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Of about fifty cases of injuries of this kind, of various degrees
of severity, which I have collected from different sources, at
least twelve were instances of infection from puerperal
peritonitis. Some of the others are so stated as to render it
probable that they may have been of the same nature. Five other
cases were of peritoneal inflammation; three in males. Three were
what was called enteritis, in one instance complicated with
erysipelas; but it is well known that this term has been often
used to signify inflammation of the peritoneum covering the
intestines. On the other hand, no case of typhus or typhoid fever
is mentioned as giving rise to dangerous consequences, with the
exception of the single instance of an undertaker mentioned by
Mr. Travers, who seems to have been poisoned by a fluid which
exuded from the body. The other accidents were produced by
dissection, or some other mode of contact with bodies of patients
who had died of various affections. They also differed much in
severity, the cases of puerperal origin being among the most
formidable and fatal. Now a moment's reflection will show that
the number of cases of serious consequences ensuing from the
dissection of the bodies of those who had perished of puerperal
fever is so vastly disproportioned to the relatively small number
of autopsies made in this complaint as compared with typhus or
pneumonia (from which last disease not one case of poisoning
happened), and still more from all diseases put together, that the
conclusion is irresistible that a most fearful morbid poison is
often generated in the course of this disease. Whether or not it
is sui generis confined to this disease, or produced in some
others, as, for instance, erysipelas, I need not stop to inquire.

In connection with this may be taken the following statement of
Dr. Rigby: "That the discharges from a patient under puerperal
fever are in the highest degree contagious we have abundant
evidence in the history of lying-in hospitals. The puerperal
abscesses are also contagious, and may be communicated to healthy
lying-in women by washing with the same sponge; this fact has
been repeatedly proved in the Vienna Hospital; but they are
equally communicable to women not pregnant; on more than one
occasion the women engaged in washing the soiled bed-linen of the
General Lying-in Hospital have been attacked with abscesses in
the fingers or hands, attended with rapidly spreading
inflammation of the cellular tissue."[Footnote: System of
Midwifery, p. 292]

Now add to all this the undisputed fact that within the walls of
lying-in hospitals there is often generated a miasm, palpable as
the chlorine used to destroy it, tenacious so as in some cases
almost to defy extirpation, deadly in some institutions as the
plague; which has killed women in a private hospital of London so
fast that they were buried two in one coffin to conceal its
horrors; which enabled Tonnelle to record two hundred and twenty-
two autopsies at the Maternite of Paris; which has led Dr. Lee to
express his deliberate conviction that the loss of life
occasioned by these institutions completely defeats the objects
of their founders; and out of this train of cumulative evidence,
the multiplied groups of cases clustering about individuals, the
deadly results of autopsies, the inoculation by fluids from the
living patient, the murderous poison of hospitals--does there not
result a conclusion that laughs all sophistry to scorn, and
renders all argument an insult?

I have had occasion to mention some instances in which there was
an apparent relation between puerperal fever and erysipelas. The
length to which this paper has extended does not allow me to
enter into the consideration of this most important subject. I
will only say that the evidence appears to me altogether
satisfactory that some most fatal series of puerperal fever have
been produced by an infection originating in the matter or
effluvia of erysipelas. In evidence of some connection between
the two diseases, I need not go back to the older authors, as
Pouteau or Gordon, but will content myself with giving the
following references, with their dates; from which it will be
seen that the testimony has been constantly coming before the
profession for the last few years:

"London Cyclopaedia of Practical Medicine," article "Puerperal
Fever," 1833.

Mr. Ceeley's Account of the Puerperal Fever at Aylesbury,
"Lancet," 1835.

Dr. Ramsbotham's Lecture, "London Medical Gazette," 1835.

Mr. Yates Ackerly's Letter in the same journal, 1838.

Mr. Ingleby on Epidemic Puerperal Fever, "Edinburgh Medical and
Surgical Journal," 1838.

Mr. Paley's Letter, "London Medical Gazette," 1839.

Remarks at the Medical and Chirurgical Society, "Lancet," 1840.

Dr. Rigby's "System of Midwifery," 1841.

"Nunneley on Erysipelas," a work which contains a large number of
references on the subject, 1841.

"British and Foreign Quarterly Review," 1842.

Dr. S. Jackson, of Northumberland, as already quoted from the
Summary of the College of Physicians, 1842.

And, lastly, a startling series of cases by Mr. Storrs, of
Doncaster, to be found in the "American Journal of the Medical
Sciences" for January, 1843.

The relation of puerperal fever with other continued fevers would
seem to be remote and rarely obvious. Hey refers to two cases of
synochus occurring in the Royal Infirmary of Edinburgh, in women
who had attended upon puerperal patients. Dr. Collins refers to
several instances in which puerperal fever has appeared to
originate from a continued proximity to patients suffering with
typhus. [Footnote: Treatise on Midwifery, p. 228.]

Such occurrences as those just mentioned, though most important
to be remembered and guarded against, hardly attract our notice
in the midst of the gloomy facts by which they are surrounded. Of
these facts, at the risk of fatiguing repetitions, I have
summoned a sufficient number, as I believe, to convince the most
incredulous that every attempt to disguise the truth which
underlies them all is useless.

It is true that some of the historians of the disease, especially
Hulme, Hull, and Leake, in England; Tonnelle, Duges, and
Baudelocque, in France, profess not to have found puerperal fever
contagious. At the most they give us mere negative facts,
worthless against an extent of evidence which now overlaps the
widest range of doubt, and doubles upon itself in the redundancy
of superfluous demonstration. Examined in detail, this and much
of the show of testimony brought up to stare the daylight of
conviction out of countenance, proves to be in a great measure
unmeaning and inapplicable, as might be easily shown were it
necessary. Nor do I feel the necessity of enforcing the
conclusion which arises spontaneously from the facts which have
been enumerated by formally citing the opinions of those grave
authorities who have for the last half-century been sounding the
unwelcome truth it has cost so many lives to establish.

"It is to the British practitioner," says Dr. Rigby, "that we are
indebted for strongly insisting upon this important and dangerous
character of puerperal fever." [Footnote: British and Foreign
Med. Rev. for January, 1842.]

The names of Gordon, John Clarke, Denman, Burns, Young,
[Footnote: Encyc. Britannica, xiii, 467, art., "Medicine."]
Hamilton,[Footnote: Outlines of Midwifery, p. 109.] Haighton,
[Footnote: Oral Lectures, etc.] Good, [Footnote: Study of
Medicine, ii, 195.] Waller, [Footnote: Medical and Physical
Journal, July, 1830.] Blundell, Gooch, Ramsbotham, Douglas,
[Footnote: Dublin Hospital Reports for 1822.] Lee, Ingleby,
Locock, [Footnote: Library of Practical Medicine, I. 373],
Abercrombie [Footnote: Researches on Diseases of the Stomach,
etc. p. 1841], Alison [Footnote: Library of Practical Medicine,
i, 95.], Travers, [Footnote: Further Researches on Constitutional
Irritation, p. 128], Rigby, and Watson [Footnote: London Medical
Gazette, February, 1842] many of whose writings I have already
referred to, may have some influence with those who prefer the
weight of authorities to the simple deductions of their own
reason from the facts aid before them. A few Continental writers
have adopted similar conclusions [Footnote: See British and
Foreign Medical Review, vol. iil, p. 525, and vol. iv, p. 517.
Also Ed. Med. and Surg. Journal for July 1824, and American
Journal of Med. Sciences for January, 1841.] It gives me pleasure
to remember that, while the doctrine has been unceremoniously
discredited in one of the leading journals [Footnote: PIsid. Med.
Journal, vol. xii, p. 364], and made very light of by teachers in
two of the principal medical schools of this country, Dr.
Channing has for many years inculcated, and enforced by examples,
the danger to be apprehended and the precautions to be taken in
the disease under consideration.

I have no wish to express any harsh feeling with regard to the
painful subject which has come before us. If there are any so far
excited by the story of these dreadful events that they ask for
some word of indignant remonstrance to show that science does not
turn the hearts of its followers into ice or stone, let me remind
them that such words have been uttered by those who speak with an
authority I could not claim [Footnote: Dr. Blundell and Dr. Bigby
in the works already cited.] It is as a lesson rather than as a
reproach that I call up the memory of these irreparable errors
and wrongs. No tongue can tell the heart-breaking calamity they
have caused; they have closed the eyes just opened upon a new
world of love and happiness; they have bowed the strength of
manhood into the dust; they have cast the helplessness of infancy
into the stranger's arms, or bequeathed it, with less cruelty,
the death of its dying parent. There is no tone deep enough for
regret, and no voice loud enough for warning. The woman about to
become a mother. or with her new-born infant upon her bosom,
should be the object of trembling care and sympathy wherever she
bears her tender burden or stretches her aching limbs. The very
outcast of the streets has pity upon her sister in degradation
when the seal of promised maternity is impressed upon her. The
remorseless vengeance of the law, brought down upon its victim by
a machinery as sure as destiny, is arrested in its fall at a word
which reveals her transient claim for mercy. The solemn prayer of
the liturgy singles out her sorrows from the multiplied trials of
life, to plead for her in the hour of peril. God forbid that any
member of the profession to which she trusts her life, doubly
precious at that eventful period, should hazard it negligently,
unadvisedly, or selfishly!

There may be some among those whom I address who are disposed to
ask the question, What course are we to follow in relation to
this matter? The facts are before them, and the answer must be
left to their own judgment and conscience. If any should care to
know my own conclusions, they are the following; and in taking
the liberty to state them very freely and broadly, I would ask
the inquirer to examine them as freely in the light of the
evidence which has been laid before him.

1. A physician holding himself in readiness to attend cases of
midwifery should never take any active part in the post-mortem
examination of cases of puerperal fever.

2. If a physician is present at such autopsies, he should use
thorough ablution, change every article of dress, and allow
twenty-four hours or more to elapse before attending to any case
of midwifery. It may be well to extend the same caution to cases
of simple peritonitis.

3. Similar precautions should be taken after the autopsy or
surgical treatment of cases of erysipelas, if the physician is
obliged to unite such offices with his obstetrical duties, which
is in the highest degree inexpedient.

4. On the occurrence of a single case of puerperal fever In his
practice, the physician is bound to consider the next female he
attends in labor, unless some weeks at least have elapsed, as in
danger of being infected by him, and it is his duty to take every
precaution to diminish her risk of disease and death.

5. If within a short period two cases of puerperal fever happen
close to each other, in the practice of the same physician, the
disease not existing or prevailing in the neighborhood, he would
do wisely to relinquish his obstetrical practice for at least one
month, and endeavor to free himself by every available means from
any noxious influence he may carry about with him.

6. The occurrence of three or more closely connected cases, in
the practice of one individual, no others existing in the
neighborhood, and no other sufficient cause being alleged for the
coincidence, is prima facie evidence that he is the vehicle of
contagion.

7. It is the duty of the physician to take every precaution that
the disease shall not be introduced by nurses or other
assistants, by making proper inquiries concerning them, and
giving timely warning of every suspected source of danger.

8. Whatever indulgence may be granted to those who have
heretofore been the ignorant causes of so much misery, the time
has come when the existence of a private pestilence in the sphere
of a single physician should be looked upon, not as a misfortune,
but a crime; and in the knowledge of such occurrences the duties
of the practitioner to his profession should give way to his
paramount obligations to society.




ADDITIONAL REFERENCES AND CASES.


Fifth Annual Report of the Registrar-General of England, 1843,
Appendix. Letter from William Fair, Esq.--Several new series of
cases are given in the letter of Mr. Storrs, contained in the
appendix to this report. Mr. Storrs suggests precautions similar
to those I have laid down, and these precautions are strongly
enforced by Mr. Farr, who is, therefore, obnoxious to the same
criticisms as myself.

Hall and Dexter, in Am. Journal of Med. Sc. for January, 1844.--
Cases of puerperal fever seeming to originate in erysipelas.

Elkington, of Birmingham, in Provincial Med. Journal, cited in
Am. Journ. Med. Sc. for April, 1844.--Six cases in less than a
fortnight, seeming to originate in a case of erysipelas.

West's Reports, in Brit. and For. Med. Review for October, 1845,
and January, 1847.--Affection of the arm, resembling malignant
pustule, after removing the placenta of a patient who died from
puerperal fever. Reference to cases at Wurzburg, as proving
contagion, and to Keiller's cases in the Monthly Journal for
February, 1846, as showing connection of puerperal fever and
erysipelas.

Kneeland.--Contagiousness of Puerperal Fever. Am. Jour. Med. Sc.,
January, 1846. Also, Connection between Puerperal Fever Epidemic
Erysipelas. Ibid., April, 1846.

Robert Storrs.-Contagious Effects of Puerperal Fever on the Male
Subject; or on Persons not Child-bearing. (From Provincial Med.
and Surg. Journal.) Am. Jour. Med. Sc., January, 1846. Numerous
cases. See also Dr. Reid's case in same journal for April, 1846.

Routh's paper in Proc. of Royal Med. Chir. Soc., Am. Jour. Med.
Sc., April, 1849, also in B. and F. Med. Chir. Review, April,
1850.

Hill, of Leuchars.--A Series of Cases Illustrating the Contagious
Nature of Erysipelas and Puerperal Fever, and their Intimate
Pathological Connection. (From Monthly Journal of Med. Sc.) Am.
Jour. Med. Sc., July, 1850.

Skoda on the Causes of Puerperal Fever. (Peritonitis in rabbits,
from inoculation with different morbid secretions.) Am. Jour.
Med. Sc., October, 1850.

Arneth.--Paper read before the National Academy of Medicine.
Annales d'Hygiene, Tome LXV. 2e Partie. ("Means of Disinfection
proposed by M. Semmelweis." Semmelweiss.) Lotions of chloride of
lime and use of nail-brush before admission to lying-in wards,
Alleged sudden and great decrease of mortality from puerperal
fever. Cause of disease attributed to inoculation with cadaveric
matters.) See also Routh's paper, mentioned above.

Moir.--Remarks at a meeting of the Edinburgh Medico-chirurgical
Society. Refers to cases of Dr. Kellie, of Leith. Sixteen in
succession, all fatal. Also to several instances of individual
pupils having had a succession of cases in various quarters of
the town, while others, practising as extensively in the same
localities, had none. Also to several special cases not mentioned
elsewhere. Am. Jour. Med. Sc. for October, 1851. (From New
Monthly Journal of Med. Science.)

Simpson.--Observations at a Meeting of the Edinburgh Obstetrical
Society. (An "eminent gentleman," according to Dr. Meigs, whose
"name is as well known in America as in (his) native land,"
Obstetrics, Phil., 1852, pp. 368, 375.) The student is referred
to this paper for a valuable resume of many of the facts, and the
necessary inferences, relating to this subject. Also for another
series of cases, Mr. Sidey's, five or six in rapid succession.
Dr. Simpson attended the dissection of two of Dr. Sidey's cases,
and freely handled the diseased parts. His next four child-bed
patients were affected with puerperal fever, and it was the first
time he had seen it in practice. As Dr. Simpson is a gentleman
(Dr. Meigs, as above), and as "a gentleman's hands are clean"
(Dr. Meigs' sixth letter), it follows that a gentleman with clean
hands may carry the disease. Am. Jour. Med. Sc., October, 1851.

Peddie.--The five or six cases of Dr. Sidey, followed by the four
of Dr. Simpson, did not end the series. A practitioner in Leith
having examined in Dr. Simpson's house, a portion of the uterus
obtained from one of the patients, had immediately afterwards
three fatal cases of puerperal fever. Dr. Peddie referred to two
distinct series of consecutive cases in his own practice. He had
since taken precautions, and not met with any such cases. Am.
Jour. Med October, 1851.

Copland.--Considers it proved that puerperal fever may be
propagated by the hands and the clothes, or either, of a third
person, the bed-clothes or body-clothes of a patient. Mentions a
new series of cases, one of which he saw, with the practitioner
who had attended them. She was THE SIXTH he had had within a few
days. ALL DIED. Dr. Copland insisted that contagion had caused
these cases; advised precautionary measures, and the practitioner
had no other cases for a considerable time. Considers it
CRIMINAL, after the evidence adduced,--which be could have
quadrupled,--and the weight of authority brought forward, for a
practitioner to be the medium of transmitting contagion and death
to his patients. Dr. Copland lays down rules similar to those
suggested by myself, and is therefore entitled to the same
epithet for so doing. Medical Dictionary, New York, 1853.
Article, Puerperal States and Diseases.

If there is any appetite for facts so craving as to be yet
unappeased,--lassata, necdum satiata,--more can be obtained. Dr.
Hodge remarks that "the frequency and importance of this singular
circumstance that the disease is occasionally more prevalent
with one practitioner than another, has been exceedingly
overrated." More than thirty strings of cases, more than two
hundred and fifty sufferers from puerperal fever, more than one
hundred and thirty deaths, appear as the results of a sparing
estimate of such among the facts I have gleaned as could be
numerically valued. These facts constitute, we may take it for
granted, but a small fraction of those that have actually
occurred. The number of them might be greater, but "'t is enough,
't will serve," in Mercutio's modest phrase, so far as frequency
is concerned. For a just estimate of the importance of the
singular circumstance, it might be proper to consult the languid
survivors, the widowed husbands, and the motherless children, as
well as "the unfortunate accoucheur."




ON THE ANTISEPTIC PRINCIPLE OF THE PRACTICE OF SURGERY
BY
JOSEPH LISTER


INTRODUCTORY NOTE


Joseph Lister was born at Upton, Essex, England, in 1827, and
received Aw general education at the University of London. After
graduation he studied medicine in London and Edinburgh, and
became lecturer in surgery at the University in the latter city.
Later he was professor of surgery at Glasgow, at Edinburgh, and
at King's College Hospital, London, and surgeon to Queen
Victoria. He was made a baronet in 1883; retired from teaching in
1893; and was raised to the peerage in 1897, with the title of
Baron Lister.

Even before the work of Pasteur on fermentation and putrefaction,
Lister had been convinced of the importance of scrupulous
cleanliness and the usefulness of deodorants in the operating
room; and when, through Pasteur's researches, he realised that
the formation of PUS was due to bacteria, he proceeded to develop
his antiseptic surgical methods. The immediate success of the new
treatment led to its general adoption, with results of such
beneficence as to make it rank as one of the great discoveries of
the age.




ON THE ANTISEPTIC PRINCIPLE OF THE PRACTICE OF SURGERY (1867)


In the course of an extended investigation into the nature of
inflammation, and the healthy and morbid conditions of the blood
in relation to it, I arrived several years ago at the conclusion
that the essential cause of suppuration in wounds is
decomposition brought about by the influence of the atmosphere
upon blood or serum retained within them, and, in the case of
contused wounds, upon portions of tissue destroyed by the
violence of the injury.

To prevent the occurrence of suppuration with all its attendant
risks was an object manifestly desirable, but till lately
apparently unattainable, since it seemed hopeless to attempt to
exclude the oxygen which was universally regarded as the agent by
which putrefaction was effected. But when it had been shown by
the researches of Pasteur that the septic properties of the
atmosphere depended not on the oxygen, or any gaseous
constituent, but on minute organisms suspended in it, which owed
their energy to their vitality, it occurred to me that
decomposition in the injured part might be avoided without
excluding the air, by applying as a dressing some material
capable of destroying the life of the floating particles. Upon
this principle I have based a practice of which I will now
attempt to give a short account.

The material which I have employed is carbolic or phenic acid, a
volatile organic compound, which appears to exercise a peculiarly
destructive influence upon low forms of life, and hence is the
most powerful antiseptic with which we are at present acquainted.

The first class of cases to which I applied it was that of
compound fractures, in which the effects of decomposition in the
injured part were especially striking and pernicious. The results
have been such as to establish conclusively the great principle
that all local inflammatory mischief and general febrile
disturbances which follow severe injuries are due to the
irritating and poisonous influence of decomposing blood or
sloughs. For these evils are entirely avoided by the antiseptic
treatment, so that limbs which would otherwise be unhesitatingly
condemned to amputation may be retained, with confidence of the
best results.

In conducting the treatment, the first object must be the
destruction of any septic germs which may have been introduced
into the wounds, either at the moment of the accident or during
the time which has since elapsed. This is done by introducing the
acid of full strength into all accessible recesses of the wound
by means of a piece of rag held in dressing forceps and dipped
into the liquid. [Footnote: The addition of a few drops of water
to a considerable quantity of the acid, induces it to assume
permanently the liquid form.] This I did not venture to do in the
earlier cases; but experience has shown that the compound which
carbolic acid forms with the blood, and also any portions of
tissue killed by its caustic action, including even parts of the
bone, are disposed of by absorption and organisation, provided
they are afterwards kept from decomposing. We are thus enabled to
employ the antiseptic treatment efficiently at a period after the
occurrence of the injury at which it would otherwise probably
fail. Thus I have now under my care, in Glasgow Infirmary, a boy
who was admitted with compound fracture of the leg as late as
eight and one-half hours after the accident, in whom,
nevertheless, all local and constitutional disturbance was
avoided by means of carbolic acid, and the bones were soundly
united five weeks after his admission.

The next object to be kept in view is to guard effectually
against the spreading of decomposition into the wound along the
stream of blood and serum which oozes out during the first few
days after the accident, when the acid originally applied has
been washed out or dissipated by absorption and evaporation. This
part of the treatment has been greatly improved during the past
few weeks. The method which I have hitherto published (see Lancet
for Mar. 16th, 23rd, 30th, and April 27th of the present year)
consisted in the application of a piece of lint dipped in the
acid, overlapping the sound skin to some extent and covered with
a tin cap, which was daily raised in order to touch the surface
of the lint with the antiseptic. This method certainly succeeded
well with wounds of moderate size; and indeed I may say that in
all the many cases of this kind which have been so treated by
myself or my house-surgeons, not a single failure has occurred.
When, however, the wound is very large, the flow of blood and
serum is so profuse, especially during the first twenty-four
hours, that the antiseptic application cannot prevent the spread
of decomposition into the interior unless it overlaps the sound
skin for a very considerable distance, and this was inadmissible
by the method described above, on account of the extensive
sloughing of the surface of the cutis which it would involve.
This difficulty has, however, been overcome by employing a paste
composed of common whiting (carbonate of lime), mixed with a
solution of one part of carbolic acid in four parts of boiled
linseed oil so as to form a firm putty. This application contains
the acid in too dilute a form to excoriate the skin, which it may
be made to cover to any extent that may be thought desirable,
while its substance serves as a reservoir of the antiseptic
material. So long as any discharge continues, the paste should be
changed daily, and, in order to prevent the chance of mischief
occurring during the process, a piece of rag dipped in the
solution of carbolic acid in oil is put on next the skin, and
maintained there permanently, care being taken to avoid raising
it along with the putty. This rag is always kept in an antiseptic
condition from contact with the paste above it, and destroys any
germs which may fall upon it during the short time that should
alone be allowed to pass in the changing of the dressing. The
putty should be in a layer about a quarter of an inch thick, and
may be advantageously applied rolled out between two pieces of
thin calico, which maintain it in the form of a continuous sheet,
which may be wrapped in a moment round the whole circumference of
a limb if this be thought desirable, while the putty is prevented
by the calico from sticking to the rag which is next the
skin.[Footnote: In order to prevent evaporation of the acid,
which passes readily through any organic tissue, such as oiled
silk or gutta percha, it is well to cover the paste with a sheet
of block tin. or tinfoil strengthened with adhesive plaster. The
tin sheet lead used for lining tea chests will also answer the
purpose, and may be obtained from any wholesale grocer.] When all
discharge has ceased, the use of the paste is discontinued, but
the original rag is left adhering to the skin till healing by
scabbing is supposed to be complete. I have at present in the
hospital a man with severe compound fracture of both bones of the
left leg, caused by direct violence, who, after the cessation of
the sanibus discharge under the use of the paste, without a drop
of pus appearing, has been treated for the last two weeks exactly
as if the fracture was a simple one. During this time the rag,
adhering by means of a crust of inspissated blood collected
beneath it, has continued perfectly dry, and it will be left
untouched till the usual period for removing the splints in a
simple fracture, when we may fairly expect to find a sound
cicatrix beneath it. We cannot, however, always calculate on so
perfect a result as this. More or less pus may appear after the
lapse of the first week, and the larger the wound, the more
likely this is to happen. And here I would desire earnestly to
enforce the necessity of persevering with the antiseptic
application in spite of the appearance of suppuration, so long as
other symptoms are favorable. The surgeon is extremely apt to
suppose that any suppuration is an indication that the antiseptic
treatment has failed, and that poulticing or water dressing
should be resorted to. But such a course would in many cases
sacrifice a limb or a life. I cannot, however, expect my
professional brethren to follow my advice blindly in such a
matter, and therefore I feel it necessary to place before them,
as shortly as I can, some pathological principles intimately
connected, not only with the point we are immediately
considering, but with the whole subject of this paper. If a
perfectly healthy granulating sore be well washed and covered
with a plate of clean metal, such as block tin, fitting its
surface pretty accurately, and overlapping the surrounding skin
an inch or so in every direction and retained in position by
adhesive plaster and a bandage, it will be found, on removing it
after twenty-four or forty-eight hours, that little or nothing
that can be called pus is present, merely a little transparent
fluid, while at the same time there is an entire absence of the
unpleasant odour invariably perceived when water dressing is
changed. Here the clean metallic surface presents no recesses
like those of porous lint for the septic germs to develope in,
the fluid exuding from the surface of the granulations has flowed
away undecomposed, and the result is the absence of suppuration.
This simple experiment illustrates the important fact that
granulations have no inherent tendency to form pus, but do so
only when subjected to preternatural stimulus. Further, it shows
that the mere contact of a foreign body does not of itself
stimulate granulations to suppurate; whereas the presence of
decomposing organic matter does. These truths are even more
strikingly exemplified by the fact that I have elsewhere recorded
(Lancet, March 23rd, 1867), that a piece of dead bone free from
decomposition may not only fail to induce the granulations around
it to suppurate, but may actually be absorbed by them; whereas a
bit of dead bone soaked with putrid pus infallibly induces
suppuration in its vicinity.