REMARKS ON A CASE OF COMPOUND DISLOCA- 

 TION OF THE ANKLE WITH OTHER INJURIES ; 

 ILLUSTRATING THE ANTISEPTIC SYSTEM OF 

 TREATxMENT 



[Edinburgh, March 26, 1870 (Pamphlet).] 



This case zvas first alluded to as follows in a Lecture delivered on the ij^th of 

 February 1870 : — 



The next case, Gentlemen, which I wish to bring under your notice, is 

 that of a labourer thirty years of age, who was seriously injured on a railway 

 three days ago. He was standing on the line, about a mile out of Edinburgh, 

 at 6 a.m., when he suddenly saw an engine close upon him coming at considerable 

 speed, and he had only just time to turn half round before it struck him on 

 the left shoulder and hurled him to the ground between the rails. On recovering 

 consciousness, he found himself unable to walk ; but about half an hour later, 

 his cap having been discovered above the buffers of the locomotive, the men 

 in charge of the engine went in search of the owner, and, finding him Iving 

 helpless, conveyed him to the infirmary. When I saw him about 8.30 a.m., 

 he was suffering considerably from shock ; and he feared, from severe pain 

 which he felt in his chest, that he had received some serious internal injury — an 

 apprehension which has happily proved groundless. I found the left foot much 

 displaced inwards, and the external malleolus protruding through a vertical 

 wound in the integument two or three inches in length. The tip of the malleolus 

 had been broken off, and remained attached to the external lateral ligament ; 

 while the extremity of the protruding part was comminuted. The internal 

 malleolus was of course fractured, as a necessary condition of such a displace- 

 ment of the foot. Now, Gentlemen, if you were experienced surgeons, vou 

 would know that this was a most formidable injury. Recoveries from it were 

 formerly exceptional. Mr. Syme informs me that at one time, on looking into 

 the hospital records, he found that the last fourteen cases of compound dis- 

 location of the ankle admitted into the infirmary had all ended fatally. He 

 therefore came to regard amputation at the ankle as the best treatment in 

 most cases ; though he sometimes modified his practice so far as to content 

 himself with removing the end of the tibia, so converting the case into one of 

 excision of the ankle. 



In our patient, however, neither of these procedures has been adopted. 

 For the purpose merely of facilitating the return of the protruding malleolus, 



LISTER II 



