OF TREATMENT IN SURGERY 73 



something giving way ; and now, on removing the apparatus, the foot was found 

 to have resumed its natural place. The wounds were then dressed with layers 

 of lint soaked with a weak oily solution of carbolic acid, and covered with the 

 antiseptic plaster ; after which, a Dupuytren's splint was appUed at the inner 

 side of the limb to prevent eversion, and Mr. Syme's horseshoe splint anteriorly 

 to obviate the tendency to displacement backwards. Fresh plaster has since 

 been applied daily ; and the result has been that, while the foot has retained 

 its position satisfactorily, the patient has not suffered at all either locally or 

 constitutionally, during the six days that have elapsed since the operation. 

 His pulse has remained 68 or 70, he has not lost his sleep a single night, his 

 tongue has been quite clean, and his appetite good. In fact, he has taken his 

 food with better relish than before, because he has been freed from his previous 

 gloomy prospect of hopeless lameness, while the operation has caused him no 

 anxiety ; as the assurance which I felt justified in giving him, that it was entirelv 

 free from danger, has been confirmed by the absence of pain or other annoyance. 

 The discharge, which was sanious and copious in the first instance, has of late 

 been only about three minims of clear serum in twenty-four hours ; and judging 

 from our previous experience with compound fractures, there is every reason 

 to expect that in a few days more it will cease entireh'. 



[The subsequent progress of the case has been, on the whole, \'ery satis- 

 factory. But, for reasons to be soon referred to, healing by scabbing did not 

 take place as was anticipated. The discharge, instead of drying up, showed 

 rather a disposition to increase, and assumed a somewhat puriform character ; 

 and, although the renewal of the superficial plaster once in two or three days 

 did not involve much disturbance of the limb, I thought it best to expose the 

 wounds when sufficient time had passed to ensure the secure coalescence of 

 their deeper parts. Accordingly, on the ist of May I removed the lower portions 

 of the dressings, disclosing two superficial granulating sores, with \'ery prominent 

 granulations, which explained the want of disposition to cicatrize. These, 

 though treated with astringents, proved rather indolent, so that they were 

 not completely healed till the 4th of June, though the bones were firmly united 

 a fortnight before. 



When he was allov/ed to walk, though he placed the sole fairly on the 

 ground, he experienced inconvenience from a contracted state of the sural 

 muscles, produced by the long-continued displacement of the foot backwards 

 and consequent downward pointing of the toes, so that he could not bend the 

 ankle beyond the right angle at which it had been maintained since the operation. 

 I hoped that this inconvenience would be overcome b\- exercise ; but in this 

 1 was disappointed ; for tliough his power of walking improved, it was by no 



