APPLICABLE TO WOUNDED SOLDIERS 163 



while the deeper layers of the thicker portion over the wound will probably 

 in a few days be destitute of antiseptic, and therefore of stimulating, properties ; 

 hence the oiled silk, though desirable in order to ensure the absence of ' anti- 

 septic suppuration ', is by no means an essential part of the treatment, and if 

 none of it be at hand the procedure may in other respects be conducted in the 

 same way without it. Again, if the surgeon have no gutta-percha at his dis- 

 posal, the risk that would otherwise arise from the permeability of the dressing 

 may be overcome by frequently changing an external antiseptic cloth, or by 

 treating its surface every few hours with the antiseptic oil. 



The changing of the outer cloth will require care in order to avoid raising 

 the edge of the gutta-percha along with it, and so admitting septic air towards 

 the wound. It may be done with perfect security by having the cloth consist 

 of two parts, one covering each half of the gutta-percha, and, as one half is 

 raised, throwing a stream of watery solution (i to 40) with a syringe upon the 

 margin of the gutta-percha, a fresh oiled cloth being at once applied before the 

 other portion of the former cloth is removed. If sufficient time cannot be spared 

 for changing the outer cloth in this careful manner, it will be better for the 

 surgeon to content himself with pouring fresh oily solution upon the exterior 

 of the cloth without disturbing it, taking care that the oil enter well beneath its 

 margins. I would advise that this should be done in preference where a large 

 number of wounded have to be treated by one surgeon. 



The strong oily solution (i to 5) would irritate the skin if used continuously : 

 after the first dressing a solution of half the strength should be employed, and 

 after a few days it may be reduced to i to 20 if excoriation should occur. 



The times of changing the outer cloth, or treating it with fresh oil, should 

 be in accordance with the amount of discharge. During the first twenty-four 

 hours the effusion of blood and serum is necessarily profuse, and it will be well 

 that fresh oil be applied to the outer cloth within twelve hours of the first dress- 

 ing, or even in six hours if there should be unusual oozing. On the second day. 

 also, in the case of a large wound, two dressings in the twenty-four hours will 

 be desirable. After this, if all go well, the discharge will diminish quickly, and 

 a daily renewal of the antiseptic supply will be sufficient ; and when hve or six 

 days have passed, to apply the oil once in two days will be all that will be 

 required. This, however, should be continued after discharge has ceased entireh*, 

 till sufficient time has passed to ensure that the wound has healed by scabbing, 

 or at least has been converted into a superficial sore. 



The earlier the case comes under treatment the greater will bo the j^rospect 

 of success, but even after the lapse of thirt^'-six hours it need not be altogether 

 despaired of. 



