170 ON A CASE ILLUSTRATING THE PRESENT ASPECT 



to bed, as a matter of precaution, was now allowed to get up, a similar dressing 

 of ' protective ' covered with antiseptic gauze having been applied. 



Four days afterwards, on December 26, the dressing was again changed, 

 when the wound over the ulna was found almost healed, and that over the joint 

 far advanced in cicatrization, while there was still no pus or putrefactive odour, 

 and the general health of the patient continued excellent. 



In some respects it would have been more satisfactory if sufficient time 

 had passed to permit reunion of the ulna, so that the usefulness of the limb 

 might be tested. But as an illustration of antiseptic treatment, the case is 

 already complete. In this respect, I cannot but hope that it will be thought 

 instructive. It is an example of a procedure, otherwise highly dangerous, if 

 not unwarrantable, rendered not only legitimate, but entirely free from risk, 

 simply because, from the circumstances of the case, and the improved means 

 at our disposal, we could calculate with certainty on avoidance of putrefaction. 

 I venture to draw special attention to the use of the spray. In every wound 

 treated antiseptically, two things are always to be attended to : first, to leave 

 the wound free from living putrefactive organisms, and, second, to employ such 

 an external dressing as shall securely prevent the entrance of such organisms 

 at any subsequent period of the case. The latter point has, in most cases, 

 been for a long time past satisfactorily accomplished ; but the former, till we 

 used the spray, was always a matter of more or less uncertainty. A floating 

 germ might enter during the operation into some cellular interstice among the 

 tissues, and, becoming surrounded with a clot of blood, might escape the action 

 of the antiseptic lotion with which the wound was washed, and, retaining 

 its vitality, might subsequently propagate its kind, and spread putrefactive 

 fermentation through the wound. But by help of the spray we operate in an 

 antiseptic atmosphere, and effectually prevent putrefactive organisms from 

 ever entering the wound alive. We thus dispense with the necessity for washing 

 the wound at all with an antiseptic lotion, and in the particular case above 

 related, not even the vapour of carbolic acid penetrated into the deeper parts 

 of the wounds, which were thus left as free from irritation as if they had been 

 made subcutaneously. 



The spray is also of the greatest value during the stitching of such wounds 

 as require it, and rids us of the troublesome and uncertain process of distending 

 the wound with lotion by means of a syringe, after the introduction of the last 

 suture. In the changing of dressings, also, the spray is in some cases, and 

 especially in stumps after amputation, a great element of security. 



Revision of the proof (January 11, 1871) affords me the opportunity of 

 giving another report of the progress of the case. On dressing the limb yester- 



