Joseph Lister

“ 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. ”

“ The pyogenic membrane, like the granulations of a sore, which it resembles in nature, forms pus, not from any inherent disposition to do so, but only because it is subjected to some preternatural stimulation. In an ordinary abscess, whether acute or chronic, before it is opened, the stimulus which maintains the suppuration is derived from the presence of the pus pent up within the cavity. When a free opening is made in the ordinary way, this stimulus is got rid of ”

“ 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. ”

“ 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. ”

“ Here the clean metallic surface presenting no recesses, like those of porous lint, for the septic germs to develop in, the fluid exuding from the surface of the granulations has flowed away undecomposed, and the result is 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 a 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. ”

“ 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 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 calice, which maintain it in the form of a continuous sheet, that 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. ”

“ At the same time any constitutional symptoms previously occasioned by the accumulation of the matter are got rid of without the slightest risk of the irritative fever or hectic hitherto so justly dreaded in dealing with large abscesses. ”