74 ON THE ANTISEPTIC SYSTEM 



means satisfactory. It also appeared that the abnormal position of the foot 

 had led to an exaggeration of the curve of its arch, to such an extent as to make 

 the foot half an inch shorter than the other, while the plantar fascia was felt 

 as a rigid band. I therefore divided that fascia and the tendo Achillis sub- 

 cutaneously on the 26th of July, and this had the immediate effect of restoring 

 the foot to its natural length, and permitting the ankle to be bent at an acute 

 angle. Had I the case to treat over again I should perform the tenotomy at 

 the same time as the main operation. But except the loss of time that has 

 occurred, the result is nearly all that could be wished. Under the use of a 

 Scarpa's shoe he has continued to improve steadily, and when I last saw him, 

 in the early part of September, he could walk firmly and well, and complained 

 only of some remaining stiffness of the ankle.] ^ 



In compound fracture, as a general rule, healing by scabbing is that which 

 should be aimed at. When this is attained, the treatment becomes greatly 

 simplified ; while the patient is saved any drain upon the system from purulent 

 discharge, and any risks that may attend the presence of a granulating sore. 

 With this object in view, it is necessary that the deeper layers of the dressing 

 should be left to form the scab, and that, while the antiseptic is renewed from 

 time to time externally, it should not penetrate to the surface of the wound ; 

 otherwise the carbolic acid will stimulate the tissues to granulation and 

 suppuration, though without putrefaction. 



But, it may be asked, Is it not objectionable to keep the wound perma- 

 nently covered up ? Is it not desirable to examine it from time to time, and 

 ascertain what is going on in it ? To this I would reply by another question. 

 Does the surgeon think it needful, in a case of simple fracture, to make an in- 

 cision and investigate the state of the broken bone, the torn muscles and fasciae, 

 and the other elements of the contused wound which, though the integument 

 remains entire, exist as surely as in a compound fracture ? No surgeon would 

 think of such a course. And, on the same principles, provided no unfavourable 

 symptoms are present, we may be well pleased to leave the deep portion of the 

 dressing to serve as a temporary skin. 



Yet it must be admitted, that to change the superficial layer of the dressing, 

 without raising the deeper layers, is often a matter of great nicety, while the 

 admission of septic air beneath the scab would be fatal to this mode of treat- 

 ment. For, the dressing being purposely so arranged that the parts in im- 



^ The Address as actually delivered continued the discussion of the principles of the dressing, and 

 gave details of the mode of procedure, supposing the lead-plaster to be employed in the form in which 

 it was then described. In order to enable me to introduce subsequent improvements, I have thought 

 it best entirely to remodel the remainder, though retaining to a certain extent its original features. — J. L. 



I 



