The ' Seat of Election ' 485 



In the lower third of the thigh than through the joint, as all the lym- 

 phatic glands, which may possibly be invaded, are thus taken away, 

 and also the origins of the gastrocnemius, poplitcus, and plantaris, 

 and the bursas about the joint, any of which may be the seat of a 

 secondary and lurking malignancy. 



Amputation at the ' seat ot election' was the favourite operation 

 years ago before the days of Syme in all cases demanding a sacri- 

 fice of the leg. The tibia was sawn just below the tubercle, and the 

 patient went about subsequently upon a kneeling-crutch, the cicatrix 

 being out of the way of all pressure. An improved and cheapened 

 system of artificial legs, and a greater conservatism in practice, have 

 now rendered the performance of this amputation of comparatively 

 infrequent occurrence, and the quaint title almost obsolete. The 

 surgeon now ' elects ' the amputation which involves the least mutila- 

 tion of the limb. 



Method of operation at the seat of election. With the left thumb 

 and index-finger the operator marks two spots on the sides of the 

 leg, two inches below the level of the tubercle, and from them he 

 shapes out liberal convex flaps of skin in front and behind. The 

 muscles are divided straight down to the bones ; the fibula is sawn, 

 and then the tibia, a piece being removed from the sharp crest of 

 the latter bone. The arteries requiring ligation are the anterior and 

 posterior tibial, and possibly the peroneal and some large sural 

 branches. 



THE LEG 



The deep fascia on the front of the leg is thick, and gives origin 

 to the tibialis anticus, extensor longus digitorum, and peroneus tertius. 

 It is attached to the crest of the tibia, and follows the curve of the 

 external tuberosity on to the head of the fibula. Down the latter bone 

 it is attached indirectly by the septa which dip on either side of th'j 

 peroneus longus and brevis. Below it is attached to the malleoli, 

 forming the anterior annular ligament. The upper part of this 

 ligament is a horizontal band which binds down the extensor tendons 

 of the toes and the peroneus tertius. In addition, the tendon of the 

 tibialis anticus passes beneath it, invested in a synovial sheath. Just 

 below the bend of the ankle there is another, a vertical piece of the 

 annular ligament, under which three synovial sheaths descend, namely, 

 the one already mentioned, around the tibial tendon, a second invest- 

 ing the great toe extensor, and a third for the long extensor of the toes 

 and the peroneus tertius. This lower part of the annular ligament is 

 attached to the inner malleolus above, and to the front of the os calcis 

 below. 



Beneath these ligaments pass also the anterior tibial vessels and 

 nerve, under cover of the extensor proprius hallucis, or, lower do\\n, 



