ON A CASE ILLUSTRATING THE PRESENT ASPECT 

 OF THE ANTISEPTIC TREATMENT IN SURGERY 



[British Medical Journal, 1^71, vol. i, p. 30.] 



A YOUNG man, eighteen years of age, was lately admitted under my care 

 in the Royal Infirmary on account of impaired usefulness of the right arm, 

 resulting from an accident which befell him three months previously, when the 

 handle of a winch, revolving with great rapidity, struck the limb at the posterior 

 aspect, about three inches below the elbow, breaking the ulna and dislocating 

 the upper end of the radius forwards, the lower ends of the bones of the forearm 

 being tilted backwards to a corresponding degree. He at once sought medical 

 aid ; but, strange to say, the nature of the injury was not recognized, and the 

 result was that when I saw him the fragments of the ulna were firmly united 

 at an obtuse angle with each other ; a marked depression existing posteriorly 

 over the seat of fracture, while the head of the radius formed a prominence 

 at the anterior and outer aspect of the joint, being securely maintained in its 

 abnormal position through the connexion of the other end of the bone with 

 the lower end of the ulna. The elbow could not be flexed beyond a right angle, 

 so that he could not put his fingers to his mouth ; and, although the hand could 

 be rotated passively, he was quite unable himself to execute pronation or 

 supination. He also complained that the limb was so weak that he could 

 not lift any heavy object from the ground, and expressed great desire to 

 have this faulty state of matters rectified. 



It was plain that before an attempt at reduction of the dislocated radius 

 could be made with any chance of success, it would be necessary to break again 

 the united ulna. But, considering the length of time that had passed since 

 the accident, and the shghtness of the leverage that could be obtained upon 

 the seat of fracture so near the elbow, it seemed hardly likely that this object 

 could be attained without a cutting operation. And even supposing the bone 

 to give way, I felt it very doubtful whether the dislocation could even then 

 be reduced, both on account of its long duration and because the angular form 

 which the ulna had assumed imphed a shortening of the forearm, wiiich at that 

 late period necessarily affected all its textures. On the other hand, there could 

 be Uttle doubt that, if the ulna were exposed and divided, and if, further, the 

 head of the radius were removed, the limb could be at once restored to its proper 



