142 CASE OF COMPOUND DISLOCATION OF THE ANKLE 



since been superseded ; and I have found it, on the whole, better to change 

 the entire dressings occasionally, in the manner to be described in the sequel.] 

 Though the patient was of gouty habit, and in other ways by no means a very 

 favourable subject, his progress was all that could have been desired had the 

 case been one of simple fracture. [Not one drop of pus appeared till, five weeks 

 having elapsed, and a little serous discharge still continuing, the deeper dress- 

 ings were removed for the first time, and disclosed a superficial sore with pouting 

 granulations, which healed in a few days under an astringent lotion.] 



The fourth case was one in which the injury was inflicted by myself, but 

 was of the same essential nature as those caused accidentally, though its effect 

 was to remedy, not to produce, displacement. The foot had been driven back- 

 wards and outwards by the violence which occasioned a simple fracture of the 

 fibula and internal malleolus four months before ; and the faulty position having 

 continued during the union of the fragments, the limb was perfectly useless, 

 and the patient, a young man of twenty-nine, had the prospect of going on 

 crutches for the rest of his life. Relying on our antiseptic means, I did not 

 scruple to divide with pliers the callus of both tibia and fibula, though I knew 

 that in so doing I was opening into the ankle-joint. For the case differed in 

 this important particular from those which result from accident, that I could 

 guard with certainty against the introduction of putrefactive mischief while 

 making the wounds ; whereas in the accidental cases we cannot help feeling 

 a degree of uncertainty till the first few days are over, whether the organisms 

 introduced before we see the patient have been all destroyed, though in truth 

 the method by injection and manipulation which I have described seems to 

 have reduced this to something very nearly approaching certainty. The foot 

 having been drawn forcibly into its proper position by means of pulleys, and 

 retained by appropriate splints, while an external antiseptic dressing was em- 

 ployed on the same principle as the putty and lac-plaster, though of different 

 materials, the wounds became superficial without suppuration and without the 

 slightest inflammation or fever ; ^ and I have the satisfaction of knowing that 

 he, like the other patients, has now a sound and useful foot. 



You see, then. Gentlemen, that I had reason for the confidence with which 

 I expressed myself. 



In a Lechtre on the lyth of February the following remarks were made : — 



The case of complicated injury which we were considering three days since 

 goes on in accordance with our anticipations ; and I wish now to say something 

 regarding its subsequent management and progress. 



' For further details of this case, see p. 72 of this volume. 



