AND THE SALUBRITY OF A SURGICAL HOSPITAL 159 



by any one accustomed to them ; yet they nevertheless require at first earnest 

 practical study until their employment has become habitual and instinctive. 

 It is therefore not to be wondered at that surgeons endeavouring to carry out 

 the treatment without having seen it in operation, and only half persuaded 

 of the importance of the object to be attained, should fail time after time, and 

 throw up the attempt in disgust. Professor Saxtorph, on the other hand, 

 having observed the effects of the antiseptic treatment, and appreciated its 

 importance, spent a considerable time in carefully watching it in operation, 

 and then set to work in right good earnest to carry it out ; and, as he beheves 

 in the germ theory of putrefaction, it is not surprising that sound principle 

 and careful practice should have been crowned with the success which he has 

 related. 



I had not intended to have published anything regarding the general con- 

 dition of my wards in Edinburgh till a longer period should have elapsed. But 

 in connexion with Professor Saxtorph's letter, I may state that, having now 

 been in charge of fifty beds for nine months in the Royal Infirmar}- here, I have 

 as yet had no instance of pyaemia, although many cases have been admitted 

 in which it might, under ordinary treatment, have been apprehended, such as 

 compound fractures, amputations in the lower hmb, and extensive gouging 

 operations upon bone. Hospital gangrene also has been entirely absent. 

 Though several cases of ulcers of long standing have been under treatment, 

 there has never been any appearance of greyness of the surface to indicate even 

 the mildest form of the disease. 



Two cases of superficial erysipelas occurred in December ; but these seemed 

 to me attributable to cold rather than to any poisonous condition of the atmo- 

 sphere. In my former paper on this subject I mentioned a case ^ in which 

 erysipelas appeared in a stump after amputation of a leg, long after the patient 

 had left the Glasgow Infirmary witli the wound entirely cicatrized ; and I 

 remarked upon the interest of that case as occupying an intermediate position 

 between traumatic and idiopathic erysipelas, implying that local irritation of 

 such trivial nature as that of a contracting cicatrix might determine the occurrence 

 of the complaint in a person predisposed to it constitutionally. We know also 

 that exposure to cold is the most common exciting cause of the idiopathic form 

 of the disease, which is entirely independent of any unhealthy state of the air. 

 It therefore seems not unreasonable to suppose that where the local irritation 

 of a wound coexists with a chill, traumatic er^'sipelatous inflanunation may 

 become developed in some persons in a perfectly jnuc atmos}-)here ; and such 

 seemed the most probable explanation of the two cases to wliich 1 am now 



' Sec p. 1J3 of this volume. 



