Harveian Lectures on the Prognosis and Treatment of Chronic Diseases of the Chest in Relation to Modern Pathology
Authors: J. E. Pollock
Journal: BMJ (1881)

THE BRITISH MEDICAL 7OfUkNL.--I87contact with the living tissues for a very small part near the skin.This small part was eroded, while the remainder, steeped in the serum, was only softened at the termination of the tenth day.A puncture was then mnade in the most dependent part of the sac, the drainage supplied being so free as to permit the coalescence of the sides of the cavity, when the tube, which had not hitherto undergone absorption, became absorbed in four days.In another case, there was a slight depression in the limb of a patient, at the bottom of which a granulating surface existed, which discharged pus.On this granulating surface, a -small portion of drain- age-tube was laid.It was found that the tube was covered with pus after the lapse of six days.The tube generally wa^, softened; but the only part which was eroded was that which lay on the granulating surface.These illustrations are sufficient to show that these tubes do not disappear by the chemical action of the secretions, kept at the tempera- ture of the human body; but that they must be placed in contact with living tissue before they disappear, the leucocytes absorbing them.In order to aid the observations of the behaviour of carbolised chicken-bones while in contact with the tissues, a small part of the tube was made to project beyond the lips of the wound.By-and-bye, this projecting portion was eaten through, and then dropped off; while the tissues closed over and absorbed the remainder.Tubes have been inserted into abscesses from which the pus has been thoroughly eva- cuated.When next looked at, fourteen days later, the portions of the tubes which projected from the wound were found detached, lying in the former opening ; while a white ring, enclosed in granulation-tissue, marked the seat of the decalcified-bone ; and, finally, the epithelium covered both from sight.As a rule, however, especially when the tubes were originally threaded with hair, their calibre generally diminished, from pressure on their walls and from the penetration and coalescence of the tissues through the apertures made in them ; so that the decalcified tubes, having served their purpose, were slowly removed by molecular activity.The tissues have in this way, so far, the control of their drainage.The greater the normal molecular activity, the more quickly will the wound heal, and the more quickly will these tubes be absorbed the weaker the vitality, the longer will the healing process take, and the longer will the drainage-tube remain.Butont and other Sdulres.-Regardingbutton-sutures, you are aware of the various kinds already in use.The objection to these is, that they have one aperture in the centre, through which a wire is drawn, and which is then fixed to a catch on one or other side of the button, thereby tending to tilt the button sideways, and so bruise the tissue with its border.This can be obviated by using the button which I show you, and which is in constant use in my wards.It has a couple of apertures, placed very near to one another in the centre, and a double thread is brought through these apertures and tied-so that the pressure comes from the centre of the button, and the wires or threads may be tightened or relaxed without tilting the edge.They are easily adjusted.