SOME CIRCUMSTANCES OF DIFFICULTY 201 



when an infant, burning the left side of the body to a frightful extent, the scar 

 being seen to reach from the upper part of the neck to the lower part of the 

 forearm, and laterally from near the spine to the mamma, the mammilla having 

 been destroyed. The healing of the huge granulating sore, and the subsequent 

 shrinking of the cicatricial tissue, led to the formation of a web of several inches 

 in length, constituting an extension of the posterior fold of the axilla down- 

 wards, and binding the arm pretty closely to the side. We all know how 

 unsatisfactory the treatment of such cases commonly is. The web, if divided 

 with the knife, becomes reproduced by the coalescence and contraction of the 

 granulations, and the condition of the patient is too often little, if at all, better 

 than it was originally. In the present instance the tendency to coalescence 

 of the granulations has been counteracted by a method which I employed first 

 several years ago in a case of webbed lingers, viz. bringing the elastic traction 

 of india-rubber to bear upon the angle of the wound made by cutting through 

 the web. At the same time this plan of treatment has been greatly assisted, 

 both in the earlier and later stages of the case, by antiseptic management. 

 The irritation of the cut surface by putrefaction being avoided during the first 

 few days after the operation, inflammation was entirely prevented, and thus 

 we were able, even from the first, to use a degree of freedom with the limb 

 in raising it from the side, which would have been otherwise intolerable. It 

 happens that I have now under my care in the infirmary another similar case, 

 operated on only two days ago, when a web of great length, and involving the 

 whole breadth of the axilla, was freely divided ; and my friend Dr. Holmer, 

 of Copenhagen, who is here to-night, and who saw the patient dressed this 

 morning, can bear me out when I say that the skin around the very extensive 

 raw surface was perfectly free from redness or tenderness ; while the young man 

 was able to get up and move about almost as if nothing had been done to him. 

 The advantages of antiseptic treatment have been equally great in the further 

 progress of the case before you, for when sores are efhcicntly protected both 

 from the irritation of putrefaction and from that of the antiseptic, they heal 

 under circumstances inconsistent with cicatrization under water dressing ; and 

 the mechanical irritation involved in the varied traction to which the sore 

 has been here exposed, would probably have prevented healing altogether had 

 the ordinary application been made. I have thought it best to exhibit the 

 patient before healing is complete, in order that you may see the treatment 

 in progress ; and as the mode of dressing presents several features of interest, 

 I will venture to trespass upon your time by performing it before \ou. The 

 retaining bandage being now removed, you sec the rod of india-rubber [a rod 

 of vulcanized india-rubber about as thick as the little linger] which exerts its 



LISTER II P 



