SURGERY

W. Pearson (Lancet, March 24, 1917) is convinced after an experience of over two years of war surgery that no general agreement has been reached among surgeons in regard to the principles of wound treatment. He states that he has modified his method of working but slightly "after two years in France. He claims that his results have been and are excellent. Ubi pus, ibi. fl'acua is a surgical maxim which is as generally accepted as it is old. AlI surgeons are agreed on the necessity for drainage in dealing with sepsis. He points out that two schools exist in which different views are held regarding drainage. The antiseptic school pin their faith to the use of antiseptic solutions. They hold that antiseptics can diminish or destroy the bacteria ill situ, and thus subdue the sepsis. The followers of this school admit that by drainage alone unsatisfactory, results are obtained. The author considers that their method of applying drainage must be inadequate. He claims that the number and variety of antiseptics reveal the weakness of this doctrine. He regards the hypochlorite group, exemplied by eusol, as the most fashionable at the present time. The second school he calls the "concentrated saline school." This school has been called into existence by Almroth Wright. The teaching of this school is that it is impossible to destroy all micro-organisms in an infected wound by means of antiseptics without destroying the tissues themselves. Sepsis and infection are best combated, according to Wright, Ity,promoting free secretion into and discharge from the wound, and this he seeks to achieve with the aid of irrigation with concentrated solutions of saline. The author recognizes that Wright has demonstrated the importance of drainage by the advocacy of his method, but he emphasizes the view that the lessons to be learned by practical surgeons have been somewhat obscured by the undue prominence given to the rOle of the concentrated solution of sodium chloride. He believes that the advocacy of Wright's method, and more recently of the eusol methods, has possibly done harm, and has tended to obscure the main issue. The paramount importance of good mechanical drainage has been lost sight of. It is universally agreed that sepsis cannot be dealt with adequately, either by antiseptics or by the application of concentrated solutions of saline, unless drainage be added. The author states that it is not generally recognized that wound infection can be thoroughly and efficiently controlled by of either antlsepttcs or saline in the wound itself. He does not assert that these aids are harmful or injurious, but he is convtnccd that they are unnecessary, provided that good and sufficient mechanical drainage be supplied. The surgeon should ask himself the question when confronted with a case that is not progressing satisfactorily: "What is wrong with the drainage system in this wound?" The answer will, in the majority of cases, supply the key to successful treatment, save in the presence of severe systemic infections and gas gangrene, both of which are fortunately uncommon. The author appends his method of applying drainage.