ection. The wound should be purified with eusol, and the
surrounding parts painted with iodine. On the whole, it is safer not
to attempt to obtain primary union by completely closing such wounds,
but rather to drain or pack them. To increase the local leucocytosis
and so check the spread of infection, a Bier's constricting bandage
may be applied.

In other respects the treatment is carried out on the same lines as in
simple fractures, provision being made for dressing the wound without
disturbance of the fracture. Massage and movement should be commenced
after the wound is healed and the condition has become analogous to a
simple fracture.

#Question of Amputation in Compound Fractures.#--Before deciding to
perform primary amputation of a limb for compound fracture, the
surgeon must satisfy himself (1) that the attainment of asepsis is
impossible; (2) that the soft parts are so widely and so grossly
damaged that their recovery is improbable; (3) that the vascular and
nervous supply of the parts beyond has been rendered insufficient by
destruction of the main blood vessels and nerve-trunks; (4) that the
bones have been so shattered as to be beyond repair; and (5) that the
limb, even if healing takes place, will be less useful than an
artificial one.

In attempting to save the limb of a young subject, it is justifiable
to run risks which would not be permissible in the case of an older
person. To save an upper limb, also, risks may be run which would not
be justifiable in the case of a lower limb, because, while a
serviceable artificial leg can readily be procured, any portion of the
natural hand or arm is infinitely more useful than the best substitute
which the instrument-maker can contrive. The risk involved in
attempting to save a limb should always be explained to the patient or
his guardian, in order that he may share the responsibility in case of
failure.

Whether or not the amputation should be performed at once, depends
upon the general condition of the patient. If the injury is a severe
one, and attended with a profound degree of shock, it is better to
wait for twenty-four or forty-eight hours. Meanwhile the wound is
purified, and the limb wrapped in a sterile dressing. Means are taken
to counteract shock and to maintain the patient's strength, and
evidence of infection or of haemorrhage is carefully watched for. When
the shock has passed off, the operation is then performed under more
favourable auspices.