OF TREATMENT IN SURGERY 53 



tin was not disturbed till about a week had expired, the patient meanwhile 

 remaining free from any unfavourable symptoms, and not a drop of pus appear- 

 ing. On removing the plate of metal, I found that the wound, instead of being 

 hollow as when I had last seen it, was on a level with the surface of the forehead, 

 being occupied by a chocolate-coloured mass which I supposed to be a clot, 

 altered by the action of chloride of zinc. But when I scraped the surface of 

 this material it bled, showing that it was in reality aliv'e and vascular. This 

 exactly corresponded to the most striking and peculiar of the results I had seen 

 to follow the use of carbolic acid in compound fracture,^ and the most likely to 

 be mistaken for the effect of a specific action of that substance, viz. that the 

 blood acted on by the antiseptic, though greatly altered by that action, 

 remained susceptible of organization. Or, speaking more strictly, the product 

 of the action of chloride of zinc upon the blood, like that of the operation of 

 carbolic acid upon it, so soon as the irritating antiseptic material with which it 

 was at first imbued had been withdrawn from it by diffusion into the surrounding 

 circulation, proved a suitable pabulum for the growing elements of living tissue 

 in the vicinity, which accordingly absorbed and appropriated it. 



In the case just related, nothing could be more satisfactory than the effects 

 of chloride of zinc. Subsequent trials, however, proved it to be very inferior 

 to carbolic acid except in one class of cases, those, viz., in which, from the cir- 

 cumstances of the part concerned, it is impossible to maintain an efficient external 

 antiseptic dressing, so that the application must be made once for all at the 

 time of the operation. Here the permanence of the effects of chloride of zinc 

 renders it highly valuable, as, for example, after the removal of portions of the 

 maxillary bones. Every surgeon is familiar with the highly offensive character 

 of the discharge for the first few days after such operations ; and there can be 

 no doubt that the fetid state of the wound, besides being a great inconvenience 

 to the patient and his attendants, involves a certain amount of danger. By 

 means of chloride of zinc this complication is nearly, if not entirely avoided. 

 In the first case of this kind in which I used it, I had to remove a considerable 

 portion of both superior maxillary bones, on account of epithelial cancer which 

 had spread to them from the face. I applied the chloride-of-zinc solution 

 freely to the raw surfaces at the time of the operation, and afterwards e.xamined 

 the breath daily, when the only smell perceptible from first to last was an occa- 

 sional odour of tobacco. [Since this address was delivered, I have used chloride 

 of zinc with great advantage after the removal of the tongue by Mr. Syme's 

 method, in a case of epithelial cancer.] 



But in ordinary cases carbolic acid is very superior to chloride of zinc, 



' Sec p. 6 of this volume. 



