﻿SULFONAMIDES 
  — 
  FOX 
  573 
  

  

  kill 
  bacteria 
  but 
  also 
  destroy 
  tissue 
  cells 
  in 
  the 
  wounds. 
  This 
  is 
  one 
  

   of 
  the 
  greatest 
  virtues 
  of 
  the 
  sulfonamides 
  — 
  their 
  selective 
  action 
  

   against 
  bacteria 
  without 
  damaging 
  tissue 
  cells. 
  

  

  With 
  this 
  background 
  you 
  might 
  predict 
  that 
  burns 
  would 
  be 
  par- 
  

   ticularly 
  suited 
  for 
  local 
  sulfonamide 
  therapy. 
  Insofar 
  as 
  burns 
  rep- 
  

   resent 
  destruction 
  of 
  the 
  skin, 
  which 
  is 
  man's 
  natural 
  barrier 
  against 
  

   infection, 
  sulfonamides 
  are 
  valuable 
  in 
  preventing 
  bacteria 
  from 
  

   establishing 
  infection 
  in 
  the 
  damaged 
  areas. 
  But 
  destruction 
  of 
  the 
  

   skin 
  also 
  presents 
  another 
  serious 
  problem 
  — 
  loss 
  of 
  the 
  mechanical 
  

   covering 
  of 
  the 
  underlying 
  tissues. 
  The 
  heat 
  of 
  a 
  burn 
  causes 
  the 
  tis- 
  

   sues 
  to 
  become 
  greatly 
  swollen 
  and 
  waterlogged 
  with 
  a 
  plasmalike 
  

   fluid. 
  Loss 
  of 
  the 
  skin 
  covering 
  from 
  burns 
  permits 
  the 
  escape 
  of 
  

   this 
  fluid 
  and 
  aggravates 
  the 
  shock. 
  Many 
  types 
  of 
  substitute 
  cover- 
  

   ings 
  have 
  been 
  proposed 
  but 
  the 
  most 
  satisfactory 
  seems 
  to 
  be 
  a 
  new 
  

   pseudo 
  skin 
  formed 
  in 
  the 
  burned 
  region 
  from 
  the 
  damaged 
  skin. 
  To 
  

   accomplish 
  this, 
  tannic 
  acid 
  has 
  been 
  used 
  for 
  years 
  to 
  coagulate 
  the 
  

   burned 
  skin 
  and 
  produce 
  a 
  hard, 
  stiff, 
  adherent 
  covering 
  known 
  as 
  an 
  

   eschar. 
  

  

  Now, 
  tannins 
  are 
  used 
  in 
  the 
  leather 
  industry 
  to 
  "tan" 
  animal 
  

   skins 
  and 
  convert 
  them 
  into 
  leather. 
  The 
  late 
  Charles 
  Wilson, 
  a 
  

   leather 
  chemist, 
  showed 
  that 
  tannic 
  acid 
  itself 
  caused 
  animal 
  skins 
  

   to 
  become 
  swollen 
  and 
  unfit 
  for 
  leather. 
  In 
  contrast, 
  however, 
  he 
  

   found 
  that 
  when 
  tannic 
  acid 
  is 
  neutralized 
  to 
  the 
  slightly 
  alkaline 
  

   reaction 
  of 
  the 
  tissues, 
  skins 
  can 
  be 
  "tanned" 
  without 
  swelling, 
  and 
  

   soft, 
  pliable 
  leather 
  is 
  formed. 
  Similarly, 
  when 
  neutralized 
  tannic 
  

   acid 
  is 
  used 
  on 
  burned 
  human 
  skin, 
  very 
  little 
  swelling 
  occurs 
  and 
  a 
  

   soft, 
  pliable 
  covering 
  is 
  formed. 
  This 
  effectively 
  prevents 
  loss 
  of 
  the 
  

   plasmalike 
  tissue 
  fluids. 
  In 
  addition, 
  pain 
  is 
  alleviated 
  immediately. 
  

  

  This 
  neutralized 
  or 
  slightly 
  alkaline 
  tannic 
  acid 
  works 
  very 
  well 
  

   with 
  the 
  sodium 
  salts 
  of 
  the 
  sulfonamides. 
  In 
  the 
  past, 
  tannic 
  acid 
  

   itself 
  has 
  been 
  used 
  with 
  the 
  sulfonamides 
  but 
  too 
  frequently 
  infec- 
  

   tions 
  have 
  occurred 
  under 
  the 
  hard 
  eschar 
  of 
  coagulated 
  burned 
  skin. 
  

   The 
  probable 
  explanation 
  is 
  that 
  the 
  acidity 
  of 
  the 
  tannic 
  acid 
  chem- 
  

   ically 
  inactivated 
  the 
  sulfonamide 
  as 
  described 
  above. 
  The 
  neutral- 
  

   ized 
  tannic 
  acid, 
  on 
  the 
  other 
  hand, 
  keeps 
  the 
  sulfonamide 
  in 
  solution 
  

   in 
  the 
  activated 
  ionized 
  form. 
  The 
  trials 
  in 
  human 
  burns 
  up 
  to 
  

   the 
  present 
  have 
  indicated 
  that 
  this 
  combination 
  effectively 
  prevents 
  

   infection. 
  

  

  The 
  mixture 
  is 
  prepared 
  in 
  ointment 
  form 
  so 
  that 
  it 
  can 
  be 
  quickly 
  

   and 
  easily 
  applied 
  and 
  then 
  covered 
  with 
  a 
  light 
  protective 
  bandage. 
  

   Since 
  the 
  soluble 
  sulfonamide 
  is 
  brought 
  into 
  immediate 
  contact 
  with 
  

   the 
  zone 
  of 
  potential 
  infection, 
  no 
  additional 
  drug 
  by 
  mouth 
  is 
  neces- 
  

   sary. 
  It 
  is 
  not 
  understood 
  how 
  this 
  mixture 
  relieves 
  the 
  pain, 
  but 
  the 
  

   fact 
  remains 
  that 
  the 
  pain 
  disappears 
  after 
  applying 
  the 
  ointment. 
  

  

  