ON ANTISEPTIC DRESSING UNDER SOME CIRCUM- 

 STANCES OF DIFFICULTY, INCLUDING 

 AMPUTATION AT THE HIP-}OINT 



[Edinburgh Medical Journal, vol. xvii, 187 1-2, p. 144.] 



At a meeting of the Medico-Chirurgical Societ}^ of Edinburgh on the 6th of 

 June, a communication was made by Mr. Lister to the following effect : — 



Mr. President. — I have to exhibit this evening, in the first place, a case 

 illustrating the results of excision of the wrist for caries, performed according to 

 the principle and method described by myself in the Lancet several years ago ^ ; 

 the principle being the removal of the entire articular apparatus of the wrist, in- 

 cluding all the carpal bones, together with the articular extremities of the radius 

 and ulna and five metacarpals, so as to place this excision in the same favourable 

 position as that of the elbow, while the method (fully described in the Lancet) 

 permits free access to the affected bones with the least possible injury- to the 

 tendons. The young man now before you is Case 5 of those described in the 

 Lancet (March 25, 1865), and I may quote shortly from the account there 

 given." ' Thomas Morris, aged twenty-one, a miner, was admitted on the 8th of 

 July, 1864. i\bout six months before, when suffering from small-pox, he was 

 seized with inflammation in the right tibia and the left carpus, resulting in 

 necrosis of the former, and caries of the latter. When he came into the hospital, 

 the back of the wrist was swollen, and presented two sinuses, through which 

 a probe could be passed down to the diseased bone. The hand was extremeh- 

 feeble, and drooped when the arm was extended horizontallv. It was ver\- 

 painful, interfering seriously with his night's rest, and his general health was 

 otherwise much deranged, his pulse being 135, and his appetite impaired, while 

 he was constantly bathed in perspiration.' On the i6th of July, I removed 

 the parts represented in a sketch given in the Lancet, as you will see from the 

 copy I have brought with me. (The sketch is reproduced on p. 200.) 



You observe, it includes the entire articular apparatus of the wrist. ' A 

 carious cavity occupied the place of the semilunar bone, and the adjacent 

 part of the cuneiform was excavated. The other carpal bones, except the 

 trapezium, were anchylosed into one mass.' Nearly seven years having elapsed 

 since the operation, we are in a good position for judging of its results. You 

 observe that the liand has, on the whole, a very natural appearance, but that 



' See p. 417 of this volume. ' See p. 4^3 of tliis volume. 



