340 Suppuration 



a steam atomizer the air over the wound was kept filled 

 with a disinfecting vapor during the whole operation. 



More recent researches, however, have shown not only 

 that the atmosphere need not be disinfected, but also that the 

 air of ordinarily quiet rooms, while containing a few sapro- 

 phytic organisms, very rarely contains pathogenic bacteria, 

 and is rarely an important factor in wound infection. A 

 direct stream of air, such as is generated by an atomizer, 

 really directs more bacteria toward the wound than would 

 ordinarily fall upon it, thereby increasing, instead of lessen- 

 ing, the danger of infection. 



The strong disinfecting solutions once employed have like- 

 wise been largely abandoned, the modern view being that it 

 is far wiser to prevent the entrance of organisms into wounds 

 than to destroy them by the application of strong and 

 irritating solutions. 



Suppuration, while nearly always the result of micro- 

 organismal activity, is not a specific infectious process, but 

 the expression of a violent tissue-reaction that may result 

 from various injurious agents. 



Being, therefore, but the expression of tissue irritation 

 arising through strong chemotactic influences, it is only to 

 be expected that as many bacteria may be associated with 

 it as can bring about the essential conditions. Bacteria with 

 which these qualities are exceptionally marked appear as the 

 common cause of the process; those with which it is less 

 marked, as exceptional causes. 



Attention has already been called to the fact that certain 

 micro-organisms are so intimate in their relation to the skin 

 that it is almost impossible to get rid of them, and in this rela- 

 tion the experiments of Welsh, Robb, and Ghriskey upon 

 hand disinfection have been cited. These observers have 

 shown that, no matter how rigid the disinfection of the 

 patient's skin, the cleansing of the operator's hands, the 

 sterilization of the instruments, and the precautions exer- 

 cised, a certain number of wounds in which sutures are em- 

 ployed will always suppurate, the cause of the suppuration 

 being the skin cocci, all of which it is impossible to remove. 

 We thus carry infectious organisms constantly with us upon 

 our skins, and so pave the way for suppuration in wounds. 

 That all wounds do not suppurate probably depends largely 

 upon the local and general immunity of the individual, 

 rather than upon the absence of organisms from the wounds. 



