COMPOUND FRACTURE, ABSCESS, ETC. 29 



and the tongue clean and moist. The surface of the crust was touched with 

 carbohc acid, the hmb being still fomented ; and the same treatment was con- 

 tinued daily for the following fortnight, during which the limb was entirely 

 free from pain, redness, or suppuration, while his constitution was quite un- 

 affected by the injur}-, the tongue remaining clean, and the pulse varying onl}- 

 between 72 and 85. 



I was present when the crust was removed, eighteen days after the accident. 

 Not a drop of pus existed beneath it. On the contrary, the superficial sloughs 

 of the cutis occasioned by the caustic action of the acid first applied remained 

 still undetached. The exposed surface was treated with water dressing, and 

 in two days presented the appearance of an ordinary granulating sore, which 

 healed without interruption. Six weeks and three days after the receipt of the 

 injury the splints were removed, the bones being satisfactorily united. 



This is an excellent example of the effects of the carbolic-acid treatment 

 in a compound fracture of the leg of average severity. No simple fracture 

 could have caused less disturbance, either local or constitutional. 



Case ii. — The following case, though incomplete, is given on account of 

 the conclusive evidence it affords regarding a complication of compound fracture 

 of much interest both practically and theoretically — viz. emphysema of the 

 limb in consequence of air being introduced into the wound, and diffused among 

 the interstices of the tissues by a pumping action of the fragments of the broken 

 bone when freely moved through restlessness of the patient or carelessness of 

 his attendants before he comes under the surgeon's care. Such a state of things 

 may seem at first sight to render it impossible to prevent decomposition of the 

 extravasated blood, since it would be out of the question to attempt to apply 

 carbolic acid to all the emphysematous tissues. But I have long indulged the 

 hope that, the air entering in small successive portions, its floating organisms 

 might be arrested by the first blood with which they came in contact, and 

 remain for some time confined to the vicinity of the external wound, in which 

 case, by squeezing out as much blood as possible from the orifice in the integu- 

 ment, and introducing carbolic acid freely, we might get rid of all causes of 

 decomposition in the limb, the mere atmospheric gases diffused more remotely, 

 however abundant, being entirely innocuous. This hope, it now appears, was 

 not ill-founded. 



John D , aged fifty-five, a calico-printer, of intemperate habits, was 



admitted under my care in the Royal Inlirmary at six p.m. on the 4th of April, 

 1867, having broken both bones of his right leg about an hour before b}' jumping 

 out of a window into the street, from a height of between fifteen and twenty 



