OR MADNESS. 287 



also owns some disadvantages. A skilful surgeon, therefore, 

 will bind himself to neither, but will use the one or the other 

 as occasion suits, or will often unite them in the same opera- 

 tion. The partizans for the use of the knife argue, that the 

 operation of excision is quicker, and can be applied more ex- 

 tensively. It is certainly, where much is to be done, more 

 quickly performed ; but when it is so done, unless perfect 

 ablution has removed all surrounding virus, may not the 

 very instrument which is to insure life be sowing the seeds 

 of death, by making a fresh morbid inoculation at every 

 section? To prevent this, therefore, when excision is ab- 

 solutely necessary, it is prudent, after every stroke of the 

 knife, to wipe the blade carefully. Towards animals, parti- 

 cularly of the larger kinds, where despatch is requisite, and 

 where deformity and a destruction of parts are not of so much 

 consequence, excision may be considered preferable. In the 

 neighbourhood of large blood-vessels, nerves, &c., it is evi- 

 dent that the knife must be used with extreme caution, 

 whereas the caustic may be applied freely with much less 

 fear, as the eschar which starts up protects the parts under- 

 neath, and enables them to reinstate themselves previously to 

 sloughing, if they should be slightly injured. 



The flow of blood, during excision, is very apt to obstruct 

 a proper and clear view of the extent of the injury, and a 

 consequence follows which I have frequently witnessed among 

 surgeons in operations on the human subject *, which is the 



* I cannot help thinking, that surgeons, from fear of the after con- 

 sequences, perhaps to themselves, as well as their patients, commit an 

 unnecessary waste of parts often. I have seen a hite of the end of the 

 finger, and graze of the skin of the knuckle of the same finger, treated 

 not only by an excision of the whole phalange, but also of the meta- 

 carpal bone it adhered to. I was present, also, when an eminent sur- 

 geon, for a moderate puncture of the lip from one tooth only, took out 

 the whole surrounding portions completely through, as in the operation 

 for hare lip. A similar deformity and stricture of lip was thereby oc- 

 casioned through life. I have likewise had many other occasions to re- 

 gret this over caution and free use of the knife. 



