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invariably putrid within 24 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 days, during which union by the first intention proceeded undisturbed except in the track of the ligatures upon the 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 in four days at the latest. The ligatures, on the other hand, were not fully detached till a later and variable period; and so long as they remained they perpetuated the formation of pus in the depths of the wound, the retention of which by a dry dressing long continued would have involved disastrous consequences.
Thus, under the best possible management which the knowledge of those days permitted, suppuration was an inevitable attendant on nearly every wound; and so long as it continued there was no security against the advent of one of the various specially unhealthy conditions, then quite inexplicable, which might ruin the results of the most beautifully planned and executed operations.
