20 ON A NEW METHOD OF TREATING 



of the limb. There still remained considerable depression anteriorly over the 

 seat of fracture ; but the lower fragment did not seem to project towards the 

 ham so much as to forbid the use of the long splint. This I accordingly employed 

 with two interior splints to support the muscles of the thigh, one of Gooch's 

 material on the outer aspect, the other a large sheet of stout block-tin, embracing 

 the anterior, inner, and posterior aspects of the limb to a little below the knee, 

 padded in the first instance with a dry towel, for which a hot fomentation should 

 be substituted when all tendency to haemorrhage should have ceased. The 

 object of having the tin extend round the back of the thigh was that it might 

 prevent the discharges from soaking into the bed beneath ; and in this way it 

 proved extremely useful. 



He passed an uneasy though not entirely sleepless night, suffering more 

 from his shoulder and bruised side than from the thigh. Next morning his 

 aspect was favourable, the pulse 76, and tongue natural ; he took a little tea 

 for his breakfast, but nothing solid. The tin cap having been removed, care 

 being taken to avoid detaching the crust along with it, carbolic acid was applied 

 to the surface of the latter. A hot fomentation cloth was then placed on the 

 inner side and front of the thigh and gave him great comfort, and when the 

 dressing was completed he was quite easy. The interior splints being kept in 

 position by looped bandages, and the long splint by the usual folded sheet fixed 

 by pins, along with the perineal band and handkerchief round the foot, the 

 fomentations could be changed night and morning without any disturbance of 

 the limb. 



The following night he had a good deal of sleep, the thigh not causing him 

 any inconvenience ; and next day, the third after the accident, he took solid 

 food with relish. His pulse was 72, and his tongue continued moist, though 

 he was somewhat thirsty. The crust was touched again with carbolic acid, 

 and covered with a circular piece of calico to prevent the tin cap from adhering 

 to it. He still found comfort in the fomentations. 



On the fourth day he made a substantial breakfast after a good night's 

 rest, and was not so thirsty. There was, however, now seen for the first time 

 a slight blush of redness on the front of the thigh over the seat of injury. This 

 was on the fifth day somewhat increased, and the thigh and calf were both 

 more swollen. The tongue also was slightly furred at the base, and his appetite 

 was not quite so good. 



On the sixth day the dimensions and appearance of the limb were unaltered, 

 but on the seventh both the redness and swelling were distinctly diminished. 



By the end of the second week his appetite was improved and his pulse 

 was 76 ; while there had not been a drop of discharge from beneath the crust. 



