144 CASE OF COMPOUND DISLOCATION OF THE ANKLE 



vasated blood, recovers quickly and surely under the protection of the unbroken 

 integument, it is plain that all that is required in an external wound is to guard 

 it against the disturbing influence of external agency. The injured tissues 

 do not need to be ' stimulated ' or treated with any mysterious * specific ' ; 

 ALL THAT THEY NEED IS TO BE LET ALONE. Nature will then take care of them : 

 those which are weakened will recover, and those which have been deprived 

 of vitality by the injury will serve as pabulum for their living neighbours. Now, 

 of all external agencies the most injurious by far is putrefaction, and this, above 

 all, we endeavour to exclude. But a substance employed with this object, 

 if sufficiently potent to destroy the life of the putrefactive organisms, cannot fail 

 to be abnormally stimulating to the exposed tissues ; and these must be pro- 

 tected from its action if the wound is to progress exactly like a subcutaneous 

 injury. 



Our ' protective ', then, should be a material unstimulating in its own 

 substance, and impervious to carbolic acid. At the same time it must be 

 insoluble in the discharges, and sufliciently supple to apply itself readily to the 

 part. But it is by no means easy to find anything fulfilling all these conditions. 

 Gutta-percha or caoutchouc, which naturally suggest themselves, transmit the 

 acid from particle to particle of their substance with the utmost facility, and 

 are utterly useless for this object. A metallic plate is quite impervious to the 

 acid. But thin block-tin, which I once used, is too rigid, while tinfoil soon 

 wears into holes. I have been lately trying a microscopically thin layer of 

 metal, in the form in which you see it in this specimen. Cotton cloth, coated 

 on one side with caoutchouc, is gilded on the caoutchouc side, and then covered 

 with a film of india-rubber applied in solution. We have ascertained that the 

 gold-leaf thus enclosed between two layers of caoutchouc spread on cloth wears 

 thoroughly well ; and, if I can get a manufacturer to enter into the thing, I have 

 hopes of obtaining at last something like a perfect protective. And when this 

 is attained, as the lac-plaster is quite trustworthy for excluding putrefaction, 

 our treatment will yield to the full the beautiful results which theory indicates 

 as possible. 



There is one more point that must be mentioned with reference to the 

 protective. It is essential that it should be itself antiseptic at the moment of 

 its application, otherwise there would be a risk of its communicating septic 

 particles. This object can be attained by covering it with an extremely thin 

 film of some material soluble in water ; so that when dipped into a watery 

 solution of the acid it may be uniformly moistened with the antiseptic, but in 

 so small a quantity as will be rapidly absorbed by the wound and by the skin, 

 so as not to interfere to any material extent with the purely protective office of 



