266 DEMONSTRATIONS OF ANTISEPTIC SURGERY BEFORE 



of putrefaction, the serous oozing being so extremely trifling. [The case had been 

 dressed four times in all during the sixteen days that had passed since the 

 incision was made, viz. on the day immediately following the operation (which, 

 as a rule, should always be the case), and afterwards at increasing intervals, 

 as the serous oozing diminished. But the deepest part of the dressing, con- 

 sisting of the protective and the small piece of gauze immediately over it, had 

 been left in place from first to last, to avoid as much as possible the stimulation 

 of the clot. I ma}' add, in preparing this paper for the press, that the case has 

 continued to progress well. The patient told me yesterday (August i6), 

 that the last trace of the jerking pain which he used to feel left him on the 

 evening of the day of demonstration ; and Mr. Rice informs me, that, on changing 

 the dressing on the 14th, after an interval of six days, he found cicatrization 

 almost complete. We may therefore say, without much risk of mistake, that 

 this foot has been saved from amputation by antiseptic treatment.] 



The next case is one of ununited fracture in the lower part of the femur 

 of a year's standing, in a man thirty-six years of age. Twelve days ago, I cut 

 down on the outer side of the limb, a very long incision being required. Finding 

 the fragments overlapping about an inch, I removed portions with the gouge 

 and hammer from the posterior surface of the upper fragment and the opposing 

 part on the anterior surface of the lower one, so as to leave two fresh osseous 

 surfaces in apposition. Without antiseptic treatment, this would have been 

 a very dangerous operation. The risk of pyaemia would have been so great, 

 that, in common with most surgeons, I should have regarded such interference 

 as unjustifiable ; but I think we may venture to say that, with antiseptic treat- 

 ment in its present form, all such risk may be certainly avoided. It is now 

 twelve days since the operation. For the first few days blood and serum were 

 effused very copiously, and we had an arrangement by means of which a large 

 mass of gauze could be applied in considerable extent under the limb. But 

 the time has come when it might be put up in a more permanent form. This 

 plaster-of-Paris arrangement was applied yesterday, while the limb was kept 

 well extended by the pulleys, the patient being under chloroform. I have here 

 a limited space for the dressing, and therefore use a correspondingly thick mass 

 of gauze. This you will find often a matter of importance, as in operating for 

 strangulated hernia, where you have not much space between the wound and 

 sources of putrefaction in the perineum. And so in the present case, the window 

 left in the plaster-of-Paris is occupied by a very substantial mass of gauze. 

 The discharge of the last twenty-four hours has caused, you see, merely a small 

 brownish stain upon the gauze, the result of a slight amount of serum, tinged 

 with the colouring matter of the blood. The ends of the wound were stitched 



