ILLUSTRATING THE ANTISEPTIC SYSTEM OF TREATMENT 139 



a second time for greater security, and the skin in the vicinity having been 

 previously well washed with the lotion, to destroy organisms adhering to it or 

 to the hairs, an external dressing was applied, similar to that which you have 

 seen used after removal of the fatty tumour. Lac-plaster was wrapped in two 

 layers round the limb, from three or four inches above the upper extremity 

 of the wound to as far below its low^er end — that is to say, extending well up 

 the leg and embracing the heel and instep ; the foot meanwhile being held in 

 good position. A cloth, to absorb the blood and serum which would be discharged 

 from beneath the margins of the plaster, was then bandaged on, and a splint 

 applied to the inner aspect of the leg and foot. [The lac-plaster has been very 

 much improved of late, by being incorporated with a soft cloth, instead of being 

 spread upon starched calico. It is thus rendered beautifully flexible, and at 

 the same time much more durable, the cloth incorporated with it enabling it 

 to withstand any amount of wear and tear. But as in this form it is very thin, 

 it is well, where much discharge is anticipated, or when a long time is intended 

 to elapse between the dressings, to use it in two layers, so as to double the store 

 of the acid in the application.] 



But, Gentlemen, the compound dislocation of the ankle was not the only 

 injury which this poor man received. Observing some blood about his hair, 

 I examined the head, and found four scalp-wounds, varying in length from two 

 to five inches, three of them exposing the bone, into which black dirt had been 

 ground — probably, as he suggests, by the fire-pan of the engine. We used to 

 reckon that when the bone was thus extensively exposed in a scalp-wound, and 

 subjected at the same time to such violence, the cure was pretty sure to prove 

 tedious, protracted by the exfoliation of osseous scales of greater or less thick- 

 ness. There was at the same time more or less risk of head symptoms or of 

 erysipelas. It is, therefore, very satisfactory in such cases to be able to reckon 

 on primary union under antiseptic management. The region occupied by the 

 wounds being extensive, the greater part of the scalp was shaved, and thoroughly 

 washed with the strong antiseptic lotion ; and the wounds were treated just 

 like that at the ankle, except that their edges were approximated by antiseptic 

 sutures. [The material which I have used of late for this purpose is silk steeped 

 for a while in a mixture of melted bees-wax with a certain proportion of carbolic 

 acid — say a tenth part. As the silk is taken out of the hot liquid, it is drawn 

 through a dry cloth to remove the superfluous wax ; after which it ma\- be 

 wound on a reel, and kept in any close vessel. The wax, besides giving the knot 

 a better hold, prevents the antiseptic from being washed out of the thread, 

 and also, lilhng up the interstices of the fibres, renders the silk incapable of 



imbibing stimulating h([uids ; and so confers an unirritating qualit}' corrc- 



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