ILLUSTRATING THE ANTISEPTIC SYSTEM OF TREATMENT 151 



In the same way, an antiseptic must act for days upon a wound before it 

 can convert it into a granulating sore liable to suppuration ; so that no harm 

 is done by omitting the protective for the first twenty-four hours. 



The other injuries in our patient have thus far proceeded as satisfactorilv 

 as that of the ankle. The four severe scalp-wounds were dressed on the day 

 after the accident, and each was covered with protective before the cap of lac- 

 plaster was reapplied. On the following day, the discharge to be seen on the 

 cloth round the lac was so slight that I thought it safe to leave the head undis- 

 turbed for another day. The second dressing was witnessed by some of vou 

 just after last lecture. The discharge of the two days amounted to onlv a few 

 minims of serum, and there was entire absence of redness, puffiness, or tender- 

 ness of the scalp. I removed the numerous sutures, each coming out as clean 

 as when it was introduced ; and all the wounds seemed already completely 

 healed, except a small superficial raw surface here and there. 



The compound fracture into the elbow-joint, when last dressed, presented 

 only a trace of serous discharge, so that I shall not think it needful to disturb 

 it till five da^'s shall have passed since that occasion. 



The following remarks conclude the case : — 



Before proceeding to relate the further progress of this case, I have to 

 direct attention to another circumstance of great practical importance in the 

 injury to the ankle. On the day after the accident it became apparent that 

 the violence to which the part had been subjected had destroyed the vitality 

 of portions of the integument, not only at the anterior margin of the wound, 

 where a slough about half an inch in breadth existed, but also in detached 

 patches at the outer aspect of the dorsum of the foot. Now, if any one of these 

 dead pieces of skin had been left exposed to atmospheric influence, it would 

 have putrefied ; and the putrefaction would in all probability have spread 

 along the extravasated blood and serum in the subcutaneous tissue till it had 

 reached the seat of fracture and the articulation, and all our antiseptic treatment 

 of the wound would have proved nugatory. I once saw a case of compound 

 fracture of the forearm, in which the antiseptic treatment had been pursued 

 with thoroughly efficient means, but after the lapse of some days I was asked 

 to look at the limb, in consequence of unsatisfactory appearances. I found the 

 dressings applied perfectly correctly, and I had no reason to doubt that they 

 had been so from the first ; but the wound, when exposed, emitted an offensive 

 discharge. On investigation I found a small slough of tlio skin, about half an 

 inch in diameter, situated some inches from the wound, and just beyond the 

 limits to which the lac-plaster had been extended. The little slough had by 



