COMPOUND FRACTURE, ABSCESS, ETC. 17 



surgery that a piece of bone once dead must all come away as an exfoliation. Why 

 it was that in the case before us the osseous tissue destroyed by external violence, 

 aided by the action of carbolic acid, was so exceptionally affected by surrounding 

 parts, the granulations in its vicinity discharging the office of absorbents of 

 the dense tissue, instead of forming pus like those around an ordinary exfolia- 

 tion, I will reserve for future discussion, when I shall have occasion to point out 

 the great importance of the fact in its bearing both on pathology and practice. 

 Meanwhile I may remark that it illustrates beautifully the function of absorp- 

 tion, which, even where solid substances are taken up, does not require any 

 special set of absorbent vessels, but may be effected even by granulations, the 

 most rudimentary of all tissues, each cell feeding upon any suitable substance 

 in its vicinity. 



We also see at once the value of the observation with reference to the treat- 

 ment of compound fracture with carbolic acid ; for it shows that in cases in 

 which the bone is exposed, the acid may be applied so freely as to cause death 

 of its tissue without necessarily inducing exfoliation. 



The case was now reduced to one of simple fracture with a large granu- 

 lating sore, and this was greatly diminished and healing rapidly, while the 

 union of the fragments was becoming very firm ; and the limb would doubtless 

 soon have been entirely sound had it not been for that cruel scourge, hospital 

 gangrene. This, however, had shown itself ten days before the removal of the 

 exfoliation, not in the sore, but about an inch from its edge, as a pustule in the 

 cicatrix, which on bursting disclosed a grey slough that soon showed its characters 

 unmistakably, producing considerable destruction of the scar, although the 

 original sore continued to heal kindly. 



I will not enter into the history of this and numerous subsequent attacks 

 of the disease further than to state that they were partial in their eftect, the 

 unaffected parts still healing with rapidity, and that they continued to yield 

 to the treatment with nitric acid ; so that at one time the whole sore was \-er\' 

 nearly healed. 



But in the early part of October the disease assumed a more intractable 

 form, and in spite of the most energetic use of nitric acid on several occasions, 

 which produced illusory appearances of temporary impro\"ement, by the 27th 

 of the month the sore had become enlarged to nearly its original dimensions, 

 while the limb had swollen greatly through inflammation caused by the irrita- 

 tion, and the boy's general health was rapidty giving way under the increased 

 discharge and nervous excitement. 



The question of amputation now again presented itself, but a good airy 

 room in a different department of the hospital being hai^pily now at m\' disposal, 



LISTER II C 



