IN THE PRACTICE OF SURGERY 43 



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. 



I have so lately given elsewhere ^ a detailed account of the method by 

 which this is effected, that it is needless for me to enter into it at present, further 

 than to say that the means employed are the same as those described above 

 for the superficial dressing of compound fractures — namely, a piece of rag dipped 

 in the solution of carbolic acid in oil, to serve as an antiseptic curtain, under 

 cover of which the abscess is evacuated by free incision ; and the antiseptic 

 paste, to guard against decomposition occurring in the stream of pus that flows 

 out beneath it : the dressing being changed daily till the sinus has closed. 



The most remarkable results of this practice in a pathological point of view 

 have been afforded by cases where the formation of pus depended upon disease 

 of bone. Here the abscesses, instead of forming exceptions to the general 

 class in the obstinacy of the suppuration, have resembled the rest in yielding 

 in a few days only a trijfiing discharge ; and frequently the production of pus 

 has ceased from the moment of the evacuation of the original contents. Hence 

 it appears that caries, when no longer labouring, as heretofore, under the irrita- 

 tion of decomposing matter, ceases to be an opprobrium of surgery, and recovers 

 like other inflammatory affections. In the publication before alluded to - 

 I have mentioned the case of a middle-aged man with psoas abscess depending 

 on diseased bone, in whom the sinus finally closed after months of patient per- 

 severance with the antiseptic treatment. Since that article was written I have 

 had another instance of success, equally gratifying, but differing in the circum- 

 stance that the disease and the recovery were both more rapid in their course. 

 The patient was a blacksmith who had suffered four and a half months before 

 I saw him from symptoms of ulceration of cartilage in the left elbow. These 

 had latterly increased in severity, so as to deprive him entirely of his night's 

 rest and of appetite. I found the region of the elbow greatly swollen, and on 

 careful examination discovered a fluctuating point at the outer aspect of the 

 articulation. I opened it on the antiseptic principle, the incision evidently 

 penetrating to the joint, giving exit to a few drachms of pus. The medical 

 gentleman under whose care he was (Dr. Macgregor of Glasgow) supervised the 

 daily dressing with the carbolic-acid paste till the patient went to spend two 

 or three weeks at the coast, when his wife was entrusted with it. Just two 

 months after I opened the abscess he called to show me the limb, stating that 

 the discharge had for at least two weeks been as little as it then was — a trifling 

 moisture upon the paste, such as might be accounted for by the little sore caused 



' See p. 32 of tliis volume. See p. 3O of this volume. 



