444 ON A CASE OF EXCISION OF THE KNEE-JOINT 



branch or nervous trunk without injuring it, and when at length it is apparent 

 that there is nothing but skin between the instrument and the surface, the 

 tough integument is divided with a knife over the point of the forceps, and the 

 blades being forcibl}^ expanded so as to enlarge somewhat by laceration the 

 opening which has been made in the muscles, or other deeper textures, the 

 drain is seized between the blades of the forceps, and drawn into place. So 

 in the present case the most eligible position for a dependent opening was at 

 the outer aspect of the limb, where the use of a knife would have involved the 

 risk of injuring the external popliteal nerve, or of dividing some articular arterial 

 branch. Any such difficulty was avoided by employing the dressing-forceps 

 in the manner described. 



It is only right that I should mention, when alluding to the horsehair drain, 

 that its use did not originate with myself. We were led to its adoption in the 

 following manner. Mr. Chiene, of Edinburgh, suggested some time ago the 

 employment of catgut as a substitute for the caoutchouc tube. He hoped by 

 this means to provide adequate drainage through capillary attraction, and at 

 the same time, by virtue of the proneness of the catgut to absorption, to do 

 away with the necessit}^ for the withdrawal of the drain from time to time, 

 which there is when the caoutchouc tube is used, whether for the purpose 

 of shortening the tube or substituting a small one for a large. Mr. Chiene's 

 anticipations were to a considerable extent realized. In all cases in which 

 the wound remained aseptic the absorption of the deeper part of the catgut drain, 

 and consequent falling off of the part outside the wound, might be reckoned 

 on as a matter of course ; and in several cases in which the catgut was so used, 

 both b}^ Mr. Chiene and afterwards by myself, the drainage proved adequate 

 and satisfactory. Mr. White, of the Nottingham General Infirmary, afterwards 

 substituted horsehair for catgut ; not because it was supposed to be superior, 

 but because, whereas the prepared catgut is a somewhat expensive article, 

 a horse's tail is a very cheap one. A notice of this use of horsehair was pub- 

 lished by Mr. White's house surgeon. Dr. L. W. Marshall, in the Lancet of the 

 2nd of December, 1876 ; and in the following month it was employed by myself 

 in the Edinburgh Royal Infirmary, in a case of chronic bursitis of the sheaths 

 of the flexor tendons at the wrist, in which it seemed likely to be peculiarlv 

 serviceable. In this affection the bursa is distended both above the wrist and 

 in the palm, the cavities thus constituted being connected by a constricted passage 

 under the annular ligament ; and it is desirable that both the expanded parts 

 should be opened to give exit to the fibrinous concretions which are generally 

 present (varying in size from that of a millet-seed to that of a small bean), and, 

 further, that drainage should be provided for effused serum, the operation being 



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