140 CASE OF COMPOUND DISLOCATION OF THE ANKLE 



spending to that of the metalhc suture, over which the suppleness of the thread 

 gives it a great superiority.] When all had been stitched up, each wound was 

 once more injected with the strong watery solution, to correct any mischief 

 that might possibly have been introduced by regurgitation of blood that had 

 oozed into the cavity during the insertion of the stitches. A well-overlapping 

 cap of lac-plaster, in double layer, was then applied, surrounded by a cloth to 

 absorb discharge, secured by bandage and pins. 



I cannot too strongly impress upon you the importance of having the 

 plaster extend freely beyond the wound at every part, so that the discharge 

 may have to travel a considerable distance beneath the impermeable antiseptic 

 layer before reaching the sources of mischief externally. It is only in this way 

 that you can guard securely against the spread of the putrefactive fermentation 

 into the wound. Yet there is nothing in the antiseptic treatment that I find 

 more apt to be neglected. 



After I had left the patient. Dr. Cleaver [the house surgeon] discovered 

 a compound fracture of the right olecranon. The patient thinks he must have 

 fallen upon his elbow ; and in this he is no doubt correct, the fracture having 

 been thus caused by direct violence. The wound was not large (about an inch 

 in length), but, from the relations of the bone, it necessarily communicated 

 with the articulation. Here, then, was another injury, in itself sufficiently 

 serious — a compound fracture into the elbow-joint. This Dr. Cleaver treated 

 in a manner similar to that in which I had dressed the ankle, and applied an 

 anterior splint to maintain extension of the elbow. 



Now, Gentlemen, I do not hesitate to say that if our antiseptic means 

 succeed as such — that is to say, if putrefaction is prevented from occurring in 

 the wounds — neither of these severe injuries, the compound dislocation of the 

 ankle, the compound fracture into the elbow-joint, nor the scalp wounds expos- 

 ing and injuring the bone, will occasion either local or constitutional distur- 

 bance. You may perhaps think me bold to speak in this confident way at so 

 early a period of the case, at the beginning of the fourth day, the very time 

 when, under ordinary treatment, the region of the ankle would be red, swollen, 

 and painful, preliminary to suppuration, and the pulse rising, with other indica- 

 tions of increasing fever. But the progress of the patient already goes far to 

 justify me. All the injured parts are as yet in a perfectly quiet state, his pulse 

 is daily descending, his tongue is clean and moist, and he relishes his food, and 

 complains of no pain whatever, except that of the contusions of his chest and 

 shoulder. You cannot suspect me of exaggeration, for you have only to go to 

 the patient's bed and inquire for yourselves ; and any of you who are disposed 

 to witness the dressing will see it done to-morrow at the visit hour. 



