DEMONSTRATIONS OF ANTISEPTIC SURGERY 



BEFORE MEMBERS OF THE BRITISH 



MEDICAL ASSOCIATION 



[Edinburgh Medical Journal, vol. xxi, 1875-6, pp. 193, 481.] 



Demonstration I 



Gentlemen. — I propose this morning and to-morrow morning to avail 

 myself of such opportunities as happen to be at my disposal to illustrate before 

 the British Medical Association the methods and the value of antiseptic treat- 

 ment. The first case which I shall bring before you will show this treatment 

 in its simplest form, and in one of its most striking instances — a case in which 

 I propose to lay open the knee-joint. The patient (a man fifty-four years of age) 

 was under my care some years ago, with a very large effusion under the deltoid, 

 in an acute form, attended with much fever. I opened it antiseptically, and 

 the patient made a rapid recovery without suppuration. He has thus already 

 had experience of the value of antiseptic treatment, and therefore trusts it 

 implicitly for the management of what he at present suffers from, namely, 

 painful effusion into the knee-joint. It is of twelve months' duration, and has 

 resisted repeated blistering (about a dozen have been applied in all), and from 

 the peculiar prominence that exists over parts of the articulation, I suspect 

 suppuration is imminent. Now, if blistering failed in a case of this kind, without 

 antiseptic m.anagement the surgeon would be at a loss what to do. Dieulafoy's 

 aspirator might sometimes prove serviceable, but those who have tried it must 

 confess that they are often disappointed in consequence of the fine tube becoming 

 blocked by portions of lymph. But by antiseptic means we are able to obtain, 

 by incision and drainage-tube, a perfectly free exit for the fluid, and thus 

 relieving the joint altogether from the tension due to effusion, permit the natural 

 tendency to recovery to come into operation. I need hardly remark, that to 

 do this without antiseptic treatment would be madness — would be a thing 

 which no surgeon would be justified in doing ; to make a free incision into the 

 knee-joint and to keep the wound open with a drainage-tube, would be an 

 altogether unwarrantable procedure. We all know that the knee-joint has 

 often been opened by free incision for the extraction of loose cartilages, and that 

 in some such cases, the wound having healed b}^ first intention, all has gone on 

 well without any antiseptic treatment at all ; though we know also that this 



