EFFECTS OF THE POSITION OF A PART ON’) Tie 
CIRCULATION "THROUGH TT 
Read before the Harveian Society of London.’ 
[British Medical Journal, 1879, vol. i, p. 923.] 
Mr. PRESIDENT AND GENTLEMEN.—Having been honoured by a request from 
the Council that I would make some communication to this Society, I have 
thought that no subject could be more appropriately brought before an asso- 
ciation connected with the name of Harvey than some observations begun 
several years ago, but hitherto unpublished, regarding the effects of the position of 
a part upon the circulation through it. 
My attention was first directed to this subject fifteen years since, when 
I was engaged in endeavouring to devise a satisfactory method of excising the 
entire articular apparatus of the wrist for the cure of carious disease. In that 
operation, although no large arterial branches are divided, the very protracted 
character of the procedure would render the oozing from small vessels a source 
of serious loss of blood to the patient if it were allowed to go on unchecked. 
Accordingly, I was led to deviate from what was then the ordinary practice 
of restricting the use of the tourniquet to amputation, and employed the instru- 
ment in the excision referred to. And I found that, when the hand was raised 
to the utmost degree, and kept so for a few minutes, and then, while the elevated 
position was still maintained, a common tourniquet was applied to the arm, 
being screwed up as rapidly as possible, so as to arrest all circulation in the limb 
and at the same time avoid venous turgescence, I had a practically bloodless 
part to operate upon, and thus gained the double advantage of avoiding haemor- 
rhage and inspecting precisely the parts with which I was dealing. And, having 
found such great benefit from this bloodless method of operating in the instance 
referred to, I extended it to other operations on the limbs. 
In 1873, I was one day illustrating this subject to my clinical class in 
Edinburgh by raising one of my hands to the utmost while the other was kept 
dependent, in order to exhibit the contrast between them in redness, when 
a sensation of chilliness coming on in the hand that was raised made me feel, 
and at once express, the conviction that something more was occurring than 
* The paper, as now published, embraces some considerations on which I did not enter at the time 
of its delivery, and also some facts subsequently ascertained. 
