130 EFFECTS OF THE ANTISEPTIC TREATMENT 



Very different was the result of the corresponding amputations during the 

 antiseptic period. Eleven of the twelve cases recovered ; and the one death 

 which did occur was not the result of the operation, but took place in spite 

 of it, from pyaemia, which had resulted from fetid suppuration in a metacarpal 

 bone, and continued after I had removed the hand, in the faint hope that the 

 constitutional mischief might be thrown off when its original source had been 

 taken away. Some of the successful cases, I may add, were by no means favour- 

 able subjects for operation : as, for instance, a completely shattered hand in 

 a very aged person ; the avulsion by machinery of nearly the entire arm, one 

 of the flaps of the amputation at the shoulder-joint being left contused and 

 lacerated as it had been formed by the injury ; ^ and, again, an enormous 

 osteoid cancer of the upper end of the humerus, involving the deltoid muscle, 

 and permitting only the formation of skin flaps, attended with profuse haemor- 

 rhage, in a patient already anaemic from the disease. 



In the lower limb, twenty-eight amputations in all were performed during 

 the antiseptic period. Out of these, death took place in five ; but was generally 

 sufficiently accounted for by the severity of the case, as when the thigh was 

 amputated immediately below the hip-joint in a patient greatly exhausted by 

 haemorrhage from malignant disease ; or, to take another example, when 

 primary amputation was performed at the knee on one side, and immediately 

 below it on the other, in a man who had sustained very severe injuries to both 

 legs, and had been transported a considerable distance by railway to Glasgow. 



In one case only did pyaemia result from the operation — viz. after ampu- 

 tation at the knee in a young man of weakly constitution, where putrefaction 

 occurred in the stump through mismanagement. Here the symptoms of pyaemia 

 presented themselves during life, and the femoral vein was found loaded with 

 pus on dissection. When putrefaction occurs after such an operation, there 

 is no security against pyaemia, even in private practice ; and a single instance 

 of the kind in three years, and that in a feeble subject, is certainly no evidence 

 of any peculiarity in the hospital atmosphere. 



In mentioning the fact that putrefaction occurred from mismanagement, 

 I do not wish to be understood as implying that it can always be avoided in 

 stumps. In the present state of surgical practice, this is far from being the 

 case. When sinuses exist in connexion with a diseased joint, putrefaction is 

 present in them at the outset ; and even if they are injected with an antiseptic 

 solution before the operation, it can never be certain that the liquid penetrates 

 to every recess of these often complicated passages, or destroys the vitality 

 of the putrefactive organisms, lurking, perhaps, in portions of lymph or slough. 



' This case was treated by my colleague, Dr. Dunlop, during my temporary absence. 



