Joseph Lister

“ For I afterwards learned that the normal temperature of man is deadly to the cold-blooded frog. That animal, which under ordinary conditions exhibits very remarkable persistence of vitality even after somatic death, is killed by being held for about a quarter of an hour in the hand; and if one of its hind feet be similarly warmed, the blood-corpuscles will be found packed and stagnant in the vessels of the webs, as if mustard or any other powerful irritant had been applied to them. ”

“ Another instructive experiment is to dress a granulating sore with some of the putty above described, overlapping the sound skin extensively, when we find in the course of twenty-four hours that pus has been produced by the sore, although the application has been perfectly antiseptic; and, indeed, the larger the amount of carbolic acid in the paste the greater is the quantity of pus formed, provided we avoid such a proportion as would act as a caustic. The carbolic acid, though it prevents decomposition, induces suppuration obviously by acting as a chemical stimulus ”

“ For adhesiveness of corpuscles is not occasioned in the frog's web by amputation of the limb; nor is it produced in the human subject by complete detachment of a portion of tissue; as is clearly shown by the persistent healthiness of a piece of skin entirely transplanted in skin-grafting. We are therefore forced to the conclusion that the adhesiveness of the red discs in the horse's jugular, as contrasted with its complete absence in the vein of the bat's wing, was due to the larger size of the vessel in the former case. ”

“ In 1837 A. Ross made an unsuccessful experiment with ‘three glasses to admit a large pencil.’ Lister thereupon suggested a combination of three glasses ‘for the same object;’ he gave the dimensions of the lenses and the curves of the various surfaces, with a statement of the effect proposed to be produced by each glass upon spherical aberration and coma. This resulted in Ross's celebrated 1⁄8 inch object-glass, the construction of which was afterwards adopted by the other principal London makers. ”

“ It is matter for discussion how inflammatory congestion is brought about by nervous action. It may be doubted whether active congestion could alone give rise to it, though it is by no means inconceivable that the excessive supply of the nutrient fluid might in time exhaust the tissues by over-stimulation, and so bring about more or less of that impairment of vital energy which we have seen reason to regard as the essential cause of the blood-corpuscles lagging behind the liquor sanguinis. ”

“ Hence it is easy to understand how, when a wound is very large, the crust beneath the rag may prove here and there insufficient to protect the raw surface from the stimulating influence of the carbolic acid in the putty, and the result will be, first, the conversion of the tissues so acted on into granulations, and subsequently the formation of more or less pus. ”

“ But diffusion was no mere passive phenomenon, such as might follow according to any ordinary arrangement of matter, when the agency that caused the grouping of the molecules ceased to operate. The transference of the granules from the body of each cell to its remotest ramifications, and their close packing there, were an act such as a living organism alone could have effected. Pigmentary concentration and diffusion were vital functions of a profound character concerned with the relative distribution of different constituents of the cells. ”

“ 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 that may fall upon it during the short time that should alone be allowed to pass in the changing of the dressing. ”

“ A very interesting observation which I made long ago, but to which I have not before directed attention in this point of view, shows that an extreme degree of adhesiveness of the red discs may exist within a blood-vessel the walls of which are in perfect health with reference to coagulation. If a horse's jugular vein, obtained in the manner I have described, is suspended vertically, the blood in it remains fluid for an indefinite period, hut the red corpuscles soon fall from the upper parts of the fluid, leaving a huffy layer of plasma, readily seen through the translucent wall of the vessel. ”

“ These truths are even more strikingly exemplified by the fact, which I have elsewhere recorded, [5] 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. ”

“ Yet from the very happy circumstance of the conspicuousness of the pigment, the results of their activity could be observed with the utmost facility, and their behaviour in relation to inflammatory congestion easily studied even under a low magnifying power.
The pigment cells pervade the skin and subcutaneous tissue of which the frog's web consists, and are especially numerous about the blood-vessels, round which their branches twine abundantly. They must, therefore, be acted on along with the vascular parietes by anything applied to the surface of the membrane. ”

“ Each of Chevalier's compound plano-convex lenses when used singly presented a bur or coma outwards, but when two of them are combined this coma, instead of being exaggerated, as might have been expected, was ‘less than with any single glass,’ while the performance was in other respects satisfactory. ‘Observing the advantages resulting from this combination,’ Lister ‘tried some others,’ among the rest two of Tulley's triple glasses, each of which taken singly was of fine performance. ”

“ 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 sanious 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 were a simple one. ”

“ The tissues, as distinguished from the blood, were therefore the parts primarily and essentially affected by the action of the irritant. And we have seen that, in their relation to the blood-corpuscles, they approached more or less closely, according to the degree of the irritation, the behaviour of ordinary solids, such as glass, as distinguished from the living structures. The natural inference was that they had lost more or less, for the time being, certain special properties which they possessed when in active health as constituent structures of the living body. ”

“ In order that the treatment may be satisfactory, the abscess must be seen before it has opened. Then, except in very rare and peculiar cases, [6] there are no septic organisms in the contents, so that it is needless to introduce carbolic acid into the interior. Indeed, such a proceeding would be objectionable, as it would stimulate the pyogenic membrane to unnecessary suppuration. All that is necessary is to guard against the introduction of living atmospheric germs from without, at the same time that free opportunity is afforded for the escape of discharge from within. ”