OF TREATMENT IN SURGERY 79 



answer well. I have, as yet, only had opportunity to try this method in two 

 cases, but both of these have presented points of interest which make them 

 deserving of mention. 



Case of Contused Wound treated with Block-Tin and Antiseptic Lac. — The 

 first was a contused wound, three inches long, over the lower part of the tibia, 

 with some undermining of the skin, in a young man of twenty, occasioned by 

 the limb being violently squeezed between a heavy iron pipe and a fixed piece 

 of machinery. Happening to be at the infirmary soon after his admission, 

 I dressed the case myself, washing and syringing out the wound with a saturated 

 watery solution of carbolic acid, and covering it with a well-fitting piece of thin 

 block-tin of rather larger size, washed with the watery solution, and then apply- 

 ing a piece of lac-plaster, deprived of its gutta-percha layer, overlapping the 

 tin freely on all sides. A piece of calico was placed outside the lac-plaster, to 

 prevent adhesion of its edges to a dry cloth, which was wTapped round the leg 

 to absorb discharge, and w^as intended to be changed. Next day there was 

 a good deal of sero-sanguineous effusion on the cloth, for which another was 

 substituted, moistened with a solution of carbolic acid in four parts of olive oil. 

 The same was afterwards done daily ; the discharge diminishing rapidly, and 

 the limb remaining free from sweUing or pain, and the constitution from dis- 

 turbance, till, on the fourth day, the patient, who was a silly youth, was seized 

 with a desire to see the injured part, and tore off all the dressings. This foolish 

 proceeding on his part gave us the opportunity of making an interesting obser- 

 vation. The w^ound w'as found perfectly level with the general surface of the 

 skin, being filled with a clot of smooth surface corresponding to that of the tin 

 which had covered it, while the edges of the skin were pale and natural in appear- 

 ance. The dressing was re-applied as before, the wound being superficially 

 washed with carbolic acid lotion in the process. Two da^'s later the patient 

 again, without any reason, laid bare the wound, which still presented the same 

 characters, except that the surface of the smooth clot showed, here and there, 

 some minute whitish specks, probably in consequence of the action of the watery 

 solution of carbolic acid with which it was washed two days previously. A 

 similar dressing w^as again employed, the use of carbohc lotion being again 

 necessarily involved. After two more days, that is to say a week after the 

 accident, the patient, though free from symptoms, having again remo\'ed the 

 dressings, the wound was again examined. It was free from pus or odour of 

 putrefaction, but its surface was mottled with red and yellow spots, and was 

 not quite level. The dressing was continued one dav longer, when it was aban- 

 doned, as the patient could not be induced to leave it alone, water dressing 

 being used instead ; and on the following day the wound presented the characters 



