254 AN ADDRESS ON THE EFFECT OF THE ANTISEPTIC TREATMENT 



more severely tried than before. uThere had previously always been an annual 

 cleaning of the wards of our infirmary. Now, this involves considerable incon- 

 venience. The patients had to be transported to another part of the hospital, 

 and some cases were liable to be injured by this transport. Therefore, when 

 the annual cleaning came about, I used to consider whether the patient would 

 get more harm from the want of the cleaning of the wards, or from the trans- 

 portation. I thought they were more likely to get harm from the transport ; 

 and this being year after year my conviction, it is now three years since any 

 cleaning took place in these wards of mine.^ The year 1872 was the last in which 

 it was practised, except in the case of one individual ward where a sore throat 

 prevailed last summer, which seemed to be of the nature of scarlatina, and on 

 that account the ward was emptied and purified. I have sometimes observed 

 remarks made with regard to the results of treatment in my wards, to the effect 

 that I work under superior hygienic conditions. It is, in truth, exactly the 

 opposite. My wards, in these respects, are more severely tried, I believe, than 

 those of any other surgeon in the kingdom. 



Then it is said that greater cleanliness is involved in the antiseptic treat- 

 ment. This, again, is an entire mistake. If we take cleanliness in any other 

 sense than antiseptic cleanliness, my patients have the dirtiest wounds and 

 sores in the world. I often keep on the dressings for a week at a time, during 

 which the discharges accumulate and undergo chemical alteration, probably 

 from oxidation and the action of the resin of the gauze upon them ; and, when 

 the wounds are exposed after such an interval, the altered blood with its various 

 shades of colour conveys often both to the eye and to the nose an idea of 

 anything rather than cleanliness. Aesthetically they are dirty, though surgically 

 clean. 



There is yet another way in which my wards have been unusually tried — 

 namely that I now perform operations which, without antiseptic means, I should 

 not have considered justifiable, some of them being of a character which used 

 to involve especially the risk of pyaemia, such as cutting down on ununited 

 fractures of the femur, and removal of the ends of the fragments. 



Yet, in these circumstances, if I have had one case of pyaemia where I have 

 operated myself, it is the only one I know of ; and that was a spurious form 

 of the disease. It occurred in a patient from whom I had removed the mamma, 

 and, at the same time, cleared out all the axillary glands ; and putrefaction 

 took place in the axilla, in consequence, as we had reason to believe, of mis- 

 management of the spray. Of hospital gangrene we have not had one single 

 case during these six years. As regards erysipelas, our experience has been 

 various. As a rule, it is very rare in my wards. I have been two entire years 



