Large surfaces should never be exposed to carbolic solutions, because the skin absorbs them readily, followed by untoward results. Dangerous symptoms have been known to result from the internal administration of seven drops of the acid, and fatal termination has followed its use as a surgical dressing (Bartley).
Mild acid poisoning is first noted in the urine, which turns olive green. If the agent is continued, the urine appears dark and turns almost black on standing. The coloring is due to the presence of indican. If the absorption is not prevented beyond this there is dull frontal aching, tinnitus aurium, dizziness, fainting, severe and uncontrollable vomiting. Untoward symptoms are noted by albuminuria, total absence of sulphates in the urine, a contracted and inactive pupil, elevation of temperature, unconsciousness, muscular contraction, and death.
The treatment consists in immediately removing the cause and employing another antiseptic. Support the patient with stimulants, freely given. Cracked ice and brandy to allay the vomiting. Small doses of sodium sulphate, frequently repeated, as a means of converting the acid into nonpoisonous sulphocarbolate (Bauman). Albumen and milk internally. Magnesium sulphate, five per cent.
Chromic Anhydrid.—Improperly called chromic acid. Made by adding one and one half parts sulphuric acid, c. p., to one part of concentrated solution of dichromate of potash. Appears in saffron-colored crystals. It acts as a caustic upon tissue, and, although a splendid antiseptic, cannot be used for such purposes, but is well adapted for the preparation of catgut, as mentioned.
Creolin.—Is an antiseptic prepared from coal by dry distillation, and is used to stimulate granulations, being much more powerful than carbolic acid. It is nonirritant and practically nontoxic. Used in two-per-cent aqueous solutions, in which it appears as a turbid but effective mixture. It is well suited for cleansing the hands, a five-per-cent solution having none of the irritating or anesthetic effect of carbolic acid. Owing to the opacity of the aqueous solution, it is not suitable for the immersion of instruments for operation.
Eucalyptol (W. Schultz).—A nonpoisonous volatile oil of considerable antiseptic power. Soluble in alcohol, and used in three-per-cent solution. It is claimed to quickly reduce the temperature in a wound. It was much used by Lister on gauze dressings, the formula of which is given elsewhere.
Glycerin.—It is said to have certain antiseptic power, but is used principally as a staple solvent of carbolic and boric acid. Soluble in all proportions in water and alcohol.
Hydrargyrum Bichloratum Corrosivum (v. Bergman, Schede, Buchholz, Billroth, R. Koch).—The most valuable and effective, although the most toxic of all antiseptics. It appears as a white crystalline powder. A 1-50,000 watery solution is efficacious as a germicide (Koch; anthrax bacilli killed by 1-20,000 solution). Albumen decomposes the bichlorid, forming a white insoluble precipitate, albuminate of mercury. The same effect takes place in aqueous solutions allowed to stand for a time—the resultant being either calomel or metallic mercury. The addition of sodium or ammonium chlorid or a weak acid, such as tartaric, prevents this. As much sodium as of the sublimate, weight for weight, should be used (Koch). When tartaric acid is used for this purpose, five times the weight of the sublimate is employed.
For all surgical purposes, except in irrigation, solutions of 1-500 and 1-1,000 are used. For the sterilization of wounds and during operations a 1-3,000 is employed.