DEPARTMENT OF SURGERY. 
729 
frequent occurrence. 'We can wash the stall, scrub the floor, 
use clean litter and confine our patients in such a manner that 
the wound will not come in contact with any of these items, 
but of course these precautions are only used as supplementary 
to the usual occlusive dressing. The soil and the stable floors 
are important in that they are the exogenous habitat of one of 
the dangerous wound diseases, namely, tetanus, and punctured 
wounde exposed to them must always be treated with this point 
in mind. , 
Wound Sterilization. 
There is of course no part of surgical sterilization of more 
importance than that of dealing with the wound itself, its vi¬ 
cinity or region in which a surgical wound is to be made. All 
accidental wounds must be regarded as septic ones and there¬ 
fore the first duty in their treatment is to sterilize them and 
their immediate vicinity as perfectly as possible. I use the ex¬ 
pression “as perfectly as possible” because it is impossible to 
perfectly sterilize the surface of the body or the recesses of a 
wounded texture. It is clear that no form of disinfection is 
capable of completely destroying the organisms lodged in the 
recesses of the skin or wounds without also destroying the tis¬ 
sues. We may boil an instrument or immerse it in a concen¬ 
trated antiseptic, but the living tissues will not withstand such 
treatment, and therefore when organisms have once invaded a 
wound it cannot be again made aseptic—in the literal sense— 
without the use of agents which will cauterize the textures in 
which they are lodged. Therefore we can only make wounds 
aseptic with the hot iron or with eauterant chemicals and never 
with the ordinary innocent antiseptics. The condition we aim 
to create is asepsis in the “surgical sense,” i. e ., we render the 
organisms as innocuous as possible and then establish conditions 
which are unsuited for their growth. Such a wound the sur¬ 
geon calls aseptic. The method of making a wound aseptic 
when it is once contaminated is by patient irrigation with anti¬ 
septics of such concentration that the body tissues will not be 
materially injured. The vicinity is first scrubbed energetic¬ 
ally and treated with stronger solutions and finally the whole 
area is clothed with absorbent-antiseptic material, which pre¬ 
vents further invasion from without and by absorbing the 
wound exudates deprives those within of their nutrient media. 
We might also take into consideration the assistance we receive 
from the tissues themselves. Having temporarily deprived the 
wound organisms of their virulence and their media the phago- 
