AND HORSEHAIR AS A DRAIN FOR WOUNDS 445 



performed antiseptically, in order to avoid the very serious iniiammator}' dis- 

 turbance and suppuration wluch are otherwise apt to occur. I had previously 

 used the caoutchouc tube as a drain in such a case, but I found a difficulty from 

 the liability of the tube to be compressed by the tendons. This might, I thought, 

 be overcome by the use of the horsehair drain, which at the same time would, 

 for this particular purpose, be superior to one of catgut, because the catgut 

 would probably be absorbed before the necessity for drainage would be over. 

 Accordingly I cut down above the wrist, making my way between the tendons 

 of the flexor sublimis to the distended sheath of the flexor profundis, and, as 

 soon as this was opened, passed in a large bullet-probe, somewhat curved, slipped 

 it along under the annular ligament, and pressed it forcibly towards the palm, 

 so as to perforate the palmar fascia while avoiding injury to the palmar arch, 

 and, having divided the skin over the point of the probe, dilated the opening 

 in the fascia with dressing-forceps, and then passed into the eye of the probe 

 a substantial drain of horsehair, which had been well purified by steeping in 

 a I to 20 solution of carbolic acid, and withdrew the probe, leaving the horsehair 

 drain in its track. The drain answered admirably, and presented the further 

 great advantage that it could be reduced in bulk in accordance with the diminu- 

 tion of the serous discharge, by drawing out as many hairs as miglit be desired ; 

 and in the course of three weeks, the last portions of the drain having been with- 

 drawn, the wound healed without the occurrence of suppuration from first to last. 



While the horsehair has the advantage over the catgut that it can be 

 used when necessary over a longer period, it has, in some cases, the converse 

 superiority that it can be not only reduced in bulk, but withdrawn altogether 

 at an earlier period than is required for the absorption of the catgut : for the 

 catgut, in process of organization and absorption, becomes more or less 

 incorporated with surrounding tissues through the medium of the cells of new 

 formation which invade it, and, if an attempt is made to withdraw the drain 

 in whole or in part, there will often occur inconvenient oozing of blood through 

 the rupture of newly formed vessels. And if, on the other hand, the drain 

 is left intact till the parts of the catgut within the wound are entirely absorbed, 

 there remains a small granulating sore at the place of exit of the drain, which 

 may retard for some days the complete healing of the wound. Further, the 

 threads of the catgut, as they undergo organization, are increased in bulk by 

 the formation of the new cells, and their intei'stices are liable to be more or less 

 choked, so as to interfere with effective drainage. The horsehairs, on the other 

 hand, lie unchanged among the tissues, and their interstices remain to the last 

 as effective as they were at the outset. 



The next case in which I used the horsehair drain was one which you your- 



