242 



ON RECENT IMPROVEMENTS IN THE 



in contact of their own accord, any number of superficial sutures being added 

 that may seem desirable to keep the edges of the skin in accurate apposition with 

 a view to primary union. 



The larger the surface which the buttons present to the skin the greater 

 is their hold upon it, and the less, consequently, is their liability to glide and 

 allow the wire to cut through the tissues by ulceration. When the circumstances 

 of the wound allow them to be used as large as they are represented in the sketch, 

 as after removal of the mamma, it will probably be found, when they are removed 

 after the lapse of a week or ten days, that the buttons still occupy precisely 

 the same situations that they were originally placed in, the surface beneath 

 them being slightly depressed, but, in consequence of the diffusion of the pres- 

 sure, not ulcerated, and this even in cases in which, a large amount of skin 



having been sacrificed, they have been made to exercise a degree of traction 

 which without experience would seem inadmissible. But much smaller buttons, 

 though less perfect in their action, will often be found of great value in small 

 wounds, as, for example, after the operation for hare-lip, where they take the 

 place of strapping, but work much more effectually and also much more con- 

 veniently, as they leave the cutaneous margins free from compression and open 

 for inspection. Here, indeed, at the upper part of the wound the small size 

 of the buttons is attended with little disadvantage, because, being applied to 

 the alae of the nose in planes nearly perpendicular to the direction of the wire, 

 which perforates the tissue deeply below the septum narium, they cannot glide 

 at all upon the surface, but, retaining their position perfectly, prevent in a very 

 satisfactory manner the stretching of the uniting tissue at the nostril which 

 is so prone to occur under strapping. In this particular situation, therefore, 

 the only disadvantage of the necessarily small size of the buttons is that, their 

 pressure being concentrated on comparatively small portions of the skin, they 



