76 ON THE ANTISEPTIC SYSTEM 



next to the deep dressing, to prevent adhesion, while the external surface of the 

 putty is covered either with thin block-tin or sheet-lead, or, what more recently 

 we found to answer quite as well, gutta-percha tissue, which, though it permits 

 carbolic acid to escape through it, is not objectionable on that account if the 

 putty be sufficiently thick, while the gutta-percha, like the metallic plate, pre- 

 vents the putty from becoming dry and hard. The putty is made to overlap 

 the permanent dressing well on all sides, and I may remark that, whether the 

 impermeable antiseptic guard be composed of putty or not, it is of the utmost 

 importance that it should extend freely beyond the source of the discharge 

 in every direction, so that the putrescible fluid may have to flow for some dis- 

 tance beneath it before it reaches the atmosphere or any dressing containing 

 active putrefactive organisms. The degree of overlapping of the crust by the 

 external dressing must vary according to the amount of discharge which may be 

 anticipated. When this is large, it should be to the extent of three or four 

 inches. Failures have undoubtedly often occurred for want of attention to 

 this essential point. 



But though this method will, with proper care, generally succeed/ it would 

 be very desirable, if possible, to get rid of the trouble involved in it. At one 

 time I hoped this might be done by means of the plaster above mentioned, by 

 employing a layer of it instead of the calico as the upper part of the permanent 

 dressing, so that the adhesiveness of the emplastrum might keep the whole 

 deep dressing securely applied to the skin, except at limited spots where the 

 discharge might ooze out ; another layer of plaster being used instead of the 

 putty, with calico moistened with a watery solution of the acid interposed to 

 prevent adhesion of the two layers of plaster. My anticipations, however, 

 have not been verified in this respect. For the plaster, though it answers 

 extremely well for an external antiseptic guard, whether in compound fracture, 

 incised wounds, or abscesses, has proved unsuitable for the permanent dressing. 

 The substance of the emplastrum becomes softened by the solution of carbolic 

 acid used to moisten the calico, and permits it to enter beneath it and soak 

 into the lint below, and stimulate the raw surface to granulate and suppurate, 

 and this was what occurred in the case of displaced foot above mentioned. 

 At the same time the lint is kept moist, instead of forming a dry crust, and 

 hence it may gradually shift its place along with the plaster that covers it, 

 involving the risk of leaving the wound insufficiently overlapped, if not exposed. 



* For an admirable example of success with this method, the reader is referred to the Lancet, 

 August 29, 1868, where Mr. Cresswell, of Merthyr Tydvil, reports a case of gunshot- wound of the 

 femur, shattering the trochanteric region and neck of the bone ; the wound by which the ball entered 

 posteriorly and that in the groin by which it was extracted by incision, both healing completely by 

 scabbing, under a crust of oiled lint, covered with antiseptic putty, daily renewed. 



