COMPOUND FRACTURE, ABSCESS, ETC. 35 



which had of late been rapidly on the increase, and caused a large swelling below 

 Poupart's ligament, communicating with a fluctuating mass, dull on percussion, 

 reaching to a considerable distance up the abdomen, the femoral vessels being 

 raised over the communication between them. Six days ago I opened, in the 

 manner above described, the swelling in the thigh at the anterior part of the 

 limb where it was nearest the surface, giving exit to twenty-seven ounces of 

 pus, thin, but containing numerous large curdy masses. I introduced a piece 

 of lint, dipped in the carbolic acid and oil, into the incision ; and this prevented 

 any discharge from escaping during the next twenty-four hours, when, on re- 

 moval of the plug of lint under an antiseptic rag, three ounces of turbid serum 

 escaped. For the next three days there was scarcely any discharge, the deeper 

 parts of the incision having cohered. On firm pressure, however, the product 

 of seventy-two hours escaped, and amounted to four drachms of serum. Mean- 

 while the girl's general health, which had not been interfered with by the abscess, 

 continued perfectly good, neither pulse, tongue, appetite, nor sleep having been 

 disturbed. 



In this case, though there is no deformity of the spine, there is great prob- 

 ability that caries of the vertebrae is present. But even though such be the 

 case, there is good reason to hope for a favourable issue. Regarding caries 

 as merely the suppurative stage of chronic inflammation in a weak form of 

 tissue, I have been not surprised, though greatly rejoiced, to find that it exhibits 

 the tendency of inflammatory affections generally — viz. a disposition to spon- 

 taneous cure on the withdrawal of irritation. Hitherto, in surgical practice, 

 caries has had to contend against the formidable irritation of decomposing 

 matter, which, under circumstances of weakness, is often sufficient to cause 

 ulceration, even in the soft parts ; yet, in spite of this irritation, caries is often 

 recoverable in the child where the vital powers of all the tissues are stronger. 

 If, therefore, this serious complication can be avoided, there seems nothing in 

 theory against the probabilit}^ that caries may prove curable in the adult. And 

 even should portions of necrosed bone be present, as is not infrequently the case, 

 our experience of the treatment of compound fracture with carbolic acid has 

 taught us that dead bone, if undecomposed, not only fails to induce suppuration 

 in its vicinity, but is liable to absorption by the granulations around it.^ 



Such were the hopes which I ventured to express se\'eral months ago to 

 my winter class. Since that time I have opened numerous abscesses connected 

 with caries of the vertebrae, the hip, knee, ankle, and elbow, and in all cases 

 I liave found the discharge become in a few days trifling in amount, and in 

 many it has ceased to be puriform after the first twenty-four hours. Finally. 



' Sec p. 16 of this volume. 

 D Z 



