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LORD LISTER 



of compound fractures, in which the effects of decompo- 

 sition in the injured part were especially striking and 

 pernicious. The results have been such as to establish con- 

 clusively the great principle that all local inflammatory 

 mischief and general febrile disturbances which follow 

 severe injuries are due to the irritating and poisonous in- 

 fluence of decomposing blood or sloughs. For these evils 

 are entirely avoided by the antiseptic treatment, so that 

 limbs which would otherwise be unhesitatingly condemned 

 to amputation may be retained, with confidence of the best 

 results. 



In conducting the treatment, the first object must be the 

 destruction of any septic germs which may have been in- 

 troduced into the wounds, 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 

 raj; held in dressing forceps and dipped into the liquid. 1 

 This I did not venture to do in the earlier cases; but ex- 

 perience 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 organisation, provided 

 they are afterwards kept from decomposing. We are thus 

 enabled to employ the antiseptic 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 Glasgow Infirmary, a boy who was admitted with com- 

 pound fracture of the leg as late as eight and one-half 

 hours after the accident, in whom, nevertheless, all local 

 and constitutional disturbance was avoided by means of 

 carbolic acid, and the bones were soundly united five weeks 

 after his admission. 



The next object to be kept in view is to guard effectually 

 against the spreading 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 



1 The addition of a few drops of water to a considerable quantity of the 

 acid, induces it to assume permanently the liquid form. 



