i66 ON A CASE ILLUSTRATING THE PRESENT ASPECT 



form. But to do this would be to make voluntarily a compound fracture of 

 the ulna and a compound dislocation of the elbow-joint — a procedure which, under 

 ordinary treatment, I should have regarded as unjustifiable. But with the 

 means now at our disposal of guarding against the mischievous influence of 

 external agents upon wounds, I believed that these two operations could be 

 performed without any chance of mischief resulting. Accordingly, at a clinical 

 lecture on December 12, 1870, having explained the aspect of the case, and 

 having failed to rebreak the ulna by very forcible measures under chloroform, 

 I first washed the skin of the forearm and elbow with i to 20 watery solution 

 of carbolic acid, to destroy all putrefactive particles in the epidermis and hair- 

 follicles, and then made a longitudinal incision about two inches long over the 

 back of the ulna where it had been broken, while an assistant threw over the 

 part a cloud of spray of i to 40 carbolic lotion by means of Richardson's 

 apparatus ; and, having sufficiently detached with the knife the muscles from 

 the bone, and ascertaining precisely with the finger the situation of the callus, 

 I inserted the blades of a pair of strong bone-pliers, smeared with an oily solution 

 of the acid (i to 10), and, cutting through the bone, used the pliers as a powerful 

 lever to wrench the fragments sufficiently apart, and detach them enough from 

 surrounding soft parts to ensure free mobility, the antiseptic spray being mean- 

 while constantly maintained. A sponge wrung out of i to 40 watery solution 

 having then been bandaged upon the wound, I made an attempt to reduce the 

 dislocation of the radius ; but, meeting with the failure I had anticipated, 

 I at once cut down upon its head in a cloud of spray, and removed it by nipping 

 through its neck with the pliers, the blades of which had been again smeared 

 with the oil. A folded cloth dipped in the watery solution having been laid 

 upon the wound, I had the satisfaction of finding the forearm assume, under 

 moderate extension and coaptation, a perfectly normal shape. The limb was 

 then enveloped in lac-plaster from the middle of the arm to the lower part of 

 the forearm, the sponge and cloth having been previously removed under the 

 spray, the wounds being left unstitched, to secure complete absence of tension 

 from accumulating blood or serum. Cloths to absorb discharge, and a roller 

 smoothly applied so as to adapt the plaster well to the limb, and a pair of 

 Gooch's splints, anterior and posterior, with a special pad in front over the seat 

 of fracture, completed the dressing, the elbow being kept at a right angle. 



Next day, the dressings were entirely changed, when it was found that 

 a good deal of blood and serum had oozed into the cloths. The lac-plaster 

 was cut up with scissors along a line distant from the wounds ; and, as it was 

 raised from the limb, the spray of i to 40 lotion was made to play beneath it. 

 The gaping wounds were found filled with blood-clot, while the limb was^free 



