30 ON A NEW METHOD OF TREATING 



feet, while in a state of intoxication. He was carried upstairs to his lodgings, 

 kicking about in his drunken frenzy. A cloth was then put round the leg, 

 but no efficient means were employed to steady it, and he was conveyed to 

 the hospital from a distant part of the city in a cab, moving the limb recklessly 

 during the whole journey. His friends stated that he had lost a great deal of 

 blood, and the cloth which was round the limb on his admission was saturated. 

 Mr. H. Cameron, the house surgeon, found a wound about half an inch in length, 

 situated over the spine of the tibia, at the junction of the middle and lower 

 thirds of the bone, the fracture being half an inch lower down, and obviously 

 communicating. The wound was bleeding very freely, and the leg was con- 

 siderably swollen through extravasation of blood into it. On manipulation, 

 Mr. Cameron found the tissues about the seat of fracture emphysematous, the 

 characteristic crackling sensation being experienced fully four inches above 

 the wound and two inches below it, and also on the opposite side of the limb, 

 over the fibula ; and as a result of the handling, a frothy mixture of blood and 

 air, in larger and smaller bubbles, escaped from the orifice. The fragments 

 were much displaced, the foot being greatly everted. 



Mr. Cameron, having squeezed out as much blood as possible from the 

 wound, introduced melted crystallized carbolic acid in a piece of calico held 

 in dressing-forceps, which he passed in various directions for more than two 

 inches beneath the integument and about an inch and a half among the deeper 

 structures of the limb, using three different pieces of calico soaked with the 

 acid, and leaving the last in the wound as a plug to check the very free haemor- 

 rhage, which the treatment had considerably increased. He then applied several 

 layers of calico steeped in carbolic acid and smeared with blood, so as to make 

 a pretty thick crust overlapping the skin by about half an inch, and adapted 

 to the crust a cap of block-tin of slightly larger dimensions, pressing it down 

 upon the skin by means of a looped bandage encircling the leg. Having next 

 corrected the displacement of the fragments, he moulded a pasteboard splint 

 to the outer side of the leg and foot, strengthening it with a temporary Gooch's 

 splint, and laid the limb on its outer side upon a pillow with the knee bent. 

 The patient now stated that the pain he had suffered was greatly relieved. 

 His pulse was loo. Two hours later, as a good deal of oozing of blood was 

 still going on, a folded cloth was placed upon the tin cap and pressed down upon 

 it with a bandage. The limb meanwhile was considerably more swollen, from 

 bleeding into its interior, kept up, no doubt, by the sudden jerking movements 

 which in his unreasoning condition he could not be prevented from making. 

 The pressure employed greatly diminished the external haemorrhage, but did 

 not entirely arrest it ; and when two hours more had elapsed Mr. Cameron 



