Page images
PDF

vegetable and mineral powders—even poudrette—when mixed with coaltar furnish a more convenient and less costly disinfectant than that prepared with plaster, the experiments of the committee have proved that while coal-tar, mixed with common earth, well dried, or with sand, is equally, or perhaps much more, efficacious for disinfecting fecal matter as when mixed with plaster; that while comparative experiments made from this point of view upon sulphate of lime, clay, charcoal, linseed meal, and earth have resulted in favor of the latter, the same is by no means true in surgery. When applied to wounds or infectious suppurations these different mixtures were only partially successful, having proved to be less efficacious than the mixed plaster and coal-tar. In like manner the proposal to use an emulsion of coal-tar and tincture of saponine has not been found advantageous in practice: most patients complained of it, their wounds exhibited scarcely anything satisfactory, while the disinfection was very imperfect. The mixture of plaster and coal-tar was substituted for it, upon the same wounds, with decided advantage. Although the modifications of Corne and Demeaux' process have not been particularly felicitous thus far, they have nevertheless served to confirm the fact that in reality it is the coal-tar which acts the principal part as disinfectant in these various mixtures.* Among the numerous other substances proposed as disinfectants, or for dressing wounds, the following have not afforded satisfactory results: Chlorate of potash,_mixed with clay or kaolin (for example, 10 parts of chlorate to 90 parts of white clay or fine sand) which was proposed as an absolute disinfectant, neither disinfected nor absorbed the pus of fetid wounds. The mixture would be in any case much more costly than coal-tar and plaster and certainly less efficacious. Whites of eggs, –mixed with chalk and applied to wounds, previously oiled, succeeded no better than simple-cerate.

* The inefficiency of sulphate of lime as a general disinfecting agent when used by itself may be readily demonstrated by the following experiment which is of interest in view of the fact that a belief in the utility of gypsum as a deodorizer appears to be widely spread among recent writers. For that matter we are told by Paulet (Comptes Rendus, xlix, 199) that during the last 25 years more than fifty authors of processes of disinfection have announced, each as he believed for the first time, the use of plaster as a means of disinfection.

If a mixture of about equal volumes of powdered gypsum and fresh urine be introduced into a small phial, the mixture placed in a warm room and thoroughly shaken several times a day until the urine has become putrid, it will be observed that an exceedingly disagreeable odor will be developed, differing from that of ordinary stale urine inasmuch as it is unalloyed with the odor of ammonia. For the complete success of this experiment it is important that a large excess of sulphate of lime should be present and that the mixture should be frequently agitated, else the whole of the carbonate of ammonia will not be decomposed and will tend to mitigate the fetor of the special odor of the putrid urine. So far from disinfecting in this case the sulphate of lime really destroys a deodorizing, or at least a masking agent, ammonia; leaving free, purified as it were, and unadulterated, an odor, the peculiar offensiveness of which is remarkable. Sulphate of iron being substituted for gypsum in this experiment afforded a somewhat similar result, although the odor obtained was a trifle less insufferable than that of the experiments with sulphate of lime. It should be here mentioned that the odors in question were in no instance contaminated with sulphuretted hydrogen-as was ascertained by careful trials. F. H. STOBER.

Powdered sugar.—When employed in layers upon ulcers forms crusts,

i. which the suppurations accumulate and hinder the process of €all Il Co.

Cherry-laurel water, glycerine and cellulose.—According to Antier, glycerine mixed with equal parts of cherry-laurel water forms a valuable absorbent or disinfectant to be applied as a lotion or injection. This mixture converted into pomade by mixing it with powdered almonds was also proposed as a topical application for all kinds of wounds. But in the hands of the committee neither the liquor nor the pomade by themselves or mixed with kaolin produced any effect more marked than that of leadcerate and other anti-putrid or detergent solutions already in use.

The members of another group of disinfectants are worthy, in various degrees of consideration.

Among these charcoal appears in the front rank-Surgeons have long regarded it as one of the best antiseptics known. Confined between pieces of linen according to the process of Malapert and Pichot it is more readily applied than when used as powder directly upon wounds; but the mixture of coal-tar and plaster, which disinfects still better and is more cleanly, is susceptible of a simpler and a more general application.

Coke of Boghead coal,—in powder as proposed by Moride” like carbon

* In view of the claim of Moride (Comptes Rendus, xlix, 242) as well as from its general interest the following extract from a report made to the British Secretary of War by Lewis Thompson (London Journal of Gas Lighting, Water Supply and Sanitary Improvement, 1856, v, 11) may here be cited.

Mr. Thompson states that he has instituted a set of experiments having a purely money basis as their exponent.—The articles enumerated were each employed until they practically deodorized one uniform quantity of the same mass of putrid sewage and the money value of the proportions thus used was deduced either from a broker's price-list or, where this failed to give the requisite information, by special inquiry from a wholesale dealer. The amount of sewage operated upon in each experiment was half a gallon taken from a single tank which had been recently filled out of a large and very offensive ditch or open sewer. Two indications of the progress of the disinfection were had recourse to in these experiments; one with paper dipped in sugar of lead which gradually ceased to become brown as the deodorizing agent was added in successive portions; the other had reference to the discontinuance of any offensive smell; and the attainment of this last condition was regarded as the termination of each experiment. .

By this means he was enabled to draw up the subjoined table which shows at a glance the comparative cost of executing the same amount of deodorizing work with each agent on the supposition that Boghead charcoal can be had at the rate of $3:00 [= 128.] per ton. .

Table showing the cost of Purifying one uniform Quality of Feculent Sewage by the several Articles mentioned.

[ocr errors]

The sulphates of zinc, iron, and alumina; common gypsum; sulphuric, sulphurwhen employed comparatively with coal-tar and plaster, alternately upon the same patients, proved to be less efficacious, less convenient and more disagreeable than the latter. Mized plaster and charcoal,—proposed by Herpin of Metz, irritates the wounds, disinfects badly, and soils everything it touches. Carbonic acid, proposed by the same author, appears to the committee to be too difficult of application in practice, though theoretically founded upon important analogies. Bituminous Water of Visos—proposed by Manne, and the mud of rivers used as a poultice by Desmartis, do not appear to be susceptible of being substituted for the mixture of Corne and Demeaux. The following substances have long ago acquired a place, each in its own way, in the class of disinfectants. Tincture of iodine has been employed as an antiseptic by hospital surgeons since 1823. By modifying the surfaces to which it is applied, it usually improves the appearance of the pus, lessens its acridity, and is, to a certain extent, antagonistic to putrid infections. It disinfects, however, only incompletely, causes severe pain when applied to open wounds, and would be expensive if used on a large scale; finally, the odor of iodine is neither agreeable nor unattended by inconveniences. Perchloride of iron has been used for some twelve years in hospitals as an antiseptic and as a means of modifying certain wounds, and putrid or sanguineous foci—Without diffusing the disagreeable odor of tincture of iodine, it has, like the latter, the fault of disinfecting badly, of causing much pain, and of acting violently upon the diseased tissues, besides injuring the cloths which are soaked in it even more than is the case with the coal-tar and plaster. Both iodine and the salt of iron just mentioned, are in fact agents of another order; they have rendered, and do still render important services. They are certainly well worth preserving, but should not be compared with the mixture of coal-tar and plaster. Nitrate of lead,” Creosote, and other substances which have been proposed at one time or another, have not realized the expectations of their inventors; their price has been too great, their employment required too much care, or their action has not been sufficiently certain that they could be advantageously used in practice. There is, nevertheless, one of these which deserves special mention, viz., chlorine. Ever since Guyton Morveau demonstrated the true action of muriatic acid upon putrefying animal matters, the efficacy of chlorine has been tested in almost innumerable ways. Solutions of chlorine, of “chlorid of soda,” and of “chlorid of lime,” have rendered signal services to medicine and in the cause of public

ous, and muriatic acids; peroxyd of iron, highly dried clay, litharge, and saw-dust were found imperfect even when very large quantities were employed. Arsenious acid and creosote on the contrary, were very active; but the danger of a subsequent evolution of arseniuretted hydrogen in the first case, and the difficulty of diffusing an oily fluid like creosote in the second, seemed to interdict the use of these substances. F. H. S. * [An excellent, though somewhat expensive “disinfecting fluid" (Ledoyen's), which was quite extensively used in this country a few years since, consisted, according to analyses of F. E. Holyoke, of an aqueous solution of this salt.—F. H. s.]

SECOND SERIES, Vol. XXX, No. 88.-JULY, 1860.

health, especially since Labarraque, some thirty years since, indicated an improved method of employing them. But the odor of chlorine, disagreeable in itself, is neither easily borne nor devoid of inconveniences. Wounds, moreover, hardly accommodate themselves to it any better than the sense of smell, whenever somewhat large doses of it are required. Chlorinated Sponge.—The idea of applying sponges saturated with chlorinated solutions, directly upon purulent or gangrenous wounds, as suggested by Hervieux, appears to be excellent for certain cases. Such sponges, renewed several times per day, absorb the pus gradually as it forms better than anything else, and disinfect the wound very well. Unfortunately, chlorine rapidly alters or destroys the sponges and soon causes undue irritation. While this method, therefore, is an excellent one for cleaning certain gangrenous and sinuous wounds, it is, nevertheless, inferior in most instances to the mixture of coal-tar and plaster. Submitrate of bismuth—suggested by Frémy as an absorbent and disinfectant, was applied to a large number of wounds. Upon large cavernous cancers it disinfected somewhat better than Peruvian bark, charcoal, or chlorate of potash, but less than the coal-tar and plaster. By its use, however, several bad looking wounds were cleansed quite rapidly. Since it causes no pain or irritation, and since it neither soils the skin nor the clothes, the submitrate of bismuth is preferable to a multitude of other antiseptic powders; but it is useful rather as a solidifier (incarnatif), or dryer, than as an absorbent or disinfectant. In their résumé the committee affirm : -I. That coal-tar mixed with plaster, according to the formula of Corne, (see this Journal, xxviii, 426), can disinfect putrefying organic matters. Mixed with alvine dejections this powder destroys their odor, and leads one to hope that by its aid profound reforms in the present system of maintaining and clearing out cess-pools, &c., may some day be brought about. For this purpose, ordinary earth, coal-ashes, or sand may be substituted for the plaster, as Cabanes prefers, being at least equally efficacious. II. In therapeutics the coal-tar and plaster has fulfilled only a part of its promises. As a disinfectant in the dissecting-room, upon the folds of bandages, everywhere where there is infectious matter, its qualities are incontestable. This is also true as regards putrid or gangrenous foci, fetid suppurations, sanious wounds, ichorous putrilagenous cavities, hospital gangrene, &c.; but upon acute and exposed wounds, or upon ordinary wounds or ulcers, other topical applications are preferable to it. III. Used with lint upon cloths, with pomades or cerate, it has afforded no useful result, and nothing has occurred to prove that when administered internally it has produced the least benefit. IV. As an absorbent it leaves much to be desired, although it is not entirely devoid of action. When applied as a poultice, in particular, it absorbs very incompletely. For that matter the mixtures of coal-tar with earth or with other powders, absorb still less than the mixture of Corne and Demeaux, and are scarcely at all applicable in therapeutics. In this connection it must not be forgotten that the morbid liquids, and particularly pus, are very different from water. A substance like plaster, for example, which absorbs water strongly, might be incapable of absorbing pus. It is nevertheless true, that as an absorbent, the mixture of coaltar and plaster, either as powder or as poultice, is of some use upon fetid and putrid wounds or suppurations. W. Cellulose, glycerine and cherry-laurel water; chlorate of potash mixed with talc, clay, marl or kaolin, are neither sufficiently efficacious, nor in application are they convenient enough to be retained in practice. WI. The mixture of saponine and coal-tar does not appear to be preferable for dressing wounds to many other liquids already known, tincture of aloes for example. The same may be said of the mixed coal-tar and charcoal of Herpin ; nor does it seem as if carbonic acid should be used, unless some improved method of applying it can be devised. VII. The Boghead residue would be useful only in lack of coal-tar and plaster. While charcoal in porous envelopes does not mould itself to cavernous and sinuous wounds with sufficient readiness to come into general practice. VIII. From its low price, and by its action, at once mild, absorbent, and disinfectant, as well as by its drying properties, the subnitrate of bismuth will render important services in default of the mixture of coal-tar . and plaster. It is even preferable to this when the wounds are accompanied or surrounded with heat or irritation. IX. Tincture of iodine and perchlorid of iron act rather by modifying the surfaces of wounds and of purulent foci, than as absorbents or disinfectants. They have their special applications in surgery, but agents of this sort are not comparable with the mixed coal-tar and plaster. X. Sponges soaked in chlorinated water can also render good service upon pale, burrowing sores and upon gangrenous foci. We have occupied ourselves, say the committee, only with the practical or experimental side of the question. A discussion of its theoretical or chemical bearings would have carried us too far. Moreover, since the authors of the different communications which have been submitted to us have themselves neglected this for the most part, it has seemed to us useless to treat of it at present; whether it be the phemic acid or rosolic, or brunolic acid, or the anilin, picolin, etc., of the coal-tar, which disinfects, is in reality of but little importance. Science will inform us of this some day no doubt; for the moment we have merely to ascertain whether or no the various disinfectants which are brought to us do really disinfect. After citing the labors of various persons who have proposed methods of disinfection, the committee go on to say: “M. Corne, and the authors indicated above, occupied themselves only with the disinfection and the solidification of animal matter, having in view the preparation of manures. * * * * It is M. Demeaux who appears first to have had the thought of applying to fetid wounds, in surgical practice, the powder invented, or adopted and extolled, by his neighbor. In addition, it is evident that here, as is the case with so many other complex facts with which science is enriched, there is, so to say, neither invention nor priority for any one. The subject has been worked upon for more than a century—a multitude of savans having competed with each other in studying it. Little by little the evolution of the discovery has been effected. M. Corne disengaged it from its gangue a little better than his predecessors, and Demeaux, knowing, perhaps, that from time immemorial sailors and the inhabitants of certain southern countries often dress their wounds

« PreviousContinue »