274 LORD LISTER 



maintain it in the form of a continuous sheet, which may 

 be wrapped in a moment round the whole circumference 

 of a limb if this be thought desirable, while the putty is 

 prevented by the calico from sticking to the rag which 

 is next the skin. 8 When all discharge has ceased, the use 

 of the paste is discontinued, but the original rag is left 

 adhering to the skin till healing by scabbing is supposed 

 to be complete. I have at present in the hospital a man 

 with severe compound fracture of both bones of the left 

 leg, caused by direct violence, who, after the cessation of 

 the sanious discharge under the use of the paste, without 

 a drop of pus appearing, has been treated for the last two 

 weeks exactly as if the fracture was a simple one. During 

 this time the rag, adhering by means of a crust of in- 

 spissated blood collected beneath it, has continued per- 

 fectly dry, and it will be left untouched till the usual 

 period for removing the splints in a simple fracture, when 

 we may fairly expect to find a sound cicatrix beneath it. 



We cannot, however, always calculate on so perfect a 

 result as this. More or less pus may appear after the 

 lapse of the first week, and the larger the wound, the more 

 likely this is to happen. And here I would desire ear- 

 nestly to enforce the necessity of persevering with the anti- 

 septic application in spite of the appearance of suppura- 

 tion, so long as other symptoms are favorable. The surgeon 

 is extremely apt to suppose that any suppuration is an 

 indication that the antiseptic treatment has failed, and that 

 poulticing or water dressing should be resorted to. But 

 such a course would in many cases sacrifice a limb or a 

 life. I cannot, however, expect my professional brethren 

 to follow my advice blindly in such a matter, and there- 

 fore I feel it necessary to place before them, as shortly 

 as I can, some pathological principles intimately connected, 

 not only with the point we are immediately considering, 

 but with the whole subject of this paper. 



If a perfectly healthy granulating sore be well washed and 



1 In order to prevent evaporation of the acid, which passes readily 

 tbrough any organic tissue, such as oiled silk or gutta percha, it is well 

 to cover the paste with a sheet of block tin, or tinfoil strengthened with 

 adhesive plaster. The thin sheet lead used for lining tea chests will also 

 answer the purpose, and may be obtained from any wholesale grocer. 



