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 adhering portions of slough. Having at hand some saturated solution of chlorine gas in water (the liquor chlori of the British Pharmacopoia), I applied it freely to the sore and also to the surrounding integument, and then dressed with protective dipped in chlorine water and covered with overlapping lac, as formerly. On the following day the sore was destitute of odour of any kind, while the discharge was greatly reduced. For the future it will be treated as a superficial ulcer.

With regard to the injury to the ankle, it only remains to be mentioned that at the present time, six weeks after the accident, the fracture of the internal malleolus has united firmly, and the foot is in good position; while the patient can already move the ankle-joint through a considerable angle.

The four severe scalp wounds-three of which, it will be remembered, involved exposure and injury to the bone-healed completely, without the formation of a drop of pus. And it was an interesting circumstance that, on the removal of some scabs, one of the silk sutures, which had been accidentally left, was found still securely in its place, three weeks after its introduction, and came away clean and dry, like a metallic stitch.

The compound fracture into the elbow-joint also healed without any suppuration. Five weeks after the receipt of the injury the splint was removed. The broken olecranon was found firmnly united, and the patient has now free motion of the articulation.-Lancet, March 19, 26, and April 9, 1870, pp. 404, 440, 512.

40.-ON THE USE OF CARBOLIC ACID IN COMPOUND FRACTURES, WOUNDS, AND BURNS.

By EDWIN P. GUTTERIDGE, Esq., Maldon, Essex.

Thinking that the carbolic acid treatment of compound fractures, &c., is not generally adopted, I venture to send the following cases which have occurred in my practice during the last few months, to bear testimony to the wonderful effects produced by this valuable remedy, feeling sure that when once fairly tried and properly carried out, no medical man would go back to the old system of treating compound fractures, and if success does not follow, it arises in most cases from improper management. The following is the plan that I have pursued:

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1st. Having reduced the fracture, I introduced pure carbolic acid into all accessible recesses of the wound. I prefer doing this by means of a piece of lint, held in dressing forceps, and dipped in the liquid, large enough to overlap the sound skin, as the caustic action of the carbolic acid has a stimulating influence, and excoriates the skin.

Having prepared carbolic oil, consisting of one part of carbolic and four parts of boiled linseed oil, I soak a piece of lint, folded three or four times thick, in it, and place it over the wound, the size of the lint being about three inches square, and over this a piece of sheet-lead doubled, rather smaller than the lint, and having straightened the limb, place it in splints. Sheet-lead is superior and preferable to block tin (which is advised to be used by some), on account of the facility with which it can be moulded to any shape that is desired.

For the next three weeks, every day, I pour carbolic oil on the edges of the lint, so that it is kept constantly wet.

If every thing goes on well, I do not disturb the dressing for five or six weeks, when, on taking it off, I find the wound either perfectly healed, or merely a superficial granulating sore with prominent granulations, which require daily for a short time to be touched with sulphate of copper, under which the wound very soon heals.

Since treating compound fractures in this manner, I have never found my patients suffer from any severe constitutional disturbances; the system receives no shock from the accident; no fever follows; the pulse keeps low, never rising above 84 per minute; the appetite remains good, the tongue clean; and there is no formation of pus. In fact, with carbolic acid, compound fractures are rendered simple to the surgeon, and the patient rapidly improves.

Case 1.-David P., higgler, aged 45, on the 6th February, 1868, was thrown out of a cart, and sustained a severe compound fracture of the right leg, the upper fragment of the tibia protruding an inch on the inner aspect. The fracture could not be reduced without enlarging the wound and sawing off the protruding portion of the bone. Afterwards the leg was put up as above described, and in Cline's splints. During the first twelve hours there was considerable hemorrhage, but after that time it ceased. Everything went on well, with the exception that the patient suffered much pain at the seat of injury. At the end of five weeks, on taking off the dressing, the wound was found completely healed.

Case 2.-Henry H., aged 14, on September 3rd, 1868, fell off a horse. Compound fracture of the left leg; the wound small, on the inner side; no bone protruding. He was treated in the same way. Had no bad symptoms of any kind, and did well. At the end of six weeks the wound was perfectly

cicatrised.

Case 3.-Henry S., aged 10, on October 19th, 1868, was thrown from a horse. Compound fracture of the right femur, with laceration of the artery profunda femoris; wound on the outer aspect. The bone did not protrude; but the limb was so distorted and distended from extravasation of blood, that from above the knee it looked like a large ball. The leg was very cold; and the boy was much prostrated by the shock of the accident, as well as by the hemorrhage so much so that it was uncertain whether the limb could be saved. It was merely tied up in a pillow, and the carbolic oil applied as above. On the following day the leg had become warmer; and the boy went on so well that after six days I straightened the leg and applied a long splint, bandaging up only as far as the knee-joint, applying the usual perineal bandage, &c. Six weeks after the accident I took the dressing off, but allowed the splint to remain on for another week. I found a superficial sore, with fungous granulations, the size of a shilling. Applied sulphate of copper daily, and dressed with calamine ointment; and after seventeen days the wound healed. During the whole time the child did well in every way, except that he suffered pain during the first fortnight.

Case 4.-Geo. H., aged 18, a painter, on Jan. 14th, 1869, whilst at his work on a ladder, it slipped from under him, and his right leg was caught between the spokes. He sustained a compound fracture of the tibia, the wound on the outside of the leg being sufficiently large to admit the tip of my index finger. Treated as above. Serous discharge for forty-eight hours from beneath the dressing; but every thing went on well, with the exception of great pain at the seat of fracture. At the end of five weeks the wound had healed, a few granulations only requiring a week's attention with sulphate of copper. Case 5.-William M., aged 29, an engine-driver on the Great Eastern Railway. On June 15th, 1869, the 8 p.m. train from Witham to Maldon left the rails, and went down an embankment, the engine turning over and burying him underneath, both legs being under the engine. It was above two hours before he was dug out. On examination, I found a comminuted fracture of the left leg, and a compound comminuted fracture of the middle third of the right leg, the wound transverse, one inch in length on the anterior aspect. In consequence of having to convey him three miles, the fractures were not reduced for upwards of four hours. He was treated as above. Hemorrhage happened during the first twelve hours; but afterwards he progressed favourably, although he suffered a great deal of pain for two months, which was relieved by anodynes. June 25th. Moved him on to a water-bed.

July 2nd. Placed the right leg on a fracture-box.

27th. Removed the dressing, and found the wound completely healed, the cicatrix the size of three quarters of an inch. The surface of the skin excori

ated from carbolic acid, which had been put on pure on a piece of lint before the fracture was reduced. The union between the broken fragments not perfectly consolidated. The splints were re-applied for six weeks.

Sept. 16th. The leg united, solid, straight, and in every way doing well. Case 6.-Feb. 12th, 1869: I removed an adipose tumour, weighing two pounds, situated over the right scapula, from William B., aged 56, a miller. Having sponged the whole of the raw surface with the pure acid, and brought together the edges of the skin with seven sutures, the incision being eight inches in length, I placed over it lint soaked in carbolic oil. During the process of healing (fourteen days) not more than a drachm of pus was discharged.

Case 7.-May 1st, 1869: Robert H., aged two years, whilst playing with lucifer matches, ignited his bedgown, and was severely burnt over the chest, abdomen, and thighs. The case was treated for the first week with medicated wool and linseed oil; afterwards with a lotion consisting of half a drachm of carbolic acid to twelve ounces of water. The sufferings of the child were intense until the lotion was applied, when the pain was mitigated in a few hours. Healthy action set up, and the little patient rapidly progressed favourably.

With such satisfactory results as these, there can be no doubt of the efficacy of the carbolic-acid treatment; whereas fractures treated in the ordinary way are frequently attended with local inflammation and suppuration, profuse discharge of pus from abscesses, long-continued exfoliation of bone, hectic fever, and sometimes loss of limb or life.—Lancet, Nov. 20, 1869, p. 704.

41.-ON WHISKY AS AN ANTISEPTIC DRESSING IN SURGERY. By Dr. DAVID BLAIR, Ballachulish.

[Alcohol has lately been used in some of the Paris hospitals as an antiseptic dressing for wounds, and, as it has been the practice in Islay to use whisky for the same purpose, Dr. Blair has had considerable experience in the matter.]

The district (Islay) in which for eight years I practised medicine, is one where whisky distillation is carried on extensively, and where, consequently, as may be inferred, this article can be got undiluted and unadulterated. In any serious cases of accident in which it may be recommended by the medical man, the distillers very liberally give it in the pure state, to be applied under his direction. From this source the poorer classes, who could not otherwise obtain it on account of its high price, are often supplied, and thus the medical attendant is enabled to adopt this treatment in any case for which he may think it applicable. As a dressing to wounds, I have found it not only efficacious, but what is a great recommendation to its use, especially in country practice, it is easily applied. In the wards of an hospital, with the assistance of well-trained nurses, and all the other "appliances and means to boot," it is comparatively easy to carry out any line of treatment, however difficult or complicated its manner of application; but in general practice, and particularly in extensive country districts, where patients are not unfrequently many miles distant from the medical practitioner, and where necessarily much of the treatment must be entrusted to attendants who are not at all times very intelligent or trustworthy, it is of great importance to employ simple means, and nothing can be simpler or less troublesome as a dressing to wounds, than spirit lotions. I usually apply the whisky as follows:

To remove foreign substances or clotted blood, the wound is first washed thoroughly with strong whisky, it is then closed with stitches if necessary; again bathed with whisky, and covered by a rag and bandage both saturated with the same fluid; and finally, all is enveloped in gutta percha tissue or oiled silk, and directions given to the attendants to wet the bandage from time to time with the spirits. As a rule, the first dressing is not disturbed for three or four days, and afterwards it is changed every day, or every second day, according to circumstances. The principal thing to be attended to is to

have the bandage kept wet with the whisky-but not too wet, or it will impede the progress of the cure. I have never seen much sloughing, and I have not once seen erysipelas occur in wounds treated in this way. Probably because septic germs, if they exist at all, are not numerous in our hyperborean regions.

Since I left Islay, a year ago, I have not used whisky in all my cases of wounds, still I have used it occasionally, and its value has not diminished in my estimation, although I have tried carbolic acid and other antiseptics. The following cases may be given in illustration :

Case 1.-J. M. P., a boy, aged 10 years, was amusing himself near a corn thrashing machine, his hand got entangled in the wheels, and before they could be stopped, the middle finger and its metacarpal bone were crushed to pieces, the palm of the hand was lacerated severely, the ring finger was denuded of the flesh on the palmer aspect, but the bone was not broken. The boy, having been put under the influence of chloroform, I removed the lacerated part and injured bone, then dressed the wound with strong whisky. The following day, when visited, the boy was sitting by the fireside, supporting his hand on a pillow laid on his knee. He was quite comfortable and cheerful, and could not be induced to remain in bed. I need not detail the progress of the case, suffice it to say that the hand healed rapidly, and I ceased attendance in three weeks.

Case 2.-Boy, 8 years, had his hand caught between the wheels of a haycrushing machine, which was driven by a horse. Before the animal could be stopped, the hand of the boy was fixed in, and the arm drawn round the wheel so firmly that the little fellow could not be extracted until the machinery had been turned backwards. The thumb and next two fingers were torn off at their articulation with the metacarpus. The palm of the hand and inner aspect of arm up to axilla were lacerated so badly that we feared it would not be possible to save the whole arm; the metacarpal bone of the thumb was smashed and had to be wholly removed. We resolved to take away, in the first place, only what was strictly necessary of the hand, and gave the arm a chance of recovery. The parts were wrapped in cloths with whisky, in the usual way, and the friends directed to wet the bandage two or three times daily. On the fourth day we removed the dressing for the first time; there was no discharge, no inflammation, no swelling. The arm looked well; the case went on uninterruptedly, and I only required to see him thrice.

Case 3.-J. S., aged about 60, had his finger crushed by machinery; amputated part of two of them. Applied whisky; no inflammation, no suppuration. Result good.

In other three cases of amputation of the finger I used it with equal

success.

I have also used whisky as an application to bed sores. When fever occurs epidemically in country districts and villages, especially in the Highlands, it generally causes a panic among the inhabitants. The dread of contagion is so great that occasionally no one will venture to undertake the duties of nurse; under these circumstances bed sores are of frequent occurrence. I have seen more than one case in which the os sacrum and coccyx were exposed from sloughing in typhus, and yet the patients recovered. The bed sores were treated with linseed and oatmeal poultices, mixed with whisky, until the slough separated, then whisky lotions were applied.

In cases of chronic and scrofulous abscess, I have used whisky as an injection, and find that it checks the discharge and hastens the cure. In a case of scrofulous abscess of the hip joint I attribute the recovery of my patient to its having been used in this way. The pain and hectic before and for some time after the abscess was opened, caused so much prostration that I had slight hopes of my patient's recovery. I persisted, however, in using the injections two or three times daily, bathed the whole limb often with spirits, and kept it wrapped in cotton wadding and a bandage. The stomach for a time would not tolerate solid food of any kind, and even beef tea provoked nausea. Notwithstanding, in an incredibly short time, my patient rallied, and I had the

pleasure of seeing him able to walk well, although the joint continued somewhat stiff.

In a singular case of abscess, situated beneath the muscles in front of the abdomen, which opened at the umbilicus, I was highly pleased with the result gained by these injections. The discharge obstinately continued, although I perseveringly applied for a considerable time poultices and lotions of different kinds; at last, I resolved to inject with strong spirits, but from the peculiar situation of the abscess, and fearing inflammation might supervene, I used it very cautiously at first, but no unfavourable symptom having followed the first application, by degrees it was used more freely-two or three syringefuls at a time repeated twice or thrice daily. In a few days there was a marked improvement, and soon the discharge ceased completely, and the patient is now well.-Glasgow Medical Journal, Feb., 1870, p. 205.

42.-ON TRANSVERSE FRACTURES OF THE PATELLA.

By JONATHAN HUTCHINSON, Esq., Surgeon to the London Hospital,

[Mr. Hutchinson concludes a long and able paper upon this subject by the following recapitulation of what he has shown in it.]

1st. That a very remarkable state of physiological inactivity in the damaged muscle results from fracture of the patella.

2nd. That the fact of this inactivity destroys the common explanation of the displacement of the upper fragment.

3rd. That this displacement is usually due, not to muscular traction from without, but to fluid pressure from within.

4th. That the real cause of weak union is the bulging of fluid between the fragments.

5th. That atrophic shortening of the quadriceps often follows these injuries, and, whilst it greatly disqualifies the muscle for extension, renders flexion very dangerous to the uniting ligament.

6th. That an exceedingly interesting and curious occasional result is, permanent and complete atrophy of the muscle concerned.

Should the conclusions which I have stated be confirmed by future expe-. rience, it is probable that they will also be found applicable to some other forms of fracture and of injury to tendons. Indeed, it is in the possibility that they may illustrate a physiological law of wide bearing that their chief interest consists.-Medico-Chirurgical Transactions, Vol. lii., p. 339.

43.-FOREIGN BODIES IN THE KNEE-JOINT.

By HENRY M. TYRRELL, Esq., Surgeon to the Mater Misericordiæ Hospital, Dublin. [The patient was a cook, 26 years of age. On admission her left knee was found slightly flexed, the joint was a little swollen and painful, and on any attempt being made to lean on the limb the pain became intolerable.]

The patient, who is of a strong robust habit, gave the following history. Eight days before admission, whilst discharging her ordinary duties, she was seized with a sudden pain in the joint, which at the same time became fixed in a slightly flexed position; she was unable to walk and had to be carried to bed. On the following day mustard plasters were applied, without affording any relief; these were followed by poultices and other soothing applications, but as no good effects were produced she was recommended to come into hospital, which she accordingly did, her symptoms being as already described, viz., pain and swelling in joint with the limb in a slightly flexed position.

Mr. Tyrrell, considering_the_case to be one of sub-acute synovitis, placed the joint on a pillow and ordered evaporating lotions to be assiduously applied; in three days the swelling subsided, but the pain and rigidity remained.