THE THIRD HUXLEY LECTURE 517 



resolved to amputate. On the evening before the day for the operation 

 I again })ut the patient under chloroform, and, after scraping the sore ver\' 

 thoroughly, allowed the liquid caustic to lie in pools upon it for a quarter 

 of an hour in order to destroy as effectually as possible all material in the 

 sore which might otherwise infect the amputation wound. With a similar 

 object I washed the skin of the limb thoroughly with soap and water, including 

 the shoulder, where it had been decided to perform the amputation. The 

 limb having been removed next day, the stump healed perfectly kindl\-. Here, 

 as in the other cases, local treatment proved efficacious. 



I was greatly struck with the clear evidence which these cases seemed to 

 afford that the disease was of the nature of a purely local poison. In the hope 

 of discovering its nature I examined microscopically the slough from one of 

 the sores, and I made a sketch of some bodies of pretty uniform size which 

 I imagined might be the materies morbi in the shape of some kind of fungus. 

 Thus as regards that form of hospital disease, the idea that it was probably of 

 parasitic nature was at that early period already present to my mind. 



On visiting Edinburgh by Dr. Sharpey's advice in order to see something 

 of Mr. Syme's practice, I was fascinated by the prominence that he gave to the 

 pathological side of surgery as well as by his rare diagnostic judgement and 

 his surpassing powers as an operator. Under him I had the unexpected great 

 privilege of a second house-surgeoncy, which extended over upwards of a year, 

 and in the great Royal Infirmary I had ample opportunity for observing the 

 behaviour of wounds under the most varied conditions. I was charmed with 

 the superiority of the treatment of recent wounds which I witnessed there o\-er 

 the ' water dressing ' which was used at Universit}^ College after the precepts 

 of Liston, who introduced it in place of what he termed ' filthy unguents '. 

 Water dressing, though cleanly when applied, was invariably putrid within 

 twenty-four hours, and had to be changed daily, Mr. Syme placed pads of 

 dry lint upon the bodies of the flaps, leaving the lips of the wound free for the 

 escape of blood and serum, covering all with a single layer of dry lint and a 

 retaining bandage which gently pressed the cut surfaces together. This dressing 

 was left untouched for four davs, during which union by the tirst intention 

 proceeded undisturbed except in the track of the ligatures upon th.e blood- 

 vessels, while the discharge found on changing the dressing was scanty and 

 not specially offensive. 



But highly successful as this practice was, it could not be continued in 

 the further progress of the case. The ligatures were separated by a process 

 of suppuration, which, even when the tissues had been healthy at the time of 

 operation, became fully established ni lour days at thr latest. The ligatures, 



