DETAILS OF ANTISEPTIC SURGERY 215 



can be readily removed. In order to admit of the free application of this dressing 

 to all parts of the cut surface, the wound is made to gape freely by depressing 

 the toes along with the foot-piece of the MTntyre splint on which the limb 

 rests. The oiled lint is renewed every three hours day and night during the 

 first twenty-four hours, and after this the interval is gradually increased as 

 discharge diminishes, till after three or four days one dressing per diem is sufficient. 

 The free exposure of the wound has this further important advantage, that 

 it permits the surgeon to examine the surface with the finger from time to 

 time in order to ascertain when the bones are entirely covered with soft granu- 

 lations ; for then and not till then can he be sure that the bones are perfectly 

 sound, and as soon as this is the case the foot-piece is adjusted at right angles 

 with the leg, so as to permit the granulating surfaces to coalesce and the wound 

 to heal. In all the five cases in which I have hitherto had occasion to employ 

 this treatment, the immediate object was completely attained, the foot remaining 

 quite free from inflammation, and the constitution without febrile disturbance. 

 Two of the cases are still under treatment, not yet completely cicatrized. Of 

 the other three feet operated on in this way, two are useful and strong, though 

 more or less shortened. The other, after being a perfectly serviceable foot 

 for several months, became the subject of relapse, requiring amputation at the 

 ankle. The practice was suggested to me by the remarkably satisfactory results 

 of antiseptic treatment in a case of wound by a circular saw which divided the 

 soft parts completely at the instep, laying the ankle-joint freely open. The 

 patient not only recovered with a freely movable ankle-joint, but, except a line 

 of cicatrix across the instep, there was nothing abnormal in either the appearance 

 or actions of the foot. And it is somewhat remarkable that, in the cases of 

 disease, where the wound has been left gaping for weeks, not only has the power 

 of extension of the toes been restored, but sensation has been recovered in the 

 parts supplied by the divided nerve. 



As another example of the usefulness of the oiled lint may be mentioned 

 abscess beside the rectum, where the vicinity of the anus renders a permanent 

 gauze dressing inapplicable. The skin having been washed wdth i to 20 watery 

 solution of carbolic acid, the abscess is opened under the spray where it points, 

 and a pad of lint soaked with i to 10 carbolic oiP is applied and retained by 

 a T bandage, and changed every live or six hours. Before defecation, the jiatient 

 draws the bandage and pad towards the side where the wound is, so as to keep 

 the latter covered while exposing the anal outlet, which is carefully cleansed 

 with a piece of lint dipped in the antiseptic oil before the ]xid is readjusted. 



* Lord Lister afterwards substituted glycerine for oil as the vehicle for the carbolic acid in the 

 dressing ; the anus being cleansed, on exposure, with the wateiy solution. 



