ILLUSTRATING THE ANTISEPTIC SYSTEM OF TREATMENT 153 



of external agency, was undergoing the same kind of change as is experienced 

 by parts deprived of vitahty in the subcutaneous injury of a simple fracture. 



The appearances of the wound itself presented an equally striking difference 

 from those met with under ordinary treatment. Even at that late period, five 

 weeks after the accident, the original clot was still to be seen, of an orange- 

 brown colour, on a level with the surrounding skin, but greatly diminished by 

 contraction and also by cicatrization, epidermic formation having advanced 

 considerably from all parts of the margin of the wound, except anterior Iv, 

 where the slough was present. An open sore healing by cicatrization without 

 suppuration, or even granulation, is something new in the history of surgery, 

 though exactly what might have been expected from what we know of healing 

 by scabbing. At the lower extremity of the wound the new and vascular tissue 

 which had been formed by organization of the clot was slightly more prominent 

 than the rest, and had somewhat the characters of granulations covered with 

 epidermis. But not a trace of pus had been produced. On the occasion when 

 these observations were made, eight days had been allowed to pass since the 

 last dressing, and in order to estimate accurately the quantity and quality of 

 the discharge, I removed the lac-plaster without injecting any watery solution 

 beneath it, knowing that at this late period no risk would be incurred by free 

 exposure of the wound. The bandage outside the plaster being free from stain, 

 the whole discharge of eight days had accumulated beneath the impermeable 

 layer of lac, and consisted only of about two minims of white but thin fluid, 

 together with some desquamated epidermis. I subjected the milky liquid to 

 microscopic examination, and found that the opaque element was composed 

 exclusively of epidermic scales. 



The vascularization of the clot, like that of the sloughs, had been advancing 

 from below as well as round the margins. Fifteen days after the accident 

 I cut into the central part of the then chocolate-coloured coagulum, under the 

 protection of a stream of watery solution of carbolic acid, and found that it 

 did not bleed, though the knife penetrated about a quarter of an inch. But 

 on a repetition of the experiment twelve days later, blood oozed up from an 

 incision carried to only about the depth of an eighth of an inch. 



The process of organization of clots and sloughs thus observed in an external 

 wound, though of the same essential nature as that which occurs in subcutaneous 

 injuries, was undoubtedly retarded by a certain degree of abnormal stinuilation 

 inseparable from the method of treatment. For, besides the fact that the 

 protective was not perfect — i.e. not absolutely impermeable to the carbolic acid 

 furnished by the lac-plaster — the clot and sloughs were more or less soaked with 

 the antiseptic lotion every time the dressings were changed ; and thougli tlie 



LISTER II ]\I 



