146 CASE OF COMPOUND DISLOCATION OF THE ANKLE 



day following the injury ; because the effusion from the wound is then of a 

 bloody character, and though the lac-plaster certainly sheds the discharge 

 admirably, yet it is possible that a layer of clot may be lying beneath it, which 

 might interfere with its antiseptic operation. But after the first day, sangui- 

 neous effusion having ceased, the interval between the times of dressing should 

 be regulated by the amount of discharge to be anticipated ; for the more copious 

 it is, the sooner does it exhaust the carbolic acid in the plaster. The lac may 

 happily be always trusted to retain enough of the acid for twenty-four hours, 

 however free the discharge may be. If the stain on the cloths indicates an 

 effusion of only a few drachms, the plaster may be safely left for two days. 

 If the serous oozing be not more than a few minims, the interval may be extended 

 in proportion to the smallness of the amount, till finally, when, as sometimes 

 happens, the plaster is maintained as a precautionary measure though no 

 discharge is present, it may be left for a week without losing its antiseptic virtue. 

 When the interval between the dressings is thus prolonged, the pains taken 

 during the first few days are rewarded by great saving of trouble, as well as 

 by the satisfactory progress of the patient ; and when the case is one of fracture, 

 the avoidance of frequent disturbance of the limb is of course a matter of most 

 material consequence. 



At the next dressing, four days aftei the accident, the ankle presented an 

 appearance which would have been impossible without antiseptic management. 

 The hollow wound, about three inches long, and gaping about an inch, was 

 still occupied by the original coagulum on a level with the surrounding skin ; 

 while the discharge of the last two days had caused only a serous stain of a few 

 minims on the cloths. But this state of things was not merely the result of 

 antiseptic treatment. It implied that our protective, also, was answering its 

 purpose well. Had the antiseptic been acting directly on the wound, the dis- 

 charge would have been much more considerable, and we should probably 

 have already had a hollow sore with commencing suppuration. Here I cannot 

 help observing that it seems to me strange that some who have not scrupled to 

 criticize me with great severity should have taken so little trouble to ascertain 

 what I have written on this subject. From the remarks made by some persons, 

 you would imagine that I regard putrefaction as the sole cause of suppuration ; 

 whereas my treatment of abscess depends essentially upon the fact that the 

 pus in the unopened cavity, being the result of the inflammatory stimulus 

 without atmospheric influence, is free from putrefaction, so that it is needless to 

 apply the antiseptic to the interior, all that is requisite being to provide exit 

 for the discharge while guarding against the entrance of putrefactive fermenta- 

 tion. Again, from the statements of others you would suppose me to have 



