2o8 ON RECENT IMPROVEMENTS IN THE 



in quantity that the dressing was left unchanged for several days together, 

 when, in consequence of imperfection of the macintosh, the discharge was 

 observed to have soaked directly through the dressing opposite the wound, 

 and, apparently as a result of this, putrefaction had crept in, which soon led to 

 profuse suppuration and hectic, necessitating excision of the hip-joint. 



It is therefore needful to have this material specially prepared to obviate 

 the tendency to adhesiveness. And in all cases a second piece of the macintosh 

 should be at hand, so that when one piece is observed to become impaired by 

 wearing, the other may be substituted for it. 



The macintosh having no antiseptic property except mechanically by its 

 impermeabihty, but, on the contrary, being, like other indifferent materials, 

 covered more or less with septic matter, it is necessary, when the dressing is 

 a compound one, or, in other words, consists of more pieces than one, that the 

 macintosh be well covered in at the place of junction of the two pieces, for if 

 it were allowed to project uncovered in the vicinity of the wound, it might 

 communicate septic mischief. 



As an example of a compound dressing may be given one which, from the 

 frequency of the cases requiring it, is the most important of all — viz. that used 

 after removing the mamma. It consists of two pieces of folded gauze and 

 macintosh, a posterior and an anterior one. The posterior portion is about 

 half a yard square, and reaches vertically from above the acromion to a little 

 below the elbow, and transversely from the spine to the arm, which it envelops 

 as it lies beside the chest, thus forming a complete antiseptic basis for the region 

 of the shoulder, and effectually guarding against what would otherwise be most 

 difficult to avoid, the extension of putrefaction from the bedding through the 

 axilla into the outer angle of the wound. The anterior dressing, though not so 

 broad as the posterior one, is of about equal length, so that when applied to 

 the chest it may reach from some inches beyond the anterior angle of the wound 

 to the posterior dressing, which it joins below the back of the axilla ; and here 

 it is that it is needful to have the macintosh well covered in among the folds 

 of the gauze. The infra-axillary region being the part where the chief discharge 

 occurs, it is of the utmost importance that the outer part of the anterior dressing 

 be maintained well in apposition with the skin, and this is ensured by stuffing 

 a substantial mass of gauze irregularly packed together between the patient's 

 side covered by the dressing and the lower part of the arm. This additional 

 mass of gauze has the further advantages that it serves as a supplementary 

 antiseptic material to absorb the discharge, and that it prevents the arm from 

 being closely pressed to the side — a position which, besides being irksome to 

 the patient, would entail the serious evil of interference with free drainage from 



