THE

Leavenworth Medical Herald.

C. A. LOGAN, M. D., AND T. SINKS, M. D. EDITORS.

Vol. II.

JANUARY, 1869.

Original Communications.

No. 8.

ART. I.-Carbolic Acid as a Dressing for Wounds. Case by S. T. ODELL, M. D., St. Louis, Miami County, Kansas.

A correspondent of one of our western journals of a late date, writing from Europe, states that carbolic acid as a dressing for wounds falls far short of the efficiency claimed for it by Prof. Jas. Lister, of the University of Glasgow. As to what Prof. Lister's claims for the acid are, (briefly stated,) see Rankin's Half Yearly Abstract, vol. XLVI, pp. 146, et seq.

The accompanying case is reported in substantiation of the following propositions set forth by Prof. Lister, in the paper above referred to 1st. "All the local inflammatory mischief and general febrile disturbance which follow severe injuries are due to the irritating and poisoning influence of decomposing blood or sloughs." 2d. "These evils are entirely avoided by the antiseptic treatment," (i. e., carbolic acid treatment.)

A casual reader of the article by the "European correspondent" above referred to, and one who had never tried carbolic acid as a dressing for wounds, would, from the said article, naturally form the conclusion that Lister claimed every thing for the acid, and that it performed almost nothing. Conservatism in science or art, as in politics, is a "nice thing" We look

with distrust on any thing radical, and naturally bow to the conservative element. More especially is this true in medicine and surgery. Witness the conduct of our profession in the matters of vaccination and anaesthesia, in the introduction of cinchona as a remedial agent, and in innumerable other instances familiar to the medical scholar. While the conservative element has in some cases retarded our advance, in others it has preserved us. Mesmerism, the vagaries of Hahnemann, &c., &c., furnish instances of this. But while we would acknowledge the debt we owe conservatism and the necessity of exercising a due amount of caution in the acceptance of things new and untried, we would deprecate the habit of playing unduly upon that particular string of the harp medical, and especially the manner of its manifestation exhibited by the correspondent mentioned. It is easier to condemn untried, than to weigh new claims and pass impartial judgment. We cannot try every thing new, but we can at least refrain from hasty condemnation.

Although the claims of carbolic acid as an antiseptic have been for some time before the profession with such names as Lister, Syme, Maisonneuve, and others of equal repute indorsing its efficacy, yet the writer has, in the past year, seen wound after wound treated after the old style, and patients suffering exhaustion from suppuration in consequence; treated, too, by physicians who "read the Journals," and in general keep up with the times, and not by "old fogies" who say by their practice that the last twenty-five years has added nothing worth attention to our knowledge. We have used the acid in other cases than the one reported here, and it has always given results as good as in this case; therefore we think that the statement that it has disappointed expectations in its favor is unfounded, and only calculated to retard its introduction into general use. Such statements may be all well enough for the correspondent in search of local fame as a medical critic and observer, but are they for the best of our prefession? These considerations have induced the publication of this article. There is nothing startling in the results of the following case; yet it proves, so far as one case can prove, the propositions of Mr. Lister, as stated above.

Case: Lawrence W., aged S, farmer's child, of good consti

tution, and medium growth for his age, fell off a horse going at speed over the prairie, on August 27, 1868, at about five o'clock p. m., and suffered a fracture of the forearm. I was called to the case, and arrived at eight o'clock p. m. On examination, found a compound fracture of both bones of the left forearm at a point corresponding to the junction of the lower and middle thirds. The wrist and lower fragments were bent backwards at almost a right angle to the upper fragments, which latter protruded through an opening on the anterior aspect of the arm to the extent of at least one inch. The protruding portions of the ulna and radius were covered with the black soil of the prairie, indicating that at his fall they had been forcibly jammed into the earth. On my remarking this, Mrs. W., (the patient's mother,) stated that she thought the ends of the ones were pieces of sticks which had somehow gotten there in his fall, and had, prior to my arrival, made several efforts at their extraction.

I cleansed the ends of the bones as far as might be, and removed the patient to a table. After constructing a rude set of splints with a jack-knife and a couple of shingles, (the only material and tools at hand,) making in the anterior splint an opening opposite the position of the open wound to facilitate its dressing, I proceeded, with the assistance of Dr. Steger, to administer ether, intending to more thoroughly cleanse the parts of dirt, clotted blood, &c., when the patient should become anæsthetized. He struggled considerably during the administration of the ether, and the party having care of the wounded arm, not holding it properly, the bones became replaced beneath the integument. After etherization, I attempted, by gentle means, to reproduce the external appearance of the ends of the bones, for the purpose above alluded to, but finding that I could not accomplish this without further laceration of the soft parts, I desisted. After attending further to the cleansing of the wound, I obtained coaptation of the fragments, and secured the arm in the usual manner; dressed the wound by laying upon it a compress soaked in a solution of carbolic acid in water of strength gtt. v. to 3i, and over this a pad of raw cotton wetted with the same solution; left orders for the cotton to be reapplied every half hour.

I should have attempted the more speedy conversion of the compound into a simple fracture by the dressing of lint soaked in a solution of carbolic acid in linseed oil, and covered with a putty made of whiting and the acidulatory oil as described by Mr. Lister in the periodical above referred to, but for the fact that neither linseed oil or whiting were to be had; the nearest drug store being fifteen miles distant. Nor did I deem it expedient to attempt the immediate closure of the external wound, because I was satisfied there was foreign matter within, which could only be cast out by suppurative process.

Second day.- Patient somewhat fretful; slept but little last night; states that his arm did not pain him during the night. He suffered, in fact, only from the ordinary after effects of etherization. Arm not swollen any worth the naming. Compress covered with particles of dirt and clotted blood. No fever, no appetite. Continue acid to wound every two hours.

Third day.-Patient has recovered his usual spirits; appetite good; tongue natural in appearance; no fever. On removal of the compress found a trace of pus upon it, perhaps four or five drops. Took steps for the more thorough application of the acid.

Fifth day.- Patient apparently in his usual health; runs about the house and yard, and stoutly objects to being "doctored" any longer. Found again a few drops of pus on the compress next the wound. Wound looks healthy.

Ninth day.-Wound almost entirely closed; no pus on the dressing.

Thirteenth day.-Wound entirely healed.

Twenty-first day.- Removed splints and found union complete. Pronation and supination perfect. Reapplied the splints loosely to be worn a few days to guard against accidents, and discharged the patient.

Here was a compound fracture with a wound large enough to permit the passage of both bones of the forearm. The wound healed in less than thirteen days without discharging altogether as much as a dram of pus, though there was unavoidably some foreign matter left in the wound at its original dressing. As I only saw the patient on the second, third, fifth and ninth days

while the wound was open, I form my estimate of the amount of pus discharged by the amount I found on the slip of cloth which lay next the wound on the mornings on which I dressed it myself, and on the statement of Mrs. W., who attended to the dressing of the wound in my absence. Although the cotton was soaked in the acid solution and reapplied every two hours, the cloth next the wound was only changed once a day.

At no time after his recovery from the effects of ether, was there any fever or constitutional disturbance.

ART. II.-Secondary Fatus, or Superfotation. By T. G. HORN, M. D., Junction City, Kansas.

Mrs. S., a very estimable lady, of this place, being pregnant, and, as she supposed, about the seventh month, was taken suddenly with a chill, severe pain in the back, followed with fever.

November 5th, 1868. Thinking it was nothing more than an ordinary chill peculiar to this country, she would not send for a physician. During the evening, the fever gave way, and the sweating stage came on, and next morning she arose as usual, but with constant pain in the lumber region. This continued until the evening of the 9th, when I was hastily summoned to see her. I was soon at the bed side, and found my patient in actual labor. Upon inquiry, I found that she had been in pain the most of the day, but was not aware (being the first child) that it was labor. A careful examination proved the os completely dilated with the head of the foetus presenting. Labor progressed favorably, and in three hours the child was delivered. The circulation was very feeble, and in ten minutes using all the means in our power to bring about nature's respirationdid we work, before any signs of breathing could be detected; a few deep inspirations, and our efforts were crowned by the welcome "cry," and it was turned over to the nurse.

My attention was then turned to the mother, who, in this time, had several strong after pains. Making light traction upon the cord, but finding the placenta firm, I passed my finger up the cord, and to my surprise found a foot presenting. Making light