in many instances the benefits derived from Pasteur's inoculative procedure have been of doubtful importance among intelligent observers.

With regard to the administration of serum, several precautions are of great importance. The absolute cleanliness of the syringe, for example, should be an object of especial care. To this end a glass barrel is preferable, in order that impurities may be readily detected and removed. For packing purposes rubber or asbestos should be employed, and the instrument should be so constructed as to permit cleansing and sterilizing of every part before and after

use.

The mode of injection and the amount of dosage (measured in antitoxin units) vary somewhat according to the nature of the disease and the age and susceptibility of the patient. Care should be taken to use only the most reliable preparations.

It has been impossible to present within a necessarily limited space the entire field covered by this profoundly interesting subject. For a multitude of details, embodying a wide range of experimentation, and for many expressions of individual opinion awakened by a consideration of so absorbing a theme, the student is referred to the extensive bibliography relating to every phase of serumtherapy.

It may be readily imagined what would have been the discussion of Jenner's vaccination had our bacteriological and chemical knowledge and delicate appliances for investigation existed in his day. It is scarcely surprising, therefore, that the renewal of similar studies, after an interval of unprecedented scientific progress, should elicit from all parts of the world a zeal and enthusiasm impossible in any previous epoch, together with a mass of concurrent or dissenting testimony touching new discoveries proportionate to the greatly increased number of competent investigators. Whatever be the limitations of serum-therapy, the consensus of opinion among thoughtful observers is that its importance to mankind and its purpose are deeply rooted in the eternal laws of matter and the methods of great Nature. Its rationale, its mysterious power, and startling phenomena awaken new and greater problems of bacteriological science; yet, though the entire subject, embracing as it does so ample and momentous a field of inquiry, remains sub judice, the character of modern scientific investigation must surely reveal its truth or falsity.

DIVISION III.-ANTISEPTICS.

Acidum Carbõlicum-Acidi Carbolici-Carbolic Acid. U. S. P.

Origin. A constituent of Coal-tar, obtained by fractional distillation and subsequently purified.

Description and Properties.-Colorless, interlaced, or separate, needle-shaped crystals, or a white, crystalline mass, sometimes acquiring a reddish tint, having a characteristic, somewhat aromatic odor, and, when copiously diluted with water, a sweetish taste, with a slightly burning after-taste. Deliquescent on exposure to damp air.

Soluble in about 15 parts of water, the solubility varying according to the degree of hydration of the acid; very soluble in alcohol, ether, chloroform, benzol, carbon disulphide, glycerin, and fixed and volatile oils. It is liquefied by the addition of about 8 per cent. of water. The vapor of the acid is highly inflammable. Carbolic acid is faintly acid to litmus-paper. It should be kept in dark amber-colored, well-stoppered bottles.

Dose.--2 grains (0.03-0.12 Gm.). If liquefied, 1-2 minims (0.03-0.12 Cc.).

Official Preparations.

Glyceritum Acidi Carbolici-Glyceriti Acidi Carbŏlici-Glycerite of Carbolic Acid (25 per cent.).-For external use.

Unguentum Acidi Carbŏlici-Unguenti Acidi Carbŏlici-Ointment of Carbolic Acid (10 per cent.).—For external use.

Unofficial Preparations.

Aqua Acidi Carbolici-Aquæ Acidi Carbolici-Carbolic Acid WaterStrength, 2 drachms in 1 pint (8.0--473.17 Cc.). Dose, 1-2 fluidrachms (4.0-8.0 Cc.). Oleum Acidi Carbolici-Ōlei Acidi Carbolici-Carbolated Oil.-1 in 20 of Olive or Cotton Seed Oil. For external use.

Cărbasus Acidi Carbolici-Cărbasi Acidi Carbolici-Carbolic Acid Gauze. -Gauze containing Carbolic Acid, I; Resin, 5; Paraffin, 7 parts. Used as a surgical dressing.

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Emplǎstrum Acidi Carbolici-Emplăstrum (acc.) Acidi Carbolici-Carbolic Acid Plaster.-Composed of Carbolic Acid, 25; Shellac, 75; coated with Guttapercha dissolved in Carbon Disulphide. For external use.

Camphora Carbolisāta-Camphōræ Carbolisātæ-Camphorated Carbolic Acid (PHENOL-CAMPHOR).—Camphor, 2; Carbolic Acid, 1; allow to liquefy. A colorless, oily liquid, having the odor of camphor, soluble in fixed oils, alcohol, and ether, nearly insoluble in water and glycerin. Used as a local anesthetic, chiefly for toothache. Liquor Sōdii Carbolātus-Liquōris Sōdii Carbolāti-Phenol-Sodique.Composed of Carbolic Acid, 188 grains (12.5 Gm.); Caustic Soda, 31 grains (2.06 Gm.) Distilled Water, 4 ounces (118.29 Cc.). For external use.

Liquor Sōdii Borātis Compositus-Liquōris Sōdii Borātis Compositi Dobell's Solution.-Composed of Borax and Sodium Bicarbonate, of each, 2 drachms (15.0 Gm.); Carbolic Acid, 24 grains (1.8 Gm.); in Water, 1 pint (473.17 Cc.). Used externally in spray.

Acidum Carbolicum Iodātum (N. F.)—Ăcidi Carbolici Iodati-Iodized Carbolic Acid (PHENOL IODATUM).—Composed of Iodine, 20 parts; Carbolic Acid, 76 parts; Glycerin, 4 parts. The iodine, the acid which has been previously melted, and the glycerin are put in a flask, digested at a gentle heat, and frequently agitated until the iodine is dissolved. It should be kept in glass-stoppered bottles in a dark place. Used locally, especially in gynecological practice.

Creasols.

Allied Compounds.

Obtained by distilling Coal-tar between 200° and 210° C.; also obtained by fusing Toluene Sulphonic Acid with Potash. The familiar compounds of creasols are Crealin, Lysol, Solutol, Saprol, etc. They are powerful disinfectants and germicides, and less poisonous than carbolic acid. Aseptol, or orthophenol-sulphonic acid, is a commercial article, a straw-colored, slightly caustic liquid. It is a powerful antiseptic.

Antagonists and Incompatibles.-Bromine, metallic salts, antipyrine, collodion, alkalies, saccharate of lime or lime, and soluble sulphates like Epsom or Glauber salts, are incompatibles. Atropine is a physiological antagonist.

Synergists. All members of the carbolic-acid group, antiseptics, and motor depressants.

Physiological Action.-Externally.-Carbolic acid is a local anesthetic, and, applied in full strength to animal tissues, acts as a caustic, but does not produce vesication. In weaker solutions it produces a burning and reddening of the skin. It acts more severely upon mucous membranes. It coagulates albumin, and therefore its caustic action is limited.

The eschar is first whitish, subsequently becoming brownish. It is readily absorbed through the skin or through raw surfaces, and toxic effects have been thus produced. Weak solutions are antipruritic and gratefully cooling and anodyne. It is a disinfectant, a deodorant, and a parasiticide.

Internally.-Digestive System.-In small doses it is cooling and sedative to the stomach. In large or poisonous doses it is a pow erful gastro-intestinal irritant. Ordinary medicinal doses are converted by the gastric contents into the sulphocarbolates.

Circulatory System.-Medicinal doses have no apparent effect on the circulation. Large doses first depress and later accelerate the heart. Poisonous doses powerfully depress the heart, stopping it in diastole. The arterial tension is lowered by lethal doses, from paralysis of the vaso-motor center in the medulla.

Nervous System.-Medicinal doses have no special effect upon the nervous system. Large or poisonous doses depress the cerebrum. Vertigo may first be noticed, which is soon followed by stupor. Owing to stimulation of the anterior cornua of the spinal cord, there may be muscular trembling or convulsions. The cornua are ultimately depressed, causing abolition of reflexes and paralysis.

Respiratory System.-Small doses do not affect the respiration. Large doses first accelerate the respiratory movements, rendering them full, but shallow respirations soon follow. This action is due to stimulation of the vagi, both at the periphery and at the center. If the dose has been a poisonous one, there is great depression, and ultimately paralysis of respiration, due to depression of the

centers.

Absorption and Elimination.—It is absorbed from the stomach, and diffuses into the blood with great facility, circulating in that tissue probably as an alkaline carbolate.

It is eliminated by all the secretions-chiefly by the kidneys and lungs—and appears in the urine as salts of sulphocarbolic and glycuronic acids, and the oxidated products hydrochinon and pyrocatechin. To the last substance is mainly due the peculiar smoky or olive-green color imparted to the urine after large or continued doses have been taken. (There is also, probably, some other factor causing this change, for pyrocatechin can exist only in alkaline urine.)

When a very large amount of carbolic acid has been taken, some of it can be found in the urine unchanged.

Temperature. It is not specially affected by small doses. Full medicinal doses tend to lower bodily temperature in fever, while poisonous doses lower the temperature several degrees. The reduction of temperature is due to its diminishing heat-production and increasing heat-dissipation.

Eye.-Poisonous doses almost invariably cause the pupil to be minutely contracted, due, probably to paralysis of the radiating fibers, the circular fibers being unaffected.

Untoward Action.-Headache, either in the frontal or the occipital region, heaviness and a sensation of fulness in the head, dizziness, and the appearance of rings before the eyes, muscular weakness, especially of the legs, profuse sweating, formication.

Where there is an idiosyncrasy on the part of the individual against this drug, small doses even may produce the symptoms of poisoning.

Poisoning-Carbolic acid is one of the most deadly poisons, often equalling hydrocyanic acid in its rapidity of action.

The patient is rendered rapidly unconscious or may drop dead within a very few moments from paralysis of respiration. Should the dose be insufficient to produce so sudden a death, the patient suffers from all the symptoms of gastro-enteritis-intense pain, with violent vomiting and purging. Fibrillary trembling may be present. Stertorous breathing appears, with cold, clammy skin, pinched face, anxious expression, abolition of reflexes, weak, thready, and often imperceptible pulse, feeble respiration, and frequently dyspnea, and death finally occurs from failure of respiration.

As toxic symptoms may be produced by the external application of solutions of carbolic acid, as in surgical dressings or vaginal or intra-uterine douches, the toxicity of this drug should be appreciated, and patients carefully watched for the first untoward manifestations, such as pain in the lumbar region, smoky urine, nervousness, and cerebral disturbance, when the drug should be immediately withdrawn.

Treatment of Poisoning-The immediate administration of magnesium sulphate (Epsom salts) and warm demulcent drinks should be resorted to. The application of external heat. Atropine and strychnine hypodermically. Digitalis and coffee may also be required. Opium, or some preparation of it, for the relief of pain. If the patient is seen soon after the drug has been taken, the stomach should be washed out, after which the above treatment should be followed.

Therapeutics.-Externally and Locally.-For some time after it was so prominently brought forward by Lister carbolic acid was thought to be indispensable in antiseptic surgery. It is now known that the solutions which are safe to use are inefficient, ordinarily, beyond the mere mechanical effect of washing.