262 DEMONSTRATIONS OF ANTISEPTIC SURGERY BEFORE 



me fear that putrefaction had occurred. This, however, I felt confident could 

 not have been the case, and another probable explanation suggested itself. 

 The peculiar bulging above alluded to, situated over one of the pouches of the 

 synovial capsule beside the ligamentum patellae, had tempted me to make the 

 opening in that situation ; but the bulging part collapsing on escape of the 

 fluid, the only way in which I could ensure complete introduction of the drainage- 

 tubes into the joint was by passing their ends under the ligamentum patellae ; 

 and I thought it not unlikely that they might have been compressed, and their 

 function so interfered with. Accordingly, on changing the dressing, I found 

 that the gauze presented a bloody stain, which appeared sufficiently accounted 

 for by oozing from the surface of the wound, while the joint was fully distended. 

 And it appeared that the disturbance to which the articulation had been sub- 

 jected had led to unusually rapid effusion from the synovial surface, and this 

 being unable to escape, had produced great tension, attended with pain and 

 fever. I at once placed him under chloroform, and made a fresh incision at 

 the outer side of the limb into the pouch above the patella, and introduced a 

 drainage-tube larger in diameter than the little finger, after pressing out the 

 clear serous and fibrinous contents of the capsule. This was of course done 

 with antiseptic precautions, and a dressing like that employed the day before 

 was applied. The result was that almost immediately after awaking from the 

 chloroform sleep, he felt himself entirely relieved of his pain ; and not only has 

 that which was induced by the first operation left him, but he has entirely lost 

 that which had annoyed him for so long a period previously. The temperature 

 in the evening was found to have fallen to 99° Fahr., and has since remained 

 normal, and the discharge, which has continued to be merely serous, has so 

 diminished in quantity, that when I last saw him (August 15) I substituted 

 a drainage-tube of medium size for the large one, and was able to direct that 

 an interval of three days should be allowed to pass before the next dressing. 

 I must add that he has tested the limb, contrary to orders, by getting out of 

 bed and resting his weight upon it, but without any of the pain which he formerly 

 experienced on so doing. In all other respects he is in perfect health. 



It happens, by a curious coincidence, that another patient requiring the 

 same operation has since been admitted under my care in the infirmary ; a man 

 twenty-six years of age, who, six days before admission, observed a painful 

 swelling in the left knee, without assignable cause, and both pain and swelling 

 had since steadily increased. The skin, however, was free from redness, and, 

 subacute as the case was, I hoped that entire rest, with efficient fomentation, 

 would relieve him. On the contrary, pain continued to increase during the 

 next five days, while the temperature rose above 100° Fahr. ; and on the nth 



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