JOHN A. KOLMER 1105 



4. They should possess the property of penetrating cells and tissues, and especially 

 phagocytic leukocytes and other cells in which living bacteria may be lurking. This 

 is one of the most important principles of all, and especially in the treatment of 

 chronic infections of mucous membranes in which the bacteria are almost sure to have 

 taken up a position of great strategic strength in the depths of glands and cells. 



5. They should be free of local organotropic or toxic effects for the fixed tissues, i.e., 

 free or almost so, of irritating and inflammatory properties; on the contrary, they 

 should be of a soothing or bland nature and preferably possess some degree of an- 

 algesic effect. 



6. They should not he excessively toxic for the body as a whole in case considerable 

 amounts are absorbed. This is especially important in the irrigation of wounds and 

 much less so in infections of the skin and mucous membranes, the whole subject bear- 

 ing a direct relation to the question of absorption. 



7. They should exert a chemotactic effect, i.e., attract leukocytes about the focus 

 of infection and thereby aid in the walling off of the involved area and possibly aid 

 phagocytosis and the elaboration of cellular proteolytic and lipolytic enzymes. At 

 least they should not repel or destroy leukocytes and thereby favor the extension of 

 the infection. 



8. They should not destroy or paralyze the immunological substances like complement, 

 bacteriolysins, and opsonins (bacteriofropins) concerned in the destruction of organisms. 



9. They should be rapid in bacteriostatic and bactericidal activity. This is especially 

 important in the treatment of such infected surfaces as the urethra, conjunctivae, etc., 

 where the contact of disinfectant is extremely brief. Indeed, this largely accounts for 

 failure in practice, and it is commonly observed that clinical results are very much 

 better when the disinfectant is retained for some time as, for example, in the case of 

 instillations into the urinary bladder or when it is frequently applied, as in the Carrel 

 method of irrigation of wounds. But whenever the conditions are such that pro- 

 longed contact is not possible, rapid penetration and rapid bactericidal effects be- 

 come of increasing practical importance. 



10. They should possess some degree of dynamo genie activity, i.e., the property of 

 stimulating the fixed tissues to proliferative activity as a further aid in the walling 

 off of lesions followed by cutting off oxygen and blood supply to the organisms and 

 thereby allowing their own acid and waste products to check their growth and 

 eventually destroy them. 



METHODS OF TOPICAL TREATMENT OF LOCALIZED INFECTIONS IN 

 RELATION TO CHEMOTHERAPY 



But a compound possessing all or the majority of these essential and desirable 

 properties may yet fail to prove useful in the treatment of localized bacterial infec- 

 tions because it may not be possible to apply it correctly. Indeed, I believe that the 

 essential reason for the skepticism of surgeons regarding the practical value of 

 topical appUcations of chemical disinfectants in the treatment of infected wounds, 

 serous cavities, sinuses, etc., is due largely to the difficulties or impossibiUty of cor- 

 rect application. Merely to apply the disinfectant on gauze is usually insufficient, as 

 this may only protect against secondary infection without appreciably influencing the 



