.62 ON THE ANTISEPTIC SYSTEM 



protruding externally ; and, the wound being thus plugged antiseptically, he 

 appHed a sheet of paste composed of whitening mixed with the oily solution 

 of carbolic acid before mentioned, taking care that it was large enough to over- 

 lap the skin around the orifice by several inches in every direction, retaining 

 it in position by strapping and bandage. It may, perhaps, be said by some 

 of you, ' Surely it was heroic practice to introduce irritating carbolic acid so 

 freely into that important serous cavity. Would it not have been a milder 

 and more prudent course to have plugged the wound with a piece of dry lint ? ' 

 But any one who argues in this way forgets what would have been the inevitable 

 result of such a procedure. The mass of blood accumulated in the pleura would 

 necessarily have been soon decomposed through the agency of the germs con- 

 tained in the lint ; and the putrefying mass, growing from day to day more 

 acrid in the cavity in which it was confined, would undoubtedly have soon 

 caused the death of the already prostrated patient. On the other hand, carbolic 

 acid, being a local anaesthetic, is much less irritating, even when first applied, 

 than the products of decomposition ; and it also differs from the latter in this 

 all-important point, that it soon becomes dissipated by diffusion and removed 

 by the surrounding circulation, when, the blood on which it has acted being 

 still amenable- to organization and absorption, the part is as favourably situated 

 as if affected only with a subcutaneous injury. Next day, when I saw the 

 patient for the first time, I cautiously withdrew the plugs, under the protection 

 of a large piece of lint dipped in the oily solution of carbolic acid, and continued 

 the use of the paste. For about ten days the patient progressed admirably, 

 the pulse descending, the laboured rapid respirations growing less laboured 

 and less rapid, and altogether his condition becoming so much improved that 

 he could not be prevented from sitting up in bed, singing songs, and conducting 

 himself otherwise in an imprudent manner. Meanwhile, examination of the 

 thorax disclosed signs of the presence of both blood and air in the pleura, such 

 as dullness of the base and preternatural resonance of the upper and anterior 

 part of that side of the chest, and metalHc tinkhng, which was well marked. 

 And to such an extent had this accumulation of blood and air proceeded, that 

 the heart had been pushed over towards the right side, so that its apex beat 

 below the right nipple. And yet this mass of blood, freely exposed to the 

 influence of air, had not decomposed. Any putrefactive germs introduced 

 through the external wound had been destroyed by the carboHc acid, and the 

 air, entering the pleura through the wounded bronchial tubes, had deposited 

 its floating organisms upon the slimy mucous secretion of those tortuous canals. 

 Hence the patient remained free from any symptoms of irritation, and suffered 

 only from loss of blood and the embarrassment of the respiration which was 



