JOHN A. KOLMER 1107 



according to the infection and the kind of compound administered. For example, it is 

 doubtful if we have available at present a chemotherapeutic agent capable of pene- 

 trating tubercles, although some of the dyes may do so; on the other hand, clinical 

 reports indicate that gentian violet and mercurochrome are apparently able to pene- 

 trate localized infections caused by B. coli, staphylococci, and streptococci, and in 

 severe acute localized bacterial infections it may be possible to reinforce disinfection 

 by local or topical application of disinfecting agents by the systemic administration of 

 a medicament and especially by the administration of mercurochrome. 



Related to this subject of specific chemotherapeusis of local bacterial infections 

 by the topical or local application or systemic administration of a disinfectant agent 

 is the possibility of treating infections of the organs of the urinary, biliary, gastro- 

 intestinal, respiratory, and cutaneous systems by the administration of compounds 

 largely eliminated in these tracts. Hexamethylamin, for example, apparently owes a 

 part of its beneficial effects in the treatment of infections of the genito-urinary organs 

 to the elimination of small fractions of formaldehyde liberated in acid urine, although 

 it is doubtful if sufficient formaldehyde is liberated in other tissues as in the bile, 

 milk, saliva, cerebrospinal fluid, etc., to produce beneficial results, and hexamethyla- 

 min itself is practically free of bactericidal effects. Recently it has been shown that 

 mercurochrome and hexyl-resorcinol administered by ingestion or intravenous injec- 

 tion may be eliminated in the urine in sufficient amounts to render it bactericidal, 

 and the same may be true to a lesser extent of other mercurial conipounds. It is well 

 known that arsenic is largely eliminated in the bile, but unfortunately the bactericidal 

 activities are so feeble that curative effects in bacterial infections of the liver, gall- 

 bladder, and ducts are not apparent. It is not improbable, however, that mercurial 

 compounds eliminated in the bile may reach bacteriostatic concentrations and even 

 reduce to some extent the bacterial flora of the small intestines. The beneficial effects 

 of creosote, guaiacol, and their derivatives in bronchitis are apparently due in part 

 to their elimination in the bronchial secretions, but I do not know of any drug 

 eliminated by the skin exerting curative activity in bacterial infections of this organ. 



But the principle is well established and worthy of much more attention than has 

 been heretofore given this subject. This is especially true of bacterial infections of 

 the genito-urinary organs and biliary passages. It is probable, however, that com- 

 pounds eliminated in the urine and bile may be so profoundly altered that bac- 

 tericidal effects are lost; this is apparently true of the organic trivalent arsenicals like 

 arsphenamin and neoarsphenamin, which are largely elirninated in the bile as inert 

 pentavalent compounds, and half- or pseudo-complex compounds of mercury may be- 

 come dissociated and combine with proteins and thereby lose greatly in bactericidal 

 effects. Unfortunately, the converse of this is apparently an infrequent occurrence; 

 i.e., relatively inert compounds do not acquire bactericidal effects during elimination 

 except in the case of hexameth}'lamin when traces of formaldehyde are liberated in 

 an acid medium. But it may be that similar effects are more common than we now 

 suppose and thereby explain such beneficial results as those observed, for example, 

 with creosote, guaiacol, and their derivatives in bronchial infections, the salicylates in 

 acute rheumatic fever, etc., which possess but feeble bactericidal effects in vitro. 



