8o ON THE ANTISEPTIC SYSTEM 



of a healing superficial granulating sore. Two days later, he was so unruly 

 that he was discharged for misconduct. 



In the following case we have had the opportunity of seeing the effects of 

 this mode of dressing w^hen left undisturbed. 



Case of Compound Fracture of the Leg treated with Block-Tin and Antiseptic 

 Lac. — On the 3rd of October, 1868, a porter, twenty-five years old, was unloading 

 a wagon in a warehouse, when a box, weighing about four hundredweight, 

 slipped, and, striking him upon the left leg, knocked him down over an opening 

 in the floor, through which he would have fallen into the room below had not 

 the heavy box, pressing upon the limb, pinned him down and kept him sus- 

 pended. When rescued from this situation, he was taken to the infirmary, 

 where my house surgeon, Mr. Malloch, found the leg much distended with 

 extravasated blood, with a wound, three-eighths of an inch in length, on the 

 inner side, about midwa}^ between the knee and ankle, bleeding freely and 

 communicating with a transverse fracture of the tibia. A probe (smeared with 

 an oily solution of carbolic acid to prevent the introduction of septic particles) 

 could be introduced beneath the undermined fascia for about three inches in 

 every direction except downwards, and also passed, for the same extent, directly 

 outwards behind the tibia which was felt to be denuded of its periosteum. 

 Having injected into the wound, with a syringe, several ounces of a saturated 

 watery solution of the acid, and diffused it freely through the limb by pressure, 

 to mix it with the extravasated blood, Mr. Malloch placed a piece of thin block- 

 tin about an inch square over the orifice, and, after pressing out as much as 

 possible of the blood and watery solution, applied a piece of lac-plaster deprived 

 of its gutta-percha lining, overlapping the tin a couple of inches in every direction, 

 and over this a folded cloth moistened with a solution of carbolic acid in four 

 parts of olive oil. The limb was then put up in lateral pasteboard splints. 

 This treatment relieved the severe pain which he was suffering ; but it returned 

 in the course of the next few hours, during which very free haemorrhagic effusion 

 occurred. Next day the discharge became greatly diminished, and in the course 

 of the following day it ceased entirely. The pain also left him about twelve 

 hours after the accident and never returned. The after treatment consisted 

 for the first two days, in renewing the oily cloth once in the twenty-four hours ; 

 but from the third day onwards the cloth was left permanently upon the limb 

 and merely brushed over with a mixture of equal parts of carbolic acid and oil, 

 the inner splint being raised for the purpose without disturbing the limb, which 

 lay upon its outer side with the knee bent. After the sixth day, the antiseptic 

 oil was only applied once in forty-eight hours. On the third day, some wrinkling 

 of the epidermis indicated subsidence of the swelling, which afterwards fell 



