iio6 CHEMOTHERAPY OF BACTERIAL DISEASES 



existing infection. As so clearly shown by Carrel and his colleagues with the chlorin 

 group of antiseptics in the treatment of infected wounds, it is essential to bring the 

 disinfectant solution into frequent and intimate contact with the infected tissues 

 along with the surgical removal of necrotic tissues when possible and advisable and 

 always the establishment of the best possible drainage. Furthermore, these ends 

 should be attained with the least meddling and disturbance in order to permit granu- 

 lation and healing to proceed; for these reasons Carrel has contributed his valuable 

 method of irrigation with rubber tubes laid in the wound as a substitute for frequent 

 syringings and packings. 



The method of application, therefore, is of considerable importance; indeed, I be- 

 lieve it decidedly outranks in importance the choice of antiseptic solution itself, pro- 

 viding the latter approaches in blandness simple physiological saline or Locke's solu- 

 tions with a reasonable degree of bactericidal activity. 



But, of course, not all localized bacterial infections demand disinfectant treat- 

 ment. Judgment must be exercised according to the kind of organism present and the 

 duration and extent of the lesion. Ordinary acute staphylococcus abscesses, for ex- 

 ample, usually do best with simple incision for adequate drainage; and much handling, 

 squeezing, and syringing are to be avoided. As a general rule, when the incisions of a 

 localized lesion are only large enough for drainage, no attempt should be made to 

 disinfect because of the danger of blocking drainage by additional tubes; but in large 

 lesions, as infected wounds, widely incised staphylococcus and streptococcus ab- 

 scesses, streptococcus infections of the uterus, etc., where provisions may be made for 

 both drainage and irrigation, I believe that disinfection at short intervals is indicated, 

 and especially in streptococcus infections. 



It is true that disinfectant solutions may not reach or influence those bacteria 

 already deeply situated in the tissues and especially in the lymphatics, but the proper 

 kind of disinfectant solution along with drainage may tend to reverse osmosis and 

 thereby reduce the degree of absorption of bacteria and toxins and at least greatly 

 reduce their production, which may be a factor of no little value in streptococcus and 

 pneumococcus infections. Furthermore, some localized bacterial lesions cannot be 

 subjected to frequent disinfection because of anatomical difficulties, but in the treat- 

 ment of chronic empyema, chronic suppurative arthritis, chronic suppurating sinuses, 

 osteomyelitis, endometritis, etc., the possible advantages from well-directed attempts 

 at disinfection at short intervals should not be overlooked or minimized, and I believe 

 these localized infections constitute a proper field for co-operation between surgeon 

 and chemotherapeutist. 



The question of disinfecting a strictly localized bacterial infection by the adminis- 

 tration of a compound by intravenous or subcutaneous injection or oral administra- 

 tion is very important, involving the present state of the chemotherapy of bacterial 

 diseases in general, since tuberculosis, bacterial endocarditis, pneumonia, puerperal 

 sepsis, etc., may be localized infections in just the same sense as an abscess at the 

 root of a tooth, a sinusitis, a staphylococcus or streptococcus cellulitis and lymph- 

 adenitis. It involves primarily the question of penetration of chemical agents from 

 the blood into the tissues of bacterial infection, but it may be stated that a general 

 answer cannot be given since it would appear that the matter of penetration varies 



