IN THE PRACTICE OF SURGERY 39 



application contains the acid in too dilute a form to excoriate the skin, which it 

 may be made to cover to any extent that may be thought desirable, while its 

 substance serves as a reservoir of the antiseptic material. So long as any dis- 

 charge continues, the paste should be changed daily ; and, in order to prevent 

 the chance of mischief occurring during the process, a piece of rag dipped in 

 the solution of carbolic acid in oil is put on next the skin, and maintained there 

 permanently, care being taken to avoid raising it along with the putty. This 

 rag is always kept in an antiseptic condition from contact with the paste above 

 it, and destroys any germs that may fall upon it during the short time that 

 should alone be allowed to pass in the changing of the dressing. The putty 

 should be in a layer about a quarter of an inch thick, and may be advan- 

 tageously applied rolled out between two pieces of thin calico, which maintain 

 it in the form of a continuous sheet, that may be wrapped in a moment round 

 the whole circumference of a limb, if this be thought desirable, while the putty 

 is prevented by the caHco from sticking to the rag which is next the skin.^ When 

 all discharge has ceased, the use of the paste is discontinued, but the original 

 rag is left adhering to the skin till healing by scabbing is supposed to be com- 

 plete. I have at present in the hospital a man with severe compound fracture 

 of both bones of the left leg, caused by direct violence, who, after the cessation 

 of the sanious discharge under the use of the paste, without a drop of pus appear- 

 ing, has been treated for the last two weeks exactly as if the fracture were a 

 simple one. During this time the rag, adhering by means of a crust of inspissated 

 blood collected beneath it, has continued perfectly dry, and it will be left un- 

 touched till the usual period for removing the splints in a simple fracture, when 

 we may fairly expect to find a sound cicatrix beneath it. 



We cannot, however, always calculate on so perfect a result as this. More 

 or less pus may appear after the lapse of the first week ; and the larger the 

 wound the more likely is this to happen. And here I would desire earnestly 

 to enforce the necessity of persevering with the antiseptic application, in spite 

 of the appearance of suppuration, so long as other symptoms are favourable. 

 The surgeon is extremely apt to suppose than any suppuration is an indication 

 that the antiseptic treatment has failed, and that poulticing or water dressing 

 should be resorted to. But such a course would in many cases sacrifice a limb or 

 a life. I cannot, however, expect my professional brethren to follow my ad\ice 

 blindly in such a matter, and therefore I feel it necessary to place before them, 

 as shortly as I can, some pathological principles, intimately connected not 



* In order to prevent evaporation of the acid, which passes readily through any organic tissue, 

 such as oiled silk or gutta percha, it is well to cover the paste with a sheet of block-tin, or tinfoil 

 strengthened with adhesive plaster. The thin sheet-lead for hning tea-chests will also answer the 

 purpose, and may be obtained from any wholesale grocer. 



