36 A NEW METHOD OF TREATING COMPOUND FRACTURE, ETC. 



three days ago — viz. on the 4th inst. (July 1867) — I had the inexpressible happi- 

 ness of finding the sinus soundly closed in a middle-aged man, in whom I opened 

 in February last a psoas abscess, proved to be connected with diseased bone 

 by the discharge, on one occasion, of an osseous spiculum. For months past 

 we had persevered with the antiseptic dressing, although the discharge did not 

 amount to more than a drop or two of serum in the twenty-four hours, well 

 knowing by bitter experience that so long as a sinus existed the occurrence 

 of decomposition might produce the most disastrous consequences ; and at 

 length our patience has been crowned with success. 



Hence I no longer feel any hesitation in recommending the early opening 

 of such abscesses, because, while they remain unopened, the disease of the bone 

 is necessarily progressive, whereas when opened antiseptically, there is good 

 ground to hope for their steady, though tedious, recovery. 



The putty of the strength above recommended, though it generally fails to 

 excoriate the skin, sometimes produces this effect when long continued. In 

 such case it may be reduced in strength so that the oil contains only one part 

 to five or six without disadvantage when the discharge is very small in amount. 



The application prevents the occurrence of cicatrization in the little sore 

 caused by the incision, and perpetuates a trifling discharge from it. Hence it is 

 impossible to judge whether or not the sinus has closed, except by examining 

 it from time to time with a probe, which should be dipped in the antiseptic oil, 

 and passed in between folds of the antiseptic rag. This may seem a refinement, 

 but if we could see with the naked eye a few only of the septic organisms that 

 people every cubic inch of the atmosphere of a hospital ward, we should rather 

 wonder that the antiseptic treatment is ever successful than omit any precau- 

 tions in conducting it. 



The putty used in treating abscesses has proved very valuable in simplifying 

 the treatment of compound fracture, and enlarging the range of its applicability, 

 and also in dealing with incised wounds on the antiseptic principle. But I must 

 defer a notice of these matters to a future occasion. 



