stimulate granulations to suppurate; whereas the presence of
decomposing organic matter does. These truths are even more
strikingly exemplified by the fact that I have elsewhere recorded
(Lancet, March 23rd, 1867), that a piece of dead bone free from
decomposition may not only fail to induce the granulations around
it to suppurate, but may actually be absorbed by them; whereas a
bit of dead bone soaked with putrid pus infallibly induces
suppuration in its vicinity.
Another instructive experiment is, to dress a granulating sore
with some of the putty above described, overlapping the sound
skin extensively; when we find, in the course of twenty-four
hours, that pus has been produced by the sore, although the
application has been perfectly antiseptic; and, indeed, the
larger the amount of carbolic acid in the paste, the greater is
the quantity of pus formed, provided we avoid such a proportion
as would act as a caustic. The carbolic acid, though it prevents
decomposition, induces suppuration--obviously by acting as a
chemical stimulus; and we may safely infer that putrescent
organic materials (which we know to be chemically acrid) operate
in the same way.
In so far, then, carbolic acid and decomposing substances are
alike; viz., that they induce suppuration by chemical
stimulation, as distinguished from what may be termed simple
inflammatory suppuration, such as that in which ordinary
abscesses originate--where the pus appears to be formed in
consequence of an excited action of the nerves, independently of
any other stimulus. There is, however, this enormous difference
between the effects of carbolic acid and those of decomposition;
viz., that carbolic acid stimulates only the surface to which it
is at first applied, and every drop of discharge that forms
weakens the stimulant by diluting it; but decomposition is a
self-propagating and self-aggravating poison, and, if it occur at
the surface of a severely injured limb, it will spread into all
its recesses so far as any extravasated blood or shreds of dead
tissue may extend, and lying in those recesses, it will become
from hour to hour more acrid, till it requires the energy of a
caustic sufficient to destroy the vitality of any tissues
naturally weak from inferior vascular supply, or weakened by the
injury they sustained in the accident.
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