14 ON A NEW METHOD OF TREATING 



The leg had become sHghtly bent inwards through the yielding of the splint ; 

 and when it was now straightened, the upper margin of the crust became 

 detached, exposing a deep granulating cavity. A bit of lint, dipped in carbolic 

 acid, was applied lightly over this opening, and the tin was readjusted so as 

 to cover it. Pressure in the neighbourhood of the injured part, about the knee, 

 ankle, and calf, failed to induce the slightest increase of the discharge, which 

 was thus shown to come merely from the surface beneath the crust, and was 

 still for the most part transparent. 



At the close of the second week his state was on the whole very favourable. 

 His general health was much improved ; and although he still suffered occa- 

 sionally, especially at night, from restless movements of the limb, these had been 

 much restrained by a new splint, extending from half-way up the thigh to the 

 toes. The wound was certainly very large, measuring eight inches in length 

 by six in greatest width ; but it was healing round almost the entire circum- 

 ference. In order to permit cicatrization, which carbolic acid tends to check, 

 the detached edges of the crust had been clipped away, and the exposed narrow 

 ring of granulations was dressed with lint dipped in a solution of sulphite of 

 potash — five grains to an ounce of water. The crust, however, was still touched 

 daily as before with carbolic acid, while the tin still covered the whole of the 

 injured part. By this means it was intended that cicatrization should be 

 allowed to go on, and yet decomposition of the discharge be prevented ; and 

 this seemed to be to a great extent, if not entirely, attained. 



There was, however, one unfavourable circumstance. The little sore on 

 the outer side of the leg, which had been dressed separately without carbolic 

 acid, and had for some time been observed to be increasing rather than diminish- 

 ing, now assumed unmistakably the appearance of a mild form of hospital 

 gangrene, and became blended with the main sore. For two days an attempt 

 was made to correct the disease by touching the affected part with nitric acid ; 

 but on the eighteenth day it was clear that some more effectual measures must 

 be adopted, as the skin in the vicinity had become insidiously undermined to 

 a very serious extent. Accordingly I placed the boy under chloroform, and 

 scraped away with a spoon all the soft grey sloughs, slitting up the skin in order 

 to gain access to them, and in some parts clipping portions of it away, and 

 then applied the strongest nitric acid thoroughly to the bleeding surface. As 

 the disease extended up to the anterior edge of the crust, I thought it right to 

 examine the state of the parts beneath, and as it was pretty loose I removed it. 

 And now a sight presented itself which filled me with horror. There was, i-ndeed, 

 no appearance of hospital gangrene in the parts which the crust had covered, 

 the granulations there having the florid aspect of perfect health ; but in the 



