Am.  Tour.  Pharm. 
May,  19 1 8. 
Urinary  Antisepsis. 
345 
sion  of  the  relative  values  of  the  various  urinary  antiseptics  in 
common  use,  the  reader  is  referred  to  the  paper  published  by  Hin- 
man7  in  191 5.  This  paper  will  be  freely  quoted.  Of  the  urinary 
antiseptics  in  common  use,  hexamethylenamin  is  by  far  the  best,  but 
has  very  definite  limitations,  owing  mainly  to  the  fact  that  an  acid 
medium  is  essential  for  the  liberation  of  formaldehyde.  Further- 
more, "  the  necessity  of  concentration,  and  time  for  the  accumula- 
tion of  formaldehyde  in  antiseptic  amounts,  largely  destroys  the 
value  of  the  drug  for  kidney  antisepsis ;  for  bladder  antisepsis  in 
cases  with  polyuria  or  frequent  urination,  except  when  retention  in 
some  form  is  present ;  in  cases  of  urinary  fistula,  notably  postopera- 
tive prostatics  during  the  period  of  incontinence,  and  in  cases  with 
continual  bladder  drainage  as  in  true  incontinence  or  with  retention 
catheter;  and  for  urethral  antisepsis  no  matter  what  the  infection. 
The  greatest  usefulness  of  hexamethylenamin  is  in  bladder  prophy- 
laxis in  cases  in  which  the  above  urinary  conditions  are  not  present. 
.  .  .  Methylene  blue,  in  a  dilution  of  1  : 150,000,  will  inhibit  the 
growth  of  staphylococci,"  and  would  therefore  seem  of  value  in 
this  type  of  infection ;  but  there  has  been  no  experimental  work 
showing  that  methylene,  blue  does  not  undergo  modification  either 
in  the  blood  stream  or  in  the  urine  so  as  to  lose  its  antiseptic  value, 
which  will  be  shown  below  to  be  the  case  with  many  other  com- 
pounds. Hinman  states  that  "the  value  as  internal  urinary  anti- 
septics of  other  substances  such  as  salol,  oil  of  sandalwood,  salicyiic, 
boric  and  benzoic  acids,  is  very  limited,"  and  concludes  that  there  is 
no  known  drug  with  properties  even  approaching  those  of  an  ideal 
urinary  antiseptic. 
As  stated  before,  an  ideal  internal  urinary  antiseptic  must  be 
chemically  stable,  nontoxic,  antiseptic  in  urine  (as  well  as  in  water), 
and  must,  like  phenolsulphonephthalein,  possess  the  property  of 
high-percentage  elimination.  Possibly  a  compound  not  entirely  non- 
toxic, but  relatively  so,  might  be  suitable  for  the  purpose.  Provided 
the  renal  elimination  of  a  given  compound  is  sufficiently  rapid  and 
complete,  and  that  this  compound  causes  bacterial  inhibition  in  urine 
in  sufficiently  high  dilution,  it  is  conceivable  that  small  doses  might 
serve  to  produce  urinary  antisepsis,  even  though  the  compound  is 
moderately  toxic.  In  view  of  the  general  toxic  effects  on  the  ani- 
mal organism  that  an  antiseptic  compound  may  be  expected  to  have, 
7  Hinman,  Frank,  "  Urinary  Antisepsis :  A  Clinical  and  Bacteriologic 
Study,"  The  Journal  A.  M.  A.,  Nov.  20,  1915,  p.  1769. 
