38 ON THE ANTISEPTIC PRINCIPLE 



In conducting the treatment, the first object must be the destruction of 

 any septic germs which may have been introduced into the wound, either at 

 the moment of the accident or during the time which has since elapsed. This 

 is done by introducing the acid of full strength into all accessible recesses of 

 the wound by means of a piece of rag held in dressing-forceps and dipped in 

 the liquid.^ This I did not venture to do in the earlier cases ; but experience 

 has shown that the compound which carbolic acid forms with the blood, and 

 also any portions of tissue killed by its caustic action, including even parts 

 of the bone, are disposed of by absorption and organization, provided they are 

 afterwards kept from decomposing. We are thus enabled to employ the anti- 

 septic treatment efficiently at a period after the occurrence of the injury at 

 which it would otherwise probably fail. Thus I have now under my care in 

 the Glasgow Infirmary a boy who was admitted with compound fracture of the 

 leg as late as eight and a half hours after the accident, in whom nevertheless 

 all local and constitutional disturbance was avoided by means of carbolic acid, 

 and the bones were firmly united five weeks after his admission. 



The next object to be kept in view is to guard effectually against the spread- 

 ing 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 last few weeks. 

 The method which I have hitherto published ^ 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 decom- 

 position 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 whitening (carbonate of lime) mixed with a solution of one part of 

 carbohc acid in four parts of boiled linseed oil, so as to form a firm putty. This 



* The addition of a few drops of water to a considerable quantity of the crystallized acid induces 

 it to assume permanently the hquid form. 



* See the preceding paper in this volume. 



