SOME CIRCUMSTANCES OF DIFFICULTY 203 



and then a piece of well-overlapping antiseptic gauze, bandaged securely both 

 to the arm and to the chest. 



The gutta-percha shield for the top of the shoulder is padded with the 

 gauze ; and this illustrates another valuable use of that material. Supposing 

 that the padding were of an ordinary kind, such as cotton- wool, putrefaction 

 could hardly fail to take place in the sore. For the edge of the protective comes 

 up to the immediate vicinity of the shield, and the discharge escaping from 

 beneath it would soak into the padding and putrefy there, and the fermentation 

 would be communicated to the fluid beneath the protective ; since this layer, 

 while it protects the sore from the irritation of the antiseptic, necessarily involves 

 liability of any organic material that lies beneath it to putrefaction on access 

 of the ferment. But by having the padding of the shield itself antiseptic this 

 difficulty is overcome, the gauze of the axilla and that of the shield coming 

 in contact with each other ; and we have not had putrefaction occur on any 

 single occasion since the operation. The advantages of this material are still 

 further exemplified in this case by its use in the form of bandage, every turn of 

 which, instead of affording a nidus for putrefaction, increases the antiseptic 

 efficacy of the whole dressing. 



It yet remains to show you what the patient can do in the way of raising 

 the arm. At the time of the operation I did not get it quite up to the horizontal 

 level. In the course of a few days it could be brought up to that level. Then 

 her ambition came to be to reach up with her finger-tips to the handle of a small 

 cupboard in the ward, fixed at some distance above the floor. Afterwards, 

 stretching a little higher day by day, she was at length able to reach to the top 

 of the cupboard, about nine inches higher ; and now, within the last few days, 

 by means of this species of gymnastic exercise, she has succeeded in getting 

 her knuckles even higher than the top ; and you see at present that she can 

 raise both hands well above the head, and touch nearly as high a point on the 

 wall with the one as with the other. Thus, instead of the usual course after 

 such operations — namely, the web gradually forming again, and what was 

 gained at the operation being ultimately lost — we have here made constant 

 progress in advance of what the operation effected, and all this without the 

 use of any means of extension, or anv restraint upon the natural actions and 

 usefulness of the limb. There can therefore, I conceive, be no doubt that, by 

 persevering a httle longer with the same system, we shall attain all that can be 

 desired. 



The next case I have to bring before you is an instance of recovery after 

 primary amputation at the hip-joint, a thing bv no means of conuuon occurrence. 

 The injury that necessitated the operation in tlic boy now before you (five 



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