IN THE PRACTICE OF SURGERY 41 



those of decomposition — viz. that carboUc acid stimulates only the surface to 

 which it is first applied, and every drop of discharge that forms weakens the 

 stimulant b\' diluting it. But decomposition is a self-propagating and self- 

 aggravating poison ; and if it occurs at the surface of a sev^erely injured limib, 

 it will spread into all its recesses so far as any extra vasated blood or shreds of 

 dead tissue may extend, and, lying in these recesses, it will become from hour 

 to hour more acrid till it acquires the energy of a caustic, sufficient to destroy 

 the vitality of any tissues naturally weak from inferior vascular supply, or 

 weakened by the injury they sustained in the accident. 



Hence it is easy to understand how, when a wound is ver\' large, the crust 

 beneath the rag may prove here and there insufficient to protect the raw surface 

 from the stimulating influence of the carbolic acid in the putt\-, and the result 

 will be, first, the conversion of the tissues so acted on into granulations, and 

 subsequentty the formation of more or less pus. This, however, will be merely 

 superficial, and will not interfere with the absorption and organization of extra- 

 vasated blood or dead tissues in the interior ; but, on the other hand, should 

 decomposition set in before the internal parts have become securely consolidated, 

 the most disastrous results mav ensue. 



I left behind me in Glasgow a boy, thirteen years of age, who between 

 three and four weeks previously met with a most severe injur\' to the left arm, 

 which he got entangled in a machine at a fair. There was a wound six inches 

 long and three inches broad, and the skin was very extensively undermined 

 beyond its limits, while the soft parts generally were so much lacerated that 

 a pair of dressing-forceps introduced at the wound, and pushed directly inwards, 

 appeared beneath the skin at the opposite aspect of the limb. From this wound 

 several tags of muscle were hanging, and among them there was one consisting 

 of about three inches of the triceps in almost its entire thickness ; while the 

 lower fragment of the bone, which was broken high up, was protruding four 

 and a half inches, stripped of muscle, the skin being tucked in under it. Without 

 the assistance of the antiseptic treatment, I should certainly have thought of 

 nothing else but amputation at the shoulder-joint ; but as the radial pulse could 

 be felt, and the fingers had sensation, I did not hesitate to try to save the limb, 

 and adopted the plan of treatment above described, wrapping the arm from 

 the shoulder to below the elbow in the antiseptic application, the whole interior 

 of the wound, together with the protruding bone, having pre\-iously been freely 

 treated with strong carbolic acid. About the tenth day the discharge, which 

 up to that time had been onl}- sanious and serous, showed a slight admixture 

 of shmy pus, and this increased till, a few days before I loft, it amounted to 

 about three drachms in twenty-four hours. But the bo}' continued, as he had 



