So long as any discharge continues, the paste should changed daily, and, in order prevent the chance mischief occurring during the process, a piece rag dipped in the solution carbolic acid in oil put next the skin, and maintained there permanently, care being taken a void raising along with the putty. This rag always kept in an antiseptic condition from contact with the paste above and destroys any germs which may fall upon during the short time that should alone allowed pass in the changing the dressing. The putty should in a layer about a quarter an inch thick, and may advantageously applied rolled out between two pieces thin calico, which maintain in the form a continuous sheet, which may wrapped in a moment round the whole circumference a limb if this thought desirable, while the putty prevented the calico from sticking the rag which next the skin. When all discharge has ceased, the use the In order prevent evaporation the acid, which passes readily through any organic tissue, such as oiled silk or gutta percha, well cover the paste with a sheet block tin, or tinfoil strengthened with adhesive plaster. The thin sheet lead used for lining tea chests will also answer the purpose, and may obtained from paste discontinued, but the original rag left adhering the skin till healing scabbing supposed complete. I have at present in the hospital a man with severe compound fracture both bones the left leg, caused direct violence, who, after the cessation the sanious discharge under the use the paste, without a drop pus appearing, has been treated for the last two weeks exactly as if the fracture was a simple one. During writing phd thesis this time the rag, adhering means a crust inspissated blood collected beneath has continued perfectly dry, and will left untouched till the usual period for removing the splints in a simple fracture, when may fairly expect find a sound cicatrix beneath We cannot, however, always calculate perfect a result as this.

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More or less pus may appear after the lapse the first week, and the larger the wound, the more likely this happen.

And here I would desire earnestly enforce the necessity persevering with the antiseptic application in spite the appearance suppuration, long as other symptoms are favorable. The surgeon extremely apt suppose that any suppuration an indication that the antiseptic treatment has failed, and that poulticing or water dressing should resorted But such a course would in many cases sacrifice a limb or a life. I cannot, however, expect professional brethren follow advice blindly in such a matter, and therefore I feel necessary place before them, as shortl as I can, some pathological principles intimately connected, not only with the point are immediately considering, but with the whole If a perfectly healthy granulating sore well washed and covered with a plate clean metal, such as block tin, fitting help making a thesis statement its surface pretty accurately, and overlapping the surrounding skin an inch or in every direction and retained in position adhesive plaster and a bandage, will found, removing after twenty-four or forty-eight hours, that little or nothing that can called pus present, merely a little transparent fluid, while at the same time there an entire absence the unpleasant odour invariably perceived when water dressing changed. Here the clean metallic surface presents no recesses like those porous lint for the septic germs develope in, the fluid exuding from the surface the granulations has flowed away undecomposed, and the result the absence suppuration. This simple experiment illustrates the important fact that granulations have no inherent tendency form pus, but only when subjected preternatural stimulus. Further, shows that the mere contact a foreign body does not itself stimulate granulations suppurate whereas the presence decomposing organic matter does. These truths are even more strikingly exemplified the fact that I have elsewhere recorded Lancet, March, that a piece dead bone free from decomposition may not only fail induce the granulations around suppurate, but may actually absorbed them whereas a bit dead bone soaked with putrid pus infallibly induces suppuration in its vicinity.

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Another instructive experiment dress a granulating sore with some the putty above described, overlapping the sound skin extensively when find, in the course twenty-four hours, that pus has been produced the sore, although the application has been perfectly antiseptic and, indeed, the larger the amount carbolic acid in the paste, the greater the quantity pus formed, provided avoid such a proportion as would act as a caustic. The carbolic acid, though prevents decomposition, induces suppuration obviously acting as a chemical stimulus and may safely infer that putrescent organic materials which know chemically acrid operate in the same way.

In far, then, carbolic acid and decomposing buy essay paper substances are alike, that they induce suppuration chemical stimulation, statement writer as distinguished from what may termed simple inflammatory suppuration, such as that in which ordinary abscesses originatewhere the pus appears formed in consequence an excited action the nerves, independently any other stimulus.

There however, this enormous help me to write an essay difference between the effects carbolic acid and those decomposition, that carbolic acid stimulates only the surface which at first applied, and every drop discharge that forms weakens the stimulant diluting but decomposition a self-propagating and self-aggravating poison, and, if occur at the surface a severely inj ured limb, will spread into all its recesses far as any extravasated blood or shreds dead tissue may extend, and lying in those recesses, will become from hour hour more acrid, till requires the energy a caustic sufficient destroy the vitality any tissues naturally weak from inferior vascular supply, or weakened the injury they sustained in the accident. Hence easy understand how, when a wound very large, the crust beneath the rag may prove here and there insufficient protect the raw surface from the stimulating influence the carbolic acid in the putty and the result will first the conversion the tissues acted into granulations, and subsequently the formation more or less pus.

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This, however, will merely superficial, and will not interfere with the absorption and organisation extravasated blood or dead tissues in the interior. But, the other hand, should decomposition set in before the internal parts have become securely consolidated, the most disastrous results may I left behind in Glasgow a boy, thirteen years age, who, between three and four weeks previously, met with a most severe injury the left arm, which got entangled in a machine at a fair. There was a wound six inches long and three inches broad, and the skin was very extensively undermined beyond its limits, while the soft parts were generally much lacerated that a pair dressing i need help writing a term paper forceps introduced at the wound and pushed directly inwards appeared beneath the skin at the opposite aspect the limb. From this wound several tags muscle were hanging, and among them was one consisting about three inches the triceps in almost its entire thickness while the lower fragment the bone, which was broken high was protruding four inches and a half, stripped muscle, the skin being tucked in under Without the assistance the antiseptic treatment, I should certainly have thought nothing else but amputation at the shoulder-joint but, as the radial pulse could felt and the fingers had sensation, I did not hesitate try save the limb and adopted the plan treatment above described, wrapping the arm from the shoulder below the elbow in the antiseptic application, the whole interior the wound, together with the pay for essay writing protruding bone, having academic research writing service previously been freely treated with strong carbolic acid. About the tenth day, the discharge, vhich that time had been only sanious and serous, showed a slight admixture slimy pus and this increased till a few days before I left amounted about three drachms in twenty-four hours.

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