ILLUSTRATING THE ANTISEPTIC SYSTEM OF TREATMENT 143 



The dressings were changed entirely on the day after the accident. [In 

 doing this the greatest care is requisite. For the antiseptic injected into the 

 wound on the previous day having been absorbed into the circulation, the 

 extravasated blood, and any portions of tissue killed b}^ the violence of the 

 injury, are as susceptible of putrefaction as if no such treatment had been pur- 

 sued ; and my experience leads me to believe that if, when the dressings are 

 removed, a single drop of serum were to be pressed out by the movements of 

 the limb and then regurgitate into the interior, after being exposed even for 

 a second to the influence of septic air, putrefaction would be pretty certain to 

 occur. The skill required to guard against this risk during the first few days, 

 before the wound has consolidated, used to be a serious drawback to the treat- 

 ment. But the difficulty and uncertainty arising from this cause have been 

 changed to facility and security by a most simple means — the employment of 

 a syringe, the nozzle of which is inserted beneath the margin of the lac-plaster, 

 and, as this is raised, a stream of weak watery solution of carbolic acid (i to 40) 

 is made to play upon the wound till a piece of calico, soaked with the same 

 lotion, has been placed upon it by an assistant, as a temporary securit}' until 

 the plaster is reapplied. Any examination of the wound that may be desired 

 is made with freedom through the transparent solution thrown over it b}' the 

 syringe, the wound being never left for an instant without an antiseptic guard. 

 The cloths outside the lac-plaster adhere to its edges through drN'ing of the 

 discharges which they absorb, and care must be taken in removing them to 

 hold the plaster down over the region of the wound, so that it may not be, even 

 for a moment, dragged up along with them. These details, while essential to 

 success, are, happily, easy of execution.] 



The dressing on the day after the accident and subsequently has differed 

 from that used in the first instance in this respect, that, before applying the 

 lac-plaster, the wound itself was covered with a layer of material designed to 

 protect it from the stimulating and irritating influence of the carbolic acid in 

 the antiseptic stratum. You have often seen this ' protective ' in use in other 

 cases, but I desire now to direct your attention to it more particularly. 



Of all those who use antiseptics in surgery, I suspect that I apply them 

 least to the surface of the wound. After the first dressing, the object wliich 

 I always aim at is to have the material in contact with the exposed tissues 

 approximate as closely as possible to the perfectly bland and neutral characters 

 of the healthy living textures. If you consider the circumstances of a simple 

 fracture, which you cannot too often call to mind if vou wish to keep your ideas 

 clear and riglit upon this subject — if you remember how the severe contused 

 internal wound, with the interstices of the mangled tissues loaded with extra- 



