368 ON SOME POINTS IN THE 



This enabled me to use carbolic acid for washing wounds after operations, 

 and so to extend the application of the antiseptic principle to surgery in general. 

 In the state of knowledge at that early period it seemed imperative to apply 

 a powerful germicide to the wound before closing it. To use undiluted carbolic 

 acid for operation-wounds, as I had done in compound fracture, was out of the 

 question ; and carbolic oil, though I did indeed try it, was ill adapted for the 

 purpose. But the watery solution could be satisfactorily used not only for 

 washing the wound, but also for purifying the surrounding skin, the hands of the 

 operator, and the instruments. 



The entire absence of carbolic acid in the layer of water on the ' German 

 creosote ' with which I made my first attempts with compound fractures indicates 

 that there were present in the crude product substances for which the acid had 

 incomparably greater attraction than it had for water. When purified from 

 these substances, it is indeed soluble in water, but only in small amount ; and 

 being so feebly held by water, it is free, when in watery solution, to act upon other 

 matters for which it has stronger attraction. Thus was explained the remark- 

 able germicidal energy of a lotion containing only a twentieth part of carbolic 

 acid, as illustrated by the foul sore in the hand before referred to. 



With linseed oil, on the other hand, the acid could be mixed in any pro- 

 portion, and being firmly held by the oil, it was mild in action, though present 

 in the large proportion of i to 4, as used in the carbolic putty. The i to 4 

 carbolic oil is bland when applied to the tip of the tongue, whereas the i to 20 

 watery solution is intolerably pungent. 



The acid in the watery solution, while potent in action when applied, is 

 soon dissipated, whereas it is slow in leaving the oil. Hence the watery solution, 

 powerful but transient in operation, was admirably adapted for application 

 to a cut surface as a detergent, while the carbolic putty, bland in action and 

 serving long as a store of the antiseptic, could be used with good effect not only 

 for abscesses, but also as an external dressing for operation-wounds ; and for 

 that purpose I long employed it. The putty was used in a laj^er spread on 

 calico, freely overlapping the skin around the wound, and covered with a folded 

 cloth to absorb the serum that flowed from beneath its edges. Although 

 this mode of dressing gave place in time to others which were more convenient, 

 the change effected under its use at that early period was of the most striking 

 character : healing without suppuration, pain, or fever, instead of being the 

 rare exception, became the rule, and operations were safely performed which 

 had previously been utterly prohibited on account of the danger that attended 

 them ; while pyaemia and hospital gangrene, which had before been disastrously 

 rife, were banished from my wards. 



