DETAILS OF ANTISEPTIC SURGERY 231 



cut off and laid upon the surface with which they are to unite, by taking up 

 each graft upon one side of the point of the knife and stroking the other side 

 of the instrument upon the granulations so as to have the graft behind. Care 

 must be taken that the deeper surface of the graft is placed downwards, but 

 this is readily done from the fact that the shaving always curls up with the 

 deeper aspect on its concavity. 



It is an interesting pathological fact brought out by this mode of procedure, 

 that the surface of healthy granulations is as prone to adhere to freshly cut 

 perfect tissues as granulations are to coalesce with each other, or the sides of 

 a recent wound to unite by first intention. The practice often followed of 

 cutting beds in the granulations to receive the grafts, very inconvenient from 

 the bleeding which it involves, is therefore wholl}' unnecessary. The several 

 pieces of epidermis, of which twelve are furnished by a slice a sixth of an inch 

 square, if simply applied to the uninjured surface of the sore, will probabU' 

 be found to afford as many starting-points for cicatrization, provided that the 

 granulations are healthy to begin with, and that all needless irritation of the 

 grafts is avoided. As regards the former condition, it is a great mistake to 

 wait till healing has considerably advanced, and the sore has become already 

 stretched and weakened by its own contractions ; and, as regards the latter 

 point, the avoidance of needless irritation, the stimulus of putrefying materials 

 must be got rid of by thoroughly purifying the sore as a preliminary measure, 

 while the irritation of the antiseptic itself is reduced to a minimum by the 

 dressing employed. In order to make sure against septic contamination during 

 the process of grafting, it is well to cover the sore as soon as it is exposed with 

 a piece of muslin dipped in the boracic solution, and uncover successive portions 

 for the application of the grafts. Then, as each graft is put down, it is covered 

 at once with a small piece of protective dipped in the lotion, and at the conclu- 

 sion of the process any parts of the granulating surface remaining exposed are 

 covered in either by separate pieces of protective or by a general piece over the 

 whole, as no harm is done by the layer being double. Boracic lint wrung out 

 of the lotion, and well overlapping the surrounding skin, is then applied, two 

 layers being used at the more dependent parts if the sore is large and much 

 discharge expected, and a retaining bandage is put lightly on. This dressing 

 is left untouched for two or three days ; and when it is changed, all the protective 

 will be found to come off as one piece adhering to the lint, but not sticking 

 at all to grafts or granulations, which are covered with a layer of pus or lymph. 

 This being free from putrefaction or anv other irritating property, there is no 

 need to wash the surface of the sore, a process which might disturb the grafts ; 

 but without any delay a fresh piece of dipped protective is applied, and over 



