ON SUBCUTANEOUS SURGERY; O 



of fractured boues where the skin is not wounded." The 

 illustrations given by Hunter, in proof of the general law 

 adverted to, are sufficiently conclusive. No surgeon, he tells 

 us, could have failed to observe the difference between a 

 simple and a compound fracture, in reference to the progress 

 and result of the case. How rarely is a simple fracture 

 followed by suppurative inflammation, and how seldom does 

 a compound fracture unite without suppuration, even when 

 the wound is small and apparently insignificant! Here, then, 

 we have two similar accidents produced in the same way, 

 by the same amount of mechanical violence ; or, it may be 

 that the simple fracture is occasioned by a greater amount of 

 mechanical violence than the compound fracture. The only 

 difference is, that an external wound exists in the one case 

 and not in the other ; yet, how different the results ! And 

 who can suppose that the difference depends upon the additional 

 injury to the soft parts, skin, and cellular tissue — which alone 

 distinguishes the compound from the simple fracture ? The 

 exceptional cases in which suppuration occurs after simple 

 fracture or dislocation are undoubtedly^ very rare. I have 

 only seen three cases of this kind, and in each of them the 

 injuries were associated with an unusual amount of deep 

 bruising, and this, I believe, sufficiently explains the occur- 

 rence of suppurative inflammation, the liability to which Hun- 

 ter described in the class of bruises, or contused wounds. 



Two of these cases were the result of railway accidents ; 

 one a fracture of the humerus, which seemed to progress 

 favorably, but suppuration at the seat of fracture occurred, 

 and the individual died of pyaemia on the tenth day ; several 

 ribs were also fractured, and he had sustained other injuries. 



The other case was one of dislocation of the hip-joint, which 

 we were not able to reduce; other injuries existed, and I had 

 previously amputated the opposite leg. The efforts at reduc- 

 tion could not be continued in consequence of the sinking 

 condition of the patient, who, however, survived eight days, 



