COMPOUND FRACTURE, ABSCESS, ETC. 19 



his position, and the procuring of a conveyance involved further delay ; so that 

 a considerable period elapsed, during which he lost much blood from the thigh, 

 before he could be taken to Helensburgh. Here he was placed on a litter, with 

 a warm moist blanket round the limb, with the object, as he said, of checking 

 the bleeding, which, however, it could not but tend to encourage. He was 

 then conveyed by train to Glasgow, where he reached the infirmary six hours 

 after the occurrence of the accident. 



Dr. Archibald Cameron, the house surgeon, seeing the case to be a very 

 grave one, at once sent for me, but without any delay introduced carbolic acid 

 into the wound by means of a piece of lint held in a pair of dressing forceps, 

 passing it about an inch in every direction beneath the integument, after squeez- 

 ing out a considerable quantity of extravasated blood from the orifice, which 

 was large enough to admit the tip of the finger. 



On arriving, an hour after the patient's admission, I found him in a state of 

 prostration sufficiently explained by the severity of his injuries and by the 

 blood lost to the circulation, including a large amount extravasated in the 

 limb, and distending, not only the whole thigh, but the calf, the tenseness of 

 which contrasted strikingly with the flaccidity of the other. 



Under these circumstances decomposition of the blood effused among the 

 tissues would have been necessarily fatal. And yet, considering the length 

 of time that had elapsed since the receipt of the injury, and the fact that a 

 reeking flannel had been for two hours in contact with the wound, and had 

 already a somewhat offensive odour when removed from it, there seemed but 

 a poor chance for the treatment with carbolic acid. On the other hand, taking 

 into account the man's time of life and general condition, I believed that to 

 amputate through the thigh infiltrated with blood would be certainly to kill him. 

 And therefore, as it was impossible to say that the other treatment had no 

 chance, while, if it should prove successful, it would have the immeasurable 

 superiority of saving limb as well as life, I determined to persevere with it. 



Having removed from the wound the dressings placed on it by Dr. Cameron, 

 I forcibly squeezed out a further large amount of blood, and applied carbolic 

 acid in lint and also mixed with blood, so as to provide for a crust of considerable 

 thickness overlapping the skin by about half an inch every way. This was 

 covered w'ith a circular piece of tin, two inches across, well bulged out except 

 a flat margin about a quarter of an inch wide, which rested on tlie surrounding 

 integument. This tin cap was retained in position by a single turn of bandage 

 tied round the limb. 



The lower end of the upper fragment was mucli displacctl tknvnwards in 

 the vicinity of the wound, but returned towards its natural position on extension 



C2 



