220 ON RECENT IMPROVEMENTS IN THE 



the temperature was normal, and the serous oozing diminishing. Two days 

 later, or six days after the operation, the pain in the limb, of which he had 

 complained at the last dressing, had left him ; but a considerable serous stain 

 being still found on the gauze, the drainage-tube was continued, though shortened 

 by cutting off a piece from the deeper end. Eight days after the operation the 

 cotton-wool was removed for the first time from the leg and ham. The foot 

 was free from oedema, and otherwise natural in appearance, and the aneurysmal 

 tumour had become greatly reduced, being now only a flattened mass about 

 one inch and a half across, free from pulsation. All trace of the jerking pain 

 he had in the limb before the operation had left him, and his general appearance 

 was much improved on what it was on admission. The wound being dressed, 

 the line of incision was found entirely healed, except at the point occupied by 

 the drainage-tube, and the serous stain on the dressing was so much diminished 

 that I reduced the little tube to a quarter of an inch in length, and allowed 

 three days to pass before the next dressing. On then exposing the w^ound, 

 however, I was disappointed to find the serous stain on the gauze fully as great 

 as on the last occasion, and pressure on the skin in the vicinity of the wound 

 caused a drop of clear serum to escape. This had never been seen before, and 

 implied that the shortened drainage-tube had not been answering its purpose 

 completely, but had permitted a certain amount of serum to accumulate ; and 

 slight as this accumulation was, I knew from experience that it was enough 

 to perpetuate serous oozing by the tension which it occasioned. I therefore 

 substituted for the short drainage-tube another of the same calibre, but twice 

 as long — viz. half an inch, being as deep as it could be passed without violence, 

 and dressed again in two days. The result was such as I hoped. There was 

 an almost entire absence of serous stain on the gauze, and nothing could be 

 pressed out of the tube, which was now again slightly shortened. The dressing 

 was then left untouched for four days, when the drainage-tube was found lying 

 out of the wound, having been forced out by the consolidation going on in the 

 interior. There was almost no stain upon the gauze, and nothing could be 

 pressed out of the orifice where the tube had been. It was therefore finally 

 abandoned, and by the 19th of July, twenty-one days after operation, the 

 dressing being changed after an interval of six days, cicatrization was found to 

 be complete, not a drop of pus having appeared from first to last. 



So late as the 13th of July, seventeen days after the operation, or at a later 

 period than that at which a silk ligature applied without antiseptic means 

 commonly separates, pulsation could be felt in the femoral artery as low down 

 as the junction of the middle and lower thirds of the incision ; or, in other 

 words, down to the very site of the ligature. It appeared, therefore, that some 



