192 THE ADDRESS IN SURGERY DELIVERED BEFORE 



quantity of blood happened to become effused into the sac during the first 

 twenty-four hours, so as to reproduce the appearance of tumour, though not in 

 sufficient amount to cause tension, and this made the absence of putrefaction 

 and suppuration all the more striking. And now occurred a most unhappy 

 circumstance, though at the same time instructive. The patient, who, as 

 I afterwards learnt, had before been liable to temporary attacks of mental 

 alienation, became, I fear, permanently mad, and a week after the operation 

 she was up and w^alking about the ward, certainly testing the catgut stitches 

 most severely, yet without any bad result. When the wound had healed, she 

 was taken to a lunatic asylum ; and I have not been able to hear of her later 

 than six weeks afterwards, when she left for another institution of the same 

 kind ; but up to that period there had been no return of hernia. Thus, you 

 see, the catgut stitch becomes a new engine in surgery, enabling us to attach 

 deeply seated parts to each other, leaving the connecting medium to be removed 

 by absorption. 



As another striking illustration of antiseptic treatment, hitherto unpublished, 

 I may mention a case of ununited fracture of the neck of the thigh-bone. The 

 patient was a fine powerful man, forty-five years of age, who had fallen down 

 from a cart, and broken the neck of the femur. He had been treated in hospital 

 elsewhere ; but, strange to say, according to his own statement, he was turned 

 out of that institution in five weeks on crutches, whereas he ought surely to 

 have had at least six weeks with the long splint ; and eighteen months after- 

 wards he applied to me. There were all the ordinary symptoms of an ununited 

 fracture of the neck of the femur. There was shortening to the extent of an 

 inch and an eighth, while the trochanter was correspondingly nearer to the 

 iliac crest than on the other side, and, instead of moving in the arc of a circle 

 on rotation of the limb, turned on its own axis with a crunching sensation. 

 The man could not raise his leg beyond a trifling degree, or turn round, as he 

 lay, without supporting the trochanteric region with his hand ; and he could 

 rest no weight whatever upon the limb. Under ordinary treatment, this man 

 would have been condemned to a life of hopeless uselessness. But, considering 

 his time of life, there could be little doubt that the fracture was extracapsular, 

 and that, if the ends of the fragments could be brought into the condition of 

 a recent fracture, there would be union under proper treatment, if the man 

 survived. But to effect this would involve making a free external wound, 

 and, for aught I could tell, opening into the capsule of the hip-joint. And 

 would that be a justifiable procedure ? Thinking the matter over, although 

 our antiseptic means were then comparatively imperfect, I believed I could 

 operate so as to avoid putrefaction ; and I felt sure that if putrefaction did 



