366 ON SOME POINTS IN THE 



I do not remember whether you saw the case that led me to apply the 

 antiseptic principle to abscess. The patient was a woman above the middle 

 period of life, with lumbar abscess. Taught by the disastrous results that sooner 

 or later followed the evacuation of such abscesses, whether by valvular opening 

 or by cannula and trocar, I left the case undisturbed ; till one day, on looking 

 at it, I found that nothing but epidermis seemed to intervene between the pus 

 and the external world, so that if left for another day it would in all probability 

 burst. 



I therefore resolved to open it and apply a dressing which should imitate, 

 as much as circumstances permitted, that which we used in compound fractures. 

 The pus which escaped on incision was as thick as any I ever saw. Mixing 

 some of it with undiluted carbolic acid, I applied some layers of lint soaked with 

 the mixture to the wound and surrounding skin, and covered them with a piece 

 of thin block-tin moulded to proper shape, such as we used for covering the 

 crust in compound fracture. This metal covering, which prevented loss of 

 carbolic acid by evaporation and soaking into surrounding dressings, was fixed 

 by strapping, and a folded towel was bandaged over it to absorb discharge. 



Next day, on changing the dressing, I was greatly astonished to see nothing 

 escape from the incision except a drop or two of clear serum. What was now 

 to be done ? I had no longer any pus to mix with the carbolic acid. But it 

 occurred to me that I might make a satisfactory crust by mixing carbolic acid 

 with glazier's putty. Accordingly I sent to the dispensary for some whiting and 

 boiled linseed oil, and making a solution of one part of carbolic acid in four of 

 the oil, rubbed it up with whiting in a mortar, thus making a carbolic putty. 

 This I spread on a piece of block-tin and applied it as I had done the first 

 dressing. There never was any further discharge of pus ; the serous oozing 

 diminished rapidly, and before long healing was complete. 



In that case, as there was no spinal curvature, I could not be sure that the 

 abscess was connected with the vertebrae. But similar results afterwards 

 followed the same treatment where discharge of bone showed that such con- 

 nexion existed, and also in suppuration of the hip-joint, whether attended with 

 shortening of the limb or not, scrupulous care being taken to keep the affected 

 part completely at rest. The time required for final closing of the sinus was, 

 however, generally much longer than in the first case. 



Precisely the same beautiful result, so entirely novel and so full of deep 

 interest both for pathology and practice, was seen when acute abscesses were 

 treated in the same way ; the only difference being that in the acute cases the 

 serous oozing which followed evacuation of the pus came much more rapidly 

 to a conclusion. 



