DETAILS OF ANTISEPTIC SURGERY 221 



branch of unusually large size must have taken origin so close to the part tied 

 as to prevent entirely the formation of a superior coagulum ; and it is probable 

 that with an ordinary ligature the case might have terminated disastrously 

 from secondary haemorrhage. Thus we seem to have here an example of the 

 safety of the antiseptic Ugature in the vicinity of a considerable arterial branch. 



But to return to the point which this case is intended to illustrate — viz. the 

 value of the drainage-tube in the later stages of the treatment of wounds. 

 Supposing that instead of substituting a longer tube for the shorter one on 

 the eighth day after the operation, when a little serum was found to have 

 accumulated, I had then given up the use of the tube altogether, the probability 

 is that by the time of the next dressing, the outlet at the integument having 

 become partially occluded by granulation and contraction, a greater amount 

 of serum would have been pent up in the cavity, and that in course of time 

 the additional tension so occasioned would have led to suppuration and to the 

 opening up of the nearly cicatrized wound. 



The effect of an accumulation of serum in keeping up inflammatory dis- 

 turbance, and the usefulness of the drainage-tube combined with antiseptic 

 management under such circumstances, are well exemplified by chronic bursitis 

 patellae, with fluid effused into the sac. The skin being washed with i to 20 

 carbolic lotion, a puncture is made under the spray with a tenotomy knife, 

 sufficient for the introduction of a drainage-tube scarcely larger than a crow- 

 quill, care being taken that it penetrates fairly into the cavity of the sac, which 

 often lies at a considerable depth in consequence of thickening of the membrane 

 and of surrounding textures. The narrow drainage-tube may be readih' inserted 

 by means of a simple modification of the dressing forceps introduced by myself 

 several years ago, but hitherto unpublished. The blades, which are straight, 

 are ground down to the size of a probe at their extremities, as shown in the 

 accompanying sketch (p. 222), so that they can be passed into a very small 

 orifice. This instrument, which goes by the name of sinus-forceps among the 

 Edinburgh instrument-makers, will be found very useful for extracting small 

 exfoliations and for various other purposes. 



The clear fluid contents being all pressed out of the sac. a gauze dressing 

 is applied, and retained in position with a figure-of-8 bandage. The dressing 

 being changed next day, the gauze is found considerably soaked with serous 

 discharge, but, if the tube is acting efficiently, nothing can be pressed out of 

 the cavity. And it will very likely be found that the end of the tube is pro- 

 jecting slightly above the level of the skin, and cannot be pushed in again to 

 its original position, so that it is necessary to shorten it a little. This depends 

 on the fact that, even witliin twentv-four hours of the opening of the sac, the 



