COMPOUND FRACTURE, ABSCESS, ETC. 3 



gery by pneumothorax with emphysema, resulting from puncture of the lung 

 by a fractured rib. Here, though atmospheric air is perpetually introduced 

 into the pleura in great abundance, no inflammatory disturbance supervenes ; 

 whereas an external wound penetrating the chest, if it remains open, infalUblv 

 causes dangerous suppurative pleurisy. In the latter case the blood and serum 

 poured out into the pleural cavity, as an immediate consequence of the injur\-, 

 are decomposed by the germs that enter with the air, and then operate as a 

 powerful irritant upon the serous membrane. But in case of puncture of the 

 lung without external wound, the atmospheric gases are filtered of the causes 

 of decomposition before they enter the pleura, by passing through the bronchial 

 tubes, which, by their small size, their tortuous course, their mucous secretion, 

 and ciliated epithelial lining, seem to be specially designed to arrest all solid 

 particles in the air inhaled. Consequently the effused fluids retain their original 

 characters unimpaired, and are speedily absorbed by the unirritated pleura. 



Applying these principles to the treatment of compound fracture, bearing 

 in mind that it is from the vitality of the atmospheric particles that all the 

 mischief arises, it appears that all that is requisite is to dress the wound with 

 some material capable of kilhng these septic germs, provided that any substance 

 can be found reliable for this purpose, yet not too potent as a caustic. 



In the course of the year 1864 I was much struck with an account of the 

 remarkable effects produced by carbolic acid upon the sewage of the town of 

 Carlisle, the admixture of a very small proportion not only preventing all odour 

 from the lands irrigated with the refuse material, but, as it was stated, destroying 

 the entozoa which usually infest cattle fed upon such pastures. 



My attention having for several years been much directed to the subject 

 of suppuration, more especially in its relation to decomposition, I saw that such 

 a powerful antiseptic was pecuHarly adapted for experiments with a \-iew to 

 elucidating that subject, and while I was engaged in the investigation the 

 applicability of carbolic acid for the treatment of compound fracture natural!}" 

 occurred to me. 



My first attempt of this kind was made in the Glasgow Royal Infirmar\- in 

 March 1865, in a case of compound fracture of the leg. It proved unsuccessful, 

 in consequence, as I now beheve, of improper management ; but subsequent 

 trials have more than realized my most sanguine anticipations. 



Carbolic acid ^ proved in various ways well adapted for the purpose. It 



' Carbolic acid is found in the shops in two forms— the glacial or crystalline, solid at ordinan.- 

 temperatures of the atmosphere ; and the fluid, which sometimes passes under the name of German 

 creosote. The fluid variety is sold in various degrees of purity. The crude forms are objectionable 

 from their offensive odour; but the properly rectified product is almost fragrant. Different samples, 

 however, differ much in energy of action, and hence, though I have hitherto employed the Uquid 



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