The first class of cases to which I applied it was that of
compound fractures, in which the effects of decomposition in the
injured part were especially striking and pernicious. The results
have been such as to establish conclusively the great principle
that all local inflammatory mischief and general febrile
disturbances which follow severe injuries are due to the
irritating and poisonous influence 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 introduced
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 rag held in dressing forceps and dipped
into the liquid. [Footnote: The addition of a few drops of water
to a considerable quantity of the acid, induces it to assume
permanently the liquid form.] This I did not venture to do in the
earlier cases; but experience 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 compound 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.
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