THE ANTISEPTIC MANAGEMENT OF WOUNDS 355 



to the diminished irritation there is less serous effusion, and therefore less 

 necessity for drainage.'- 



Before proceeding to consider the second division of our subject, the best 

 form of external dressing for the wound, I have a few words to say regarding 

 the course you might adopt in case you were called upon to operate under 

 circumstances where you had no chemical antiseptic at your disposal. First, 

 you should have your sponges well boiled, and also the line silk threads which 

 you will use for securing bleeding-points (the ends being cut short). Such 

 instruments as will not be injured by the process may also be purified in the 

 same way ; and for washing the sponges during the operation it will be well 

 to use boiled water, although, from the facts before brought under your notice, 

 you may infer that unboiled water, if free from visible floating particles, would 

 not be likely to cause mischief. Towels dipped in the boiled water and spread 

 about the seat of operation will diminish the chance of contamination of the wound 

 from surrounding objects. Then thorough cleanliness in the ordinary sense, 

 by the free use of soap and water, must be practised for the hands of the surgeon 

 and his assistants and for the skin of the part operated on. For sutures under 

 these imperfect antiseptic arrangements, materials incapable of absorbing 

 putrescible liquids, silver wire, silkworm gut, or horsehair, should be used 

 rather than sterilized silk, in order to avoid suppuration in the stitch tracks. 



For dressing the w^ound in the absence of chemical antiseptics, dry sub- 

 stances such as absorbent cotton-wool or old linen (preferably boiled before use) 

 are far better than anything kept permanently moist, like water dressing. It 

 was shown several years ago by Naegeli of Munich that the more concentrated 

 an organic solution is, the less easily do bacteria de\'elop in it. much in the same 

 sort of way as a cook who makes her jam has to boil it down until the syrup 

 has a sufficient proportion of sugar in it, or else fungi will develop in the preserve. 

 And so the blood and serum oozing into a dr\^ dressing, becoming more or less 

 inspissated by evaporation, are in proportion a less favourable soil for microbic 

 development. If w^e look back to our old experiences with water dressing, 

 we can only wonder that wounds ever united by flrst intention at all under 

 such treatment. The water dressing, clean at the moment of application, was 

 invariably stinking when it was taken off in the course of twenty- four hours. 

 and it seems astonishing that septic mischief ever failed to develop in a wound 

 with this putrid mass lying over its outlet. It only ser\-es to iUustrate how 

 powerful are the means by which Nature defends herself against the microbes. 



But with dry dressing, in conjunction with the care in other respects which 



' Note by Lord Lister, 1907 : la luy later practice, when I could feel secure against contamination 

 of the wound by assistants, I omitted the final washing. 



