ON SUBCUTANEOUS SURGERY. 7 



are those of an imperfectly subcutaneous character, such as a 

 case of osteotomy in which the gimlet and chisel are used, and 

 repeatedly introduced, and reintroduced during a prolonged 

 operation. In this class, additional protection would probably 

 be afforded by the addition of the antiseptic method. 



Within the last few months I have been present at two 

 operations for subcutaneous osteotomy, in London, one by 

 Mr. Willett, at St. Bartholomew's Hospital, in which he 

 divided the neck of the femur upon the method recommended 

 by myself; and one by Mr. Croft, at St. Thomas's Hospital, in 

 wliich he divided the shaft of the femur just below the small 

 trochanter, according to Dr. Gant's method ; and the antiseptic 

 method was carefully employed in both these operations, yet 

 deep suppuration occurred in both instances. I have now given 

 a few general illustrations of the subcutaneous law of the i-e- 

 parative process, and have alluded to the exceptional cases in 

 which suppuration occurs, without an}'- fear that the truth of 

 the observations made by Hunter, that subcutaneous wounds 

 seldom inflame, and that wounds exposed to the air commonly 

 both inflame and suppurate, will be doubted by any scientific 

 surgeon. 



We now approach another and extremely interesting part 

 of these inquiries in a scientific point of view, viz., the phy- 

 siology and pathology of the subject in reference first to the 

 modus ojyerandi of atmospheric air in the production of 

 inflammation; and second, the differences observed on micro- 

 scopical examination, in the mode of development of the 

 material effused during the reparative process in subcutaneous 

 and open wounds, corresponding to the differences in the 

 clinical history of these two classes of injuries. The first 

 question is then, how docs the air act in exciting inflamma- 

 tion ? First, is it merely the presence of the air acting, quoad 

 air^ by virtue of its chemical constitution — the action of its 



