154 CASE OF COMPOUND DISLOCATION OF THE ANKLE 



acid is soon diffused and carried away by the circulation, this circumstance 

 necessarily operated as a disturbing cause. Hence the rate of healing will be 

 more rapid in proportion to the efhciency of the protective, and also to the 

 length of the intervals that can be allowed to pass between the dressings con- 

 sistently with security against putrefaction. In the present case, the period 

 between the dressings was extended as the discharge diminished, and it may 

 be worth while to mention the successive intervals. From the date of the 

 accident they were as follows : one day ; one day ; two days ; three days ; 

 three days ; five days ; five days ; seven days ; and finally eight days ; bringing 

 the time up to five weeks from the receipt of the injury. But I am not prepared 

 to recommend a longer time than a week, and even that only when the discharge 

 is practically nil. Indeed, in our patient, putrefaction did take place in the 

 period following that of eight days. I had intended allowing another week to 

 pass before meddling with the limb, but at the close of the sixth day my house 

 surgeon informed me that the patient had got up two days before, without 

 leave, and had made his way, on chairs as crutches, to the fire, a distance of 

 several yards ; and, further, that there was an appearance of a stain upon the 

 bandage. I therefore exposed the limb, and found that the discharge was 

 considerably greater (amounting to perhaps half a drachm), fetid, and, for the 

 first time since the accident, unmistakably puriform. The dressings removed 

 on the last occasion had been perfectly odourless ; and the most probable 

 explanation seemed to be, that the vascular engorgement of the limb occasioned 

 by the dependent posture had induced an unusual exudation of serum from 

 the wound, and that this circumstance, combined perhaps with some movements 

 of the foot, had proved too much for the antiseptic power of the lac-plaster at 

 that period after its application. Happily the occurrence was of no consequence, 

 as the wound was practically superficial, and beyond the reach of danger from 

 putrefaction. But it may serve as a warning. And it must ever be borne in 

 mind that, in the earlier stages of such a case as this, where the avoidance of 

 putrefaction may be a matter of life and death, it is better to err on the side of 

 dressing too often, rather than too seldom. 



The putrefaction had evidently occurred quite recently, for the clot and 

 sloughs were not yet detached. I clipped away most of the slough, and scraped 

 off the clot till I got down to bleeding tissue, and, with the view of correcting 

 the putrefaction in such portions of dead material as remained, I treated the 

 sore with a strong solution of carbolic acid in spirit of wine (one part to five), 

 and, having washed the skin around with watery solution, applied lac-plaster, 

 omitting the protective. Next day, however, the putrefaction was reproduced ; 

 showing that the antiseptic employed had not thoroughly penetrated the adher- 



