AN ADDRESS ON THE ANTISEPTIC MANAGEMENT 



OF WOUNDS 



Delivered at King's College Hospital in the London Post-Graduate Course, January i8, 1893. 

 [British Medical Journal, 1893, vol. i, pp. 161, 277, t,^/', wdth subsequent Corrections.] 



This day five weeks the patient before you was operated on for a badl}- 

 united fracture of the patella. He had been kicked on the knee by a horse twelve 

 months previously. In spite of the care of excellent surgeons his limb was in 

 a very useless condition. He could not raise it at all in the extended position, 

 and, in short, he was a complete cripple. When we operated both the upper 

 and lower fragments were firmly adherent to the bone beneath, and separated 

 by a considerable interval. The operation was difficult and protracted, but at 

 length we succeeded in getting the fragments together and fixing them by means 

 of two stout silver sutures. The patient, as you see, can now walk without a stick ; 

 he can raise the limb freely in the extended position, and bend it through a limited 

 angle. A useful limb is already assured to him, and he will no doubt acquire in 

 course of time a much greater degree of movement than there is at present. 

 I bring this case before you as an illustration of what may be done by antiseptic 

 measures. In my opinion, such an operation would be unjustifiable unless the 

 surgeon could say to himself with a good conscience that he was practically 

 ,sure of avoiding septic contamination of the wound. If you consider how terrible 

 the disaster would probably be if septic suppuration occurred after such an 

 operation, I think you will see that I am warranted in this view. 



I propose, therefore, now to offer a few remarks as to the principles on which 

 we proceed and the means we employ in order to attain constancy of aseptic 

 results in our wounds. The matter divides itself into two heads : first, during 

 the operation to avoid the introduction into the wound of material capable 

 of inducing septic changes in it ; and, secondly, to dress the wound in such a 

 manner as to prevent the subsequent entrance of septic mischief. 



As regards the former of these heads, advancing knowledge has enabled us 

 greatly to simplify our procedure. When I first entered upon tliis subject, 

 knowing as we did that our wounds, with rare exceptions, underwent putrid 

 su})puration, it was natural to suppose that they were ^•cry favourable soils for 

 the development of septic organisms. We knew from the experiments of Pasteur 

 that the air of every inhabited place teemed with microbes of various kinds. We 



