210 ON RECENT IMPROVEMENTS IN THE 



overlap as is desirable — for example, in the vicinity of the pubes, as after 

 herniotomy — the deficiency of surface of the dressing may be compensated by 

 using the gauze in a thicker mass ; say in sixteen or thirty-two layers. By 

 this means such wounds may be securely kept from putrefaction, which with 

 only eight layers it might be impossible to avoid. 



Details like these, tedious as they are to describe, are of course very easy of 

 execution, and attention to them will, I doubt not, be rewarded, in the hands 

 of others as it has been in my own, by a constancy of results which leaves little 

 if anything to be desired. 



With regard to the times of changing the dressing, it is, as a general rule, 

 prudent to inspect the wound the day after its infliction, whether it be accidental 

 or the result of operation. But during the subsequent progress of the case 

 the gauze may be left undisturbed for periods varying from two days to a week, 

 in proportion to the diminution of effusion ; the general rule being that the 

 dressing should be changed on any day on which the discharge is observed 

 to have extended beyond the edge of the folded gauze so as to make a stain 

 upon the clothes or bedding. 



Invaluable as the gauze is, I greatly regret to find that its use is restricted 

 by the high price at which it is often sold. I will, therefore, now describe the 

 manner in which it has been prepared for a long time past at the Royal Infirmary 

 of Edinburgh, with the effect of reducing by more than half the wholesale price 

 previously paid by the institution. First I may remark that the chief element 

 in the cost is the cotton cloth, the expense of the materials with which it is 

 charged being less than a farthing per square yard of the gauze. It is therefore 

 of great importance to obtain the muslin as cheap as possible from the manu- 

 facturer, and a little saving is effected by having it unbleached. The materials 

 used for charging the gauze are — i part of crystallized carbolic acid, 5 parts 

 of common resin, and 7 parts of solid paraffin ; the last ingredient being used 

 for the purpose of preventing undue adhesiveness. Paraffin has this advantage 

 compared with any other substance of similar consistence with which I am 

 acquainted, that it does not blend at all with carbolic acid in the cold, and 

 therefore simply dilutes the mixture of acid and resin, without interfering in 

 the least with the tenacity with which the resin holds the acid. If, for example, 

 we compare it with a substance like spermaceti, we find that a mixture of i part 

 of the acid with 5 parts of resin and 5 parts of spermaceti is really much more 

 pungent to the tongue than the 5 parts of resin and i of acid alone. For 

 although the former mixture contains only half the quantity of the acid, yet 

 the spermaceti, blending with the acid like the resin but holding it less firmly, 

 takes the acid from the mixture and gives it up to surrounding objects. Such 



