72 ON THE ANTISEPTIC SYSTEM 



hy Aid of the Antiseptic System. — A young man, aged twenty-nine, was engaged in 

 mooring a vessel on the nth of December, 1867, when one of the massive ropes, 

 used for the purpose, sUpped and struck him with violence at the outer and 

 posterior aspect of the ankle, fracturing the fibula about two inches above 

 the joint, and breaking off the internal malleolus at its base, driving the bones 

 of the leg forwards and inwards with respect to the foot, or, in other words, 

 producing displacement of the foot backwards and outwards. Four months 

 after the receipt of this injury he came under my care in the infirmar}^ with 

 the heel very prominent and the foot greatly everted, and firmly fixed in its 

 abnormal position by osseous union of the fragments. In this condition the 

 limb was absolutely useless, and the question arose whether anything could 

 be done to restore it. It was clear that the foot could not be replaced without 

 breaking through the ' callus ' which could be plainly felt in both bones, and 

 there seemed no prospect of being able to do this without cutting down and 

 adopting means which, in the case of the tibia, would necessarily involve opening 

 into the articulation, or producing artificially a compound fracture into the 

 ankle-joint. This I certainly should not have dreamed of doing without the aid 

 of the antiseptic system, being well aware of the disastrous course such injuries 

 commonly run under ordinary management. If I had operated at all, I should 

 have made a point of removing the end of the tibia, and even then I should 

 have felt that I was subjecting the patient to some risk. But feeling confident 

 that I had the means of converting a compound fracture into a simple one, 

 I did not hesitate to adopt the following procedure. On the nth inst. (April 

 1868), the man being under the influence of chloroform, I made a curved incision 

 behind and below the prominent end of the tibia ; and, a solution of carbolic 

 acid in about four parts of olive oil being dropped into the wound during the 

 progress of the operation, I detached the soft parts from the bone sufficiently 

 to enable me to insinuate behind the callus one blade of a pair of cutting pliers, 

 smeared with the same oil, and then having placed pieces of lint, soaked with 

 the oil, around the blades of the pliers, so as to prevent the chance of septic 

 air entering the joint when the bone should give way, divided the callus, and 

 at once covered the wound with the antiseptic lint. I then made a longitudinal 

 incision over the seat of fracture in the fibula, and divided it with similar 

 precautions. Having thus overcome the obstacle presented by the bones, 

 I proceeded to draw the foot towards its proper position by pulleys acting upon 

 its outer and posterior part through the medium of a skein of worsted passed 

 round it, while a padded belt supported the opposite aspect of the leg above 

 the ankle : the wounds being kept carefully covered with the oiled lint. When 

 a considerable amount of force had been used there was a sudden sensation of 



