OF TREATMENT IN SURGERY 69 



various injuries she had lost a great deal of blood, and she was also suffering 

 from contusions in other parts of the body. All the wounds were dressed with 

 layers of lint soaked with a solution of carbolic acid in olive oil ; the superficial 

 layer, larger than the rest, being changed daily while the deeper layers were 

 left undisturbed. Under this treatment the wound on the forehead healed 

 without the formation of a drop of pus, and those in connexion with the com- 

 pound fracture were converted into superficial granulating sores, without any 

 more disturbance, local or constitutional, than if the fracture had been a simple 

 one ; and the bones united in the usual period under the use of pasteboard splints. 

 But the most remarkable circumstance in the case was the progress of the injury 

 of the foot. Three days after the accident, my house surgeon, Mr. Appleton, 

 observed that a considerable portion of the undermined skin on the dorsum 

 of the foot had lost its vitality ; and instead of adopting the usual course of 

 applying wet lint or a poultice till the slough should separate, he extended the 

 antiseptic dressings so that they overlapped the dead portion of tissue for a con- 

 siderable extent in every direction ; after which, the daily changing of the 

 superficial layer was continued as before. The result, though in strict accor- 

 dance with the principles which I am endeavouring to enforce, was strikingly 

 opposed to ordinary experience. After the subsidence of the copious sanious 

 effusion which took place immediately after the injury, the discharge became 

 reduced to about one minim in twenty-four hours, without any distinct appear- 

 ance of pus, while the foot remained free from the slightest uneasiness, so that 

 she moved it as usual in the bed, and imagined it perfectly recovered. Such 

 being the case, knowing, as I did, that to remove the deep dressings would be 

 to induce, at the best, two large granulating sores which must, from that time 

 forward, furnish a considerable amount of pus that would act as a drain upon 

 the old lady's feeble system, I left the crust of hnt and dried exudations untouched 

 for seven weeks, at the end of which time it became spontaneously detached. 

 On raising it, we found a narrow line of cicatrix along the inner side of the foot, 

 complete healing by scabbing having occurred in, 1 suppose, the largest wound 

 ever known to heal in that manner in the human subject. And on the dorsum 

 of the foot, in place of the large slough, was a broad scar, a portion in the centre 

 about as large as a fourpenny-piece alone remaining unhealed ; the dead tissue 

 having, apparently, been absorbed, as none of it was found on the dressing. 

 The superficial layer of antiseptic lint, daily renewed, had answered the purpose 

 of preventing putrefaction from spreading inwards, while the thickness of the 

 permanent crust had kept the carbolic acid constantly supplied externalh' from 

 penetrating to its deepest parts. Hence, the portion of the dressing in contact 

 with the skin, having lost its original acid b}' diffusion into the circulation. 



