ApriL 8, 1915] 
NATURE 
165 

universal sepsis made us fear that our prognostica- 
tion had come true, and that the abandonment 
of antiseptics was, at least in part, accountable. It 
appears, however, that antiseptics are being very 
largely used, though with most disappointing results. 
The fact must not be overlooked that military 
surgery is exceptional, and that this particular war is 
being fought in most exceptional circumstances— 
trenches dug and monster shells exploding in the 
highly-cultivated soil of a noted tetanus area like the 
valley of the Aisne. It is almost impossible for 
us at home to appreciate what is going on. Listen, 
therefore, to this graphic extract from a_ letter 
I received last week from Sir Anthony Bowlby :— 
“Tn this trench warfare you must remember 
that, if a man is hit, he often falls into filthy 
mud and water, which may be 3 ft. deep or 
more. Remember also that the trench is only 23 ft. 
wide. If it is night, you can only grope about in the 
dark and can do no dressing of any kind, for you 
can’t even get any clothes off in the darlx, and in so 
cramped a space, and you must try to get the man 
away to a ‘ dressing station’ half a mile distant, and 
thence to a field ambulance. Jf it is daylight, you 
can’t get the man out of the trench at all, and he 
may have to be kept there for mary hours, because he 
would certainly be killed if he was got out of the 
trench. And the water in the trenches is hopelessly 
polluted, and soaks his clothes and his wound. It is 
only too evident that large lacerated wounds, and 
especially bad bone smashes, are so contaminated that 
it can never be possible to render them aseptic.”’ 
This is a dreadful picture; but all fighting is not 
trench fighting, and we might have hoped not to be 
told that all wounds, except bullet wounds, are septic, 
seeing that a few, at least, come under treatment 
within a reasonable period, say twelve hours, after 
infliction. 
I have been helping Sir Watson Cheyne to lead a 
crusade in favour of applying to these dirt-infected 
wounds Lister’s original method of purification by 
means of undiluted carbolic acid. Not that I advocate 
it for civil practice, but because I think that the only 
chance of destroying the organisms of tetanus and 
gas gangrene, and the best way of dealing with 
streptococci, is to use the most potent and _ safest 
antiseptic which is at the disposal of the surgeon for 
the purpose. ; 
The suggestion met with the cordial approval of 
those who, like myself, have employed this agent 
extensively. But it excited a certain amount of loud 
criticism from others, who were chiefly impressed by 
the fact that undiluted carbolic acid produces a certain 
amount of sloughing. This criticism is easily met, 
because, if employed with the discretion that may be 
expected of reasonable people, the slough is un- 
important, superficial, and antiseptic—incomparably 
less suited for the growth of micro-organisms than 
the extensive and spreading sloughs which they them- 
selves produce. Moreover, these antiseptic sloughs 
do no harm, but are quickly absorbed if the wound 
heals antiseptically. 
That is not the weak point in the argument. There 
is, however, another, more difficult to answer, of 
which our opponents did not make so much. Un- 
fortunately, it cannot be denied that the spores of the 
bacilli of tetanus resist the action of even undiluted 
carbolic acid for a very considerable time. Moreover, 
my colleague, Dr. Thiele, has shown that, if easily 
recognisable micro-organisms are injected into the 
subcutaneous tissue, they enter the lymph channels, 
and may pass into the circulation in the course of a 
few minutes, long before there is a chance, if the same 
thing happens in contused wounds, of getting at them 
with our antiseptics. 
NO. 2371, VOL. 95] 

abandon this line of treatment, 
and say that it is use- 
any wound in eivil or 
Are we, then, to 
to fold our hands in despair 
less to attempt to disinfect 
military practice to which spore-bearing or other 
organisms may have gained access? By no means. 
All Lister’s work cries out against such a conclusion. 
We must clear our minds of the delusion that care- 
fully planned experiments on guinea-pigs in the 
laboratory are on all fours with unrehearsed experi- 
ments in factories, or on wounded soldiers in the 
battlefield. Lister did undoubtedly succeed in 
stopping sepsis in compound fractures and in banish- 
ing tetanus and hospital gangrene from his wards, 
and the experience of generations of surgeons working 
with a saturated watery solution of carbolic acid has 
confirmed his conclusions. Surely, then, it may be 
possible to find a practical way of applying the prin- 
ciple to military practice. 
It will not, however, do to brush the argument 
aside in this way without examining it and answer- 
ing it. I therefore submit for your consideration a 
suggestion as to what happens in a case successfully 
treated antiseptically, that is, one that heals without 
suppuration. 
We do not know for certain in what form the 
anaerobic spore-bearing organisms are introduced into 
a wound. I, at all events, do not know of scientific- 
ally conducted observations upon the subject. But it 
is clear that they must be either in the form of 
bacteria, or spores, or both, probably embedded in 
decaying organic matter in the soil. If the antiseptic 
reaches them it destroys the bacteria, together with 
the other septic organisms. But possibly, or, let us 
say, probably, it has not sufficient time before becom- 
ing too diluted to kill the spores, though it may for 
a while inhibit their power of development. There, 
then, these spores lie dormant between a thin layer 
of carbolised slough and a mass of more or less 
carbolised blood clot. If sepsis is avoided, the phago- 
cytes at last invade both the slough and the clot, and 
healing takes place without suppuration. What is the 
fate of the spores? 
We must suppose that, when the carbolic acid has 
disappeared, as they are embedded in a warm, airless 
nidus, they germinate, but only to find themselves 
surrounded by active phagocytes which, if they form 
a suitable pabulum, destroy them. And so the matter 
ends so far as the wound is concerned. 
This, I maintain, is a reasonable hypothesis and a 
sufficient answer, and fortunately it is rare indeed, if 
it ever happens, for tetanus to occur affer a wound 
has healed without any suppuration at all; and, more- 
over, the abolition of tetanus in civil practice has 
coincided with the reduction in the number of sup- 
purating wounds. 
As a further support of the argument, let us now 
consider the case of the bacteria and spores of tetanus 
or gas gangrene lying together in an untreated 
wound, or in one to which less powerful antiseptics 
are applied, antiseptics not strong enough to destroy 
the pus-producing organisms. They find themselves, 
therefore, amongst extensive septic sloughs and de- 
composing blood-clots in which the phagocytes, if they 
can penetrate at all, have their time fully occupied 
with myriads of other organisms, which first weaken 
and then overpower them. Is it to be wondered at 
that lockjaw and gas gangrene affect a certain pro- 
portion of such cases? On the contrary, the marvel 
is that these complications are not more frequent. 
For, after all, though tetanus and gas gangrene are 
ghastly things, and make a great impression because 
the laity knows about them, these diseases are not 
by any means the most deadly or the most frequent. 
Probably 40 per cent. of the wounds at one part of 
the campaign were infected with tetanus, but, up to 

