132 EFFECTS OF THE ANTISEPTIC TREATMENT 



very frequent in a great centre of manufacture like Glasgow. Formerly there 

 were no injuries more unsatisfactory to deal with. The uncertainty of the 

 extent of the damage inflicted by the contusion made it a most perplexing 

 question where amputation should be performed. On the one hand, if too 

 little was removed, sloughing of the flaps ensued, or diffuse suppurative inflam- 

 mation of the weakened tissues infiltrated with extra vasated blood ; and, on the 

 other hand, if it was determined to avoid that error and to amputate through 

 perfectly sound tissues, an extravagantly large portion of the limb was often 

 sacrificed. It is therefore an unspeakable satisfaction to be able to avoid 

 amputation altogether in such cases, merely taking away such portions as may 

 be actually destroyed, and leaving the weakened tissues in the vicinity to recover 

 themselves quietly, instead of perishing under the irritating and poisoning 

 influence of putrefaction ; while any dead portions that may remain are absorbed 

 more or less completely, like the extra vasated blood, and replaced by tissue of 

 new formation. If the history of all the contused wounds of the hands and 

 feet that have been treated in my wards during the last three years were 

 recorded, including many compound fractures not reckoned as such in our 

 classification and several compound dislocations, it would be enough to 

 convince the most sceptical of the advantages of the antiseptic system. 



But the case to which I am now alluding was an exception to the general 

 rule of satisfactory progress. It was a severe injury to the hand from machinery. 

 My then house surgeon, who had only just entered upon his office, and had 

 not as yet the confidence in the antiseptic system which he soon afterwards 

 acquired, took it for granted that I should amputate the hand, and committed 

 the error of leaving it till my visit on the following day, without adopting effi- 

 cient antiseptic measures. When I saw the case I decided to try to save the 

 greater part of the hand, and endeavoured to correct the mistake which had 

 been made. Putrefaction, however, ensued, and after some days pyaemia 

 occurred, and continued, as before stated, in spite of amputation of the hand. 

 On dissecting the parts, one of the metacarpal bones was found split up, with 

 putrefactive suppuration developed in its interior. Under such circumstances 

 pyaemia might occur in a perfectly sound constitution and in the most healthy 

 atmosphere, just as, in Cruveilhier's highly instructive experiment, suppurative 

 phlebitis of the femoral vein and its branches, exactly corresponding to that 

 which is seen in traumatic pyaemia, was induced in a healthy dog by intro- 

 ducing into the vessel a bit of wood which, from its porous nature, could not 

 but originate putrefaction.^ 



^ See Cruveilhier's Anatomic Pathologique, livraison xi, where wall also be found the records of 

 important experiments, proving how readily liquids introduced into the interior of bones pass into the 

 general circulation. 



