AND HORSEHAIR AS A DRAIN FOR WOUNDS 447 



I will now expose the limb before you. We take care that this is done 

 under a full cloud of spray. We removed at the last dressings both the stitches 

 of relaxation in tlie shape of tliick wire sutures taking a substantial hold, and 

 the stitches of coaptation, of horsehair, including only the margins of the wound. 

 You observe that cicatrization is almost complete, while there is not the appear- 

 ance of a particle of jnis. The skin is still, as it has been all along, free from 

 inflammatory' blush or puffiness. The child has suffered no more uneasiness 

 than would have been anticipated had forcible extension been practised in a 

 much less severe case,without the infliction of an external wound, and her con- 

 stitutional diturbance has been equally trivial. The position of the limb is even 

 better than at the conclusion of the operation, thanks to the effect of the elas- 

 ticity of a substantial mass of cotton-wool bound down over the knee outside 

 the antiseptic dressing, while we have the satisfaction of reflecting that the 

 bones of the limb have been shortened only by the extent of the abnormal 

 downward growth of the femur ; and I think those of you who have had 

 experience in surgery will allow that it would have been unjustifiable to have 

 aimed at such a result without the use of antiseptic measures. If a joint is 

 excised without such means, all prudent surgeons would agree that enough of 

 the bones ought to be removed to ensure absence of tension. 



On raising the limb, I find that the gauze dressing presents evidence of 

 discharge, which, though of the nature of colourless serum, is still in sufficient 

 quantity to make it prudent to retain the drain. We may, however, remove 

 half of what yet remains, and you observe that I do this by withdrawing 

 successive hairs without causing the least uneasiness to the child. 



Allow me to direct your attention to the splint on which the limb is placed. 

 It is a piece of Gooch's splint, a material introduced into surgery by Mr. Gooch, 

 formerly a surgeon at Norwich, and exceedingly convenient for purposes like 

 the present. It is made slightly longer than the limb, and as broad as the 

 semi-circumference of the thigh, cut obliquely at its upper end to correspond 

 to the line from the perineum to the great trochanter, and at its lower end it 

 is excavated into a horseshoe to receive the point of the heel. Its flexibility 

 in the transverse direction permits it to form a trough which is well padded with 

 a substantial folded sheet made thicker opposite the tendo Achillis, and when 

 it is bandaged to the limb, the horns of the horseshoe, together with the padding, 

 form a satisfactory support to the sides of the ankle. The foot is kept slightly 

 above the level of the groin, and a piece of thin macintosh cloth over the ]^art 

 of the })adding towards the nates sheds the discharge and prevents it from 

 soiling the padding, while the exact quantity of effused serum can be correctly 

 estimated. In the course of a short time, when the discharge becomes trifling 



