ON SUBCUTANEOUS SURGERY. 15 



bj M, Guerin to what lie describes as the " immediate organi- 

 zation." 



The subcutaneous law in its full breadth and practical 

 significance was more fully recognized by M. Guerni than by 

 any other authority, and it is undoubtedlj^ to him that we owe 

 the first attempt to bring together in one grouj^ the facts 

 observed in subcutaneous injuries and subcutaneous opera- 

 tions, and generalizing from the facts presented, to show that, 

 for the immunity from inflammation which they enjoy, and the 

 perfection of the reparative process, such wounds especiallj'^ 

 depend upon the same general law. Although I refuse to 

 admit M. Guerin's claim to originality in the discorvery of the 

 subcutaneous law, which is purely Hunterian, there can be no 

 doubt that for its development and surgical application we are 

 principally indebted to the labors of M. Guerin. 



If time permitted, it would be interesting here to pass in 

 review, perhaps in chronological order, the surgical operations 

 performed on the subcutaneous principle, but they are too 

 numerous to admit of this, and I will, therefore, merel}'^ refer 

 to the more important and familiar examples, such as subcu- 

 taneous tenotomy, the subcutaneous operations for the removal 

 of loose cartilages from the knee-joint ; a large number of ope- 

 rations in ophthalmic surgery ; the subcutaneous operation for 

 the radical cure of hernia, as well as those for ununited fracture, 

 varicose veins, navi, and also for the obliteration of depressed 

 cicatrices ; the subcutaneous method of opening abscesses and 

 cystic tumors; the subcutaneous division of stricture; and also 

 several operations of a more or less perfectly subcutaneous 

 character, which have been performed in cases of anchylosis of 

 the hip, knee, and elbow-joints, in severe rachitic distortion of 

 the tibia, in severe knock-knee, and some other analogous affec- 

 tions. The last mentioned operations are collectively spoken 

 of as subcutaneous osteotomy, and with very few exceptions 

 Shcy have proved to be as safe as subcutaneous tenotomy. 



