DETAILS OF ANTISEPTIC SURGERY 209 



the outer angle of the wound. In order to prevent the occurrence of bed-sore 

 over the external condyle, a wisp of gauze, twisted and rolled together in the 

 form of a ring, is placed beneath the elbow so as to receive the bony prominence 

 in its hollow. The whole dressing is secured in position by suitable turns of 

 a gauze bandage, which is extremely convenient on account of its lightness, 

 and also from the circumstance that the slight adhesiveness of the material with 

 which it is charged checks the tendency of one turn to slip upon another, so 

 that it is more secure than a common cotton roller, besides the advantage that it 

 increases the antiseptic efficacy of the dressing. But, on account of its loose 

 texture, it cannot be properly fixed by ordinary pins, which would be liable 

 to shift their position in it. Those called safety-pins, made on the principle 

 of a brooch, should therefore always be employed ; for there are cases in which 

 the slipping of a single pin might, by allowing the dressing to shift its place, 

 endanger the life of a patient. 



There is another point in the use of the gauze to which I wish to direct 

 special attention. The very quality which makes this material so valuable as 

 a permanent antiseptic dressing, and renders it both mild and persistent in its 

 effects — namely, the tenacity with which the resin in its fibres holds the carbolic 

 acid — may become a source of serious danger at the time of application. For at 

 ordinary temperatures of the air the antiseptic is given off by the gauze in such 

 extremely small amount that particles of dust falling upon it cannot be expected 

 to be deprived of septic energy by contact with it, as they are by a i to 40 watery 

 solution. Hence, if a piece of gauze is applied dry to a wound communicating 

 with a cavity containing blood, serum, or pus, as in a compound fracture, a stump 

 after amputation, or an abscess, portions of septic material on the surface of 

 the gauze may become mingled with the discharge at the outlet, and. thus 

 shielded from the subsequent action of the carbolic acid, may spread fermenta- 

 tion into the interior. Had it not been for the use of the spray, which plays 

 on the under surface of the gauze when applied, I cannot doubt that this cause 

 would often have led to failure. But considering the very short time during which 

 the spray often acts on the gauze, it is plain that it would be imprudent to trust 

 to it for purifying the surface. This, however, can be done with the utmost 

 readiness, either by wetting with the i to 40 lotion the part of tlie gauze dressing 

 which is to go next to the wound, or, what is commonly more con\enient. In- 

 applying to the wound itself a separate piece of gauze soaked in the lotion, 

 and over this the dry gauze in its eight layers. When the discharge is slight, 

 a single layer of this moist loose gauze is sufficient, but it' it is copious the wetter 

 portion must be substantial. 



In situations where there is not as much extent of skin for the gauze to 



