i88 THE ADDRESS IN SURGERY DELIVERED BEFORE 



chemical change, for we never had such an occurrence when we used the lac- 

 plaster. Whether it may be the resin in the gauze, I do not know ; but certain 

 it is that you often have some smell ; and sometimes, instead of being merely 

 a faint odour of rotten hay or bad soap, it is exceedingly fetid. A few days 

 before I left Edinburgh, I opened, in a little sickly, dwindled child, a conjoined 

 psoas and lumbar abscess, associated with spinal disease. I emptied the 

 extensive cavity by free incision in the lumbar part, and dressed with the gauze. 

 Two or three days afterwards, on approaching the bed, I perceived a strong 

 smell ; and, on taking off the dressings, the stench was very great. As this was 

 the first case in which I had ever opened a psoas abscess with the one to a 

 hundred spray, and as I had seen regurgitation of the spray take place during the 

 operation, I confess I was alarmed at this foul smell ; but it so happened that 

 I could squeeze out a very little fluid from the interior ; and, taking it away 

 under the spray, and diffusing it upon a plate, so as to be able to estimate 

 accurately any odour it might have, I found that it was perfectly free from smell. 

 Just as in the pus under the vulcanized caoutchouc protective, there was decom- 

 position occasioned by the chemical action of the dressing, but no putrefactive 

 fermentation ; for that would necessarily have spread into the interior. We 

 took the course of dispensing with the macintosh among the gauze, because 

 my house surgeon, Mr. Bishop, has noticed that, if the macintosh be removed 

 so as to allow free escape for the gaseous products of decomposition, you do 

 not get nearly so much smell ; but, if the macintosh be dispensed with, you 

 must use a greater thickness of the gauze, and dress daily. This was done ; 

 and, within a week of the opening of the abscess, the discharge was only a few 

 minims of serum per diem, and the boy had already picked up wonderfully in 

 general health. 



Ligature of arteries in their continuity presents one of the most striking 

 illustrations of the advantages of antiseptic treatment. I have only had two 

 opportunities, since I published on the subject, for applying the catgut in this 

 way ; both of them were cases of popliteal aneurysm, and both were formidable 

 from having become diffuse. One of them was in a man aged forty-seven, who 

 had only noticed the aneurysm for five weeks, during which time it had been 

 rapidly on the increase, so that the patient observed a change in its dimensions 

 every day. On his admission into hospital, on the 31st of August, 1869, it 

 reached from the upper part of the ham to the top of the lower third of the femur. 

 At the same time it caused extreme pain, with numbness in the limb, and the knee 

 was bent at a right angle. I tied the femoral artery at once with a stout piece 

 of prepared catgut, cutting the ends close to the knot, and the result was that 

 within ten days the wound was a superficial sore bridged over with cicatrix, 



