^ THE TONER LECTURES. 



purposes only an eighth of an inch in width. The puncture 

 must always be made at a little distance from the structure to 

 be divided, so that a subcutaneous track exists between the 

 cutaneous puncture and the structure divided. These opera- 

 tions are all governed in their mode of performance, the nature 

 of the reparative process, and their terminations, b}- the same 

 general law, and may therefore be grouped together and spoken 

 of as subcutaneous surgery. 



It must not, however, be assumed that the exclusion of air 

 offers an absolute immunity from inflammation under all 

 circumstances, and independently of the amount of damage 

 done to the deeply seated structures, or of the constitutional 

 condition of the patient. 



When the subcutaneous method is applied to the performance 

 of operations of unusual magnitude, such as division of the 

 neck of the thigh-bone, division of the shaft of the femur or 

 humerus, it would be unreasonable to expect the uniformity in 

 favorable results which follow the subcutaneous division of 

 tendons, because the conditions upon which the safet}'' of the 

 subcutaneous method depends, cannot all be with certainty 

 fulfilled. 



In these large operations the air may be effectually excluded, 

 but the injury to the deeply seated structures may be excessive, 

 either from cutting or lacerating hy the saw ; deep-seated 

 suppuration, therefore, will occasional!}' follow such operations, 

 although the rarity of such a result has astonished every 

 surgeon who has practised such operations. As we recognize 

 the importance of the amount of injur}' inflicted on the dee[)ly 

 seated structures, in addition to the exclusion of air, it will be 

 obvious that much will depend upon the skill of the operator ; 

 and the conditions which must coexist to render tlie subcuta- 

 neous operations exempt from inflammation may be stated to 

 be as follows : — 



1. That the knife and other instruments used be of small size. 



