194 THE ADDRESS IN SURGERY DELIVERED BEFORE 



wound was stuffed, thoroughly filled, about a dozen strips of lint, an inch broad 

 and fifteen inches long, being employed ; and the haemorrhage being thus 

 arrested, lac-plaster was reapplied. Next day I extracted the lint, in an anti- 

 septic atmosphere produced by the best means then at our disposal, viz. under 

 a large cloth steeped in the strong oily solution, beneath which dressing-forceps 

 was insinuated, and with perfectly satisfactory result. No bleeding occurred 

 afterwards ; the coagula in the wound gradually became organized ; nothing 

 more was seen of the chips of bone, except two minute, partially absorbed, 

 spicula, which appeared at long periods ; and, not to enter into needless details, 

 that man, when last I heard of him, was walking about with a useful limb, with 

 only three-eighths of an inch of shortening. 



The freedom with which joints may be opened in an antiseptic atmosphere, 

 followed up with antiseptic dressing, is among the most striking and valuable 

 circumstances of this treatment. One of my earliest cases of this kind was 

 a large loose cartilage in the knee-joint, about an inch and a half long by three- 

 quarters of an inch broad — not a favourable subject for the ingenious and 

 excellent method of treatment of Mr. Square of this town. I cut down freely 

 on the loose cartilage, having carbolic acid and oil dropped on the wound. I then 

 fixed a sharp hook in its substance ; and, producing an antiseptic atmosphere, 

 as in the last case, by covering the part with a cloth dipped in the oil, so as to 

 prevent mischief from resulting from the regurgitation of air into the joint, 

 hooked it out. I have since had another somewhat similar case. In both 

 instances, I left the wound communicating with the knee-joint open, to allow 

 free exit of the discharges ; and no disturbance of the articulation took place. 

 With the spray, the direct operation would be perfectly simple, as well as safe. 

 As we can thus open joints without any mischief, we have the opportunity, 

 in case of disease, of making free incisions before suppuration has occurred ; 

 and this treatment I have found to be extremely valuable in preventing sup- 

 puration and avoiding amputation or excision. Among several such cases 

 may be mentioned one of disease of the wrist in a middle-aged woman who was 

 admitted into the Edinburgh Infirmary in July of last year, suffering extreme 

 pain night and day. Suppuration appearing imminent, and the case having 

 resisted ordinary treatment, I made a free incision antiseptically down upon 

 the carpal bones and the wrist-joint, cutting in the angle between the tendons 

 of the indicator and extensor secundi internodii pollicis. During the following 

 night the pain was altogether absent ; and, antiseptic dressing along with perfect 

 rest being continued, the wound soon became superficial, without any suppuration 

 of the joint ; and she left the hospital retaining her hand in perfect soundness. 



Partial excision of a joint, so unsatisfactory when practised for caries with 



