202 ON ANTISEPTIC DRESSING UNDER 



traction upon the angle of the wound in the axilla. Its ends are attached to 

 pieces of bandage which are tied in a half-knot over the top of the shoulder 

 and then secured to the ends of a padded handkerchief passing under the other 

 armpit, the shoulder being protected from the pressure of the knots by a shield 

 of thick gutta-percha moulded to it. It is three days since the dressing was 

 last changed ; yet it remains perfectly free from putrefactive smell, implying 

 that the antiseptic gauze, which is the essential material of the dressing,^ has 

 answered its purpose well ; and the axilla is a situation that illustrates the 

 perfect manner in which it adapts itself to any irregularities of surface. Between 

 the gauze and the healing sore is interposed the oiled-silk * protective ', to 

 exclude the irritating influence of the antiseptic ; and, in this particular case, 

 the value of the protective is especially marked. For, if it were omitted, not 

 only would the progress of cicatrization be arrested, but, as we have found by 

 experience, the newly formed cicatrix being weak from the traction to which 

 it is subjected by the old scar around, becomes excoriated under the influence 

 of the carbolic acid furnished by the gauze. Under the protective, on the other 

 hand, healing proceeds securely and uninterruptedly. 



In the earlier stages of the case the protective rendered further service, 

 because, being applied next to the raw surface, it prevented the possibility of 

 the granulations coalescing below the caoutchouc band, and enclosing it in 

 a tube of granulation structure. 



You observe how eflicacious the india-rubber band has proved. According 

 to the tightness with which it is tied up, the pressure which it exerts upon the 

 angle of the wound can be precisely regulated, so as to cause continuous ulcera- 

 tion, if desirable ; and thus, so far from the angle of the wound becoming 

 filled up by granulations, the original incision has been, as it were, extended 

 by the ulcerating process considerably beyond its original limits, yet without 

 any pain to the patient ; and you can observe the fibres of the pectoralis major 

 and latissimus dorsi lying bare in the groove which the caoutchouc rod occupied. 

 Meanwhile cicatrization has advanced both on the chest and on the arm almost 

 up to the margins of the groove. The india-rubber rod, as soon as it is removed, 

 is well washed with watery solution of carbolic acid ; and, as caoutchouc imbibes 

 the acid, it becomes itself antiseptic for the time being. The sore having been 

 also washed with the lotion [a solution of one part of the acid in two hundred 

 parts of water is sufficiently strong for the purpose], I now apply a piece of 

 protective dipped in the same liquid, and outside this the rod of india-rubber, 



' This gauze contains carbolic acid stored in insoluble resin among the fibres, with the addition 

 of paraf&n to avoid undue adhesiveness, in the proportions of one part of carbolic acid, five parts of 

 resin, and seven parts of paraffin. 



