66 ON THE ANTISEPTIC SYSTEM 



left leg with a heavy pair of tongs, resulting in intense inflammation in the 

 limb, which was red and swollen from the knee to the ankle. Fluctuation 

 being distinctly perceptible over the upper part of the tibia, the matter was 

 evacuated antiseptically. A piece of lint dipped in an oily solution of carbolic 

 acid having been laid upon the part where the incision was to be made, its lower 

 edge was raised to allow a knife smeared with the same solution to be plunged 

 into the cavity of the abscess, when the curtain was at once dropped so that 

 the pus might flow out beneath it. When all the matter had been pressed out, 

 an external antiseptic dressing was applied, and this was afterwards changed 

 daily. Four other abscesses afterwards made their appearance at intervals 

 down the limb. These were treated in the same way ; and in every case when 

 a probe, carefully guarded by being passed among folds of lint steeped in the 

 antiseptic oil, was introduced into the incision, it came into contact with bare 

 bone. This was of itself sufficient evidence that portions of the tibia, of greater 

 or less thickness, were dead ; for, had the periosteum been raised by suppuration 

 from living bone, the osseous surface would have become covered with granu- 

 lations during the process. But evidence which must satisfy the most incredu- 

 lous is afforded by the fact that, between two and three weeks after the first 

 abscess was opened, a probe introduced into the orifice still passed down to 

 bare bone. Under such circumstances, what, it may be asked, could be the 

 advantage of continuing the antiseptic dressing ? If dead bone was present, 

 whether in larger or smaller amount, must it not become detached from the 

 living osseous tissue by a gradual process of exfoliation, which an antiseptic 

 applied to the skin could neither promote nor hinder ? Such may be a natural 

 inquiry. But having seen a large mass of dead bone absorbed before my eyes 

 by the granulations that enveloped it, in a case of compound fracture treated anti- 

 septically^ ; and having also had evidence from post mortem examination in a case 

 of hip-joint disease where extensive necrosis existed in connexion with caries, that 

 bone killed by inflammation might, under antiseptic management, fail to induce 

 suppuration ; putting those facts together, I thought it not unlikely that, in the 

 case we are considering, the dead portions of the tibia would be absorbed by the 

 living tissues around them, if we perseveringly maintained an effectual external 

 antiseptic guard. Such, then, was the practice we pursued, and the result was 

 such as I had anticipated. The various incisions successively healed, till by the 

 6th of April, eleven weeks after the receipt of the injury which caused the attack, 

 the abscess last opened was soundly closed and cicatrized, not a particle of dead 

 bone having come away from any of the openings. At the same time, the swelling 

 of the limb, instead of increasing, as is the case under ordinary treatment, from 



^ See p. 1 6 of this volume. 



