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THE STRENGTH OF PICRIC ACID AS AN ANTISEPTIC.
604 much cleaner, and the discharge much thinner and less quantity, while the pain had disappeared. On August 3rd THE STRENGTH OF PICRIC ACID AS AN only a thin sanious discharge, small in amount, was ANTISEPTIC. noticeable, and the drainage-tubes were removed. By the 6th the discharge had entirely ceased, and on the 8th BY H. L. TIDY, M.D. OXON., M.R.C.P. LOND., a lotion of succus allii, 1 part to 9 parts, was employed once TEMPORARY CAPTAIN, R.A.M.C., PATHOLOGIST TO THE BRITISH RED CROSS HOSPITAL, NETLEY. daily to prevent further suppuration. CASE 4 -A female, 78 years of age, married, was operated upon on July 22nd for a huge suppurating hsematoma of Picric acid has been used very successfully for the upper part of the left thigh, and two pints of bloodthe sterilisation of skin before operation in strengths stained pus were evacuated. The cavity was washed out twice daily with a solution of hydrogen peroxide. Two of 2 or 3 per cent. in alcohol. The following estiwas
in
days later the anterior and inner wall of the abscess cavity mation of the Rideal-Walker carbolic acid coefficient sloughed out, leaving a huge cavity with pockets above was made at the request of Colonel Cuthbert and below, which discharged large quantities of offensive Wallace, R.A.M.C. pus. During this period the patient complained of general The Rideal-Walker test affords a comparison of malaise and much local pain ; the temperature varied the bactericidal powers of different substances. between 99° and 101° F., and the floor of the abscess The standard is a 1 per cent. solution of carbolic the cavity was covered by sloughs. On August 2nd acid. For given substance the strength of cavity was washed out with a solution of succus allii, solution is any found by experiment, which kills a, the 1 part to 5 parts, twice daily. Within 24 hours of culture in the same time as the bacilli in was reduced typhoid quantity, purulent discharge markedly the floor of the abscess cavity been me cleaner, pain was solution of carbolic acid. The inverse ratio of the noticeably less, and the temperature fell to normal. On strength of this solution to 1 per cent. gives the the 5th, owing to the shortage of the drug, washing of the carbolic acid coefficient of the substance. Thus if cavity with hydrogen peroxide was reverted to, with the a 0’2 per cent. solution of a substance x has the result that the temperature went up to 99°, and the local same bactericidal powers as a 1 per cent. solution of condition ceased to maintain the improvement so noticeable with the treatment with succus allii. On the resumption of carbolic acid, then the carbolic acid coefficient of x is 5. allii on August 8th the wound became cleaner within 24 hours and as it was previously. CASE 5. -A female, 5 years of age, was operated upon on July 20th for acute mastoid abscess on the left side. Partial mastoidectomy was done, and the wound was treated with iodoform. The subsequent treatment of the sinus consisted in syringing out the cavity with solution of hydrogen peroxide, and having in it a wick of gauze for the purpose of draining. As the wound continued to discharge a good deal of pus and the floor of the sinus appeared unhealthy, hydrogen peroxide was replaced by succus allii, 1 part to 3 parts, on August 7th, with the result that the sinus was, after 48 hours, exuding only a few drops of pus and the walls were covered by healthy red granulations. CASE 6.-A male, aged 1 year and 6 months, was admitted on August 2nd for suppurating wound of the scalp. The wound had been caused by a spade 12 days previously, and had been washed daily with antiseptics, and antiseptic foments applied for nine days prior to admission by a nurse under the supervision of the medical attendant. A suppurating wound of the size of a shilling, or rather less, a quarter of an inch deep, was found over the right vertex, the tissues surrounding the wound being also reddened. Succus allii, 1 part to 4 parts, was used twice daily to syringe out the wound, and boric compresses were applied. On the 3rd the wound was much cleaner, still more clean on the 4th, and since then there has been no The inflamed area surrounding the wound had dispus. appeared by August 4th, while the temperature of the child, which was 103° F. on admission, had become normal by the evening of August 3rd. succus
Technique.-The technique was followed as described in Hewlett’s " Manual of Bacteriology." The solutions of picric acid and carbolic acid were prepared from crystals dissolved in sterile distilled The test culture was a 24 hours’ broth water. culture of B. typhosus, incubated at 37° C. and The broth was prepared filtered before use. according to the formula in Hewlett’s manual, and standardised to a reaction of + 10, Eyre’s scale. Results.-Table V. records a control experiment The result agrees with published with lysol. estimations, which give the coefficient variously between 1’7 and 2’5. Experiment 1. (Table I.) shows TABLE I. += Growth of typhoid bacilli in subculture. No growth of typhoid bacilli in subculture. -
=
As the effects of the continuous use of succus that a 0’25 per cent. solution of picric acid is allii on the tissues are not known to us, a stronger than the 1 per cent. solution of carbolic weaker solution-succus allii 1 part and distilled acid. Hence the Rideal-Walker coefficient of picric water 9 parts-has been employed when suppura- acid is greater than 4. In Experiment II. a 0’2 per tion has been definitely controlled and checked. It TABLE II. has been stated that succus allii deteriorates quickly, but with the addition of 1 to 2 per cent. of alcohol it would appear to be preserved at any rate for about a month or six weeks; and it has, therefore, been found advisable to prepare the lotion just prior to its use. In conclusion, we would like to express our thanks to Dr. A. G. Stewart, medical superintendent of Paddington Infirmary, for affording us the opportunity of employing succus allii in the treatment of suppurating wounds; and, as the drug cent. solution of picric acid killed the typhoid is not readily obtainable, to mention that our bacilli in the same time as the standard solution. supply has been obtained through Messrs. J. P. Inch This shows that the required strength of picric acid is in the neighbourhood of a 0’2 per cent. and Co., 178, Kennington Park-road, S.E.
605
bacilliI
solution. In Experiment III. the typhoid were killed by solutions of picric acid of 0’16 and 0’17 per cent. in the same time as by the carbolic
Clinical Notes : MEDICAL, SURGICAL, OBSTETRICAL,
TABLE III.
AND
THERAPEUTICAL. ON ACUTE INFECTIOUS JAUNDICE. BY SIR WILLIAM OSLER, BART., M.D., F.R.S.
NOTE
AMONG the soldiers invalided from Egypt are of epidemic or acute infectious jaundice, a disease which requires further study. Outbreaks in this country are not uncommon in schools and villages. It is also a soldier’s disease, prevailing in camps and barracks. The clinical features are those of catarrhaljaundice. In Europe and America fatal cases are rare, but in Egypt, particularly in Alexandria, the death-rate, as reported by Professor F. M. Sandwith, has ranged from 10 to 50 per cent. I have seen two groups of cases among the soldiers, four in one hospital and ten in another, all mild and convalescing. Those with whom I have spoken knew of no deaths, but there were severe cases on the transports, which have been disI write this note tributed to other hospitals. to urge that careful bacteriological studies should be made. One fatal case which came under my care from a North Carolina outbreak had a widespread infection with the bacillus proteus, which was also present in two of three cases studied by Jaeger. Organisms of the colon group have also been found. In his " Diseases of Egypt"" Professor Sandwith gives an excellent account of the disease as it appears in Alexandria, and Dr. W. Hunter has published a full description in the "System of Medicine" edited by Allbutt and Rolleston. Mr. Davison of the Pathological Laboratory, Oxford, will be glad to make blood cultures and serological tests from severe cases for any of my colleagues who may not have access to laboratory facilities. cases
acid solution. In Experiment IV. a 0’15 per cent. solution of picric acid killed the typhoid bacilli less rapidly than the standard solution, and a 0’18 per oent. solution killed them more rapidly. The mean of these two figures, 0’165 per cent., agrees with the result of Experiment III. TABLE IV.
Oxford.
A CASE OF UMBILICAL HERNIA CONTAINING MECKEL’S DIVERTICULUM. BY S. G. PAPADOPOULOS, M.B., B.S. LOND.,
Hence it may be concluded that a 0’165 per cent. solution of picric acid has the same bactericidal powers towards the culture of typhoid bacteria as has the standard 1 per cent. solution of carbolic acid. Thus the Rideal-Walker carbolic acid co
M.R.C.S., L.R.C.P. LOND., RESIDENT MEDICAL
OFFICER,
MILLER
HOSPITAL, GREENWICH-ROAD, S.E.
A PATIENT, aged 50, was admitted to the Miller Hospital with the following history. Two years ago, while he was lifting a box containing tinplates and weighing (as he says) about one ton, he Netley Abbev. Hants. felt something in his abdomen giving way, and soon afterwards an umbilical and a right inguinal MEDICAL SERVICE IN THE HIGHLANDS.-The hernia developed. The patient is of big proporproposals of the Highlands and Islands Medical Service tions and weighs about 20 st. After general anaesBoard are creating widespread interest throughout the thesia the umbilical hernia was operated upon first. Highlands. A meeting of the members of the Inverness A good-sized flap of skin surrounding the umbilical division of the British Medical Association was held in knot was dissected up, after which the sac was Inverness recently to discuss the various proposals under the draft scheme of the Board. A resolution was unani- defined, emptied, and opened. Its ligaturing gave that to the mously passed owing anxiety felt amongst considerable trouble ; a very strong ligature of silk medical practitioners on the mainland of the county of had to be used, which broke twice. Before the Inverness as to the working of the proposals of the third attempt at ligature a floating piece of intestine Highlands and Islands Medical Service Board and their protruded through the opening, which on closer bearing upon future medical practice, and the numerous examination proved to be a Meckel’s diverticulum. difficulties in the way of clearly understanding the pro- It was 3 inches in length, patent and distended, and which arose the the Board be
posals respectfully asked
during
to send
a
discussion, representative
’
the size of the small intestine in diameter.
At its
meeting of be arranged by the distal end two small saccular dilatations (secondary noticed. The diverticulum was tied to
a
medical men in Inverness at a date to Board, and that in the meantime the medical men of the county of Inverness should delay completing Form 2. The attendance at the meeting was not large on account of so many Highland doctors being away on military duty.
diverticula) were
at its base, as an ordinary appendix, and the stump, after its removal, was invaginated through a longitudinal purse-string suture. The peritoneum then
in
days later the anterior and inner wall of the abscess cavity mation of the Rideal-Walker carbolic acid coefficient sloughed out, leaving a huge cavity with pockets above was made at the request of Colonel Cuthbert and below, which discharged large quantities of offensive Wallace, R.A.M.C. pus. During this period the patient complained of general The Rideal-Walker test affords a comparison of malaise and much local pain ; the temperature varied the bactericidal powers of different substances. between 99° and 101° F., and the floor of the abscess The standard is a 1 per cent. solution of carbolic the cavity was covered by sloughs. On August 2nd acid. For given substance the strength of cavity was washed out with a solution of succus allii, solution is any found by experiment, which kills a, the 1 part to 5 parts, twice daily. Within 24 hours of culture in the same time as the bacilli in was reduced typhoid quantity, purulent discharge markedly the floor of the abscess cavity been me cleaner, pain was solution of carbolic acid. The inverse ratio of the noticeably less, and the temperature fell to normal. On strength of this solution to 1 per cent. gives the the 5th, owing to the shortage of the drug, washing of the carbolic acid coefficient of the substance. Thus if cavity with hydrogen peroxide was reverted to, with the a 0’2 per cent. solution of a substance x has the result that the temperature went up to 99°, and the local same bactericidal powers as a 1 per cent. solution of condition ceased to maintain the improvement so noticeable with the treatment with succus allii. On the resumption of carbolic acid, then the carbolic acid coefficient of x is 5. allii on August 8th the wound became cleaner within 24 hours and as it was previously. CASE 5. -A female, 5 years of age, was operated upon on July 20th for acute mastoid abscess on the left side. Partial mastoidectomy was done, and the wound was treated with iodoform. The subsequent treatment of the sinus consisted in syringing out the cavity with solution of hydrogen peroxide, and having in it a wick of gauze for the purpose of draining. As the wound continued to discharge a good deal of pus and the floor of the sinus appeared unhealthy, hydrogen peroxide was replaced by succus allii, 1 part to 3 parts, on August 7th, with the result that the sinus was, after 48 hours, exuding only a few drops of pus and the walls were covered by healthy red granulations. CASE 6.-A male, aged 1 year and 6 months, was admitted on August 2nd for suppurating wound of the scalp. The wound had been caused by a spade 12 days previously, and had been washed daily with antiseptics, and antiseptic foments applied for nine days prior to admission by a nurse under the supervision of the medical attendant. A suppurating wound of the size of a shilling, or rather less, a quarter of an inch deep, was found over the right vertex, the tissues surrounding the wound being also reddened. Succus allii, 1 part to 4 parts, was used twice daily to syringe out the wound, and boric compresses were applied. On the 3rd the wound was much cleaner, still more clean on the 4th, and since then there has been no The inflamed area surrounding the wound had dispus. appeared by August 4th, while the temperature of the child, which was 103° F. on admission, had become normal by the evening of August 3rd. succus
Technique.-The technique was followed as described in Hewlett’s " Manual of Bacteriology." The solutions of picric acid and carbolic acid were prepared from crystals dissolved in sterile distilled The test culture was a 24 hours’ broth water. culture of B. typhosus, incubated at 37° C. and The broth was prepared filtered before use. according to the formula in Hewlett’s manual, and standardised to a reaction of + 10, Eyre’s scale. Results.-Table V. records a control experiment The result agrees with published with lysol. estimations, which give the coefficient variously between 1’7 and 2’5. Experiment 1. (Table I.) shows TABLE I. += Growth of typhoid bacilli in subculture. No growth of typhoid bacilli in subculture. -
=
As the effects of the continuous use of succus that a 0’25 per cent. solution of picric acid is allii on the tissues are not known to us, a stronger than the 1 per cent. solution of carbolic weaker solution-succus allii 1 part and distilled acid. Hence the Rideal-Walker coefficient of picric water 9 parts-has been employed when suppura- acid is greater than 4. In Experiment II. a 0’2 per tion has been definitely controlled and checked. It TABLE II. has been stated that succus allii deteriorates quickly, but with the addition of 1 to 2 per cent. of alcohol it would appear to be preserved at any rate for about a month or six weeks; and it has, therefore, been found advisable to prepare the lotion just prior to its use. In conclusion, we would like to express our thanks to Dr. A. G. Stewart, medical superintendent of Paddington Infirmary, for affording us the opportunity of employing succus allii in the treatment of suppurating wounds; and, as the drug cent. solution of picric acid killed the typhoid is not readily obtainable, to mention that our bacilli in the same time as the standard solution. supply has been obtained through Messrs. J. P. Inch This shows that the required strength of picric acid is in the neighbourhood of a 0’2 per cent. and Co., 178, Kennington Park-road, S.E.
605
bacilliI
solution. In Experiment III. the typhoid were killed by solutions of picric acid of 0’16 and 0’17 per cent. in the same time as by the carbolic
Clinical Notes : MEDICAL, SURGICAL, OBSTETRICAL,
TABLE III.
AND
THERAPEUTICAL. ON ACUTE INFECTIOUS JAUNDICE. BY SIR WILLIAM OSLER, BART., M.D., F.R.S.
NOTE
AMONG the soldiers invalided from Egypt are of epidemic or acute infectious jaundice, a disease which requires further study. Outbreaks in this country are not uncommon in schools and villages. It is also a soldier’s disease, prevailing in camps and barracks. The clinical features are those of catarrhaljaundice. In Europe and America fatal cases are rare, but in Egypt, particularly in Alexandria, the death-rate, as reported by Professor F. M. Sandwith, has ranged from 10 to 50 per cent. I have seen two groups of cases among the soldiers, four in one hospital and ten in another, all mild and convalescing. Those with whom I have spoken knew of no deaths, but there were severe cases on the transports, which have been disI write this note tributed to other hospitals. to urge that careful bacteriological studies should be made. One fatal case which came under my care from a North Carolina outbreak had a widespread infection with the bacillus proteus, which was also present in two of three cases studied by Jaeger. Organisms of the colon group have also been found. In his " Diseases of Egypt"" Professor Sandwith gives an excellent account of the disease as it appears in Alexandria, and Dr. W. Hunter has published a full description in the "System of Medicine" edited by Allbutt and Rolleston. Mr. Davison of the Pathological Laboratory, Oxford, will be glad to make blood cultures and serological tests from severe cases for any of my colleagues who may not have access to laboratory facilities. cases
acid solution. In Experiment IV. a 0’15 per cent. solution of picric acid killed the typhoid bacilli less rapidly than the standard solution, and a 0’18 per oent. solution killed them more rapidly. The mean of these two figures, 0’165 per cent., agrees with the result of Experiment III. TABLE IV.
Oxford.
A CASE OF UMBILICAL HERNIA CONTAINING MECKEL’S DIVERTICULUM. BY S. G. PAPADOPOULOS, M.B., B.S. LOND.,
Hence it may be concluded that a 0’165 per cent. solution of picric acid has the same bactericidal powers towards the culture of typhoid bacteria as has the standard 1 per cent. solution of carbolic acid. Thus the Rideal-Walker carbolic acid co
M.R.C.S., L.R.C.P. LOND., RESIDENT MEDICAL
OFFICER,
MILLER
HOSPITAL, GREENWICH-ROAD, S.E.
A PATIENT, aged 50, was admitted to the Miller Hospital with the following history. Two years ago, while he was lifting a box containing tinplates and weighing (as he says) about one ton, he Netley Abbev. Hants. felt something in his abdomen giving way, and soon afterwards an umbilical and a right inguinal MEDICAL SERVICE IN THE HIGHLANDS.-The hernia developed. The patient is of big proporproposals of the Highlands and Islands Medical Service tions and weighs about 20 st. After general anaesBoard are creating widespread interest throughout the thesia the umbilical hernia was operated upon first. Highlands. A meeting of the members of the Inverness A good-sized flap of skin surrounding the umbilical division of the British Medical Association was held in knot was dissected up, after which the sac was Inverness recently to discuss the various proposals under the draft scheme of the Board. A resolution was unani- defined, emptied, and opened. Its ligaturing gave that to the mously passed owing anxiety felt amongst considerable trouble ; a very strong ligature of silk medical practitioners on the mainland of the county of had to be used, which broke twice. Before the Inverness as to the working of the proposals of the third attempt at ligature a floating piece of intestine Highlands and Islands Medical Service Board and their protruded through the opening, which on closer bearing upon future medical practice, and the numerous examination proved to be a Meckel’s diverticulum. difficulties in the way of clearly understanding the pro- It was 3 inches in length, patent and distended, and which arose the the Board be
posals respectfully asked
during
to send
a
discussion, representative
’
the size of the small intestine in diameter.
At its
meeting of be arranged by the distal end two small saccular dilatations (secondary noticed. The diverticulum was tied to
a
medical men in Inverness at a date to Board, and that in the meantime the medical men of the county of Inverness should delay completing Form 2. The attendance at the meeting was not large on account of so many Highland doctors being away on military duty.
diverticula) were
at its base, as an ordinary appendix, and the stump, after its removal, was invaginated through a longitudinal purse-string suture. The peritoneum then