Pathology and treatment of war wounds / by Sir Almroth E. Wright.

  • Wright, Almroth, 1861-1947.
Date:
1942
Catalogue details

Licence: In copyright

Credit: Pathology and treatment of war wounds / by Sir Almroth E. Wright. Source: Wellcome Collection.

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    almost certainly resolve a number of important outstanding questions in connexion with vaccines. They ought very easily to resolve the question as to what is the best excipient for a vaccine—whether a menstruum which would restrain emigra¬ tion, or one like physiological salt solution which would call forth a vigorous emigrat¬ ing response at the point of injection. And lastly—and this would be one of the most important applications of observations on emigration—we ought to be able to determine what is, in the case of each bacterial vaccine, the dose which will induce the earliest possible and the most effective determination of phagocytes to the focus or foci of infection. We may, with such new knowledge as we have acquired from the experimental methods I have described, now revert to the consideration of those three ways of combating wound infections enumerated earlier in this discourse. It will be remem¬ bered that these were : Treatment by Antiseptics, Treatment by Physiological Methods, and Vaccine Therapy. We will take them one by one. (I) Treatment by Antiseptics. If we adopted the Socratic method, and were to inquire of the first man we found engaged in washing out a wound what were the grounds for his confidence in the utility of the procedure, he would probably make some such answer as the following : 41 know that the antiseptics which I am bringing into application are agents wdiich directly kill and inhibit the growth of microbes. There is no other agency known which would be competent to do the bactericidal work that these antiseptics do in the wound. And, again, it is everybody’s knowledge that Lister, by introducing his antiseptic treatment, extirpated those septic infections of wounds which before the advent of his method devastated the surgical wards of every hospital.’ And if we were to push our question further, and ask of the surgeon to what particular end and object his procedures were directed—whether it was the sterilisa¬ tion of the wound ; or the killing off of a large proportion of the microbes ; or the imposition of a check upon the survivors ; and if we were further to ask, whether the particular antiseptic in the particular strength in which he was employing it could be relied upon to achieve the end in view ; we should probably be told that, supposing that the antiseptic did not completely sterilise the wound, it would in¬ evitably kill a large number of microbes ; and it would probably also inhibit the growth of any survivors. And, inasmuch as one or other of these objects would be sure to be achieved, there could be no question but that advantage would accrue to the patient. We should, in short, get an answer which proceeded upon at least one erroneous assumption, and which betrayed loose and inconsequent thinking, and a reluctance to come to close quarters with the question. But the reasonings of the larger part of humanity are neither better nor worse than this ; it is not for that less necessary to take them into very serious account, and to do our best to correct them when they mislead. Let us begin, since Lister is the fount and origin of all antiseptic treatment,