From Levai's data and from observa tions made on out-patients of the Tubingen clinic, it is estimated that one case of carbolic-acid gangrene occurs in every thousand surgical patients. In literature are found 43 examples suffi ciently described; in 30 of them the strength of the solution was from 1 to 5 per cent. The thromboses found are not the cause of the gangrene, but only an accompaniment. As compared with that due to the other caustics mentioned, there is nothing specified in the gangrene induced by carbolic acid; it acts by giving rise to excessive transudation into the subcutaneous cellular tissue, and so choking the circulation, especially in the fingers. The most effective prophylactic would be to restrict the sale of carbolic acid. Honsell (Beit. zur klin. Chir., xis, 9; Centralb. f. Chir., Mar. 5, '98).
Fatal case in an infant, 7 days old, due to accidental application over the right inguinal region of only enough carbolic acid to make two eschars, one the size of a quarter, the other that of a dime. Death occurred ten hours after the first convulsion, the latter ceasing two hours before death. Cyanosis and spasm of the face continued to the end. The nurse had been preparing a carbolic douche for the mother; accidentally she touched the pure carbolic acid with her thumb and index finger and immediately after touched the baby with the moist fingers. Five minutes later the convulsions began. R. Abrahams (Pediatrics, Mar. 15, 1900).
Carbolic acid in concentrated solution is relatively less toxic than when diluted, its penetrability during its brief influ ence is but slight, and the bactericidal action of pure carbolic acid surpasses that of sublimate in albuminous com pounds. It has personally been employed in more than eighty cases of infected wounds, plegmons, suppuration of joints, etc. After incision, and subsequent curetting or excision of the wound, the surrounding skin is protected against the excess of carbolic acid by wetting it with absolute alcohol; the wound is then thoroughly swabbed with a gauze sponge previously immersed in pure carbolic acid. The amount of carbolic acid em ployed depends upon the size of the wound, but more than 2-6 grains was not even used in the largest wound. The pure carbolic acid is applied for one minute, followed by immediate irriga tion with absolute alcohol. Von Bruns (Phila. Med. Jour., May 18, 1901).
Treatment of Poisoning by Phenic (Carbolic) Acid.—The soluble sulphates
are chemical antidotes to carbolic acid, their combination forming insoluble sulphocarbolates. Epsom, or Glauber's, salts in solution readily the acid into the vessels and tissues of the body and combine at once with it. They should, therefore, be given even if hours have elapsed since the poison was taken. Liquor calcis saccharatus, or syrup of lime, is also a useful antidote. Warm mucilaginous drinks may be given to soothe and protect the inflamed digestive tract. Oils should not be given, as they dissolve the acid and favor absorption. Collapse requires hypodermic injections of digitalin and strychnine, and friction and hot applications to the extremities. Failing respiration calls for atropine in jections; pain may be relieved by injec tions of morphine and counter-irritation over the abdomen. Emetics will not act on account of the condition of the stom ach; the stomach-pump is generally contra-indicated on account of the le sions along the oesophagus and in the stomach. If the patient survive, small doses of the soluble sulphates may be given at stated intervals for several days, to counteract any acid that may have been absorbed.
Case of a girl, 18 years old, suffering from carbolic-acid poisoning. When ad mitted to the hospital she was quite un conscious, cyanosed, and nearly pulse less. The lips and the tongue were dis colored, and the breath had a slight carbolic-acid odor. Hypodermic injec tion of strychnine (V„ grain) was given. A soft stomach-tube was passed and the stomach washed out with equal parts of vinegar and water, this being followed with about 6 pints of warm water; 5 ounces of milk and an ounce of brandy were then given. She was put into bed and kept warm. She gradually regained consciousness, and a few hours after ward was able to speak. She was fed on 13enger's food, milk, and soda-water for the next three days. Carboluria was present for two days. Conclusion is that vinegar should be given a fair trial in carbolic-acid poisoning. A. Paget (In dian Med. Rec., Dec. 1, '97).
In the treatment of poisoning by car bolic acid, 30 to 60 minims of sulphuric ether should be injected immediately by hypodermic syringe. A rectal injection of 2 ounces of sulphate of sodium in 3 pints of filtered water is then given, the bowel being irrigated as high as possible after the manner of Cantani.