COMPOUND FRACTURE, ABSCESS, ETC. 27 



abscess in compound fracture, independently of atmospheric influence. That 

 it was so in this instance is clearly shown by the entire absence of constitutional 

 symptoms for the first five days, the circumscribed character of the suppuration, 

 and the odourless nature of the pus. The injured part suppurated, probably 

 from the same cause as a severe bruise may without any breach of the integu- 

 ment. The satisfactory results obtained by treating the wound with carbolic 

 acid diluted with oil, instead of the undiluted acid, will naturally suggest the 

 inquiry whether this would not always be the better practice. And I may 

 mention that my former house surgeon. Dr. A. Cameron, met with similar 

 success in two cases in which he pursued the same treatment — one of them 

 a compound fracture of the ulna at the elbow, the other a severe contused wound 

 of the back of the hand communicating with a fractured metatarsal bone. But 

 considering how much is at stake, and that the patient's life may depend upon 

 entire destruction of the septic germs that lie in the wound, I am inclined to 

 think it wiser to avail ourselves of the full energy of the pure acid, more especialh- 

 since we have had sufficient evidence that any caustic effects it may have are 

 not productive of serious consequences. 



Case 9. — William C , aged thirty-three, was admitted on the 29th of 



September, 1866, under the care of Dr. Eben. Watson, with a compound 

 fracture of the left tibia, produced by an omnibus passing over the limb at 

 eight o'clock p.m. The broken part of the bone was exposed in a wound six 

 and a half inches in length, a little above the ankle. The skin in the vicinity 

 was detached from the subjacent tissues for about two inches, and there was 

 ecchymosis reaching some distance up the leg, with other evidence of severe 

 contusion. 



An hour and a half after the accident Dr. A. Forsyth, the house surgeon, 

 from whose notes these particulars are obtained, sponged out the wound 

 thoroughly with undiluted carbolic acid, and placed over it la\-ers of calico 

 soaked with the acid ; and, in order to provide for a sufficiently substantial 

 crust, spread over the calico some paste composed of starch moistened with 

 carbolic acid, covering the whole with a piece of block-tin secured with a bandage, 

 the fracture being treated with a suitable apparatus. After the dressing, the 

 patient, though unable to express his feelings, being dumb, appeared entirely 

 free from uneasiness. 



Next day the tin was carefully removed from the crust, the surface of which 

 was touched with carbolic acid, and, the tin having been readjusted, hot fomenta- 

 tions were applied to the leg and foot. The ])ulse was now gO, the tongue 

 clean, and appetite good. The same treatment was pursued till the thirteenth 



