OF TREATMENT IN SURGERY 67 



formation of new bone in tlie periosteum under the stimulating influence of exfolia- 

 tions soaked with putrid liquids, had disappeared almost entirely from the upper 

 part of the leg, which was that primarily affected, and was rapidly diminishing 

 elsewhere. [On the i8th of May, the boy left the hospital with the full use 

 of the limb. I had intended giving him a somewhat longer rest in bed as a 

 measure of precaution. But I found that for a considerable time it had been 

 impossible to keep him from getting up and running about the ward ; and 

 he was none the worse for his activity.] This certainly was very different from 

 the tedious course of such cases under ordinary treatment. 



With regard to the manner in which the dead bone has been disposed of, 

 some who have not witnessed similar occurrences may doubt the possibility 

 of its absorption, and believe that the necrosed pieces are still l}ing unchanged 

 in the interior of that leg. But even those who take such a view must admit 

 that we have here a most striking illustration of the important truth, that dead 

 tissue, if protected from putrefaction, is of itself incapable of exerting any 

 disturbing influence upon surrounding parts. 



Carbolic Dressings. 



I will now proceed to speak of the mode of dressing. CarboHc acid, as 

 I have already remarked, is soluble in liquids of very different kinds, so different, 

 for example, as water and one of the fixed oils ; and each solution has its own 

 special value. Water, having little affinity for the acid, dissolves but a small 

 quantity, only one-twentieth part of the pure crystals,^ and holds that small 

 quantity very loosely, so as to permit it to act with energy on any substance 

 for which it has stronger attractions, and also to become soon dissipated on 

 exposure. Hence, the watery solution is a pretty potent but transient applica- 

 tion. Now this is exactly what we want when we apply carbolic acid to the 

 interior of a wound for the purpose of destroying any germs which may have 

 been introduced into it. We require something that will act with energ\- for 

 the moment ; but which, as soon as it has extinguished the vitality of the septic 

 particles, may disappear from the wound, in order that the tissues may be left 

 free from all unnecessary irritation. The fixed oils, on the other hand, have so 

 strong an affinity for the acid that they will mix in any proportions with it, 

 and hold it so firmly as not to permit it to act with much energy on the tissues, 



'■ The impurities often met with in carboUc acid interfere with its solubihty in water. The first 

 specimen with which I happened to experiment was an impure hquid kind, sold as ' German creosote '. 

 and tliis was absolutely insoluble in water ; the associated organic compounds having, apparently, 

 too strong an affinity for the acid to permit water to appropriate any of it. I was thus led into the 

 mistake of stating that carbolic acid is insoluble in water (see note on p. 4 of tliis volume). I may remark 

 that the public are much indebted to Mr. Grace Calvert, of Manchester, for his successful efltorts to pro- 

 pare carbohc acid in a pure form at a moderate price. 



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