360 SURGERY 



for the relief of ankylosis of the lower jaw by subcutaneously divid- 

 ing the masseter muscle. In forcing open the mouth after teno- 

 tomy of the muscle, he accidentally fractured the bone, thus pro- 

 ducing a false joint until the fracture united. Carnochan conceived 

 then the idea of excising a wedge-shaped piece from the jaw and 

 establishing a false joint. For the relief of this distressing condi- 

 tion, in 1873, Gross excised the condyle and a portion of the neck 

 of the bone, and in 1875 Mears excised the coronoid and condy- 

 loid process together with the upper half of the ramus. Wood, in 

 1876, cured a patient with fracture of the cervical vertebra associ- 

 ated with paraplegia and brachial paralysis, by the use of the 

 plaster-of-paris jacket. The patient, though completely paralyzed, 

 made an excellent recovery and was able to resume his work as a 

 carpenter. 



Compound fracture may be designated as the touchstone of sur- 

 gery, because a discussion of the treatment of compound fractures 

 includes all the great principles involved in every department of 

 the science. It embraces a consideration of cerebral, thoracic, and 

 abdominal surgery; it includes a discussion of the great principles 

 of antisepsis, it covers operative technic, it embraces the study of 

 surgical pathology, it touches upon the higher departments of the 

 science, and opens up the field where surgery must be considered, 

 as an arena for the exercise of sound judgment, for the display of 

 clear foresight, and for the exhibition of accurate knowledge and 

 ripe erudition. Finally, a full discussion of this subject inevitably 

 leads to a consideration of the progress of surgery during the pre- 

 sent century and its precise status at the present day. In consider- 

 ing the management of compound fractures, I shall confine my- 

 self to the results of my own personal work as embodied in an ex- 

 tensive clinical experience embracing a report of 1000 cases, which 

 I published some time ago, and since then hundreds more can be 

 added to my list, with substantially the same result. These cases 

 occurred within a period of a year in four metropolitan hospitals 

 devoted to the treatment of acute surgical cases, and also in pri- 

 vate practice. The accumulation of so vast an amount of clinical 

 material has been attained with considerable labor. The conscien- 

 tious treatment of these serious cases has been attended with a 

 sense of great responsibility, and the results have been attained 

 only by close attention to the minutest details in the management 

 of each individual case. There are some points in the treatment 

 of compound fractures that deserve special consideration, and it 

 is only by a study of these cases in groups that clinical facts of essen- 

 tial importance can be established. The same plan of treatment 

 has been carefully watched in many cases at the same time, and 

 it has been by a process of evolution that some of the opinions 



