Læknablaðið - 01.04.1943, Blaðsíða 13

LÆKNABLAÐIÐ
green and o.i % neutral acrifla-
vine. This solution of dyes has
niany advantages over tannic acid.
First, it is strongly germicidal, the
gentian viblet against the grani
positive organisms, which include
the usual iníecting group, the
streptococci, and the other two
dyes against the gram negative
bacteria. Secbnd, the solution is
quite non toxic. Thi’rd, it forms
a tough, but much more pliable
eschar than does the tannic acid.
Fourth, and this is extremely
important, it does not mask
infection if it shoukl occur.
This is readily seen upon in-
spection. If infection does occur,
the affectecl area becomes moist
and softened. It can be readily
spotted, and the softened area of
the eschar can be readily removed
by careful sponging. All that is
necessary for treatment is a reap-
plication of the dye. Fifth, the
solution is extremely stable, and
can Ire kept on hand for long
períods of time.
Aldrich also proved, by repeat-
ed cultures taken from the burned
areas, that they were sterile after
the injury, and remainecl so for
about 18 hours. After that infection
ensued, which was at first strep-
tococcic, although mixed infections
occurred later. He also stated that
he believed that these infections
were the cause of the toxemias,
and contributed largely to second-
ary shock. and not the split pro-
tein factors.
Use of the triple dye method
greatly redued the percentage of
infections, and the resulting mor-
tality. It also reduced the severe
contractures due to scar tissue, as it
was much less harmful to the
growing islands of epethelium
In 1941, Pickrell of Johns Hop-
117
kins University developed a new
method of treatment, which had
all of the advantages of the triple
dye, with some added advantages.
His solution was also an eschar
producing substance. It was 3%
sulfodiazene in 8% triethanola-
mine. This was a relatively non
toxic solution, having a Ph of 8.7.
It was odorless, stainless, and
strongly bactericidal. It jrenetrates
tissue, and forms a tough, but
very pliable, transparent eschar.
There have been a few toxic mani-
festations at'ter its use, such as
cyanosis, jaundice, íever ancl rash,
but none have been serious. After
its use, the sulfo drug is rapidly
absorljed, and can be detected in
the blood stream. It rapidly appro-
aches a maximum concentration,
and then falls to a fairly steady
level. If the blood concentration
is closely watched, and kept below
15 milligrams percent, no kidney
damage will result.
In England, during the present
war, due to the tremendous num-
liers of cases much opportunity for
careful work has existed. And
much work has been done.
One of their methds of treat-
ment, whic'h has now lieen large-
ly discarded, is the Stannard bag
method. The burned areas were
primarily irrigated with a solution
of 10% electrolytic hypochlorite,
with the patient under general
anaesthesia. Following this a
water tight container of oilecl silk
was constructed arbuncl the at'-
íectecl area, having two outlets.
This permitted irrigation two or
three times daily with the hypo-
chlorite siolution without distur-
bing the hag. This permitted very
early motion in cases of burns of
the hands.
Other substances, such as cod