204 ON ANTISEPTIC DRESSING UNDER 



years of age) was of extreme gravity. The little fellow had been endeavouring 

 to climb up into a luggage-truck, when his right leg became entangled in one 

 of the wheels, and frightfully mangled. The hamstrings and popliteal vessels 

 were torn through, the knee-joint opened posteriorly, the femur fractured in 

 the wound, and the soft parts of the thigh contused to so high a level, that 

 I was obliged, as you observe, to make the anterior flap shorter than usual, 

 and eke it out by extending the posterior flap ; and, in spite of this, a small 

 portion of the anterior flap lost its vitality from being implicated in the con- 

 tusion. Now, there can be no doubt that, under such circumstances, the 

 avoidance of putrefaction in the large wound was a most important condition 

 of his recovery. Considering the state he was in, I believe that, if we had not 

 succeeded in this respect, he would not have been alive before us this evening ; 

 and my reason for bringing him here is, that he affords another striking 

 illustration of the advantages of our present mode of antiseptic dressing. 



Of all incised wounds, those resulting from amputation have been the 

 most difficult to manage antiseptically ; and of all stumps, that at the hip- 

 joint is the worst to deal with. When a stump has considerable length, we 

 have for some time past managed quite satisfactorily by having it enveloped 

 in about eight layers of the gauze, a piece of impermeable tissue, such as thin 

 macintosh cloth,^ being placed beneath the outer layer to compel the discharge 

 to travel throughout the extent of the antiseptic tube formed by the dressing, 

 before reaching the external air. The essential condition of free overlapping 

 of the surrounding skin is thus complied with, while the use of a spray of carbolic 

 acid lotion avoids any chance of the entrance of septic mischief during the 

 changing of the dressing. But in a case like this, such an arrangement is of 

 course impossible ; and we had two special difficulties to contend with. One 

 was the vicinity of the inner angle of the wound to sources of putrefaction in 

 the perineum. This was overcome partly b\^ stitching up the wound very 

 closely at the inner side, and having the ' drain ' (of lint soaked with carbolized 

 oil) projecting towards the outer aspect, so that discharge might be as small 

 as possible towards the perineum. At the same time, the gauze, from its 

 absorbent as well as antiseptic property, was of the utmost value, and, being 

 folded of double thickness at the perineal side, answered the purpose completely ; 

 while in this case, as in the last you saw, the antiseptic quality of the bandage 

 was of peculiar value, every turn round the perineum adding to the antiseptic 

 security. And I may notice here another incidental advantage of this bandage, 

 namely, that the slight adhesiveness which it possesses makes it cling to the 

 part to which it is applied, and prevents the turns from slipping, as those of 



^ This tissue is known by the caoutchouc manufacturers under the name of ' hat-hning '. 



