i86 THE ADDRESS IN SURGERY DELIVERED BEFORE 



only open the abscess in an antiseptic atmosphere by free incision, pressing 

 out the pus — ensuring, in short, free exit for the contents, without the possibihty 

 of the entrance of putrefaction. The antiseptic never enters the abscess-cavity 

 at all ; and I would beg of those who still hold the view that carbolic acid exerts 

 its beneficial influence by acting upon the tissues of the part, to consider carefully 

 the case of abscess — say a psoas abscess connected with diseased vertebrae. 

 Under the carbolic-acid spray, a free incision is made into the cavity ; and 

 I may remark that the spray is of peculiar value for this purpose, because, 

 if an artery happen to be divided during the dissection, it can be secured without 

 any difficulty, or it can be tied after the abscess has been opened. As we used 

 to proceed, plunging in a knife, and effecting the opening at one stroke, if a deep 

 vessel were divided it was a matter of very great inconvenience. Suppose 

 now a large psoas abscess has been opened under the antiseptic spray by free 

 incision, we press out the pus — letting out, it may be, a quart or more ; and 

 on the following day we find, if we have emptied the abscess thoroughly, that 

 there is not a drop of pus to be pressed out, and no pus is formed from that 

 abscess for the future. This is a thing that must be seen to be believed. It 

 seems so contrary to one's experience, and yet it is exactly in accordance with 

 pathological theory. Now suppose a few more days have passed, probably 

 nothing whatever can be squeezed from the abscess-cavity ; but, if you can 

 squeeze out a drop of anything, it is a drop of clear serum — clear, transparent 

 serum. Hence, Mr. President, I say it is transparently clear that the carbolic 

 acid does not enter into the abscess-cavity at all. Still less, if possible, can it 

 penetrate to the diseased bone of the vertebrae ; because, if the carbolic acid 

 did enter in even a slight degree into the abscess-cavity, it would produce 

 opacity of the serum, from coagulating its albumen. Therefore the clear drop 

 which you press out is certain proof that the carbolic acid does not act on the 

 affected part at all. 



I have here a piece of bone which came out along with the pus from a large 

 psoas abscess which I opened in April last — a portion of cancellated bone. 

 I must not hand it round, because it is precious, and one similar piece has already 

 been lost through injudicious exhibition. But you, Mr. President, can see 

 that this is cancellated bone, proving that the abscess really did communicate 

 with the diseased vertebrae. The patient was an adult, with an acute curvature 

 of the dorsal region of the spine, and other symptoms of spinal disease. He 

 had a sense of painful constriction round the waist, pain shooting down into 

 the haunches and lower limbs ; and he was in a state of very great general 

 prostration. Still, if we had not seen these bits of bone, it might have been 

 said by anybody, and perhaps fairly said, * I do not choose to believe that this 



