UPON SALUBRITY OF A SURGICAL HOSPITAL 131 



And if a single such organism remain alive, it will propagate and spread in the 

 wound as soon as the antiseptic applied at the time of the operation has been 

 absorbed into the circulation ; and any external antiseptic dressing will, under 

 such circumstances, be of course entirely nugatory. It is, I suspect, for want 

 of bearing this point in mind that disappointment has often been experienced 

 in applying antiseptic treatment to amputations and excisions. The full possible 

 benefits of the system can never be obtained in such cases till it shall be deeply 

 impressed upon the profession and the public that abscesses, more especially 

 those in connexion with diseased joints, must never either be allowed to break 

 of themselves, or be opened without antiseptic precautions.^ 



I am bound to add that there is another respect in which the antiseptic 

 principle has not yet had justice done to it in the larger amputations in the 

 ower limb. Of all incised wounds, these have proved the most difficult to 

 manage ; and putrefaction has repeatedly occurred in my practice, even where 

 no sinuses were present. It was so in the two cases above referred 'to, of 

 amputation just below the hip-joint for malignant disease, and double primary 

 amputation for injury. Considering the condition of those patients on the day 

 after the operation, I believe both w^ould have recovered had we succeeded in 

 avoiding putrefaction, which, apart altogether from the risk of pyaemia, terribly 

 aggravates formidable cases, hke those, by the irritation and prostration which 

 it occasions. Hence we may fairly look for better results in the future from 

 amputation in the lower limb. For I am satisfied that the difficulties of the 

 antiseptic management are not insuperable. I have devoted much attention 

 to this branch of the subject during the last twelve months, and steady progress 

 has been made in it ; so that the proportion of stumps in which healing has 

 taken place without any deep-seated suppuration has been markedly increasing, 

 and I anticipate that before long we shall be able to reckon with certainty on 

 the absence of putrefaction in all cases where sinuses are not present. 



But to return to the subject of pyaemia. The two cases above alluded to 

 were the only instances of its occurrence in my department during the antiseptic 

 period. One of them requires further notice here. It belonged to a class of 

 injuries in which the benefits of the antisei)tic system have been conspicuously 

 apparent — namely, severe contused w^ounds of the hand or foot, such as are 



' The practice which I have found to answer best in amputations and excisions in parts aftccted 

 with sinuses is, after injecting the sinuses with a powerful antiseptic, to apply to the cut surface a pretty 

 strong sokition of chloride of zinc (say forty grains to an ounce of water), such as was recommended 

 by Mr. Campbell De iNIorgan, and then employ an external antiseptic dressing, in the hope, though never 

 in the certainty, that putrefaction will be avoided. Chloride of zinc, having the peculiarity of producing 

 a remarkably persistent antiseptic effect upon the cut surface, protects it during the dangerous period 

 preceding granulation, when the recently divided tissues arc both sensitive and prone to absorption ; so 

 that even if putrefaction does occur, the risk of inliammatiou and pyaemia is greatly diminished. 



