Am.  Jour.  Pharm.) 
September,  1911.  J 
Standard  Surgical  Dressings. 
415 
of  the  antiseptics  used  at  this  time  were  markedly  different  from 
these  in  use  to-day.  For  example,  we  find  at  this  time  acid  used 
in  a  strength  of  i  in  12,  i  in  20;  corrosive  sublimate  1-200,  and 
iodoform  20  per  cent. 
The  method  of  preparing"  iodoform  gauze  in  the  practice  of  the 
originators  may  be  mentioned :  Iodoform  was  first  used  by  dusting 
directly  over  the  wound.  Bilroth  afterwards  stated  that  when  the 
iodoform  was  dusted  over  the  fibre  of  cloth  it  was  less  irritating 
than  when  applied  directly  to  the  wound,  and  he  later  adopted  a 
dressing  containing  20  per  cent,  iodoform. 
A  feature  of  this  period  was  the  English  practice  of  using 
boracic  acid  in  a  strength  as  high  as  40  per  cent.  It  is  stated  that 
this  was  fostered  by  the  producers  because  the  dressings  were  sold  by 
the  pound,  and  boracic  acid  was  much  cheaper  than  the  fabric. 
This  was  only  twO'  decades  ago.  Now  we  find  that  carbolic  acid, 
the  agent  which  helped  in  the  revolution  of  the  world  of  surgery  in 
the  time  of  Lister,  has  passed  into  disuse  in  surgical  technic;  that 
the  strength  of  corrosive  sublimate,  and  its  preparations,  has  be- 
come weaker  and  weaker  until  there  is  now  demanded  a  strength  of 
1-10,000 ;  that  iodoform  has  shrunk  from,  a  strength  of  40  per  cent, 
to  2  per  cent. ;  and  that  many  antiseptics  once  in  very  large 
demand  and  for  which  much  was  claimed  have  been  forgotten. 
In  the  later  days  of  the  third  era  of  surgery  and  in  the  opening 
of  the  fourth  era,  antiseptic  surgical  dressings  have  been  but  little 
used.  The  demand  is  now  for  sterilized  cotton,  sterilized  gauze, 
sterilized  bandages.  If  antiseptics  are  used  they  are  applied  in 
certain  classes  of  cases  and  as  an  adjunct — not  as  an  important  part 
of  the  technic.  The  surgeons  are  learning  the  value  of  procedures 
briefly  characterized  as  "  skilful  neglect  " ;  they  are  learning  that 
antiseptics  even  in  a  weak  solution  are  damaging  to  the  growth 
of  new  tissue ;  that  sterilized  water  produces  untoward  results ; 
and  that  the  much  lauded  hydrogen  peroxide  is  destructive.  Some 
go  so  far  as  to  claim  that  cotton  or  gauze  placed  ever  so  gently 
upon  a  surface  undergoing  cell  repair  is  harmful,  because  new 
cells  are  caught  in  the  fibrous  mesh  and  torn  away  when  the  dressing 
is  changed. 
All  that  is  necessary,  is  a  protection  medium.  At  best  in  the 
present  day  practice  we  have  tO'  consider  only  plain  absorbent  gauze 
cloth  in  its  various  forms,  such  as  bandages,  tapes,  etc.,  and  ab- 
sorbent cotton.  These  two  substances  represent  almost  entirely  the 
surgical  dressing  of  the  period. 
