THE USE OF CARBOLIC ACID. 
175 
entertained about the antiseptic treatment having done posi¬ 
tive good. In compound fractures^ too, the average of suc¬ 
cess has been high; and there has been, in particular, one 
very notable case of a middle-aged man, under Mr. MarshalPs 
care—a compound and badly comminuted fracture of the 
tibia in its lowest third, to which were superadded a com¬ 
pound fracture of the fibula and severe laceration of the soft 
parts,—a case apparently, at first sight, demanding immediate 
amputation. The absence of constitutional disturbance in 
this case was extremely remarkable; after the second day 
the man had literally none whatever, and the deep parts of 
the wound closed in with the formation of hardly any pus. 
The fracture was firmly united when he left the hospital. 
In the treatment of wounds of all kinds, whether produced 
by surgical operation or by accident, the success has been 
of a more moderate kind. Many of the cases would have 
recovered as soon under ordinary treatment, provided no 
complication—especially the terrible one of pyaemia—had 
supervened; but, on the whole, the belief is that, though in 
many of these cases the time of convaleseence may not 
have been accelerated, in a very great number the constitu¬ 
tional disturbance, and in nearly all the amount of suppura¬ 
tion, were diminished. It so happened that during the earlier 
months of last year, pyaemia was exceedingly rife in this 
hospital. Patient after patient perished by it; and indeed 
recovery after amputation of a limb was almost becoming an 
exceptional rarity. This endemic of pyaemia continued up 
to the date at which carbolic-acid dressings began to be 
used. Not one of those treated antiseptically died ot pyaemia, 
or indeed ever had a pyaemic symptom. 
Phlegmonous erysipelas has not once occured here in con¬ 
nection with antiseptic dressings in the wards. Among the 
out-patients several cases presented themselves; but in all 
the dressings had been tampered with, and the wound (in 
the arm, in most of the cases) had not been kept at rest. It 
was the occurrence of these and other similar cases that led 
to the comparative disuse of antiseptic dressings in the 
casualty-room. 
Secondary abscesses and sloughing of the skin are occur¬ 
rences of infinite rarity now that the acid has ceased to be 
used in a concentrated form. 
Notably, there have been more cases of persistent and 
uncontrollable vomiting after operations since the introduc¬ 
tion of carbolic-acid dressings than there were before; and 
it is not unreasonable to suppose that the absorption of some 
of the acid from the raw surface of the wound superadds a 
