DEVELOPMENT IN NINETEENTH CENTURY 361 



which I shall enunciate have become fixed laws in routine prac- 

 tice. To see in one day nineteen compound fractures in the same 

 ward with a normal temperature is not a coincidence. The number 

 might possibly be, but the same condition in all is the result of the 

 application of fixed principles which have been established as the re- 

 sult of long study and observation. To see at another time twelve 

 cases in the same ward and all with a normal temperature is like- 

 wise no coincidence. These circumstances make it evident that 

 the application of fixed rules is necessary to arrive at certain and 

 uniform results. 



The complete history of each one of the 1000 cases of compound 

 fracture is carefully preserved. Each case is given in full, with the 

 name of the patient, the date of his or her admittance to the hos- 

 pital, the age, a description of the injury, the treatment in full, 

 and the result, together with the name of the house surgeon on 

 duty at the time as a matter of reference. It is obvious that time 

 will not permit to discuss in detail these histories, and therefore I 

 can only give a summary. 



The general summary in the 1000 cases is as follows: 



Skull 178 



Nasal, malar, maxillas, and patellas 89 



Arm 40 



Forearm 41 



Fingers and toes 97 



Ilium, clavicle 2 



Thigh 87 



Leg 295 



Fractures involving shoulder, elbow, or wrist-joints, as a result of disease 



or accident 39 



Fractures involving hip, knee, or ankle-joints, as a result of disease or 



accident 85 



Fractures involving carpal or metacarpal, tarsal or metatarsal joints, as 



a result of disease or accident 47 



1000 



Now, following the example of surgical writers who have care- 

 fully tabulated the results of treatment in compound fractures, 

 I shall eliminate all those cases in which primary amputations were 

 performed, because they do not concern the point at issue; and 

 I shall also, according to the practice of writers, reject all those 

 patients who died of hemorrhage, collapse, shock, etc., within a 

 few hours after injury. I shall also leave out cases of compound 

 fractures of the hand and foot, as too insignificant to be classed 

 with compound fractures of the long bones. After these deduc- 

 tions are made, there remain 681 cases of compound fractures, with 

 one death due to sepsis. This gives a death-rate of about ^ of 1 %. 



In order to appreciate fully what aseptic surgery has accom- 

 plished in reference to the management of compound fractures, 

 it is necessary to compare the results obtained prior to the intro- 



