UPON SALUBRITY OF A SURGICAL HOSPITAL 127 



on the antiseptic system, while no internal treatment has been used, I have not 

 had pyaemia in a single instance, althoiigli I have had in all thirt^^-two cases — 

 six in the forearm, five in the arm, eighteen in the leg, and three in the thigh. 

 These cases do not include those in which the injury was so great as to demand 

 immediate amputation. But it must be remarked that many of the limbs 

 saved were so severely injured that I should formerly have removed them without 

 hesitation. I almost forget the kind of considerations which used to determine 

 me to amputate under the old treatment ; though I know that experience 

 taught us that it was only in comparatively mild cases that it was justifiable to 

 attempt to save the limb. Now, however, there is scarcely any amount or kind 

 of injury of bones, joints, or soft parts which I regard as inconsistent with con- 

 servative treatment, except such destruction of tissue as makes gangrene of the 

 limb inevitable as an immediate consequence. 



But I may take this opportunity of observing that the attempt to save 

 a limb which, under ordinary treatment, would be subjected to immediate 

 amputation, ought not to be made lightly, or without a thorough acquaintance 

 with some trustworthy method of carrying out the antiseptic system ; by which 

 I mean, not the mere use of an antiseptic, however potent, but such management 

 of the case as shall effectually prevent the occurrence of putrefaction in the part 

 concerned. Without this such endeavours are far worse than useless ; for by 

 the time that local disturbance and constitutional disorder have made it apparent 

 that the antiseptic means have failed, the patient is so much prostrated by 

 irritation and blood-poisoning, that the operation, if performed, is probably 

 too late ; and thus a loose and trifling style of ' giving the treatment a trial ' 

 swells the death-rate at once of compound fracture and of amputation. 



On the other hand, the surgeon will not on this account be justified in 

 contentedly pursuing the old practice of primary amputation : for the antiseptic 

 means which it has been the main labour of the last five years of my life to 

 improve are now so satisfactory that any one duly impressed with the 

 importance of the subject, and devoting to it the study and practical attention 

 which it demands, will, with little trouble to himself, securely attain the results 

 which he desires. "^ 



I lately visited my wards in Glasgow after an absence of some weeks, and 

 saw, amongst other cases, a compound dislocation of the ankle in a man who had 

 fallen about four feet from the platform at a railway station, and lighted on the 

 outer side of the right foot, which had been forced violently inwards, producing 

 a contused and lacerated wound, about four inches long, crossing the external 

 malleolus, and communicating with the articulation. When I saw the patient 

 the wound had been converted into a superficial sore, cicatrizing rapidly ; and 



