6 ON A NEW METHOD OF TREATING 



that the cure was assured. On my return, however, I was deeply mortified 

 to learn that hospital gangrene attacked the sore soon after I went away, and 

 made such havoc that amputation became necessary. 



While I could not but feel that this case, by its unfortunate issue, might 

 lose much of its value in the minds of others, yet to myself it was perfectly 

 conclusive of the efficacy of carbohc acid for the object in view. At the same 

 time it suggested some improvement in matters of detail. It showed that the 

 acid may give rise to a serous exudation apt to irritate by its accumulation, 

 and therefore that a warm and moist apphcation would be advantageous to 

 soothe the part, and also ensure the free exit of such exuded fluid. At the 

 same time it appeared desirable to protect the crust with something that would 

 retain the volatile organic acid more effectually than oiled silk or gutta-percha, 

 through which it makes its way with the utmost facihty. For this purpose 

 a metallic covering naturally suggested itself, and as ordinary tin-foil is unsuit- 

 able from its porosity, I employed thin sheet-lead, and afterwards block-tin, 

 such as is used for covering the jars of anatomical preparations, superior to 

 lead on account of the facihty with which it can be moulded to any shape that 

 is desired. 



For a long time, however, I had no opportunity of giving this improvement 

 a trial, the compound fractures admitted into my wards during the next eight 

 months bein? merelv two cases with small wounds. One of these was a fracture 

 of the ulna into the elbow-joint in a woman so old that suppuration, had it 

 occurred, would probably have proved fatal. The orifice in the integument 

 was extremely small, and all would most likely have gone on well had the bit 

 of dry lint apphed to check the free bleeding from the interior been left undis- 

 turbed, instead of being saturated with carbolic acid as it was. This, however, 

 could not but be an additional safeguard, and at the same time it was satis- 

 factory to find that the caustic application did not interfere with the usual 

 healing by scabbing, cicatrization being found complete when the crust was 

 removed. 



The other case was a fracture of the humerus a little above the elbow in a 

 young man, caused by a fall from a height of thirty-five feet, the wound, which 

 was not quite half an inch in length, being situated at the inner side of the limb, 

 where it must necessarily be covered by a splint. Dr. Watson, then my house 

 surgeon, applied lint dipped in carbolic acid covered with a slightly concave 

 piece of sheet-lead about as large as a shilling, and put up the limb in pasteboard 

 padded with cotton. At the end of ten days the inner side of the limb was 

 uncovered for the first time, and merely as a matter of curiosity, when the lead, 

 with the lint adhering to it, dropped off, disclosing a small superficial granulating 



