ON RECENT IMPROVEMENTS IN ANTISEPTIC SURGERY 207 



the apparatus, modified to adapt it for our purpose, being both self-acting and 

 self-directing, so as to dispense with the services of an assistant. But in this 

 case the water of the condensed steam dilutes the solution with which it becomes 

 blended in forming the spray, so that it is needful to use a larger proportion of 

 the acid. In the machines hitherto constructed, one part of water is consumed 

 by ebullition for three parts of solution sucked up to mingle with it, and thus 

 I to 30 is the proper proportion of the acid in order to form a i to 40 spray. ^ 



As a dressing for excluding putrefactive fermentation from wounds, the 

 antiseptic gauze, which contains in its fibres carbolic acid stored up in common 

 resin, which is of course insoluble in the discharges and holds the acid with 

 great tenacity, has continued to prove thoroughly trustworthy if properly 

 used ; so that, provided always we have the essential condition of a sufficient 

 space of skin in every direction from the wound for the gauze to cover, we may 

 be quite sure that a wound left free from the causes of putrefaction when dressed 

 will be found similarly aseptic when we change the dressing — a fact which no 

 one, perhaps, who has not gone through the labours and anxieties which have 

 fallen to my lot in striving after its attainment can fully appreciate. Under 

 ordinary circumstances we still use the gauze in eight layers, with a sheet of 

 some trustworthy impermeable tissue placed beneath the outermost layer to 

 prevent the discharge from soaking directly through the dressing, for if it did 

 so a copious effusion might wash out the antiseptic from the part immediately 

 over the wound and putrefy within twenty-four hours. The most durable 

 and therefore most reliable material for the purpose, consistent with the requisite 

 lightness, is a fine cotton cloth with a thin layer of caoutchouc on one side, 

 known in the shops as hat-lining or thinnest macintosh. This, if of good 

 quality, may be used for the same case for weeks together. But, unless parti- 

 cular care is taken with its manufacture, the caoutchouc layer tends to adhere 

 in the folds which it acquires from the various altered positions of the dressing, 

 and portions of it may then be torn off when the folds are straightened out, 

 thus destroying the essential property of impermeability ; and if the macintosh 

 be still used in that condition, entire failure of the dressing may result. 



I have just now under my care a case in which I opened antiseptically 

 an abscess connected with disease of the hip-joint, where all went on typically 

 for a considerable time, the discharge being merely serous, and so diminished 



* Different steam spray-producers may differ in this respect in conseiiucncc of slight variations in 

 the relative sizes of the orifices for emitting the steam and lotion respectively. It is therefore right 

 that in every case the actual proportion between the steam and solution consumed should be ascertained 

 by the maker, and stated to the surgeon. In absence of such information the surgeon can readily settle 

 the point for himself by working the spray for a while with given quantities of water in the boiler and 

 lotion in the bottle, and then measuring the amount remaining in each vessel. 



