COMPOUND FRACTURE, ABSCESS, ETC. 23 



care in guarding against decomposition. But be this as it may, the method 

 which we pursued in order to avoid it was not, as experience has since 

 shown, thoroughly trustworthy. Would that I had at that time known of 

 the mode of proceeding which will be found described in a future section 

 of this communication. Very different then might have been the issue of 

 the case ! 



On the twenty-second day pus was again found in the flannel, and some 

 bubbles of gas were observed to escape along with the two or three drops that 

 could be squeezed from the limb, and these had a distinctly offensive odour. 

 Judging it now useless to retain the crust any longer, I removed it, and found 

 the original wound still sealed by the original clot, the openings by which the 

 pus had escaped being new apertures in the skin overlapped by the crust. In 

 the after-part of the day he had a good deal of uneasiness, and in the evening 

 half an ounce of pus, with numerous air-bubbles, was pressed out of the limb 

 by Dr. Cameron. iVfter this the patient passed a comfortable night, and in the 

 morning onlv two drachms of matter could be procured from the thigh, but 

 this was thicker and more opaque than it had been, with decidedly offensive 

 odour, and contained bubbles of gas ; there was also pus in the flannel. There 

 was, further, some return of swelling over the seat of fracture. 



But though the plan of dealing with the abscess had failed to accomplish 

 all that I desired, its essential object appeared to have been attained. For 

 during the week in which decomposition was prevented, the thigh had become 

 so much consolidated and strengthened that all danger of serious consequences 

 seemed to have been tided over. No extension of the suppuration took place 

 beyond the trifling degree above described, and his constitution did not suffer. 

 Any further use of carbolic acid being obviously uncalled for, the sore was 

 simply dressed with a lotion, the lint being so arranged as to allow free escape 

 for the pus, and afterwards, to promote this more effectualh', a small perforated 

 caoutchouc tube w^as introduced, a dry cloth being substituted for the fomenta- 

 tion. Under this management the discharge gradually diminished in quantit}-, 

 and became again thinner and more transparent, and the sweUing of the calf 

 became steadily reduced. 



Still the opening did not close, and on the 2nd of December, more than 

 a fortnight having passed in this way, I introduced a probe, and found that it 

 passed downwards to bare bone, including a considerable extent of surface in the 

 lower fragment. Here, then, was presented the prospect of a tedious process 

 of exfoliation ; whereas if decomposition of the pus had not occurred, the granu- 

 lations would probably have closed upon the dead bone, and absorbed it, as 

 in the last case, and the fact that any part had lost its vitalit\- would then never 



