268 DEMONSTRATIONS OF ANTISEPTIC SURGERY BEFORE 



time past I have done, I systematically placed the protective right across from 

 one lip of the wound to the other, and then stretched the small piece of moistened 

 gauze over, so as to keep the protective flat, in order that the blood-clot might 

 accumulate under the protective, and so fill the wound. But we forgot to 

 arrange the limb in proper position. It was allowed to lie resting on its posterior 

 surface, and on changing the dressing next day I found that a large portion 

 of the blood had drained out of the cavity. The deepest recesses of the excava- 

 tion in the bone were indeed filled with clot, but a great cavity still remained. 

 Well, there was an observation made by my colleague Mr. Chiene not long 

 since that gave me a hint as to how to do in this case. He observed that, having 

 systematically arranged for the formation of blood-clot in a hollow wound, 

 a portion of the blood in his case, as in mine, trickled out, and the blood-clot 

 only partially filled the wound. After the lapse of sixteen days, Mr. Chiene 

 proceeded to ascertain by scratching with the point of a knife whether the 

 blood-clot was organized. He found it was, for blood was effused from the 

 vessels of the tissue into which it had become converted. Dressing was applied 

 as before ; and the remarkable thing is, that this secondary blood-clot, formed 

 on the top of the first, became also organized like the first, producing living 

 vascularized tissue level with the surface of the skin.^ That observation gave 

 me the hint how to deal with this case ; for it showed that if the blood-clot 

 is insufficient in the first instance, we may supplement it by letting fresh blood 

 into it at a later period ; and if the secondary clot became organized in Mr. 

 Chiene' s case, though formed so late as sixteen days after the operation, still 

 more might such an occurrence be expected if the second bleeding took place 

 at an earlier period. Accordingly, three days after this operation had been 

 performed, I took a sharp knife and made a few slight incisions in the sides 

 of the wound. A considerable quantity of blood poured out, and the limb 

 being kept on its side, to prevent it from escaping, the result is that, twenty-two 

 days after the operation, and nineteen days after this secondary procedure, 

 I could show you still a portion of the secondary blood-clot visible, while the 

 greater part of it has given place to granulations. [It may be added, that the 

 patient has lost all her pain from the time of the operation, and that here, as in 

 the case of disease of the foot and in the ununited fracture, there has never 

 been the faintest inflammatory blush around the open wound.] 



Demonstration II — Part I 



Gentlemen. — The first patient I wish to show you to-day presents an 

 illustration of the effects of ligature of an artery in its continuity by means of 



^ See Lancet, July lo, 1875 



