92 FISTULA AND POLL-EVIL 
from septicemia, even in the most vigorous sub- 
jects. 
The prevention lies in making the best of 
the situation by using sterilized instruments, 
cleaning the hands well, packing the wound 
with a safe wadding and then protecting it 
thereafter until the danger of a grave infection 
has passed. It is also very essential to remove 
the packing material at the end of twenty-four 
hours so that the blood supply of the tissues 
pressed upon by the tight packing will be re- 
stored to the walls of the wound. A packing 
of doubtful purity wadded tightly into a 
wound as large as this one is indeed a hazard. 
It weakens the tissues and hesides impregnates 
them with infections. 
Malignant Edema 
We have had cases of malignant edema fol- 
low operations where the directions given about 
the removal of the packing were not carried 
out. To let a packing sojourn forty-eight 
hours in a large wound always invites anaér- 
obic infections of this character. In fistule of 
the withers it is positively disastrous. There 
is danger from this disease even after appar- 
ently clean operations because the condition 
created is so favorable. The prompt removal 
of the packing at the end of twenty-four hours 
