8 ON A NEW METHOD OF TREATING 



from the knee to the ankle, being retained in position by looped bandages. 

 This proved a very satisfactory arrangement, the tin having sufficient firmness 

 to answer the purpose of a splint, while it most effectually retained the moisture 

 of the flannel, which, again, served as an excellent padding. The fomentation 

 was changed night and morning, and gave great comfort to the patient, and 

 once a day carbolic acid was applied lightly to the crust. 



Two days after the accident the limb was easier, but the circumferential 

 measurement of the calf continued the same, and the pulse was 96, though soft. 

 On the fourth da\^ — the critical period with reference to suppuration — the limb 

 was free from pain, and the calf less tense, and distinctly reduced in dimensions ; 

 while the pulse had fallen to 80, and the patient had enjoyed his food after 

 a good night's rest. After this the swelling steadily subsided, the skin remain- 

 ing, as it had been from the first, free from the slightest inflammator}- blush, 

 and his general health was in all respects satisfactory. Seven daj's after the 

 receipt of the injur}^ there was some puriform discharge from the surface of the 

 skin where the carbolic acid, confined by the smaller piece of tin that covered 

 the crust, had produced excoriation by its caustic action ; and to prevent need- 

 less irritation from this cause, the tin was reduced so as to leave only a narrow 

 flat rim round a bulging part which corresponded to the crust. 



About a fortnight after the accident a sense of fluctuation was experienced 

 over the seat of fracture, but, as all was going on favourably otherwise, I hoped 

 that this was due simply to serum from the effused blood ; and in a few days 

 it had completely disappeared, not a drop of pus meanwhile having escaped 

 from beneath the crust. About this time the edges of the crust became softened 

 by the superficial discharge from the surrounding parts, and these softened 

 portions were daily clipped away with scissors. Thus the circumferential part of 

 the crust which had overlapped the skin was removed, and that which lay over the 

 extra vasated blood in the wound was also reduced to smaller and smaller size. 



On the 7th of June, nearly three weeks after the accident, an observation 

 of much interest was made. I was detaching a portion of the adherent crust 

 from the surface of the vascular structure into which the extravasated blood 

 beneath had been converted by the process of organization, when I exposed 

 a little spherical cavity about as big as a pea, containing brown serum, forming 

 a sort of pocket in the living tissues, which, when scraped with the edge of 

 a knife, bled even at the very margin of the cavity. This appearance showed 

 that the deeper portions of the crust itself had been converted into living tissue. 

 For ca\dties formed during the process of aggregation, like those with clear 

 liquid contents in a Gruyere cheese, occur in the grumous mass which results 

 from the action of carbolic acid upon blood ; and that which I had exposed 



