2i8 ON RECENT IMPROVEMENTS IN THE 



It is impossible to exaggerate the importance of drainage-tubes. In 

 abscesses they must be employed till the cavity is completely closed ; and in 

 wounds not only are they invaluable during the first twenty-four hours, when 

 the irritation caused by the action of the antiseptic on the tissues during an 

 operation renders the flow of bloody serum more free than it would be without 

 antiseptic management ; but when the wound is of any considerable depth 

 they should be used so long as even trifling serous oozing continues. For if 

 the outlet proves insufficient for the free escape of the plasma still effused into 

 the interior, the fluid, accumulating in the cavity, gives rise to tension, and 

 hence to inflammatory disturbance, which may lead to suppuration and more 

 or less opening up of the wound. 



As an illustration of the value of drainage-tubes in the later stages of the 

 treatment of wounds I may take a case of popliteal aneurysm in which I tied 

 the femoral artery last summer. The patient, a man thirty-eight years of age, 

 who had been a soldier, was admitted into the Royal Infirmary on the i6th of 

 June, with a swelling about as large as an orange in the left ham, with expansile 

 pulsation and thrill, and other signs of aneurysm ; and he stated that the swelling 

 had appeared suddenly five months previously, as he was sitting with his legs 

 crossed, accompanied by a throbbing sensation, which had since continued to 

 increase. The left leg was very weak, and was occasionally affected with darting 

 pains, and the foot was somewhat oedematous. He had a worn, cachectic 

 aspect, and the stethoscope indicated the presence of valvular disease of the 

 heart, both at the mitral and the aortic orifice. Believing that, brilliant as 

 are the results often obtained by compression, the patient's interest will on the 

 average be best consulted by at once tying the femoral artery antiseptically, 

 provided that the catgut be thoroughly trustworthy, and that the operation 

 and after-treatment be really so conducted as to secure absence of putrefaction 

 in the wound, I applied a ligature on the 24th of June, turning aside the edge 

 of the sartorius so as to gain access to the vessel four inches and a half below 

 Poupart's ligament, the situation which Mr. Syme used to advise in order to 

 ensure a sufficient distance of the point of deligation from any considerable 

 arterial branch ; though indeed the antiseptic treatment seems to render this 

 consideration of comparatively little importance, a fact which this case itself 

 will be found to exemplify. The catgut employed was more substantial than 

 that commonly used for tying vessels in wounds, being rather more than one- 

 fiftieth of an inch thick. It had been prepared by myself more than a year 

 before b}^ the method described elsewhere,^ and as the quality of the gut improves 

 the longer it is retained in the preparing liquid, I knew that this specimen was 



^ See Holmes's System of Surgery, second edition, vol. v, p. 622. 



