1870 The Lancet  
578 repeated, but always manifests an impatience of rest and quiet." 23rd.-No trace of suppuration, but a small quantity of lymph was found in a coagulated state filling up the wound. The edges of the wound were separated, but showed no inflammatory tendency. No return of pulsation in the tumour, and no softening. 24th.-Rather more discharge than yesterday, but not purulent. 26th.-Discharge copious, but without any taint. No trace of suppuration. Measurement, in same spot as before, 13a inches.
more » ... before, 13a inches. Patient keeps in excellent health. No return of pulsation in tumour. Wound cleaner, but edges are wide apart. Dressed by Mr. Clark. 28th.-Wound healthy; discharge less. March llth.-Granulations have now completely filled up the wound and are closing in, but the dressing has caused some irritation and excoriation of surrounding skin. 15th.-As the carbolic dressing was found too irritating, the wound was dressed with simple ointment. To have two ounces of brandy per day. 16th.-On removing the dressing it was found that pus had formed; but, as the wound appeared to be healing up very fast, I ordered the simple ointment to be continued. 31st.-Wound nearly cicatrised, and patient quite well. The aneurism is now converted into a small hard tumour. Remarks. -It will be observed that the time occupied by the process of granulation and cicatrisation was considerable-over six weeks ; but during all that time there was not a drop of pus nor a trace of inflammatory action. I always most carefully examined the few drops of discharge, with the view of detecting pus if it were present, and of discovering anything which I could take for shreds of catgut ; but I am bound to say that throughout there was no appearance of either. When I found that the superficial granulations were sluggish under the carbolic plaster, I dressed them with lint and simple ointment, and the next day there was undoubted pus, but the granulating surface rapidly cicatrised. There is no question that under the favourable circumstances above detailed the plan described has yielded a very fortunate result. On a former occasion I ligatured the femoral artery with a silk thread steeped in carbolic acid, the ends being cut short, and the wound dressed most carefully with carbolic acid and oil, and over all a large dressing of putty imbued with carbolic acid. But the result was very different from what is here described ; for, although the patient ultimately made a most excellent recovery, I never saw such profuse suppuration from such a limited wound as that which I made. It appears, then, that the success of this as of any other plan of treating wounds depends on attention to the most minute details, and perhaps on the constitution of the patient, to an extent which is apt to be overlooked when the interest is concentrated on the management of the local wound or disease.
doi:10.1016/s0140-6736(02)66251-8 fatcat:e3yjr75okvc3xhaurimgddpaxu