:\IEMBERS OF THE BRITISH MEDICAL ASSOCIATION 273 



The purchase thus secured upon the venous texture prevented the hgature 

 from shpping, and the bleeding was permanently arrested. The healing of the 

 wound has proceeded undisturbed, and cicatrization is, you observe, already 

 almost complete. Here the small part that remains unhealed being entirely 

 superficial, it is no longer needful to use the spray in changing the dressing. 



Another reason that has made me bring this patient before you is, that 

 you may see how the drainage of the axilla was provided for, and this I believe 

 to be a matter of great importance. In all previous cases of this kind, when 

 it was necessary to clear out the axilla, my practice had been to extend the 

 transverse incision made for removal of the mamma, and introduce a drainage- 

 tube at the outer angle of the wound. But if this is done, it will sometimes 

 happen, if the patient be stout, that in spite of the presence of a substantial 

 pad of folded gauze between the arm and the chest, the skin of the fat side 

 and that of the fat arm will come in contact with each other, and the drainage- 

 tube will become obstructed, leading to tension in the axilla, and, it may be, 

 inflammatory suppuration. But here, for the first time, I have got over this 

 difficulty completely, by making a special perforation for the drainage-tube so 

 far back as to be out of the way of the pressure of the arm. Here, you observe, 

 is the place where the tube was inserted, viz. in the angle between the arm 

 (as it lies against the side) and the back. Thus, while you avoid a needlessly 

 long incision, you have the most complete possible drainage, and the result, 

 as you see here, has been very rapid healing. We all know that wounds after 

 removal of the mamma may heal quickh^ and sometimes without suppuration, 

 without any antiseptic treatment at all. But this, I suspect, could not have 

 been an instance of that kind. A large amount of skin implicated in the disease 

 had been removed, so that, notwithstanding the use of button-stitches,^ tension 

 was great ; and if we add to this the presence of the large hollow wound in 

 the axilla, it is not at all likely that under any treatment not antiseptic, healing 

 would have occurred without suppuration, as it has done here. 



The other patient whom I wish you to see, as an illustration of the arrest 

 of venous haemorrhage by means of catgut, will now be brought in. She had 

 long suffered from varicose veins, which you see conspicuous in tlie leg. even 

 in the recumbent position in which she is ; and I was asked to see her on account 

 of haemorrhage that had occurred from a tumour about as big as an orange, 

 which had formed in the ham, the most prominent part being formed of blood- 

 clot. It was evidently composed of a mass of greatly distended veins, one of 

 which had given way by ulceration. The case seemed m-gontl\- to demand 

 interference, and I resolved to remove the mass — a thing which 1 sliould have 



* Sec Lancet, June 5, 1875 (p. 241 of this volume). 



