INTRODUCTION xi 
which should guide the surgeon in dealing with the several parts of each limb, 
and omits those tedious details which are often more confusing than instructive. 
One of the best amputations of the thigh is here described for the first time. 
The essay on anaesthetics set forth the methods then employed in Edinburgh, 
and supported them by scientific arguments in favour of their validity. The 
subject of anaesthetics was one in which Lister has always taken the keenest 
interest, and it is needless to add that his teaching has many followers at the 
present day. 
Another very interesting paper was that on the effects of the position of 
a part on the circulation through it.1. For years before the introduction of 
Esmarch’s bandage, Lister had been in the habit, in operations on the extremities, 
of elevating the limb for a few minutes, and then, while it was still elevated, 
applying a tourniquet at the upper part; in this way he brought about a blood- 
less state of the limb. On the publication of Esmarch’s paper, Lister adopted 
his elastic band in place of the tourniquet ; but he continued to employ elevation 
of the limb, as a safer means of emptying it of blood in the first instance than 
the application of a bandage from below upwards, as advised by Esmarch. In 
the paper to which reference is made Lister explained his views as to the mode 
in which his plan brought about the desired exsanguine state. 
As soon as it became evident that antiseptic methods protected the patient 
against septic diseases, a great change came over general surgical treatment, and 
from the very first there was not a case admitted into Lister’s wards which was 
not considered from a fresh point of view. The dangers arising from the risk of 
wound infection being averted, the question arose in most instances whether 
something better might not be done in the way of treatment by operation than 
had been customary. The result of the treatment of compound fractures by 
the antiseptic principle was that instead of looking on amputation of the limb 
aS an imperative procedure, in the great majority of cases that plan became 
relegated to a secondary place, and all the surgeon’s energies were devoted 
to an attempt to save the limb. The result is that nowadays amputation is 
only very rarely performed in compound fracture, or compound dislocation. 
The method led also to a complete revolution in the treatment of spinal abscess 
and tuberculous abscesses of joints generally. Quite early the subject of 
ununited fractures was taken up, and instead of employing apparatus or 
inefficient subcutaneous operations, the bones were boldly cut down upon and 
repaired in any way which seemed mechanically advisable. From that it was but 
a step to operations on recent fractures,—the patella, for example—to operations 
for malunited fractures, and to osteotomy for knock-knee and other deformities. 
> Vol; 15, ps 176: 
