OF THE ANTISEPTIC TREATMENT IN SURGERY 167 



from swelling, redness, or tenderness. The limb having been washed from 

 bloody stain with a cloth dipped in i to 40 lotion, while the wounds were kept 

 covered with bits of rag wrung out of the same, oiled-silk ' protective ' ,^ dipped 

 in the lotion to give it a temporary antiseptic film, was placed upon each wound 

 to protect it from the stimulating action of the acid in the lac-plaster, which was 

 then wrapped round the limb in two layers, extending several inches beyond the 

 'protective' in every direction, after which the splints were reapplied as before. 



This dressing was left unchanged for two days, after which the patient 

 was again dressed in a precisely similar manner before the clinical class, walking 

 into the theatre and upstairs again to his bed just like a person affected with 

 a simple fracture or dislocation. His pulse was 70, his temperature 98-2, and 

 he was entirely free from pain. The stain on the cloths corresponded to about 

 half a drachm of bloody serum ; the clots remained unaltered in appearance 

 in the wounds, and the limb in the vicinity had still a perfectly natural aspect. 

 Feeling sure that the discharge would now be very slight in amount, I left this 

 dressing untouched till the following lecture, four days later, or just one week 

 after the operation, when the wounds were again exposed before the class. All 

 remained the same, except that while there was no pus, and merely a stain 

 corresponding to a few minims of serum as the product of both wounds for four 

 days, the blood-clots had been extensively^ converted into vascular tissue, while 

 some portions yet unvascularized had assumed a grey or yellowish colour, and 

 in both wounds there was a broad cicatrizing margin. Healing, though under 

 a moist dressing, was going on as under a scab ; or, in other words, putrefaction 

 being excluded by means of an efficient antiseptic guard, while the exposed 

 tissues were protected from the action of the antiseptic salt by the interposition of 

 a layer of unstimulating material, the disturbing influence of external agency was 

 avoided, and we attained very closely to the conditions of a subcutaneous injury. 



On this occasion, instead of the lac-plaster, a folded muslin cloth, of open 

 texture, imbued with a mixture of paraffin, resin, and carbolic acid, was em- 

 ployed to combine the functions of the lac-plaster and absorbing cloth. Hitherto 

 I have been opposed to porous antiseptic dressings, having observed that, when 

 in the form of lint steeped in an oily solution of carbolic acid, the discliarge, 

 if at all free, washed out the antiseptic liquid from among the neutral fibres, 

 and opened a way for the penetration of putrefaction. But, lia\in^ heard 



' This protective is made by varnishing oiled silk on both surfaces with copal varnish, wliich renders 

 it considerably less permeable to carbolic acid, and when dry it is brushed over with a mixture of starch 

 and dextrine to give it a film of material soluble in water, so that it becomes uniformly moistened when 

 dipped into the antiseptic lotion. When it is not at hand, common oiled silk mav be used as a substitute 

 for it, if smeared with an oily solution of carbolic acid, and used in two layers to m.ikc up for its inferior 

 efficiency. [See also pp. 184-5 of 'this volume.] 



