The action of chemical and physiological antiseptics in a septic wound

Abstract

SINCE the war began, much attention has been directed t o the treatment of suppurating wounds, for in the earlier years-1914-15-16-practically all the gunshot wounds becanie infected, and even in 1918 nearly all the wounds which were left open for more than a week became grossly infected with pyogenic cocci and other organisms.Prior to the war, the surgeon gave most of his attention to aseptic methods, his great object being to exclude microbes from the wound. The question of how to deal with thc bacteria after they were in possession was a problem of much less interest to him. 1 can remember in tlie days when I was first admitted to the surgical wards as a dresser, there were always a certain number of septic wounds which we were instructed to dress with this or that antiseptic, which stood in jars around the fire, and which we were told 110ssessed great virtue as destroyers of microbes in the wound. These antiseptics were chiefly carbolic acid, mercury salts, and boric acid. The wounds were religiously dressed once or twice a day with these lotions, and although it was obvious that the antiseptic did not kill all the microbes in the wound, we were always told that it would kill many of them. and so the condition would be better than if no antiseptic were used. We werc not then in a position to criticize this view.At the beginning of the war in 1914, a11 the old antiseptics were used in military hospitals, in just such a manner a s when I started surgery. Carbolic acid, perchloride or biriiodidc of mercury, boric acid, and hydrogen peroxide were poured into septic wounds once or twice a day, either singly or in mixtures of two or more, according to the fancy of the rncdical ollicer. Very soon, however, campaigns were started in favour of particular antiseptics. I h r l y in 1925, tlic merits of pure carbolic acid and of 2 per cent iodine in spirit were tested. R certain number of cases were treated with these two chemicals a t the Front, and tlie patients were sent down to No. 13 General Hospital, where I had the opportunity of seeing tlic wounds and examining them bacteriologically. I n the carbolic series there was a higher pcrcentage of gas gangrene than in tlie general run of the wounded, while the iodine cases showed practically no diflerence from the cases treated in other ways. Soon after this, antiseptic pastes were advocated. The wound was plugged with the paste, but it soon appeared that in France, a t any rate, the chief result of this method of trcatment was to shut off all drainage, so that gas infections dcveloped in a large number of cases.These pastes, therefore, very soon disappeared from the antiscptic arnramcntariurn.The first real advance in the 'antiseptic' treatment of wounds was the introduction of tlic hypochlorite solutions. Lorrain Smith introduced eusol, which is a solution of Ilypochlorous acid, while Dakin, about tlie same time, produced a solution of sodium liypoclilorite, which has come to be recognized as Uakin's solution. Both of these solutions attained grcat favour in wound t...

Myeloperoxidase Selectively Binds and Selectively Kills Microbes

“…In the absence of RBCs, 700 mM H 2 O 2 was effective in destroying all bacteria tested but was only partially effective against C. albicans. However, the microbicidal capacity of 700 mM H 2 Ϫ is a potent microbicidal agent, but it is more effective at destroying host cells, e.g., RBCs, than killing microbes (14,16).…”

“…The reactivities of these agents are indiscriminate and capable of damaging mechanisms of immune defense as well as destroying microbes. Alexander Fleming appreciated this relationship, stating that "leukocytes are more sensitive to the action of chemical antiseptics than are the bacteria, and, in view of this, it is unlikely that any of these antiseptics have the power of penetrating into the tissues and destroying the bacteria without first killing the tissues themselves" (16).…”

Treatment of War Wounds: A Historical Review

“…Carrel and Dehelly described the successful treatment of various wounds-fresh, phlegmonous, gangrenous, and suppurating-all of which were disinfected and closed within 20 days [24]. Alexander Fleming (1881Fleming ( -1955 noted an initial benefit to the use of topical solutions, such as carbolic acid, perchloride/biniodide of mercury, boric acid, and hydrogen peroxide, but concluded antiseptics had a longer-term negative effect on healing and advised the surgeon to rely ''on his skill alone'' [44]. Although Dakin's solution fell into disfavor after the war, some contemporary surgeons have called for a reevaluation of its potential usefulness [93].…”

Local Antibiotic Therapy in the Treatment of Bone and Soft Tissue Infections

“…During World War I, Alexander Fleming observed that locally applied antiseptics failed to sterilize chronically infected wounds, but they did reduce the burden of bacteria (Fleming, 1920). In 1939, the instillation of sulfanilamide crystals, along with thorough debridement, hemostasis, primary closure and immobilization, resulted in a reduced infection rate for open fractures (Jensen et al, 1939).…”