CICATRIZATION OF WOUNDS : VII. STERILIZATION OF WOUNDS WITH CHLORAMINE-T.
Sodium stearate has no effect upon the bacteriological condition of a wound, but the addition of 4 parts per 1,000 of chloramine-T renders it antiseptic. Experiment I enabled us to compare the action of sodium stearate alone with that of sodium stearate containing 4 parts per 1,000 of chloramine-T. Wounds which had been previously sterilized could be maintained in an aseptic condition by 4 parts per 1,000 of chloramine-T, although in some cases reinfection occurred (Experiments 2, 3, and 5). For this reason the concentration of chloramine-T was increased. Surface wounds, deep-seated wounds, and osseous cavities, which had previously been either completely or almost completely sterilized, could be maintained for days and even weeks in a condition of surgical asepsis by the use of a paste containing 7 and 10 parts per 1,000 of chloramine-T. Experiments 7, 8, 9, 10, and 12 are examples of this. Slightly infected wounds (Experiments 9, II, and 12) were sterilized in the same manner. Next, it was attempted to sterilize wounds which were suppurating and more or less infected, and in some cases accompanied by fracture. This attempt was probably successful because the wounds used for the experiments showed but slight quantities of secretions and only a shallow layer of necrotic tissue. It is useless to attempt to sterilize severely infected wounds with a paste, for the volume of chloramine-T that can be applied is too limited. A large volume of an active substance is required to sterilize a wound which secretes great quantities of pus, for owing, on the one hand, to the dilution of this substance with the secretions, and, on the other, to its combination with the proteins contained in the pus, the concentration of the antiseptic is rapidly diminished. For these reasons it is essential that the antiseptic solution should be constantly renewed, so that the concentration may be sufficiently strong to effect the destruction of the bacteria. Therefore, the chloramine-T paste cannot sterilize a severely infected wound. The concentration of the active substance contained in a paste must at the same time be sufficiently weak to be innocuous to the tissues. We have seen that it should not exceed 15 parts per 1,000. Thus, it is evident that if the secretions from the wounds are abundant, the substance could exert its action upon the microorganisms for the space of only a few hours. For this reason the chloramine paste should only be applied under the conditions specified in our experiments; that is, in connection with moderately infected wounds which have been carefully washed with sodium oleate, and possess but slight quantities of secretion. Under these conditions, the chloramine paste effects the complete disappearance of the bacteria and maintains the sterility thus secured for as long a time as may be wished. If the technique followed in the dressing is not exactly as above described, reinfection will occur. If applied in this manner the chloramine paste is not injurious to the tissues, for the cicatrization curves of the wounds thus treated show but slight modification from the calculated curves. Chloramine paste makes it possible, therefore, to keep wounds sufficiently free from microorganisms so that the effect of substances which are believed to influence cicatrization can be studied.
Carrel
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Laboratories of The Rockefeller Institute for Medical Research, New York, and Hospital 21, Compiègne, France.
Hartmann
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