FiG. 17. - Influence of hypochlorite on an infected wound. The preceding wound, under the influence of vaselin, became slightly reinfected. The dressings, however, were continued, the part A with vaselin, the part B with hypochlorite. The continuous outline represents the state of the wound Dec. 20. The dotted line represents the state of the wound Dec. 24. It is seen that the cicatrisation has taken place more rapidly in the part B, dressed with hypochlorite, than in the part A, dressed with vaselin.

The wounds treated by the instillation of distilled water (Figs. 18 and 19) or of Wright's hypertonic solulution (Figs. 20 and 21) behaved in precisely the same manner. The curve of cicatrisation was modified by the first application of the substance employed. The dimi-nution of the rate of cicatrisation constantly coincided with a reinfection of the wound. The apparent retarding action of the liquid employed was due simply to the rapid reinfection of the wound. This fact is clearly demonstrated by a comparison of the curves of cicatrisation and sterilisation.

Fig. 18.   Cicatrisation curve of a wound treated with distilled water. The cicatrisation, which was normal, slowed down and came to a full stop. Then the wound became slightly enlarged. The cicatrisa tion'became normal once more after a dressing with chloramine. There is a great divergence between the calculated curve and the observed curve.

Fig. 18. - Cicatrisation curve of a wound treated with distilled water. The cicatrisation, which was normal, slowed down and came to a full stop. Then the wound became slightly enlarged. The cicatrisa-tion'became normal once more after a dressing with chloramine. There is a great divergence between the calculated curve and the observed curve.

Fig. 19.   Sterilisation curve of the foregoing wound. This curve shows that a reinfection occurred after the application of irrigation with distilled water.

Fig. 19. - Sterilisation curve of the foregoing wound. This curve shows that a reinfection occurred after the application of irrigation with distilled water.

The cicatrisation of a wound treated with Delbet's chloride of magnesium is strikingly affected. Directly a sterile wound is treated with instillations of chloride of magnesium its curve undergoes modification, tending to approach the horizontal. This indicates a decided retardation of cicatrisation. In the wound whose curve we reproduce below (Fig. 22) the solution of magnesium chloride was replaced, after the lapse of a few days, by hypochlorite of soda. The curve fill once more, the cicatrisation being accelerated. At the same time the curve of microbic infection showed that the retardation of cicatrisation coincided with a reinfection of the wound, which was covered with vast numbers of microbes (Fig. 23). After the application of hypochlorite of soda the wound again became sterile. This is why the cicatrisation curve tends to become normal again when the use of M. Delbet's solution is discontinued. In these two cases the retarding action of the substances employed was only apparent. The retardation was due in reality to the infection which occurred immediately.

Fig. 20.   Cicatrisation curve of a wound dressed with hypertonic solution.

Fig. 20. - Cicatrisation curve of a wound dressed with hypertonic solution.

The observed curveidiverges from the calculated curve after the application of the hypertonic solution, and returns to it as soon as a dressing of chloramine is applied.

Fig. 21.   Sterilisation curve of the same wound.

Fig. 21. - Sterilisation curve of the same wound.

Under the aseptic dressing the wound becomes reinfected; it proceeds towards sterilisation,as soon as the chloramine is applied.

Fig. 22.   Cicatrisation curve of a wound treated with chloride of magnesium. (Case No. 799.)

Fig. 22. - Cicatrisation curve of a wound treated with chloride of magnesium. (Case No. 799.)

From the day when chloride of magnesium is applied to the wound the observed curve diverges rapidly from the calculated curve, showing retarded cicatrisation. From the moment when Dakin's solution is applied the observed curve tends to rejoin the calculated curve.

Fig. 23.   Sterilisation curve of a wound treated with chloride of magnesium. (Case No. 799.)

Fig. 23. - Sterilisation curve of a wound treated with chloride of magnesium. (Case No. 799.)

Directly chloride of magnesium is applied to the wound the curve rises, for the number of microbes quickly becomes very great. The lowering of the curve which follows is due to washing the wound with oleate of soda. When the washing is discontinued the number of microbes again becomes innumerable. The last drop of the curve is due to the application of hypochlorite of soda, which results in sterilisation.

Fig. 24.   Cicatrisation curve of a wound dressed with flavine. Directly flavine is applied the observed curve diverges from the calculated curve, for the wound increases in size. The cicatrisation becomes normal again as soon as chloramine is applied once more. A second experiment upon the same wound produces the same arrest of cicatrisation.

Fig. 24. - Cicatrisation curve of a wound dressed with flavine. Directly flavine is applied the observed curve diverges from the calculated curve, for the wound increases in size. The cicatrisation becomes normal again as soon as chloramine is applied once more. A second experiment upon the same wound produces the same arrest of cicatrisation.