COMPOUND FRACTURE, ABSCESS. ETC. 15 



large sore lay the lower fragment of the tibia, freely exposed to the extent of 

 two inches and a half in length, bare and white hke a macerated bone. At the 

 upper end of this fragment, and apparently for a considerable distance from it, 

 the bone was thus denuded round its entire circumference ; and, judging from 

 previous experience, there was reason to expect that, even if the patient should 

 survive the profuse suppuration which was to be anticipated, about two inches 

 of the whole thickness of the tibia must exfoliate, an amount of loss which 

 in the child's small limb, would of necessity render it utterty useless. The 

 upper fragment was also bare for about half an inch just above its extremity, 

 but the end itself was covered with prominent granulations. 



Though despairing of any good result, I resolved to watch for a while the 

 progress of events, prepared to amputate as soon as the boy's health should 

 show signs of failing ; and comforting myself with the reflection that he had 

 been brought into a state greatly more favourable for the operation than on 

 his admission. In order to keep down the amount of the discharge the sore 

 was dressed with the sulphite-of-potash lotion, a poultice being applied to the 

 part which had been treated with nitric acid. When the sloughs caused by the 

 caustic separated a healthy surface appeared, which in the course of the next 

 ten days was nearly healed. In other parts of the sore, however, grey patches 

 occasionally showed themselves, assuming healthy characters after being touched 

 with carbolic acid, which, when efficient, has the advantage over other caustics 

 of being painless. But at length spots of hospital gangrene appeared in a form 

 no longer amenable to this mild treatment, in spite of which the\' began to 

 extend rapidly, and on the 26th of July it became necessary to put the child 

 again under chloroform and apply nitric acid in the same thorough manner as 

 before. This had the effect of producing a perfectly healthy state of the whole 

 sore, which proceeded to heal with great rapidity ; so that by the 8th of August 

 it was found to measure an inch less in length and two inches less in greatest 

 breadth than at the time when the crust was removed. 



In the meantime his general health, instead of deteriorating, had improved, 

 and he was evidently regaining flesh, while the discharge of pus was astonish- 

 ingly little considering the state of the limb, being barely sufficient to soak the 

 single layer of lint that covered the sore. 



The explanation of this satisfactory state of things was afforded by an 

 observation of much interest made at this period. Since the removal of the crust 

 the granulations had been growing up on all sides about the bone, so that the 

 bare part of the upper fragment was almost entirely' covered in, and even the 

 lower fragment, which projected beyond the level of the upper, was to a great 

 extent embedded in the new growth. It liad been noticed before the end of 



