MEMBERS OF THE BRITISH MEDICAL ASSOCIATION 267 



up for about three inches at each side ; those parts united bv first intention, 

 and are completely healed. The central part of the wound was left open for 

 the orifices of three large drainage-tubes. And here again we see the persistent 

 blood-clot. Two days ago, I took out for the first time the drainage-tubes, 

 and they were, just as in the case you last saw, lying in tubular moulds in the 

 coagulum. One of them was permanently removed ; the other two were re- 

 introduced after being considerably shortened by cutting portions off from 

 the deeper ends. In taking out drainage-tubes you must be particularly careful 

 to have the spray properly directed. For as the drainage-tube comes out, air 

 must enter to take its place, and this air will be septic or not as the spray is 

 or is not over the wound. Here we see the orifices of the two drainage-tubes, 

 one of which may probabU^ now be dispensed with altogether. As I remove 

 them, you observe the tubular beds in which they lay. And here, as in the 

 last case, we have as yet no suppuration whatever from the open wound. 



The protective must never extend beyond the gauze ; if it did so, by excluding 

 the action of the carbolic acid it would allow putrefaction to spread in under it. 



I should have liked very much to have shown you one other case, but as 

 time does not permit this, I shall mention in brief the miain points of it. The 

 case was one of chronic inflammation of the lower part of the tibia, which had 

 induced great thickening of the bone, attended with severe and constant pain, 

 in a girl eighteen years of age. There was a small sinus present, but scarcely 

 any discharge. Introducing the probe, I found it pass deeply into the substance 

 of the bone. Supposing that there might be some small exfoliation present, 

 I proceeded to explore the bone, detaching the periosteum from the surface, 

 and making an excavation with a gouge and hammer. I found a peculiar 

 state of things pathologically. The chronic inflammation, instead of producing 

 merely a softened state of the bone, had led to a conversion of the osseous texture 

 into granulations. We operated by the bloodless method, and found these 

 granulations almost perfectly white. I proceeded to dig these out, and got 

 into cavity after cavity. At one time I thought the probe had gone through 

 the posterior surface of the tibia, but it proved to have passed into another 

 cavity in the extremely thickened bone. At last I found that the soft material 

 at the lower part of the excavation moved when the foot was moved ; or, in 

 other words, I had opened into the ankle-joint. The result of the whole pro- 

 cedure was a very large and complicated cavity, and it is to the mode in which 

 this cavity has been filled up that I wish to direct your attention. Now, 

 I desired that this should be done by means of organizing blood-clot. If tliis 

 is done it saves a great deal of time as compared witli granulation and healing 

 from the bottom, and produces a more smooth and level scar. As for a long 



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