196 THE ADDRESS IN SURGERY DELIVERED BEFORE 



weakness of the tissues was indicated by the circumstance that a Uttle bit of 

 skin, about the twentieth of an inch in breadth, sloughed at the margin of one 

 of the flaps, and a small piece of subcutaneous tissue also came away. Further, 

 after a year's respite, her proclivity to the disease has been shown \\dthin the 

 last few days by its reappearance in the tips of all the remaining toes of that 

 foot, though the scar of the operation remains sound. 



Though I regret to find that I have already greatly exceeded my allotted 

 time, I must ask you to allow me to say a word or two regarding the treatment 

 of ulcers under the gauze and protective. When shielded alike from the irritation 

 of putrefaction and that of the antiseptic, ulcers heal which would otherwise 

 refuse to do so. Last winter I had under my care in the infirmary a young 

 man who had burnt his foot very severely four years previously by treading 

 in molten metal, some of which ran down into his boot. The large sore that 

 resulted had been prevented from healing completely in consequence of the 

 shrinking of the scar, which reached from some distance up the leg along the 

 outer part of the dorsum of the foot to the toes, of which the outermost had 

 been so much retracted that it pointed backwards, the end of the metatarsal 

 bone being the most prominent part. A surgeon of considerable eminence had 

 advised amputation of the foot, and he was afterwards under my care for five 

 months in the Glasgow Infirmary, though without any good result ; and at 

 length, not wishing to submit to amputation, he came to me for a certificate 

 of incompetency for any active occupation. I admitted him for the purpose of 

 trying skin-grafting ; but this failed, fortunately, as it turned out, for the 

 illustration of this branch of the subject ; for, having got the putrefaction 

 present on admission completely arrested by strong antiseptic lotions, directly 

 applied, and afterwards using nothing stronger than one of carbolic acid to four 

 hundred of water as a lotion, and so making the dressing as little irritating as 

 possible, healing went on in the most steady and beautiful manner under the 

 gauze and protective, changed once in four or five days, and the man has now 

 a thoroughly useful foot. I do not know that any result we have obtained 

 has given me more pleasure than this. 



When I first applied antiseptic treatment to ulcers, I did not aim at better 

 results as regards rapidirty of healing than those obtained by water dressing. 

 The object which I first had in view was merely to keep the atmosphere of our 

 wards clear from the contamination occasioned even by healthy sores, if their 

 discharges be allowed to putref}^ And the effects of this rigid antiseptic 

 management upon the hospital atmosphere forms one of the most important 

 features of the treatment. Last evening I learnt from one of the surgeons of 

 a large Liverpool hospital the gratifying news that pyaemia has almost, if not 



