OF TREATMENT IN SURGERY 77 



I have experienced this inconvenience in two cases of compound fracture which 

 have been treated in this way. One of these was an old lady, of seventy-five, in 

 whom the os humeri was severely comminuted just above the elbow-joint, with 

 a considerable wound from which six loose fragments were extracted ; the 

 other was a boy, twelve years old, whose right thigh was much contused as well 

 as broken by machinery. These cases, indeed, have done well ; osseous union 

 having occurred as early as if the fractures had been simple ones. But in both 

 of them the wounds healed by granulation instead of by scabbing. 



With the view of getting over these difficulties I sought to obtain some 

 kind of antiseptic cement, by which a portion of dressing might be glued down 

 firmly upon the skin. Among other materials I tried shellac, and, in so doing, 

 I accidentally hit upon a substance which appears preferable to the plaster for 

 almost every purpose. I found that this resin could be mixed with carbohc 

 acid in any amount by aid of heat, the result, when cooled, varying, according 

 to the quantity of the acid, from brittleness to fluidity, the intermediate pro- 

 portions giving a firm but flexible solid with a certain degree of elasticity, 

 approaching to some extent the characters of caoutchouc. It further turned 

 out that the lac thus associated with the carbolic acid retained it with great 

 tenacity,^ so that a thin layer spread on calico may be used to store up a large 

 quantity of the antiseptic, forming an application which retains its virtues for 

 days at the temperature of the body, and, at the same time, fails to irritate the 

 skin. It has also this great advantage over the lead plaster, that it cannot 

 be softened by either a watery or an oily fluid. The only imperfection which it 

 appeared to show, when used in practice as an external antiseptic guard, was 

 that when long applied to the skin it adhered to the surface, whereas it is desir- 

 able that such a dressing should adhere very slightly if at all. This objection 

 to it I attempted to obviate by spreading it upon gutta-percha tissue, which, 

 though insoluble in carbolic acid, allows it to travel through its substance. The 

 lac when thus lined with gutta-percha proved none the less efficient as an anti- 

 septic, and, being perfectly devoid of adhesiveness and of smooth surface, shed 

 the discharge in a most perfect manner, greatly excelling, in tliis respect, the 

 lead-plaster. But it had one fault, viz. that when subjected to much bending, 

 as at the fold of a joint, the gutta-percha cracked and admitted the discharge, 

 which, gradually insinuating itself, detached the gutta-percha more or less 

 extensively, and introduced an element of risk through the interposition of 

 a layer of liquid between the antiseptic lac and its lining. This fault has been got 

 rid of by reducing tlie gutta-percha to a mere film, incapable of aft'ording lodge- 



' In this respect, lac differs altogether from india-rubber, which, though it may be impregnated 

 with the acid to any degree, parts with it rapidly. 



