12 ON A NEW METHOD OF TREATING 



treating ununited fracture by drilling. Meanwhile, the radius being firm, and 

 the injured extensors of the fingers having completely regained their powers, 

 he will, in any event, have a very useful hand. 



This case indicated a greater range of applicability of the treatment by 

 carbolic acid than I had anticipated, and encouraged me to employ it under 

 the almost desperate circumstances of the following case. 



Case 5. — Charles F , a fine, intelligent boy, seven years of age, was 



knocked down at eight p.m. on the 23rd of June, 1866, by an omnibus crowded 

 with passengers inside and out, and one if not both wheels passed over his right 

 leg, breaking both the bones and inflicting a frightfully extensive wound. The 

 person who brought him to the infirmary said that he had lost a great deal of 

 blood, and the presence of a compress in the ham, placed there by the medical 

 man who saw him at the time of the accident, corroborated this statement. 

 When I saw the child, after an unavoidable delay of three hours, he was greatly 

 prostrated by shock as well as haemorrhage, so much so that amputation appeared 

 likely to afford but a slender chance of life, although the state of the injured 

 parts seemed at first sight to admit of no alternative. The tibia, which was 

 broken about its middle, lay exposed in a wound occupying almost the entire 

 length and breadth of the inner aspect of the leg, reaching from the inner condyle 

 of the femur to within an inch and a quarter of the tip of the internal malleolus ; 

 the skin having been stripped back so as to lay bare the gastrocnemius as well 

 as the bone. The large flap of integument was perforated about two inches 

 from its edge opposite to the seat of fracture, and there was also an opening 

 in the skin on the outer side of the leg, implying that the violence had acted 

 with full effect upon the whole thickness of the Hmb. Yet the bone was not 

 comminuted, and the muscles, though evidently severely contused, were not 

 much lacerated, while the anterior tibial artery was felt beating in the foot ; 

 and, hopeless as would have been the idea of trying to save the limb by ordinary 

 treatment, I determined to make the attempt by the help of carbolic acid. 



Chloroform having been administered, the acid of full strength was applied 

 with great freedom, the contused mass being repeatedly squeezed, to induce 

 the liquid to insinuate itself into all its interstices, including that between the 

 riding fragments of the tibia. The flap of skin was then brought towards its 

 natural position, and hnt soaked in the acid was placed upon the wide raw 

 surface which still remained exposed, and over the lint a piece of sheet-tin. 

 The other openings in the integument were similarly treated ; and, the riding 

 of the fragments having been corrected by extension, the limb was laid on its 

 outer side, with the knee bent, upon an external pasteboard splint, moulded 



