272 DEMONSTRATIONS OF ANTISEPTIC SURGERY BEFORE 



with the loose tissue about them, should be detached with the fingers, and any 

 considerable-sized venous branch tied before it is cut. 



[If the incision is carried parallel to the margin of the pectoralis major 

 to near its insertion into the humerus, and the integument is raised a little 

 from the edge of the muscle, and also freely dissected backwards to the fold 

 of the latissimus dorsi, there will generally be obtained satisfactory access for 

 dealing in this manner with glands situated even at the apex of the axilla ; the 

 pectoralis being drawn well forward, when necessary, by means of a copper 

 spatula. If, however, the space thus obtained is not sufficient, whether for 

 the removal of glands in that situation, or for the arrest of haemorrhage there, 

 the skin should be at once dissected up from the pectoralis, and the muscle 

 divided transversely from the margin towards the collar-bone to any degree 

 that may be requisite. When I first adopted, seven years ago, the practice of 

 systematically clearing out the contents of the axilla, I divided both pectoral 

 muscles in all cases (the pectoralis major only partially), and though I have 

 since found that this is not generally necessary, yet the experience of the earlier 

 cases was valuable, by showing that the division of the muscles, though it appears 

 a severe procedure, does not seriously complicate the operation, either as regards 

 its performance or its ultimate results. The arm being kept bound to the side, 

 the divided muscles unite quickly, and the patient gives, in time, the best 

 evidence that their functions are not materially impaired by being able ' to do 

 her back hair ' .] 



In the present case, one of the glands was so very close to the vein that, 

 as I was endeavouring with the fingers to detach it, a venous branch broke 

 at its origin from the axillary, the result being an aperture in the venous trunk 

 about an eighth of an inch in diameter. I seized the opening in the vein with 

 catch-forceps, and put a catgut ligature upon it, but the thin slippery tissue of the 

 venous coat slipped from the grasp of the knot. I made a second similar attempt, 

 and again the same thing occurred. What was now to be done ? Without 

 antiseptic treatment I should have been a good deal at a loss. To have obstructed 

 the main vein of the limb by tying it across like an artery, would have been 

 most undesirable ; and to have introduced a pad of lint into the wound, to 

 compress the orifice, would have been very unsatisfactory practice. 



I did, however, what I had long contemplated doing, if such a circumstance 

 should arise. All flow of blood being temporarily stopped by pressure on the 

 vein to the distal side, I threaded a fine sewing-needle with the finest catgut, 

 and passed it through the coats of the vessel at opposite points of the wound, 

 and at a short distance from its edges, and then, cutting off the needle so as 

 to leave two threads in its track, tied one thread round each half of the wound. 



