OF TREATMENT IN SURGERY 75 



mediate contact with the wound may be free from carbohc acid, receiving none 

 from without to compensate for loss by absorption of that which they originally 

 contained, the lower surface of the application becomes, in a day or two, devoid 

 of all antiseptic properties, and the penetration of living germs beneath it would 

 lead to putrefaction there, which would spread to any extravasated blood or 

 dead tissue that might remain unabsorbed in the wound. Rather than run 

 any serious risk of such an occurrence, it would be far better to change the 

 whole dressing every day. For although this would necessitate granulation 

 and suppuration, through the continued action of the acid upon the raw surface, 

 yet the essential object of the antiseptic treatment would be attained ; that 

 object being not the avoidance of suppuration, but the prevention of putre- 

 faction in the wound. It is of great importance to bear in mind this distinction, 

 which, from want of clear ideas regarding the conditions which determine sup- 

 puration, is ver}' liable to be overlooked. A patient may die of poisoning and 

 irritation in compound fracture, from putrefaction of the blood extravasated 

 in the limb, before sufhcient time has passed for any pus to be formed ; and, 

 on the contrary, suppuration may take place in connexion with compound 

 fracture, whether from the action of the stimulating antiseptic on the wound 

 or from the occurrence of abscess in the contused limb independently of atmo- 

 spheric influence, without the patient's life being at all endangered, provided 

 always that antiseptic treatment is perseveringly continued. 



Nevertheless, the advantages of healing by scabbing are so great that it is 

 worth while to endeavour to attain them, and I have been long striving to improve 

 the method of dressing, so as to get rid, if possible, of the attendant risk. A plan 

 which has, in most cases, answered well when the putty has been used, is to 

 make the permanent dressing of two or three layers of lint somewhat larger 

 than the wound, wrung out of a pretty strong solution of carbolic acid in oil, 

 say one of acid to four of oil, and covered with a piece of oiled calico or linen 

 rag extending about an inch beyond the lint in every direction. Over this is 

 apphed a stratum of antiseptic putty, which is changed daily, or once in two 

 days, according to tlie amount of discharge. The blood from the wound soaking 

 into the lint is acted on by the carbolic acid, and changed into a firm substance 

 which consolidates the deep dressings into a crust or scab, and this crust, while 

 sufficiently thick over the wound to prevent the carbolic acid of the putty from 

 penetrating to the raw surface, is so thin at its margins formed by the rag as 

 to be there kept antiseptic through and through. Tlien, in changing the putty, 

 the first thing seen on lifting up its edge is the thin margin of the calico ; and 

 even if this be accidentally raised a little, its antiseptic property prevents any 

 mischief from resulting. The putty is spread on calico, and the calico is applied 



