Septembee 25, 1896.] 



SCIENCE. 



415 



Too often the surgeon's efforts to obtain 

 primary union were frustrated, the wound 

 inflamed and the retentive stitches had to 

 be removed, allowing it to gape; and then, 

 as if it had been left open from the first, 

 healing had to be effected in the other way 

 which it is necessary for me briefly to de- 

 scribe. An exposed raw surface became 

 covered in the first instance with a layer of 

 clotted blood or certain of its constituents, 

 which invariably putrefied ; and the irrita- 

 tion of the sensitive tissues by the putrid 

 products appeared to me to account suffi- 

 ciently for the inflammation which always 

 occurred in and around an open wound 

 during the three or four days which elapsed 

 before what were termed ' granulations ' 

 had been produced. These constituted a 

 coarsely granular coating of very imperfect 

 or embryonic structure, destitute of sensory 

 nerves and prone to throw off matter or 

 pus, rather than absorb, as freshly divided 

 tissues do, the products of putrefaction. 

 The granulations thus formed a beautiful 

 living plaster, which protected the sensitive 

 parts beneath from irritation, and the sys- 

 tem generally from poisoning and conse- 

 quent febrile disturbance. The granula- 

 tions had other useful properties, of which 

 I may mention their tendency to shrink as 

 they grew, thus gradually reducing the di- 

 mensions of the sore. Meanwhile, another 

 cause of its diminution was in operation. 

 The cells of the epidermis, or scarfskin of the 

 cutaneous margins, were perpetually pro- 

 ducing a crop of young cells of similar na- 

 ture, which gradually spread over the gran- 

 ulations till they covered them entirely, and 

 a complete cicatrix or scar was the result. 

 Such was the other mode of healing that, 

 by granulation and cicatrisation, a process 

 which, when it proceeded unchecked to its 

 completion, commanded our profound ad- 

 miration. It was, however, essentially 

 tedious compared with primary union, 

 while, as we have seen, it was always pre- 



ceded by more or less inflammation and 

 fever, sometimes very serious in their ef- 

 fects. It was also liable to unforseen inter- 

 ruptions. The sore might become larger 

 instead of smaller, cicatrisation giving place 

 to ulceration in one of its various forms, or 

 even to the frightful destruction of tissue 

 which, from the circumstance that it was 

 most frequently met with in hospitals, was 

 termed hospital gangrene. Other serious 

 and often fatal complications might arise, 

 which the surgeon could only regard as 

 untoward accidents and over which he had 

 no efficient control. 



It will be readily understood from the 

 above description that the inflammation 

 which so often frustrated the surgeon's en- 

 deavors after primary union was, in my 

 opinion, essentially due to decomposition of 

 blood within the wound. 



These and many other considerations had 

 long impressed me with the greatness of 

 the evil of putrefaction in surgery. I had 

 done my best to mitigate it by scrupulous 

 ordinary cleanliness and the use of various 

 deodorant lotions. But to prevent it alto- 

 gether appeared hopeless while we believed 

 with Liebeg that its primary cause was the 

 atmospheric oxygen which, in accordance 

 with the researches of Graham, could not 

 fail to be perpetually diffused through the 

 porous dressings which were used to absorb 

 the blood discharged from the wound. But 

 when Pasteur had shown that putrefaction 

 was a fermentation caused by the growth 

 of microbes, and that these could not arise 

 de novo in the decomposable substance, the 

 problem assumed a more hopeful aspect. 

 If the wound could be treated with some 

 substance which, without doing too serious 

 mischief to the human tissues, would kill 

 the microbes already contained in it and 

 prevent the future access of others in the 

 living state, putrefaction might be pre- 

 vented, however freely the air with its 

 oxygen might enter. I had heard of carbolic 



