ILLUSTRATING THE ANTISEPTIC SYSTEM OF TREATMENT 141 



But besides the favourable condition of this patient hitherto, I have ample 

 expei"ience to found upon. Since my attention was first drawn to antiseptic 

 surgery I have been concerned in four other cases of compound dislocation of 

 the ankle. One of them was treated in the Glasgow Infirmary just before 

 I left it. The displacement of the foot was inwards, as in our patient, though 

 produced in a very different way.^ The treatment also was the same ; and 

 the wound, which was large, became a superficial sore without suppuration or 

 any local or constitutional disturbance. 



Another of the cases was also a dislocation inwards, caused by a lady being 

 thrown out of a dog-cart. She was not under my care, but I was in so far con- 

 cerned in the treatment that the son of her medical attendant (Dr. Coats, of 

 Glasgow) being at that time one of my dressers, he was asked by his father to 

 employ the means which he had seen me use at the hospital. In accordance 

 with my practice at that time, an oily solution of carbolic acid was introduced 

 into the joint and into the rest of the wound, and a layer of putty, rendered 

 antiseptic by the admixture of a certain proportion of the acid, was used for 

 the external dressing. The means were different, but their object was the 

 same. The oily solution destroyed organisms existing in the wound ; and 

 the putty, like the lac-plaster, impermeable to watery fluid, communicated the 

 volatile antiseptic stored up in its substance to the discharge that flowed out 

 beneath it. The case was published by Dr. Coats,- who told how, after the 

 first smarting caused by the acid had subsided, the patient was free from the 

 pain previously experienced, and never after had any uneasiness in the part. 

 Here also the wound closed without any deep-seated suppuration or any febrile 

 disturbance. 



In a third case, a gentleman about sixty years of age, of heavy frame, 

 slipped in going downstairs, and the foot was driven forcibly outwards, the 

 fibula being broken, while the internal malleolus was thrust through the integu- 

 ment. I saw the patient in conjunction with Dr. George Buchanan, of Glasgow ; 

 and Mr. Berkeley Hill, of London, happening to be on a visit to me at the time, 

 witnessed the first dressing. The lac-plaster was used, but in a wa\- which 

 I have since abandoned, so that I need not trouble you with its details. [After 

 the joint had been injected with w^atery solution of carbolic acid, and the dis- 

 location reduced, a bit of thin block-tin was placed over the wound to j^'otect 

 it from the stimulating action of the acid in the plaster wrapped round the foot. 

 This was surrounded with a cloth and bandage, which were afterwards daily 

 touched with a strong solution of carbolic acid in oil, to renew a supply of the 

 antiseptic to the lac beneath, which was permanently retained. The tin has 



' See p. IJ7 of this volume. ' Sec Lancet, May 2, iSoS. 



