416 



SCIENCE. 



[N. S. Vol. IV. No. 91. 



acid as having a remarkable deodorising 

 effect upon sewage, and having obtained 

 from my colleague, Dr. Anderson, Professor 

 of Chemistry in the University of Glasgow, a 

 sample which he had of this product, then 

 little more than a chemical curiosity in 

 Scotland, I determined to try it in com- 

 pound fractures. Applying it undiluted to 

 the wound, with an arrangement for its 

 occasional renewal, I had the joy of seeing 

 these formidable injuries follow the same 

 safe and tranquil course as simple fractures, 

 in which the skin remains unbroken. 



At the same time we had the intense interest 

 of observing in open wounds what had pre- 

 viously been hidden from human view — the 

 manner in which subcutaneous injuries are 

 repaired. Of special interest was the pro- 

 cess by which portions of tissue killed by 

 the violence of the accident were disposed 

 of, as contrasted with what had till then 

 been invariably witnessed. Dead parts had 

 been always seen to be gradually separated 

 from the living by an inflammatory process 

 and thrown off as sloughs. But when pro- 

 tected by the antiseptic dressing from be- 

 coming putrid and therefore irritating, a 

 structure deprived of its life caused no dis- 

 turbance in its vicinity ; and on the con- 

 trary, being of a nutritious nature, it served 

 as pabulum for the growing elements of the 

 neighboring living structures, and these be- 

 came in due time entirely substituted for it. 

 Even dead bone was seen to be thus re- 

 placed by living osseous tissue. 



This suggested the idea of using threads 

 of dead animal tissue for tying blood ves- 

 sels ; and this was realized by means of cat- 

 gut, which is made from the intestine of the 

 sheep. If deprived of living microbes, and 

 otherwise properly prepared, catgut answers 

 its purpose completely ; the knot holding 

 securely, while the ligature around the ves- 

 sel becomes gradually absorbed and re- 

 placed by a ring of living tissue. The 

 threads, instead of being left long as before, 



could now be cut short, and the tedious 

 process of separation of the ligature, with 

 its attendant serious danger of bleeding, 

 was avoided. 



Undiluted carbolic acid is a powerful 

 caustic ; and although it might be employed 

 in compound fracture, where some loss of 

 tissue was of little moment in comparison 

 with the tremendous danger to be averted, 

 it was altogether unsuitable for wounds 

 made by the surgeon. It soon appeared, 

 however, that the acid would answer the 

 purpose aimed at, though used in diluted 

 forms devoid of caustic action, and there- 

 fore applicable to operative surgery. Ac- 

 cording to our then-existing knowledge, 

 two essential points had to be aimed at : to 

 conduct the operation so that on its com- 

 pletion the wound should contain no living 

 microbes ; and to apply a dressing capable 

 of preventing the access of other living or- 

 ganisms till the time should have arrived 

 for changing it. 



Carbolic acid lent itself well to both these 

 objects. Our experience with this agent 

 brought out what was, I believe, a new 

 principle in pharmacology — namely, that 

 the energy of action of any substance upon 

 the human tissues depends not only upon 

 the proportion in which it is contained in 

 the material used as a vehicle for its ad- 

 ministration, but also upon the degree of te- 

 nacity with which it is held by its solvent. 

 Water dissolves carbolic acid sparingly and 

 holds it extremely lightly, leaving it free to 

 act energetically on other things for which 

 it has greater affinity, while various organic 

 substances absorb it greedily and hold it tena- 

 ciously. Hence its watery solution seemed 

 admirably suited for a detergent lotion to be 

 used during the operation for destroying any 

 microbes that might fall upon the wound^ 

 and for purifying the surrounding skin and 

 also the surgeon's hands and instruments. 

 For the last-named purpose it had the fur- 

 ther advantage that it did not act on steel. 



