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ran up in the evening to 101°, without any apparent cause, except that the bowels had not been moved for four days, and he was feeling some discomfort in consequence. I may here remark that in several of our cases of antiseptic surgery, (where the temperature has been very closely watched) sudden elevations have occurred for which no cause could be assigned, except a loaded condition of the bowels, and that this was the cause seems to be established by the fact that it invariably fell to its former range as soon as the bowels were relieved by a purgative or an enema.

Dec. 2nd.-Arm dressed again. Sutures removed. Wound completely healed, except the two small openings from which the drainage tubes were removed.

Thus the wound had entirely closed in ten days after operation, and the patient was discharged with a very useful arm after thirty-nine days residence in hospital.

CASE IV.-Amputation of the Thigh in a child of four years for a railway injury, the wheels of a street car having passed obliquely over the foot and leg. I amputated after Carden's method. Antiseptic measures were adopted throughout. Union by first intention occurred without a drop of suppuration or trace of odour. On the fifth day (third dressing), the tubes were removed, and on the ninth day, (5th July) the stump was found to be perfectly healed, and all dressings were removed. The temperature chart, I venture to say, will be found on examination to be almost unique for an amputation of the thigh, following railway injury, as you see it never rose above 99o. The child slept and ate well throughout, and as far as I could learn from the nurse, never referred to the wound as if in pain.

CASE V.-E.ccision of the Elbow for bony Ankylosis.This was a lad of 18 years who sought advice on the 4th July, 1878, for ankylosis of the elbow, in an awkward position, viz: at an angle much greater than a right angle. He gave a history of having fallen from a height some four years previous, taining fracture of the bones comprising the elbow-joint. The

limb was treated in the position of full extension, the consequence being a perfectly straight arm. Partial excision was subsequently performed by Mr. Annandale of Edinburgh, resulting in ankylosis, and the condition of things found on admission.

From the notes of my clinical clerk, Mr. Thomas Gray, I glean the following :-Hand semi-prone—complete loss of motion in elbow-joint, it being in an almost semi-flexed position. Muscles of arm and forearm much wasted. On the outer side of the arm is an oblong cicatrix over the position of the external condyle, and another on the inner side just behind the internal condyle. These correspond to the incisions of Mr. Annandale. An irregular bony mass is felt corresponding to site of head of radius, and external side of humerus. The olecranon is distinct, but its anterior surface seems firmly adherent to the humerus. He complains of a tingling sensation and loss of power in the little and ring fingers, due, no doubt, to pressure of the ulnar nerve between the inner cicatrix and the bone.

As the patient was not in very good health when admitted, having recently suffered from axillary abscess, I deferred operative interference until the 24th July, on which day I proceeded to excise with antiseptic precautions. I employed the straight incision, going directly through the periosteum, which I carefully separated throughout with the blunt “elevator.” The ulnar nerve was released without being exposed. About two and a half inches of the ankylosed bone were removed. (I pass the specimen round for your inspection. You will find the bones comprising the joint completely fused together).

I return to Mr. Gray's notes for the following record :

July 25th.---Temperature 98°; pulse steady; not a single bad symptom has appeared. Some difficulty in making water, which he says is always the case when obliged to keep the horizontal position. The arm was dressed to-day, and looks “ beautiful.” No swelling, no tension. Slight serous discharge, and the edges of the incision are already meeting. In the evening his temperature was 99o.

The report for the two succeeding days is most encouraging, as the temperature chart will itself show. The interesting fact might be mentioned here, that the ulnar nerve is regaining its proper functions, as the fingers supplied by it are found to have both acquired a large share of their normal sensation and motion.

28th.—Temperature normal. Pulse 84. Dressings removed ; discharge serous in character and perfectly “sweet.” No pus has been seen. The wound is united firmly throughout with the exception of the angles occupied by the drainage tubes, which, by the way, have been very much shortened to-day.

Aug. 1st.—The antiseptic dressings and drainage tubes were removed and the part dressed simply with boracic lint and oil silk.

9th. The angles having now entirely healed, passive motion is begun. It will be seen that I employed no splint in this case the heavy antiseptic dressing being sufficient to keep the arm at any angle desired.

I beg to refer you to the temperature chart, which I look upon as a remarkable one, the index never having risen higher than 99o.1, and that for two days only following the operation.

Did time permit, I could give detailed reports of other two cases of compound fracture ; of five cases of Removal of Breast; five cases of Removal of Fatty Tumour ; seven cases of Amputation of Fingers and Toes, besides innumeraable abscesses, which have been treated antiseptically during the past twelve months, in the wards of the Montreal General Hospital, and with the most gratifying results.

Some of my colleagues also have been very suceessful, and I have no doubt they will, at no distant date, give the profession the benefit of their experience.

So much for the successes; now for the failures, and here the story is soon told : We failed in three major operations only, in maintaining the discharges in an antiseptic condition. These were 1st. A Syme's amputation ; 2nd. Removal of a large scirrhus breast ; 3rd. Re-amputation of Leg.

The first operation was performed in a man about 40 years of age, on whom a Chopart had been done some months before, leaving a painful ulcer on the face of the stump. On the third day the protective was found to be blackened (a sure sign of putrescence), and the dressing had a decided odour. The temperature had also gone up during the night to 102° ; pulse rapid and pain considerable. The cause of failure was selfevident, and indeed I had anticipated this, in some clinical remarks made after the operation. I had just completed the flaps and was about separating the foot when the spray-producer ceased to work, through some mismanagement. The “ guard was at once applied, but the instrument could not again be made to work, and the operation had to be completed without the spray. Notwithstanding that the wound was thoroughly washed out with carbolic lotion, and every antiseptic precaution taken, the result was what I have stated, some septic germs having, no doubt, crept into the crannies of the wound after the discontinuance of the spray. This case illustrates more than anything I have yet seen or read, the paramount importance of the antiseptic spray, and proves beyond a doubt that the first duty of a surgeon is to protect the delicate tissues exposed by his knife from contamination by those organic germs (call them by what name you please) which float in the air about us, and are undoubtedly the cause of putrefaction. As to the case, I succeeded after some trouble in “sweetening ” the stump, and it ultimately turned out to be a very fair result, although the man was two months in hospital, whereas he should have been there only two weeks.

The second operation which proved a failure was a case of simple removal of breast. Everything went well until the fourth day, when odour was distinctly perceptible, and the protective was blackened. The temperature chart showed a rise of nearly three degrees, and the pus was marked in amount. I could not explain it, excepting that the patient, who was very fidgety, had raised the upper edges of the dressing in the endeavor to loosen it, and thus allowed of the ingress of air. I have since discovered, however, that she was in the habit secretly of stuffing a quantity of cotton wool beneath the dressing to prevent the gauze from irritating the skin. Now, I think if germs are able to appreciate the “ comforts of a home,” they will find them among the delicate, soft, and warm fibres of the ordinary cotton wool. I really think there is nothing for which the antiseptic surgeon should entertain a greater dread than this

very material

in its raw state, and yet when properly prepared there are few forms of dressing capable of more universal application.

The third case of failure occurred only the other day in a re-amputation of the leg for painful and ulcerated stump. The case is not one of sufficient interest to call for a full report. Suffice it to say that on the fifth day (third dressing) there were evidences of putrescence. I have yet been- unable to find a sufficient cause for the failure, unless it be that a splint which I applied on thc second day beneath the heavy dressing, had not been thoroughly cleansed. A large patch of cicatricial tissue situated over the bone has since sloughed, although the case will ultimately do well.

Thus I have endeavoured to lay before you, though, I must confess, in a very imperfect manner, the result of one year's experience of the antiseptic method of Lister. The number of cases is certainly small, but the experience presented should be sufficient to convince the most sceptical of the practical efficacy of the method, and to induce them at least to give it a trial, Our success in the Montreal General Hospital has certainly exceeded our fondest expectations. For the year ending yesterday we can show a clean mortality sheet as far as the purely antiseptic operations are concerned, while traumatic erysipelas and pyæmia have been unknown. Indeed, we may confidently look forward to the time when these surgical plagues will be no longer dreaded, but, like scurvy in our day, will be considered in the light of curiosities.

No one, not even Lister himself, claims that the method is faultless, although he has been unable to make any material improvements in the past five years. Those, besides, who have attempted from time to time to modify his plan of procedure, have, almost without exception, failed. Thus, Thiersch, of Leipsic, the first German follower of Lister, has gone back to carbolic acid, having found salicylic acid a sad failure as a germicide. He declares that, although the technical details of the method may be modified, Lister's postulate—the total exclusion of putrefactive elements from the wound—will never be lost sight of by him.

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