274 DEMONSTRATIONS OF ANTISEPTIC SURGERY 



hesitated in doing without antiseptic measures, as I felt sure that I should 

 open into large varicose veins. Such proved to be the case, as you see from this 

 preparation of the part removed. On section, the most prominent portion 

 is shown to be composed of coagulum, while the deeper surface presents numerous 

 large vessels. They have shrunk a good deal since they were removed, but 

 when the operation was performed they were almost as thick as my little finger. 

 And now we have to speak of how the veins, which lay open in the wound, were 

 dealt with. Some of them presented transverse orifices, but others had been 

 divided more or less longitudinally. I tried, by detaching the veins from the 

 surrounding parts, and clipping away some portions, to get the vessels to present 

 themselves in transverse section, so that I might tie them with catgut in the 

 ordinary way ; and in most instances this was satisfactorily accomplished. 

 But there was one large vein presenting a longitudinal slit about five-eighths 

 of an inch in length, so connected that I could not readily deal with it as with 

 the others. I therefore adopted a practice which will, I believe, prove a valuable 

 addition to our resources, in wounds of large venous trunks. Using a very fine 

 sewing-needle and finest catgut as before, I sewed the two lips of the wound 

 together by continuous or glover's stitch ; leaving the calibre of the vessel 

 intact. Now, I do not think any man would have been justified in doing that 

 with ordinary silk or cotton without antiseptic measures. To do so would 

 have been to run imminent risk of suppurative phlebitis and pyaemia. But by 

 proceeding antiseptically we incurred, as I believed, no such danger, and the 

 result is, as you see, so far satisfactory. It is now three days since the wound 

 was dressed last, and five days after the operation. The discharge of the three 

 days has caused, you observe, a merely trifling serous stain upon the gauze. 

 And there is entire absence of any inflammatory disturbance. In performing 

 the operation, the skin having been very thoroughly washed with i to 20 carbolic- 

 acid lotion, I took care to cut wide of the tumour, so as to keep clear of the 

 putrefactive material on the exposed clot ; but though a considerable portion 

 of skin was thus taken awa}^ I was able, by dissecting up the integument a little 

 at each side, to free it so that its edges could be brought together closely by 

 suture, except at the spot selected for the insertion of a small drainage-tube. 

 You see the blood-clot still lying at this spot, while the stitches retain their 

 places without any suppuration about them. [Healing afterwards proceeded 

 to its completion, without gaping of the wound or any other untoward circum- 

 stance. It should be mentioned, that bloodlessness of the operation was pro- 

 vided for by encircling the thigh with a constricting elastic band, after emptying 

 the limb of its blood by keeping it elevated for a few minutes in the vertical 

 position. 



