re, such as we meet with in civil practice, whether the
result of direct or indirect violence, a considerable amount of
contusion or laceration, as the case may be, accompanies the injury to
the bone. The result of this is a widespread effusion of blood into the
limb, which tears and strips up the various layers of soft parts, and
opens up the way to the spread of infection, often into the whole
length of the segment of the limb affected. In fractures produced by
bullets of small calibre, even when the exit portion of the track is
large, the injury to the soft parts is far more localised, except in
extreme cases, while the bone itself is the tissue which has suffered
the most severe violence and contusion. When infection occurred, its
spread corresponded with this anatomical feature of the lesion, and the
bone itself and its immediate neighbourhood suffered the most severely.

At the present day one is naturally not very familiar with a large
series of suppurating compound fractures, but during my whole experience
I have never seen so many cases of what might be regarded as fairly pure
instances of acute osteo-myelitis. The symptoms corresponded with the
main seat of the suppuration; only moderate swelling of the limbs
occurred, this mainly consisting in soft superficial oedema; often
there was no redness, and fluctuation was difficult to determine. At the
same time symptoms of constitutional infection, such as continued fever,
rapid pulse, restlessness, loss of strength, progressive anaemia, and
emaciation, were marked. Pyaemia, as evidenced by secondary deposits,
was, however, rare; I only saw two cases, both in fractures of the
femur; in both recovery followed secondary amputation.

_Prognosis._--This depended almost entirely on the nature of the injury
to the soft parts; given moderate injury to these, and the preservation
of the wound from infection, scarcely any degree of injury of the bones
precluded recovery, even if this were slow and prolonged. The existence
of perforations scarcely increased to an important extent the gravity of
a wound of the soft parts alone; in fact, this injury could not be
regarded as more severe than an ordinary surgical osteotomy, putting the
risks of infection of the wound under the special circumstances on one
side.

With regard to the functional results, these depended on the degree of
comminution; when this was extreme, union was slow and for a time weak,
and shortening was often