DETAILS OF ANTISEPTIC SURGERY 241 



disturbance around an 0}:)en wound when putrefaction is really prevented from 

 taking place in it ; the ' stimulus of necessity ' of John Hunter being, in truth, 

 simply the stimulus of putrefying substances, so that the danger which usually 

 attends open wounds is entirely avoided by efficient antiseptic measures.^ But 

 whatever might be the material employed for this purpose, it was inadmissible 

 to interpose a protective layer between it and the raw surface ; for this would 

 simply have had the effect of conducting septic fermentation over the entire 

 wound from the sources of putrefaction present at the mouth and nostrils. 

 Seeing, then, that the antiseptic must be applied directly to the divided tissues, 

 it was of course desirable that it should be as mild as possible consistentlv with 

 its efficiency ; and for a situation like this the boracic ointment was much 

 better adapted than the moist boracic lint, the fine cloth spread with it applving 

 itself with facility and accuracy to the irregularities of the surface, and keeping 

 its position without any retaining means except a packing of unprepared gauze 

 applied over it to absorb discharge, and retained by a bandage of the same 

 light material. 



The eyeball, left bare by the operation, was protected from contact with 

 the dressing by having the loose skin above the upper eyelid drawn down over 

 it by means of the ' button suture ', as I may term a form of ' stitches of relaxa- 

 tion ',"^ which I have used for nearly two years with great advantage. It consists 

 of two oval pieces of sheet lead, about one- twentieth of an inch thick, with 

 a central perforation to receive a moderately thick silver wire. The silver wire 

 is first passed as an ordinary suture, except that it is carried at an unusually 

 great distance from the edge of the wound, both as regards surface and depth ; 

 each end of the wire is then passed through the hole in the corresponding lead 

 button, and secured by being wound once round the shorter diameter, as shown 

 in the accompanying sketch (p. 242). The two buttons thus take the place of the 

 tips of two fingers of the two hands in giving support to the deeper parts of the 

 wound, while leaving the cutaneous margins entirely free ; and when the wound 

 is at all extensive several pairs of buttons are applied in this way. constituting 

 a sort of interrupted quilled suture. By their means the lips of a wound which 

 otherwise could not be got to meet without considerable tension will often lie 



' To this statement it is necessary to make an exception with regard to erysipelas, which I liave 

 known to appear in some surgical patients from whose wounds, as far as I was able to judge, all fermen- 

 tative agency from without had been excluded. But, except during an epidemic of tliis disease, such 

 as prevailed in Edinburgh about two years and a half ago along with a virulent outbreak of small-pox. 

 the chance of its occurrence under strict antiseptic management is so small that it scarcely needs to be 

 taken into consideration. 



" The importance of special stitches of relaxation — ' Entspannungs-Nahte ' — was, so far as I am 

 , aware, first pointed out by Professor Simon, of Heidelberg, in liis important work on vesico-vaginal 



' fistula. 



