468 AN ADDRESS ON THE TREATMENT OF 



tion they very likely are at considerable tension, and the tension may be apt 

 to cause, through the nervous system, an inflammatory disturbance, and this 

 tends to weaken the parts, and to diminish the power of resistance by which 

 the natural tissues are able to combat the entrance of septic agencies, even 

 though they be in contact with the part. With the recent case, on the other 

 hand, everything is favourable. We have a wound involving no bleeding ; 

 and there is no need to pare the fragments. All you have to do is to sponge 

 away the clots, and the surfaces are ready for coaptation. The drilling is 

 a matter of the utmost simplicity. It is an operation of no difficulty, it does 

 not take long ; it does not cause anxiety to the surgeon ; there is no shock 

 to the system, and no tension. In every respect, the circumstances are 

 favourable as regards the operative procedure. And then, when we come 

 to consider the chances of successful antiseptic management, if there is in the 

 whole body a situation which is well adapted for antiseptic treatment it is 

 this ; for of all the conditions requisite according to our present methods of 

 procedure, that which is most important is that the skin on all sides round 

 about the wound should be able to be amply overlapped by the antiseptic 

 dressings. Here we have the wound in the middle of a long limb ; from the 

 groin to the foot we may have our antiseptic envelope. Then again we have 

 this envelope surrounded with a secure bandage, and the bandaged dressing 

 encased in a splint, and even if you come to have the patient delirious, as one 

 of my patients was, or supposing a patient to be very curious, as some patients 

 will be, it would puzzle him to get the wound exposed under these circum- 

 stances. Now there are wounds so circumstanced that you cannot well guard 

 against this risk. I had a gentleman lately under my care with a psoas 

 abscess ; he was very intelligent, and seemed duly impressed with the im- 

 portance of the antiseptic management ; and yet his brother, who was a 

 medical man, coming in one day, saw him drawing the dressing aside, and 

 peeping at the wound. Now a man cannot peep at a wound in connexion 

 with a fracture of the patella ; it is so circumstanced mechanically that he 

 cannot do it ; and I believe that if we use the means that we have now at 

 our disposal, we may say, with a safe conscience, if we use them aright, that 

 we do not subject the patient to risk, not to anything like so great a risk as 

 patients used to be subjected to not many years ago when they had fatty 

 tumours removed injgeneral hospitals in London. We must all of us remember 

 cases in which, after such operations, erysipelas or diffuse suppuration came 

 on, or some other 'unhealthy action', which, of course, was nobody's fault, 

 but the patient died. 



I have referred to a case of ununited fracture of the olecranon where 



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