External

Carbolic acid is largely used as a deodorant and disinfectant for drains, bed-pans, for which the cheaper crude acid may be employed, soiled linen, surgical instruments, the surgeon's hands, etc. Carbolic lotion (1 in 40) is used to wash wounds to keep them antiseptic, and carbolized gauze (which is bleached cotton gauze medicated with half its weight of a mixture of carbolic acid, 1; resin, 4; paraffin, 4,) is employed as a dressing for the same purpose. A spray of a solution of carbolic acid was formerly much used to keep the air around the wound antiseptic during an operation, but it is now discarded as unnecessary.

Glycerite of carbolic acid is a very efficient preparation to destroy the fungus of tinea tonsurans or tinea versicolor; for the latter it should be diluted.

Because of its anaesthetic effect a strong solution (1 in 20) will relieve itching from any cause. Carbolized vapor has been inhaled in phthisis, but by the time it reaches the lungs it is far too dilute to have any action on the tubercle bacilli.

Internal

Mouth. - The glycerite, if diluted, may be applied as a stimulant to the mouth in aphthous stomatitis, or when any indolent ulceration is present. A gargle (of carbolic acid in water, 1 in 120) is an excellent preparation. The glycerite has been used for diphtheria, but probably it does no good, except that being a local anaesthetic it soothes pain. A piece of cotton soaked in strong carbolic acid will relieve pain if placed in a decayed tooth, but care must be taken to prevent it from coming in contact with the soft parts by putting another piece of dry cotton over it.

Stomach

Carbolic acid has been given to relieve flatulence, because it was thought that it would prevent decomposition in the stomach; but it is powerless to do this, owing to the degree to which the gastric contents dilute it. Some state that it checks vomiting and helps to cure dyspepsia, but it is not a remedy which is universally regarded as useful for these purposes. It may, however, be tried in obstinate cases, and it will sometimes be found to be a good carminative. It has been given internally as an antiseptic in phthisis, but it does no good, and those who give it forget that probably very little carbolic acid reaches the lungs. It has been extensively tried in typhoid fever, but without any good effect.

Toxicology

If carbolic acid is at all concentrated, immediately on swallowing it there is an intense burning sensation in the mouth, oesophagus and stomach, and white eschars form in the mouth. The patient is collapsed, his skin is cold and clammy. The breathing becomes more and more feeble and shallow, and finally stops. The urine is darkish green. Reflex movements are abolished, and ultimately he becomes insensible and comatose. Carbolic acid taken by the mouth has proven fatal in two minutes. Post-mortem. - There are white, hard sloughs, with perhaps inflammatory redness round them, in the mouth, oesophagus, and stomach. The blood is dark and coagulates imperfectly. In some cases fatty degeneration of the liver and kidneys may be found.

Treatment

Any soluble sulphate, such as an ounce 30. gm. of magnesium sulphate or half an ounce 15. gm. of sodium sulphate dissolved in half a pint 250. c.c of water, is the natural antidote, because sulphates and carbolic acid form sulphocarbolates in the blood, and these are harmless. Saccharated lime or soap may be used as chemical antidotes. Before the antidote is given, wash out the stomach or use some very quickly-acting emetic, as apomorphine hydrochlorate given hypodermatically. It is of the utmost importance to immediately give stimulants freely, such as ether or b.randy subcutaneously. Apply hot water bottles and blankets if there are any signs of collapse. The most important antidote to carbolic acid is pure alcohol. Success in treatment demands that the acid and alcohol should be brought in contact; therefore if the acid has been swallowed for some time alcohol may not be efficacious.