DETAILS OF ANTISEPTIC SURGERY 243 



will be liable to cause patches of superficial ulceration if the traction upon them 

 should become increased by inflammatory turgescence. But if this threatens 

 to occur, either in this particular wound or in any other, the difficulty is readilv 

 got over by unwinding the wire from one of the buttons, and, after straightening 

 it, allowing the button to slip upon it to any degree to which the tension disposes 

 it, and then fixing it again by winding the wire round it. And, conversely, if 

 the support of the buttons is still required after they have become slack from 

 an}^ cause, they can be braced up at pleasure to any requisite degree. 



Even when the edges of the wound cannot be made to meet at all, the 

 extent of the exposed tissues and consequent granulating surface and cicatrix 

 may be greatly reduced by the use of the button stitches, as was illustrated by 

 the case of rodent ulcer which we are considering, where a single pair of buttons 

 being applied, one to the skin above the eyelid and the other to that over the 

 lower border of the jaw, the connecting wire lying exposed on the raw surface, 

 the integument thus drawn down formed a permanent covering for the eyeball. 



To return to the effect of the antiseptic dressing in this case. It was 

 beautiful to witness the entire absence of inflammatory disturbance in this 

 large open wound, involving such exquisitely sensitive parts, the surrounding skin 

 remaining free from day to day from any inflammatory blush or puffiness, and 

 the patient experiencing absolutely no uneasiness after the smarting ^ which 

 immediately followed the operation had subsided, as it did within a few hours 

 of its performance. On the changing of the dressing, which was done daih* 

 during the earlier periods, the entire mass came off like a mask, without adhering 

 in the least to the wound, while there was no accumulation whatever of the 

 discharge, which constantly passed freely out into the porous mass arranged 

 to absorb it ; and there was never observed the faintest putrefactive odour. 

 Cicatrization also proceeded satisfactorily from all parts of the edges of the 

 wound, and it was an interesting circumstance that, while the epithelial ring 

 which was thus formed had, in the greater part of its extent, the denseness and 

 opacity of an ordinary scar upon the skin, the portions in the vicinity of the 

 upper lip and nostrils had a peculiar delicac}^ and transparency, allowing redness 

 of the subjacent vascular structures to show so distinctl}' that, except for their 

 smoothness and dryness, these parts of the cicatrix might have been mistaken 

 for unhealed granulating surface. The explanation obviously was that tlie 

 epithelial formation, taking place only as the offspring of pre-existing epithelium, 

 partook of the character of that from which it grew, having the density and 



* This smarting was probably chiefly due to the effect of the sohition of chloride of zinc, wliich, 

 as an additional ])recaution, T had applied to the parts of the wound in the immediate vicinity of the 

 mouth and nostrils. 



