- Email: [email protected]
THE TREATMENT OF SEPTIC WAR WOUNDS.
580
THE TREATMENT OF SEPTIC WAR WOUNDS.
absolutely fatal to hæmolytic organism. This is demon. by the immediate absence of the brick colour in subsequent discharge. I do not think during the 20. years I have used super-iodine douches or the pure liniment I ever saw a. failure where penetration was possible. "Audi alteram partem." The rule carried out in regular practice was that where it wat desired to keep the wound or operation wet THE TREATMENT OF SEPTIC WAR to facilitate discharge super-iodine was used, but where WOUNDS. it was desirable to dry up nothing equalled picric. Picric and iodine should never be used together or they interact To the Editor of THE LANCET. and blister. The disadvantages of picric were in certain cases SIR,-You will hardly expect me to reply to Sir Almroth where an intolerance of coloured occurred with acute Wright’s personal attack on me either by defending my own parts after continued use due possibly toitching acid irritation of or dissecting his mentality. It is a great pity that he has This was easily removed by soda bicarb. nerve endings. made this such a personal matter ; so long as it remained the picric being discontinued. The only other disfoment, impersonal any criticisms of methods or views, however advantage was the superficial skin destruction when dressings trenchant, could have been answered, and possibly in course were left on too long. When picric dressing loses its of time the two lines of thought would have more nearly colour and becomes white it shows a need for dressings approximated one another. but sometimes the wool coating is too hard being changed, I am, Sir, yours faithfully, for,it to show through. Circumcisions dressed with picric W. WATSON CHEYNE. Sept.l8th.l916. dry have no raw period. Picric wool made by soaking wool with picric and allowing it to dry makes the best dry THE USE OF PICRIC ACID IN SURGERY dressing I know, but the wool should be cut with scissors and not torn when needed, as the small particles of picric To the Editor of THE LANCET. which then float in the air give an unpleasant taste if inhaled SIR,-In reference to the article of Major T. F. Brown, by mouth or nose. I can cordially endorse Major Brown’s plea for a more D.S.O., in THE LANCET of Sept. 2nd on the use of picric acid in surgery, a few notes may not be out of place from one who extensive trial of the many advantages of the use of picric has consistently used it during a goldfields practice of the as an immediate dressing for wounds. I am. Sir, yours faithfully, last 16 years. HENRY A. ELLIS, HENRY The staining by picric acid which only really affects the Ex-Honorary Surgeon, Coolgardie Hospitals Sydney and Coolgarlie is best sodium a hot cutaneous tissues removed by bicarb., Mi.jdleshrough, Sept. 11th, 1916. fomentation of which will readily remove the discolouration of the skin which Major Brown mentions, but it will not PLAGUE IN ENGLAND. remove it from hair or nails. Washing the hands in soda bicarb., besides removing the discomfort of having one’s To the Editor of THE LANCET. hands stained, gets rid of the equally unpleasant quinineI SIR,-May call attention to the annotation under this like flavour carried by picric-stained fingers to any food in your issue of Sept. 9th, where you state :heading handled. I found picric most efficacious dressing for all recent inSo far as we are aware, the circumstances associated with juries, especially in head and hand. It was applied by soaking the cases at Bristol and Hull are such as to suggest that the plague infection was probably ship-borne. a small piece of cotton-wool in 1 per cent. saturated lotion and it to the cut surface or the As a matter of fact, this suggestion-as regards Bristolwound, leaving applying freely a saturated piece on for cover ; over this a piece of dry wool is quite untenable, as the Local Government Board bacteriowas placed, and a bandage applied until the whole dried, logist stationed at Avonmouth reports that out of 291 rats, when the bandage and wool not adhering could be removed, a which have been examined to determine this point since the hard collodion-like dressing resulting, which took the daily occurrence of plague cases in Bristol, all have been found friction without injury. In operating it was found very to be absolutely free from any suspicion of plague infection. efficacious for all cutaneous incisions or when dry dressings The port of Bristol is, therefore, not under any suspicion of were advisable. Wounds healed without the red sensitive plague whatever ; a matter of considerable importance in line otherwise present. Its ansesthetic qualities relieves regard to our home and foreign commercial relationships. For hand and foot No suspicion of plague in Bristol city, either among rat or the patient of all cutaneous pain. abrasions I never found anything that could compare man, has arisen since August 10th. Fall reports of the with it. All superficial foot injuries caused by walking whole circumstances will be issued at an early date. were readily healed by painting with picric or applying cottonI am, Sir, yours faithfully, wool soaked in it. Bad gravel rash resulting from bicycle D. S. DAVIES, D.. DAVIES. M.D., LL D., Bristol, Medical Officer of Health, City and Port of Bristol. accidents healed in a day or two, which ordinarily would Sept. 15tb, 1916. The abrasions became have incapacitated for a week. dry and painless. A bottle of picric was to be found in most of the miners’ camps, for its efficacy became well known. ALCOHOL IN THE TROPICS. Scalp injuries, even when complicated with fractures, To the Editor of THE LANCET. was
Correspondence.
strated
__________________
swabbed out with a saturated solution, and then dressed with picric, healed as I have never seen them heal SIR,-In a review of Woodruff’s ° Medical Ethnology"" m by any other process. In this connexion it is as well to THE LANCET of June 10th, 1916, p. 1172, your reviewer dress every second day at first, as there is an organism speaks of the author’s " surprising conclusion that those who which is capable of growing under a picric dressing which drink alcohol in the tropics enjoy better health than disintegrates the superficial layer of skin without pain and abstainers." I cannot see anything surprising in this. I makes the wound look bad for a couple of days. Hot boracic should rather be surprised if the contrary were maintained. It is, as in other climates, a matter of qitale, quantum, and acid foment is rapidly fatal to it. In regard to deeper suppurating wounds with haemolytic quando. I should have thought that there was plenty of organisms giving grumous pus, I found picric not to be com- evidence in print of the wholesomeness of alcoholic beverages pared in action with pure liniment of iodine or a washing everywhere. To give a single instance of an active, hardwith hot iodine solution sufficiently strong to stain the working man in tropical Africa, let me refer your reviewer hands of the operator deeply. The reddy, brick-coloured to Sutherland’s"Adventures of an Elephant Hunter, " p. 169. discharge is always accompanied by tissue destruction. I think that he will admit that there are, at any rate, I found picric useless and iodine absolutely efficient, exceptions to his own views. Nowadays, when there is so provided there wassufficient penetration to reach into all much bigoted antagonism to the use of alcoholic drinks, and the pockets. From test-tube experiments on pus I should say it is often looked upon as a virtue to abstain, it is as well to that the limit of iodine liniment penetration is half an inch take broader views and recognise the beneficence of their at most, so that if a half-an-inch pocket was left unswabbed action, and to encourage the moderate and judicious use What would the British nation have been the organism would continue its tissue-destruction course, of them. but wherever the iodine reached the bottom of the sinus it without beer and wine, and what would it sink to if, it
THE TREATMENT OF SEPTIC WAR WOUNDS.
absolutely fatal to hæmolytic organism. This is demon. by the immediate absence of the brick colour in subsequent discharge. I do not think during the 20. years I have used super-iodine douches or the pure liniment I ever saw a. failure where penetration was possible. "Audi alteram partem." The rule carried out in regular practice was that where it wat desired to keep the wound or operation wet THE TREATMENT OF SEPTIC WAR to facilitate discharge super-iodine was used, but where WOUNDS. it was desirable to dry up nothing equalled picric. Picric and iodine should never be used together or they interact To the Editor of THE LANCET. and blister. The disadvantages of picric were in certain cases SIR,-You will hardly expect me to reply to Sir Almroth where an intolerance of coloured occurred with acute Wright’s personal attack on me either by defending my own parts after continued use due possibly toitching acid irritation of or dissecting his mentality. It is a great pity that he has This was easily removed by soda bicarb. nerve endings. made this such a personal matter ; so long as it remained the picric being discontinued. The only other disfoment, impersonal any criticisms of methods or views, however advantage was the superficial skin destruction when dressings trenchant, could have been answered, and possibly in course were left on too long. When picric dressing loses its of time the two lines of thought would have more nearly colour and becomes white it shows a need for dressings approximated one another. but sometimes the wool coating is too hard being changed, I am, Sir, yours faithfully, for,it to show through. Circumcisions dressed with picric W. WATSON CHEYNE. Sept.l8th.l916. dry have no raw period. Picric wool made by soaking wool with picric and allowing it to dry makes the best dry THE USE OF PICRIC ACID IN SURGERY dressing I know, but the wool should be cut with scissors and not torn when needed, as the small particles of picric To the Editor of THE LANCET. which then float in the air give an unpleasant taste if inhaled SIR,-In reference to the article of Major T. F. Brown, by mouth or nose. I can cordially endorse Major Brown’s plea for a more D.S.O., in THE LANCET of Sept. 2nd on the use of picric acid in surgery, a few notes may not be out of place from one who extensive trial of the many advantages of the use of picric has consistently used it during a goldfields practice of the as an immediate dressing for wounds. I am. Sir, yours faithfully, last 16 years. HENRY A. ELLIS, HENRY The staining by picric acid which only really affects the Ex-Honorary Surgeon, Coolgardie Hospitals Sydney and Coolgarlie is best sodium a hot cutaneous tissues removed by bicarb., Mi.jdleshrough, Sept. 11th, 1916. fomentation of which will readily remove the discolouration of the skin which Major Brown mentions, but it will not PLAGUE IN ENGLAND. remove it from hair or nails. Washing the hands in soda bicarb., besides removing the discomfort of having one’s To the Editor of THE LANCET. hands stained, gets rid of the equally unpleasant quinineI SIR,-May call attention to the annotation under this like flavour carried by picric-stained fingers to any food in your issue of Sept. 9th, where you state :heading handled. I found picric most efficacious dressing for all recent inSo far as we are aware, the circumstances associated with juries, especially in head and hand. It was applied by soaking the cases at Bristol and Hull are such as to suggest that the plague infection was probably ship-borne. a small piece of cotton-wool in 1 per cent. saturated lotion and it to the cut surface or the As a matter of fact, this suggestion-as regards Bristolwound, leaving applying freely a saturated piece on for cover ; over this a piece of dry wool is quite untenable, as the Local Government Board bacteriowas placed, and a bandage applied until the whole dried, logist stationed at Avonmouth reports that out of 291 rats, when the bandage and wool not adhering could be removed, a which have been examined to determine this point since the hard collodion-like dressing resulting, which took the daily occurrence of plague cases in Bristol, all have been found friction without injury. In operating it was found very to be absolutely free from any suspicion of plague infection. efficacious for all cutaneous incisions or when dry dressings The port of Bristol is, therefore, not under any suspicion of were advisable. Wounds healed without the red sensitive plague whatever ; a matter of considerable importance in line otherwise present. Its ansesthetic qualities relieves regard to our home and foreign commercial relationships. For hand and foot No suspicion of plague in Bristol city, either among rat or the patient of all cutaneous pain. abrasions I never found anything that could compare man, has arisen since August 10th. Fall reports of the with it. All superficial foot injuries caused by walking whole circumstances will be issued at an early date. were readily healed by painting with picric or applying cottonI am, Sir, yours faithfully, wool soaked in it. Bad gravel rash resulting from bicycle D. S. DAVIES, D.. DAVIES. M.D., LL D., Bristol, Medical Officer of Health, City and Port of Bristol. accidents healed in a day or two, which ordinarily would Sept. 15tb, 1916. The abrasions became have incapacitated for a week. dry and painless. A bottle of picric was to be found in most of the miners’ camps, for its efficacy became well known. ALCOHOL IN THE TROPICS. Scalp injuries, even when complicated with fractures, To the Editor of THE LANCET. was
Correspondence.
strated
__________________
swabbed out with a saturated solution, and then dressed with picric, healed as I have never seen them heal SIR,-In a review of Woodruff’s ° Medical Ethnology"" m by any other process. In this connexion it is as well to THE LANCET of June 10th, 1916, p. 1172, your reviewer dress every second day at first, as there is an organism speaks of the author’s " surprising conclusion that those who which is capable of growing under a picric dressing which drink alcohol in the tropics enjoy better health than disintegrates the superficial layer of skin without pain and abstainers." I cannot see anything surprising in this. I makes the wound look bad for a couple of days. Hot boracic should rather be surprised if the contrary were maintained. It is, as in other climates, a matter of qitale, quantum, and acid foment is rapidly fatal to it. In regard to deeper suppurating wounds with haemolytic quando. I should have thought that there was plenty of organisms giving grumous pus, I found picric not to be com- evidence in print of the wholesomeness of alcoholic beverages pared in action with pure liniment of iodine or a washing everywhere. To give a single instance of an active, hardwith hot iodine solution sufficiently strong to stain the working man in tropical Africa, let me refer your reviewer hands of the operator deeply. The reddy, brick-coloured to Sutherland’s"Adventures of an Elephant Hunter, " p. 169. discharge is always accompanied by tissue destruction. I think that he will admit that there are, at any rate, I found picric useless and iodine absolutely efficient, exceptions to his own views. Nowadays, when there is so provided there wassufficient penetration to reach into all much bigoted antagonism to the use of alcoholic drinks, and the pockets. From test-tube experiments on pus I should say it is often looked upon as a virtue to abstain, it is as well to that the limit of iodine liniment penetration is half an inch take broader views and recognise the beneficence of their at most, so that if a half-an-inch pocket was left unswabbed action, and to encourage the moderate and judicious use What would the British nation have been the organism would continue its tissue-destruction course, of them. but wherever the iodine reached the bottom of the sinus it without beer and wine, and what would it sink to if, it