of this particular species of bacillus, 

 having traversed the inflamed intestine, developed in the tissues outside the 

 bowel, and, by a peculiar fermentative action, transformed the effused liquor 

 sanguinis into the offensive material of the abscess contents. This species of 

 bacterium, however, while it throve on this foul pabulum, was unable to grow 

 in pure blood, and when the cavity of the abscess was flushed with liquor san- 

 guinis effused from its wall after it was opened, the microbe ceased at once to 

 develop ; and the abscess followed the same course as if no unusual organism 

 had been present. 



Whatever may be thought of this explanation, I venture to urge that all 

 abdominal abscesses with foul contents (excepting those which obviously contain 

 faecal matter) should be afforded the chance of following an aseptic course 

 under antiseptic management. 



Submucous abscesses of the rectum pointing beside the anus have always 

 fetid contents, but if carefully treated antiseptically will, as a rule, heal without 

 the occurrence of 'fistula in ano ', i.e. without the formation of a communication 

 with the interior of the intestine.^ 



^ See p. 215 of this volume. 



