Reprinted from, the MEDICAL BRIEF, July, 1887. 
Four Cases of Craniotomy. 
A Contribution to the Surgery of the 
Skull and Meninges, 
■With some Remarks on the Antiseptic Treatment of .Ve.iiis. 
Prof. A. C. BERNAYS, 
ST. LOUIS, MO. 
With the Compliments 
of THE 
Myron E. Meyer Mfg. So., 
Of Milwaukee, Wis., 
By the kind permission of the 
Author. 
Smith & Owens Printing Co., 318 N. Third Street, St. Louis, Mo. Reprinted from the Medical Brief, July, 1887. 
A CONTRIBUTION 
TO THE 
SURGERY OF THE SKULL AND MENINGES. 
Four Cases of Craniotomy with Chisel 
and Saw, in Old Cases of Depressed 
Fracture of the Skull. With Some 
Remarks on the Antiseptic Method 
of the Treatment of Wounds. 
confuse him in conversation. About 
seven weeks after the accident, he 
was constantly troubled with double 
vision. Strabismus internus of the 
left eye was developed, and was very 
troublesome at first, but slowly 
seemed to get better 
BY AUGUSTUS C. BERNAYS, 
A. M.; M. D., Heidelberg; M R. C. S., England; P. 
R. M. 8., London; Member German Society Sur- 
geons of Berlin; Prof, of Anatomy St. Louis 
College Physicians and Surgeons; Con- 
sulting Surgeon St. Louis City Hos- 
pital and Female Hospital. 
The objective examination which I 
conducted, with the assistance of the 
oculist, Dr. Chas. Barck, demon- 
strated the following condition on the 
day of his reception at the hospital; 
Strabismus internus paralyticus; 
memory still deficient; complains of 
a heavy feeling of pressure in his 
head, and finds it difficult to think. 
There is a depression over the left 
temporal bone, extending upwards to 
the anterior inferior angle of the pa- 
rietal bone, which is so deep that the 
index finger could be easily buried in 
it. 
Case I.—Mr. E. 8., fifty-nine years 
of age, came to St. Louis on the 12th 
day of July, 1884, and was received 
as a patient in my private hospital. 
Four months previously he fell from 
an ice-wagon and struck his head 
against the tire of the wheel. He was 
taken home and remained unconscious 
eight days. There was no external 
wound. After recovering conscious- 
ness, it was observed that his memory 
was much impaired, regarding all oc- 
currences of his previous life, for sev- 
eral weeks. This loss of memory was 
only transient; he gradually regained 
his mental power, with the exception 
of the names and appellations of dif- 
ferent objects, which still bother and 
I determined to cut down and ele- 
vate the depressed bone, and, accord- 
ingly, on the 13th day of July, with 
the assistance of Drs. D. V. Dean, L. 
Bremer, O’Reilly, C. Barck, and oth- 
ers, proceeded to perform the opera- 
tion. (See Figs. 1 and 2.) 4 
CRANIOTOMY 
raising the depressed bone nearly to 
its normal position. During the en- 
tire operation, the field was kept con- 
stantly irrigated with a solution of 
boric acid, four per cent. I stitched 
the flap, which consisted of skin and 
periosteum, into its place by fourteen 
fine silk sutures. Four catgut strings 
were left between the edges in such a 
manner that they could be drawn out 
in case there would be any suppura- 
tion under the flap. The wound was 
dressed with antiseptic gauze covered 
with rubber tissue. 
The wound united completely by 
first intention, there being no secre- 
tion of any kind, in six days. There 
was no elevation ol pulse or of tem- 
perature. Patient declared that he 
felt “ lighter,” had lost the feeling of 
pressure in his head immediately 
after the operation. 
Fig. i.—The depression just above the ear, as found in 
Case i. 
The left side of the head was 
shaved, and thoroughly cleansed with 
five per cent carbolic acid solution. I 
made an angular incision, lifting the 
flap in the manner shown in Fig. 2. 
He was dismissed on the 24th day 
of July, the strabismus having de- 
cidedly decreased. The symptom of 
double vision is not cured, but the 
double objects are seen closer to- 
gether than before the operation. The 
depression in the skull is very slight. 
On the 30th day of August, patient 
came to the city again, and we found 
him much improved, feeling free from 
the pressure in his head, memory 
nearly normal, and speaking without 
difficulty. Strabismus and double 
vision almost disappeared. 
Fig. 2 —ln the L shaped groove which has been made 
by the chisel, is seen the elevator in position for lifting 
the depressed portions. 
Case ll.—Mr. E, Z., from Belle- 
ville, 111., was injured while at work 
in a coal mine. He struck his head, 
the right frontal bone from near the 
glabella to the juncture with the pari- 
etal bone, lacerating the scalp and 
scraping the periosteum from the 
bone. The outer table was probably 
not fractured, but the inner table was 
cracked, as we afterwards found at the 
operation. After this accident he was 
a constant sufferer from a most dis- 
The anterior margin of the fractured 
bone was found completely depressed 
under the posterior portion, and the 
fracture was firmly united by com- 
pletely ossified callus. By means of 
small dental chisels, I carefully cut 
out about one-fourth of an inch of the 
callus and margin of the fracture the 
entire length of the depression, and 
by means of an elevator succeeded in BERNAYS 
5 
tressing pressure in his head,was con- 
stantly in fear of becoming insane, 
and was totally unable to do work of 
any kind. He had no symptoms of 
paralysis, but a glance at his face 
clearly proved that he was suffering 
some distressing agony. He had the 
peculiar, restless, wild and weird ex- 
pression of-the countenance which so 
frequently accompanies certain forms 
of mental disease. 
upon the head, exposed the right half 
of the frontal bone almost in its en- 
tire extent. There was a black discol- 
oration of the periosteum and the 
bone at this place, which was so in- 
tense that it made a very peculiar im- 
pression at first sight. This black pig- 
mentation permeated the bone even 
into the diploe, and was found also in 
the soft parts up to the skin, which 
was of a bluish tint. I have several 
times, when performing surgical ope- 
rations on aged coalminers, noticed 
that whatever part of the system be- 
comes the seat of disease, particularly 
of an injury the repair of which is 
associated with the formation of scar 
tissue or connective tissue thickening, 
will be found of a deep black color 
when the epidermis is removed. It is 
no rare thing to find the spleen, the 
lymphatic glands and the lungs of a 
solid black at post mortems of vete- 
ran coalminers. The latter condition 
is called pneumonokoniosis anthra- 
cotica by pathologists. In my case I 
can account for the black pigmenta- 
tion on the supposition that the so- 
called “wander cells,” which every- 
where permeate the intercellular 
spaces of connective tissue, carry par- 
ticles of pigment, which become sta- 
tionary when the cells themselves 
assume a permanent function as spin- 
dle-shaped or round elements of scar 
tissue. With a chisel I worked a ditch 
through the outer table and diploe, of 
the size and shape which seemed 
requisite to cover the seat of the in- 
jury. After this was done, I found a 
soft place—a defect in the inner table 
—at a point near the superior median 
margin of the ditch, and by introduc- 
ing the end of the elevator, between 
the dura mater and the inner table, I 
was enabled to lift the entire piece of 
bone from the dura mater, the vitre- 
ous table being very fragile. The 
lower surface of this rhomboid piece 
Fig. 3.—The pigmentation of the periosteum is seen 
on the turned down flap, as well as the size and shape of 
the defect produced by the operation. 
About a year after the accident, in 
September last (1886), the patient 
came to the Pius Hospital for the 
purpose of submitting to the opera- 
tion of craniotomy. I told him that 
the operation would be explorative, 
and that I could promise him nothing 
but that the surgical procedure would 
not in any way injure him. 
In the presence of the senior class 
of the College of Physicians and Sur- 
geons, and with the assistance of Drs. 
A. H. Ohmann-Dumesnil and J. B. 
Clancies, I made a semicircular in- 
cision around the scar on the patient’s 
forehead, and turning the flap, which, 
as in the former case, included the 
periosteum and all soft parts, back 6 
CRANIOTOMY 
of bone, corresponding to small gran- 
ulations upon the dura mater, was 
roughened. I scraped these from the 
dura with a curette, leaving this mem- 
brane uninjured. The wound was 
treated exactly as in Case I. It healed 
by first intention. The result in this 
case was not as satisfactory as could 
be desired, and I do not think now, 
about eight months after the opera- 
tion, that the patient was benefited 
much beyond being slightly relieved 
of his headache and sleeplessness. 
Case lll.—George Kohler, aged 
sixteen, received a compound fracture 
of the temporal and parietal bones, 
by the teeth of a cogwheel, while at 
work in a nail-mill in Belleville, 111. 
The wound was dressed and attended 
to in the usual manner by some of the 
bestphysicians in thatcity. Soon after 
the accident, the boy, a good steady 
worker and a favorite with his em- 
ployers, was seized with maniacal at- 
tacks, and by very frequent and severe 
attacks of screaming epilepsy. These 
attacks were sometimes as many as 
twenty per day, and he was some- 
times delirious, or in a state of frenzy, 
for several days and nights at a time, 
during which he became almost un- 
manageable,very violent, and refusing 
to take food or medicine. 
Fig. 4.—The flap is turned down covering the ear, and 
the fistula is seen perforating the flap. The two trephine 
holes as they were left after the first operation lie just 
above the small fracture disclosed by the second. The 
dotted line shows the extent to which I enlarged the 
opening in the skull before incising the dura mater. 
tal in November, 1886, and, on exam- 
ination of the case, I found a fistulous 
opening remaining, which led down 
to roughened and diseased bone. 
There were two linear scars over the 
trephine openings, a slight swelling 
of the soft parts in the temporal re- 
gion, and in that of the external ear. 
The epileptic accesses which I had 
occasion to observe were severe, 
throwing the boy into violent convul- 
sions. He complained of a constant 
severe headache, and was troubled 
with painful cramps in his hands and 
feet almost every two or three hours. 
His general health was beginning to 
be impaired; he became paler and 
weaker day by day. Before attempt- 
ing to give relief by a surgical opera- 
tion, I called in the well-known neu- 
rologists, Drs. Wm. B. Hazard and 
Ludwig Bremer, to see the case, and 
kept the boy under careful supervision 
for about ten days. The two experts, 
independently of one another, came 
to the conclusion that a further and 
more thorough exploration of the in- 
jury should be made ; both said that 
they could see no other hope of curing 
the case. They also recommended 
During this condition the boy was 
trephined, two buttons being re- 
moved, These buttons were small, not 
much larger than a silver dime. The 
operation was performed by Dr. Per- 
ryman, of Belleville, I am told. The 
operation of trephining was undoubt- 
edly justified and indicated by the 
symptoms. After this operation a 
slight improvement seems to have 
taken place for a few hours, but the 
patient soon relapsed into his former 
condition, the epileptic seizures being 
very violent and frequent. 
He was brought to the Pius Hospi- BERNAYS 
7 
opening of the dura mater, in case no 
cause for the trouble could be found 
in the more external parts, and both 
thought that there might be a blood- 
clot or a brain-abscess, which might 
only be gotten at by opening the dura 
mater and searching for it. 
from the dura mater. This being done, 
the dura was seen to bulge out con- 
siderably through the opening in the 
bone, and the bulging portion gave a 
clear sensation of fluctuation to the 
fingers. I next made an incision 
about an inch long through the dura. 
This was followed by a phenomenon 
which 1 have never seen before, and 
which was most alarming. The flow 
of cerebro-spinal fluid was so copious 
that for fully ten minutes the entire 
field of the operation was flooded with 
this clear liquid. The flow was uncon- 
trollable by sponges. The brain was 
seen to be normal; the pia mater not 
opaque, thickened or hypersemic. 
After perhaps ten ounces of the cere- 
bro-spinal liquid had escaped, the 
brain receded into the cavity, and ac- 
tually appeared much too small to 
fill out the skull. The clear liquid 
still oozed out, and I succeeded in 
stopping it only after a very careful 
suture of the dura mater with seven 
sutures of the finest catgut. 
Fig. 5.—The flap is replaced and fixed by sutures. 
Four catgut drains are drawn under the flap and twisted 
together after they were conducted to the outside through 
the fistula. 
I proceeded to perform this opera- 
tion on November 14th, in the pres- 
ence of the senior class of the College 
of Physicians and Surgeons, with the 
assistance of Drs. Graves and Oster- 
tog. The incision.was made along the 
temporal line, beginning near the 
mastoid process and extending en- 
tirely around the temporal muscle, 
and was over six inches long. The 
periosteum and all the soft parts were 
pushed down, exposing the planum 
temporale, which was the seat of the 
injury. The holes left by the two but- 
tons which had been removed were 
now readily seen, and were partially 
filled up with granulation tissue; the 
bridge of bone separating the two had 
been partially removed. Just below 
these there was a depressed and frac- 
tured piece of bone, which had been 
overlooked at the former operation. I 
chiseled this away, and also enlarged 
the trephine holes with the chisel, 
and scraped away the granulations 
At this time, the patient being 
deeply chloroformed, his pulse was 
120—regular, but weak ; respiration 
24. I used a 1-2000 bichloride of mer- 
cury solution, with which I flooded 
the whole wound for fully ten minutes 
after the opening in the dura was su- 
tured, and while I closed the flap 
wound. I drained it through the lit- 
tle fistulous tract, which was thor- 
oughly curetted, in the manner shown 
in Fig. 5, by means of four thick 
strings of catgut. 
The -wound was dressed with bi- 
chloride gauze covered with rubber 
tissue, the whole held in place by a 
ten-yard gauze bandage. The object 
of the rubber tissue, which was care- 
fully adapted and covered the moist 
gauze on all sides, was to keep out the 
air, prevent drying of the dressings, 
and thus insure drainage along the 
catgut strings into the moist gauze. 8 
CRANIOTOMY 
The external gauze bandage, of course, 
soon became dry, thus making a very 
secure and comfortable dressing for 
the head. This kind of dressing 
should be employed in all scalp 
wounds, especially if there is a suspi- 
cion of an injury to the bones of the 
skull. 
can not walk without assistance, nor 
can he use his upper extremities even 
sufficiently well to put on a shirt. His 
right side seems to me slightly more 
affected than his left. 
The injury to his scalp healed up 
well, and a fracture of the skull was 
not clearly made out at the time of 
the accident. There is a slight de- 
pression at the seat of the injury, un- 
der the scar. Mr. Prescott was de- 
sirous of having me operate on him, 
hoping that at the operation we might 
find a local lesion, which could per- 
haps be,remedied. 
This boy made a splendid recovery 
from the severe surgical operation. 
There was absolute union by first in- 
tention. His cramps in the hands 
and feet were relieved ; his headache 
much improved ; but, unfortunately, 
his epilepsy continued at intervals of 
a few days for several months. 
On Sunday, June 7th, 1887, I last 
heard from the boy, and his mother 
reports that he has been at work for 
three months without having an at- 
tack of epilepsy at all. She thinks 
he is improving in many ways. The 
fact is undeniable that at the present 
time the boy is better than at any 
time since he was injured; but I dare 
not offer an explanation or try to ac- 
count for the cure, as this would be 
mere guesswork, considering the very 
complicated factors in the case. 
Case IV.—Mr. Prescott, a highly 
educated gentleman, teacher of tel- 
egraphy, fell down a high flight of 
stairs, while going to his room on a 
dark night, striking his head on the 
left side, near the vertex. He was in 
good health up to that time, some- 
times a little jovially disposed, fifty 
years ol age, single, and gives a good 
family history. Since this fall, symp- 
toms of progressive muscular atrophy 
are developing in him in a marked 
manner. The muscles affected are 
chiefly the pectoral muscles, the ex- 
tensors of the hand and fingers, and 
the interossei, also the extensors of 
the leg and of the toes, as well as 
some other muscles of his lower ex- 
tremities in a less marked degree. He 
Fig. 6.—The size and location, as well as the shape of 
the defect in Case IV, are seen above the deflected flap. 
On Sunday, May 15th, 1887, with the 
assistance of Dr. Dalton, the superin- 
tendent, and the staff of the City Hos- 
pital, and of my private assistant, Dr. 
W. V. Kingsbury, I removed a portion 
of bone about an inch and a-quarter 
square from the skull, at the seat of the 
injury. The incision of the soft parts 
•was made as in the former case, but 
in this instance I used a circular saw, 
mounted in a dental engine, for the 
purpose of making the incisions in 
the bone. This instrument works ad- 
mirably, and I have used it for tre- 
phining in cases where there was no 
traumatism as a cause of brain dis- 
ease, in several instances, with good BERN AYS 
9 
effect.* The instrument can not be 
used to finish the removal of the piece 
of skull, but after sawing through the 
diploe the fine chisels must be used 
to finish the division of the bone down 
to the dura mater. We found some 
few little granulations on the dura 
mater, over the ascending parietal 
convolution, which are said by Hors- 
ley, Ferrier and others to represent 
the pectoral and shoulder muscles and 
the muscles of the thumb in the mo- 
tor sphere of the cortex. These were 
scraped off, the wound closed as in 
the previous cases, after the sharp 
edges of the bone were smoothed. We 
had the pleasure also in this case of 
seeing an instance of perfect union by 
first intention, with the formation of 
only a linear scar. There is scarcely 
any change perceptible in the mobil- 
ity of the patient’s limbs, although he 
himself fancies a slight improvement. 
Only five weeks have passed since the 
operation, and it is too early to judge 
of the effect of the operation. 
view, the question of the influence of 
the “Antiseptic Method” very natu- 
rally comes up. During the past ten 
years I have been practicing surgery 
with the especial intention of testing 
and comparing, in my practice in 
chosen cases, the results to be ob- 
tained by following conscientiously 
two different methods. In one set of 
cases I employed as a dressing and as 
a wash during the operation only wa- 
ter and such substances as had been 
thoroughly cleansed by the use of hoi 
water, the instruments being cleansed 
by means of steaming hot water, and 
my hands also being purified by wa- 
ter only, such as can be drawn from 
any hydrant in this city. The other 
set of cases were operated upon with 
perfect antiseptic precautions, the in- 
struments, sponges and dressings, as 
well as my hands, being thoroughly 
cleansed before the operation in the 
carbolic acid or the bichloride solu- 
tions. The operating room was also 
subjected to the strictest kind of anti- 
septic processes of purification, using 
the most approved methods and the 
most powerful disinfectants. While 
studying in Europe, from 1872 to 1878, 
I had ample opportunities of learning 
the antiseptic methods in their minu- 
test details, and I often employed the 
original Lister dressing, having been 
taught its application in Heidelberg 
by Mr. Lister himself, who visited the 
surgical wards of my teacher, Prof. 
Simon, during the spring term of 1875. 
The experiments of Pasteur, and, in 
fact, all that was known about putre- 
faction and the spreading of disease 
by means of germs, were studied and 
practically demonstrated by me in 
such a thorough manner that I may 
say I had the qualifications which are 
necessary to properly conduct the 
practical series of experiments indi- 
cated above. 
The four* cases above briefly re- 
lated are instances of what the old 
surgeons called capital operations. 
These operations were considered to 
be very dangerous, and, indeed, from 
the statistics and mortality tables of 
trephining in civil cases in European 
hospitals, it is found to be quite for- 
midable. In a list of sixty cases of 
trephining, on account of epilepsy, 
done between 1858 and 1868, I find- 
that ten died from the- effects of the 
operation, either pyaemia, phlegmon- 
ous inflammation or erysipelas being 
given as the causes of death. 
In commenting upon the result of 
my own cases from a surgical point of 
* Besides the four cases here related, I have per- 
formed craniotomy four more times in cases of ob- 
scure cerebral diseases not due to traumatism. In 
all of these the operation was successful, the wound 
healing up in every instance. In one ease, only, 
death followed within a month, and was due to the 
original cerebral disease. 10 
CRANIOTOMY 
Without entering into details, I will 
state the conclusions to which I have 
arrived: 
These tablets* are so arranged that by 
dissolving them in a given quantity of 
water they make a solution of a cer- 
tain strength. For general use, 1-4000 
is the proper strength, and large 
quantities of this should be prepared 
before beginning the operation. Three 
basinsful, each containing a gallon or 
more,will usually suffice. The sponges 
should be immersed in one, the in- 
struments and silk or catgut in an- 
other, the third being kept for use 
during the dressing after the operation 
has been finished. It is a good plan 
to keep the whole wound constantly 
irrigated with the bichloride solution 
during the operation, the object being 
to let the fluid penetrate into all the 
recesses of the wound and fill up the 
spaces between the muscles and the 
sheaths of the tendons, etc. After the 
flaps have been united by sutures and 
a drainage tube introduced in a proper 
manner, the stump should again be 
thoroughly washed with the bichlo- 
ride, No matter what may be the 
method of treating the hemorrhage 
during the operation, let the whole 
stump or wound, before and. after the 
bleeding has been controlled, be con- 
stantly irrigated with the bichloride 
solution. This irrigation is best ac- 
complished by letting the solution 
constantly flow out of a fountain syr- 
inge (irrigator), or by constantly 
squeezing it out of sponges into the 
wound. 
1. By the use of the antiseptic method 
an open wound can he made to resemble 
a subcutaneous one, in several respects; 
especially can it be made to behave 
like a subcutaneous wound during the 
process of repair. 
2. The advantage of the use of anti- 
septics in surgery is in exact proportion 
to our ability to make wounds subcuta- 
neous, or like unto subcutaneous lesions, 
by this means. 
3. The results of different operators 
with the antiseptic method will depend 
on the greater or less ability and inge- 
nuity, ivhich each surgeon can bring to 
bear, towards fulfilling the desideratum 
expressed in the previous propositions. 
4. The use of antiseptics in the prac- 
tice of surgery is not an essential ele- 
ment of success, since success can be 
achieved without their use. 
5. The use of antiseptics in the treat- 
ment of surgical cases, by general prac- 
titioners of medicine, is to be commend- 
ed, since there is greater danger of 
infectioyi of a woilnd by the general 
practitioner than by a person devoting 
himself exclusively to a specialty. 
The following simple directions, if 
followed carefully, will be sufficient 
as a guide for the application of an 
antiseptic dressing to any ordinary 
wound, such as, for instance, an am- 
putation of the leg. 
The cheapest and best antiseptic 
fluid is a solution of bichloride of 
mercury. This should be used pro- 
fusely on the limb before the opera- 
tion, in order to cleanse the skin and 
hair of all dirt and blood or other ex- 
traneous material which may be pres- 
ent. The simplest way to prepare a 
solution is by using the antiseptic tab- 
lets which have been prepared by 
some of the manufacturing chemists. 
The dressing is begun by applying 
an eight-fold layer of moist gauze 
over the wound, so as to entirely cover 
*Parke, Davis & Co., of Detroit, have prepared 
some tablets, which, for ready solubility in ordi- 
nary well or hydrant water, are the best known to 
me. They are prepared by triturating the bichlo- 
ride of mercury with citric acid, the object being 
to make the solutions permanent, so that the bi- 
chloride will not be precipitated by the salts of 
lime usually contained in the water BERNAYS 
11 
it up.* I have dispensed with the use 
of the protective silk strip, as being 
useless, and can not recommend it at 
all. The whole wound, which is cov- 
ered by the gauze, is now to be care- 
fully covered by a piece of rubber 
tissue which has been thoroughly im- 
mersed in and disinfected by the bi- 
chloride solution. This rubber may 
be supplanted by oiled silk or Mac- 
intosh cloth, but in all cases the es- 
sential point is that the impermeable 
tissue be larger than the gauze and 
overlaps it several inches on all sides. 
The whole is held in place by band- 
ages so applied as to hold the rubber 
tissue down upon the healthy integu- 
ment all around the parts covered by 
the gauze. (Fig. 7.) This acts so as 
After a surgical operation I find my 
thermometer the most indispensable 
instrument, and I rely entirely upon 
it to guide me as to the time when a 
change of the dressings becomes nec- 
essary. A rise of temperature above 
101$°, in my estimation, is an impera- 
tive indication to change the dressing, 
whether the patient complains of pain 
or not. The pulse is not a reliable 
guide in this respect, and is only of 
importance when it rises simultane- 
ously with the temperature. 
After the first dressing has been re- 
moved, an exactly similar one should 
be reapplied, the wound having been 
thoroughly irrigated with bichloride 
solution. The tablets above mentioned 
will be found most convenient and 
time-saving for making the necessary 
solution, especially in private prac- 
tice. 
The four cases above described, all 
of which healed by first intention, 
without fever or pain, were treated 
according to the method given, and I 
feel sure that no better results could 
have been attained by any other. All 
of the four patients are living, and 
those that were not greatly benefited 
directly by the operation, were at 
least not injured. From my own ex- 
perience, I am led to the conclusion 
that: The operation of explorative 
craniotomy by means of chisel and 
saw,with antiseptic precautions, ought 
to be recognized as a perfectly justifi- 
able procedure, where a diagnosis can 
not be made without it, in many cases 
of obscure brain disease. This opera- 
tion will most assuredly be the source 
of saving life, and is certainly not 
more dangerous than explorative lap- 
arotomy. 
Fig. 7.—This shows a simple antiseptic dressing as 
recommended by the author lor general use. 1: the 
skin. 2 : the layers of gauze. 3: the rubber tissue. 
4 : external bandage. 5 : stitches in the skin. 
to exclude the air and keep the wound 
in an aseptic moist chamber, thus se- 
curing perfect drainage and an equal 
temperature all the time. The dress- 
ing may be left untouched for several 
days ; in fact, I have, upon several 
occasions, applied plaster of Paris 
splints over this kind of dressing, in 
compound fractures, and have waited 
six days before cutting a fenestrum 
into the splint. 
* I take pleasure in recommending to the profes- 
sion, for this purpose, the gauze prepared by the 
Myron E. Meyer Manfg. Co., of Milwaukee, Wis. All 
the antiseptic goods made by this firm are of supe- 
rior excellence. Their antiseptic gauze is superior 
to any now on the market, both in the quality of 
the gauze itself, which is white and absorbent, and 
because it is put up in sealed cans, so that it is always 
moist, and the antiseptic qualities of the chemical 
used are sure to be active in their full strength. 
903 Olive Street, St. Louis,