The next object to be kept in view is to guard effectually
against the spreading of decomposition into the wound along the
stream of blood and serum which oozes out during the first few
days after the accident, when the acid originally applied has
been washed out or dissipated by absorption and evaporation. This
part of the treatment has been greatly improved during the past
few weeks. The method which I have hitherto published (see Lancet
for Mar. 16th, 23rd, 30th, and April 27th of the present year)
consisted in the application of a piece of lint dipped in the
acid, overlapping the sound skin to some extent and covered with
a tin cap, which was daily raised in order to touch the surface
of the lint with the antiseptic. This method certainly succeeded
well with wounds of moderate size; and indeed I may say that in
all the many cases of this kind which have been so treated by
myself or my house-surgeons, not a single failure has occurred.
When, however, the wound is very large, the flow of blood and
serum is so profuse, especially during the first twenty-four
hours, that the antiseptic application cannot prevent the spread
of decomposition into the interior unless it overlaps the sound
skin for a very considerable distance, and this was inadmissible
by the method described above, on account of the extensive
sloughing of the surface of the cutis which it would involve.
This difficulty has, however, been overcome by employing a paste
composed of common whiting (carbonate of lime), mixed with a
solution of one part of carbolic acid in four parts of boiled
linseed oil so as to form a firm putty. This application contains
the acid in too dilute a form to excoriate the skin, which it may
be made to cover to any extent that may be thought desirable,
while its substance serves as a reservoir of the antiseptic
material. So long as any discharge continues, the paste should be
changed daily, and, in order to prevent the chance of mischief
occurring during the process, a piece of rag dipped in the
solution of carbolic acid in oil is put on next the skin, and
maintained there permanently, care being taken to avoid raising
it along with the putty. This rag is always kept in an antiseptic
condition from contact with the paste above it, and destroys any
germs which may fall upon it during the short time that should
alone be allowed to pass in the changing of the dressing. The
putty should be in a layer about a quarter of an inch thick, and
may be advantageously applied rolled out between two pieces of
thin calico, which maintain it in the form of a continuous sheet,
which may be wrapped in a moment round the whole circumference of
a limb if this be thought desirable, while the putty is prevented
by the calico from sticking to the rag which is next the
skin.[Footnote: In order to prevent evaporation of the acid,
which passes readily through any organic tissue, such as oiled
silk or gutta percha, it is well to cover the paste with a sheet
of block tin.
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