510 GENERAL THERAPEUTIC MEASURES 



and (after absorption) they exert some antiseptic action on the mucous 

 membrane of the respiratory tract (volatile oils)j and also on the urinary 

 tract (urotropin), during their elimination. The principal agents used 

 as antiseptics for surgical purposes are: iodine^ dichloramine-T, phenol^ 

 compound cresol solutiouj creolin, hydrogen dioxide^ corrosive sublimate, 

 potassium permanganate, zinc chloride, iodoform, salicylic acid, aristol, 

 iodol, and boric acid. Those employed internally include naphthol, salol, 

 creolin, carbolic acid, bismuth salicylate and subnitrate, quinine, salicylic 

 acid, and many others. For a more detailed description the reader is 

 referred to special articles on these agents in the preceding pages. 



Probably the greatest advance in the treatment of wounds in the 

 great war was the use of chlorine preparations. Dakin's solution was 

 that most successfully employed, consisting of 0.45 to 0.5 per cent, of 

 sodium hypochlorite (NaOCl). The solution must be very accurately 

 made since it is antiseptically inefficient if too weak, and irritating and 

 caustic if too strong. Moreover, it is of the greatest importance that its 

 alkalinity be most precisely determined by titration with sodium thio- 

 sulphate by a competent chemist. The solution is unstable and must be 

 made every few days. The treatment is carried out by a most elaborate 

 technic (Carrel-Dakin) in v/hich intermittent or continuous irrigation 

 through a number of small rubber tubes introduced into all the recesses 

 of the wound is the chief feature. Closure of the wound is done when 

 bacterial counts, taken from the wound secretion, show not more than one 

 microbe in 5 or 6 microscopic fields on three successive days. 



Dakin's solution gives off all its chlorine and loses all its antiseptic 

 action within an hour. The difficulty of making and using it are so great 

 that it is indicated in surgery only in well appointed hospitals, and by 

 especially trained surgeons. 



Dakin has therefore prepared a more stable and non-irritating chlo- 

 rine compound in dichloramine-T. (toluene parasulfondichloramine). 

 This is a crystalline, slightly yellowish solid, having a strong chlorine- 

 like odor. It is sparingly soluble in water but is soluble in chlorinated 

 eucalyptol and in chlorinated paraffine oil, or better, in ehlorcosane, a 

 chlorinated oil of paraffin and white wax. To prepare a solution of 

 dichloramine-T, 4.6 grains of dichloramine-T are dissolved in ehlorcosane 

 (§i) (Squibb) by iirst gently heating the latter and stirring in the former. 

 The solution will keep about 3 weeks. In the treatment of wounds from 

 5 to 7.5% solutions of dichloramine-T are used. In the nose and throat, 

 from one to two per cent, solutions. 



It is said that dichloramine-T has 20 to 40 times the germicidal 

 strength of other chlorine solutions and shortens wound healing about 

 one-third over ordinary methods. It is applied to fresh accidental 

 wounds, in place of iodine, by spray, swab, medicine dropper or syringe 

 in sufficient quantity to cover the wound, and then gauze is applied and 

 the dressing renewed in 24 hours. As chlorine has a solvent action 

 on dead tissue chloramine-T is very beneficial in putrid or gangrenous 

 wounds applied twice in 24 hours. In cavities it is also most appropriate 

 as it gives out chlorine for 18 to 24 hours and its antiseptic action is 

 thus similarly prolonged. In fistulous withers and poll very encouraging 



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