Twentieth Century History of Findlay and Hancock County, Ohio, and Representative Citizens, Part 122

Author: Jacob Anthony Kimmell
Publication date: 1910
Publisher:
Number of Pages: 1189

USA > Ohio > Hancock County > Findlay > Twentieth Century History of Findlay and Hancock County, Ohio, and Representative Citizens > Part 122

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Nance (J. Ophth., Otol. & Laryngol., 1911, p. 41) reported very favorable results with scarlet red in the treatment « corneal defects.

It can be seen from the above that by the use of scarlet re! and amidoazotoluol very satisfactory results have been - tained. The tone of nearly all of these papers has been er- thusiastic, and the only unfavorable results are those reporte! by Hartmann and Beyer, Sonntag and Brühl. All of these were in aural cases.

Since the publication of my paper I have continued to ux scarlet red on a number of other cases with almost unifor success, and have little to add to the technic described at the: time.

I find marked epithelial stimulation even when the wound are unhealthy and the discharge is profuse. This has ak been the experience of Kaehler and Auerbach, although near .: all the other writers, beginning with Schmieden, have stated that it is useless to apply the scarlet red ointment to any b :: a perfectly clean granulating wound. Of course the mist rapid results are obtained on flat healthy granulating sur- faces, but a great deal of progress can be made by its Ds while the granulations are being brought into this conditie.

Strauss objects to the use of scarlet red put up in balser of Peru ointment, blue ointment, iodoform ointment, etc., # recommended by me, in the treatment of unhealthy grana- lating wounds, on the ground that the ointment is of no ue on such ulcers, but my experience has evidently been rer: different from his. I consider the use of such combination to be of value in the treatment of unhealthy granulatir .: wounds, as the scarlet red in itself has no antiseptic qualities and the cleansing process due to the balsam of Peru, etc., can in this way be carried on while the scarlet red is being use. as well as by the alternating dressing.

TECHNIC .- An outline of the technic will suffice. Clean. the wound thoroughly with boric or salt solution and dry. Peroxide of hydrogen may be used before the boric solution i! the granulations are unhealthy. The free use of a nitrate :

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Ilucture of lodine, U. S. P. strength, may follow the silver nitrate or be used on alternating days, and is a powerful and rapid method of cleansing granulations.

The strength of the scarlet red ointment ordinarily used is 8 per cent, and it should be alternated every 24 to 48 hours > with some bland ointment. By applying a weaker ointment, : say 4 per cent, it can be used over longer periods without danger of the severe irritation which occasionally occurs.

The most satisfactory method of applying the ointment is as follows: Anoint the skin surrounding the defect with some bland ointment up to about one centimeter of the wound edge, as this prevents possible irritation. Then spread the scarlet red ointment in a thin layer on perforated old linen and apply to the wound, either along the edges or over the whole surface. A light dressing of sterile gauze secured by a bandage completes the procedure.

I have applied the scarlet red ointment to a number of wounds and then exposed them to the air and sunlight. The healing is very rapid and the drying out of the surface is most noticeable.

It is safe to use a 4 per cent scarlet red ointment on partial skin grafts of all kinds 48 hours after grafting, and there is rapid stimulation of the wound edges and also of the grafts themselves.

CASE REPORTS .- I will mention only one case to illustrate the efficacy of scarlet red. A very feeble old lady, 84 years old, was badly burned across the shoulders six weeks before she came under my care. During that time she had been care- fully treated by her family physician with the usual methods. The wounds had done well for several weeks, and then had vecome sluggish and no further progress could be made. The patient's general condition was bad on account of a weak heart nd chronic nephritis, and was becoming serious under the train. I was called to consider the advisability of grafting.

There were three ulcers, one over the right scapula, 5 x 10 m., another over the left scapula, 5 x 8 cm., and a third ulcer x 10 cm. situated in the mid-line between the other two. hose over the scapula were covered with clean, but edema- mus granulations, which had not yet reached the level of the in. The central wound was still covered, to a large extent, ' a slough which was made up of the whole thickness of the in and some subcutaneous tissue. The epithelial edges of ese ulcers were very sluggish.

On account of the condition of the patient and the situation the wounds, I decided to try scarlet red instead of grafting. November 26-27, 1910. The wounds were dressed with a Isam of Peru and castor oil mixture, 1 to 3.

November 28. Scarlet red, 8 per cent, was applied, and reafter every third day, alternating with boric ointment. December 7. The last of the slough was removed.

December 16. The wound over the left scapula was healed.

December 23. The central wound was healed.

December 25. The wound over the right scapula was led

making the utatient the patient was in a critical condition almost continuously and had to be strongly stimulated in order to preserve her life.

The case is instructive from the fact that old age and great debility seem to have little deterrent effect on the stim- ulating power of scarlet red. The skin edges were stimulated in spite of the presence of a slough in the central wound. It was only necessary to use the scarlet red ointment in nine dressings to complete the healing. The result was a firm, thick and stable skin, which showed no tendency to contract.

After the appearance of Hayward's paper on the efficacy of amidoazotoluol, I had the opportunity of using this sub- stance on a number of granulating wounds of varying etiology. The results have been excellent.

Calculating the amount of amidoazotoluol in scarlet red from the molecular weights, we find that there is 3.76 per

FIG. 1A.

cent of amidoazotoluol in an 8 per cent scarlet red ointment. I have used this strength as well as 8 per cent in simple vaseline, and also in the balsam of Peru and other ointments suggested earlier in the paper. I will illustrate the efficacy of amidoazotoluol by briefly reporting two cases.

CASE I .- A boy, 14 years old, fell into the fire while in an epileptic attack and was severely burned. He was admitted to the hospital and was much improved, during his five months' stay, by grafting and various other methods. He was then sent to the Out-Patient Department for dressing, and as no further progress was made in the healing he was referred to me eight months after the accident.

The size of the unhealed areas at this time can be well made out in the illustrations. The wounds were covered with very exuber- ant granulations which secreted actively. The epithelial edges were at a standstill. The patient refused to be grafted and it was decided to try eight per cent amidoazotoluol ointment. The granulations were trimmed off with scissors, then cauterized with silver nitrate, and this was followed by tincture of iodin. This

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procedure was carried out whenever necessary throughout the treatment.

February 24, 1910 (Fig. 1, a and b). All of the ulcers were dressed with amidoazotoluol ointment and this was alternated every 24 to 48 hours with balsam of Peru and oil, zinc oxide or

FIG. 1B.

FIG. 1c.

FIG. 1 .- CASE I. Sluggish ulcers following burn. Healed with amidoazotoluol. a, b, taken February 24, 1910, eight months after the accident. The ulcers are surrounded by scar tissue. There is partial web formation in the axilla. The exuberant granulations and sluggish wound edges can be well seen. c, taken May 9, 1910. Shows the character of the healing. There is no tendency to contraction. The web formation is less marked.

boric ointment. A stimulation of the epithelial edges was notice- able within 48 hours.

:fter the first dressing of the large areas with amidoazotoluol

a temporary change of color was noticed in the urine. The patient was dressed at 5 p. m. and the urine voided was as follows: February 24, 6.40 p. m. watery, 500 cc., 9.30 p. m. light lemon, 450 cc .; February 25, 4.30 a. m. amber, 430 cc., 7.50 a. m. reddich brown, 240 cc., 11 a. m. reddish brown, slightly darker, 80 cc. 2.30 p. m. watery, 280 cc., 5.55 p. m. watery, 200 cc., 7.00 p. m. watery, 360 cc. Otherwise the urine was negative. The subse quent dressings did not cause a change in the color of the urine.

May 9. The patient was discharged entirely healed (Fig. 1, c). The healing was firm, thick, and looked like normal skin. Erami- nation of this patient 6 months later showed a firm, movable skin. with normal sensation and no tendency to contraction.

CASE II .- A man, 30 years old, was severly burned by an ex- 1 plosion of oil. He came under my care on May 5, six months after the accident, and one of the unhealed areas is well shown in the figure. This wound had improved for a time and then had become sluggish and apparently no further progress could be made from the epithelial edges. Several unsuccessful graftings had been previously done.

The wound was covered with edematous exuberant granulations which were exquisitely tender. An effort was made to put the granulations in a healthy conditon as soon as possible. Toward the end of this process four per cent amidoazotoluol ointment was

FIG. 2 .- CASE II. Sluggish ulcer following burn. Healed with small deep grafts and amidoazotoluol. a, taken May 30. 1910, six months after the accident. The ulcer is surrounded by scar tissue. The small deep grafts applied May 28 have all taken and the wound edges have begun to spread. b. taken June 4, 1910. Shows the very rapid epithelial stimula- tion from the grafts and wound edges after two dressings with amidoazotoluol. The entire wound is healed with the exception of a few small areas, whose aggregate size is not larger than a ten cent piece.

used as a dressing and was followed by marked stimulation of the edges.

On account of the tenderness it was decided to graft. The patient refused to allow Thiersch or whole thickness grafts to be cut.

May 28. The granulations being in good condition a number of small deep grafts were taken from the thigh under local anes thesia, and transplanted on the undisturbed granulations. The grafts were dressed with narrow overlapping strips of protective, over which was placed a dry dressing.

May 30. The dressing was changed, and all the grafts were found to have taken (Fig. 2, a).

June 1. The grafts were dressed with four per cent amidoszo- toluol on old linen. When the dressing was removed 48 hours later it was noted that the grafts were markedly stimulated. Dressed with boric ointment.

June 4. The entire wound, with the exception of one or two small areas was covered with epithelium (Fig. 2, b).

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1 tions of amidoazotoluol had been made. The grafts themselves had become much thickened and projected above the surrounding skin like little warts (Fig. 3, a). This condition disappeared and the entire area assumed the normal level (Fig. 3, b).

Examination of this patient eight months later showed a firm, movable skin with normal sensation. There was still some pig- mentation around the grafts, but this was less marked than at date of discharge.

COMMENTS .- I was able to compare the rapidity of heal- ing caused by scarlet red and amidoazotoluol. Following an extensive burn there were two granulating wounds of about the same size. One was dressed with 8 per cent scarlet red ointment and the other with 8 per cent amidoazotoluol oint- ment. The healing in both was rapid, but the wound dressed with amidoazotoluol healed first. The character of the heal- ing was practically the same.

FIG. 3 .- CASE II. a, taken June 24, 1910. Shows the re- markable thickening of the grafts, which project like little warts above the skin level. b, taken August 9, 1910. The grafts have assumed the level of the surrounding skin. Con- siderable pigmentation can be seen in the healed area sur- rounding the grafts.

The age of the patient seems to have little effect on the stimulating power of these ointments. The general health of the patient is most important and in some instances forced feeding, fresh air and tonics must be resorted to.

It is interesting that a number of patients with exquisitely painful ulcers have remarked that there is less discomfort after dressing with these substances that after any other dressing, however bland.

In none of the cases have I noted the slightest irritation of the surrounding skin following the use of amidoazotoluol. Although this dressing can be used continuously without irritation, it is best to apply it for 48 hours and then alter- nate with some bland ointment for 24 hours.

Dressing with both substances causes excess of secretion for one or two applications, but there is marked drying up of the granulations in a short time.

The use of scarlet red and amidoazotoluol in blue ointment is advantageous in the treatment of syphilitic ulcers, and in

In the treatment of second degree burns the ointment can be used immediately after the blisters have been cut away. In third degree burns it is best to wait until the granulations have started.

For a time after healing the newly formed skin has a tendency to be dry and somewhat scaly, but this is easily overcome by the applicaton of olive oil or vaseline.

I have not yet seen a wound break down which was healed by the use of scarlet red or amidoazotoluol, although some of the cases have been under observation for over two years.

A grayish membrane is often seen on the granulations after the application of scarlet red ointment. I have not observed this formation following the use of amidoazotoluol.

Thiersch and Reverdin grafts are sometimes tremendously thickened following early dressings with these substances, but this thickening disappears within a few weeks.

At times it is advantageous to apply either ointment directly to the wound and then expose to the sunlight and air.

Scarlet red and amidoazotoluol gauze is prepared by satu- rating gauze with a 4 per cent or 8 per cent alcoholic solution of the substances and then allowing it to dry.

The substances can be used as a dusting powder by the addition of 4 per cent to 8 per cent strength, to boric powder. I have also tried the full strength powder on a few wounds without irritation. The effect of the scarlet red and amido- azotoluol used in this way is very rapid drying up of the wound and the formation of a tough scab under which the healing takes place.

A simple and satisfactory method of preparing scarlet red and amidoazotoluol ointment is to rub up the substance with a small amount of almond oil until the mass is smooth, and then mix this mass thoroughly with the base.

Both these ointments can be sterilized without interfering with their stimulating properties.

As a rule there is no toxic effect either from scarlet red or amidoazotoluol. Gurbski reports the only case-in which any general toxic effect was noted, as follows:

A child, 11 years old, was severely burned by an explosion of turpentine. The lower two-thirds of the thigh and the entire leg to the ankle were involved. After the granulations had formed Gurbski applied 8 per cent amidoazotoluol oint- ment. Fifteen hours after the application the patient, who had previously been in very good health, began to complain of headache and dizziness. This was followed by violent vomiting and gastralgia. The pulse rose to 110 and was of low tension. The temperature rose to 102.3º F. There was cyanosis of the lips and albumin in the urine.

The dressing was removed and the patient placed on a milk diet. In a few hours all of these phenomena disappeared. Eight days later amidoazotoluol ointment was again applied and the same symptoms reappeared with the exception of the albuminuria. A third dressing, five days later, caused the same symptoms except that the vomiting was less marked.

During the rest of the treatment he applied the ointment to

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only one-fourth of the wound at a time, and the toxic symp- toms did not again occur. Rapid healing followed.

Gurbski thinks the poisoning was due to the amido group in the amidoazotoluol.

I have dressed very large granulating areas for some time with these substances without any deleterious effect.

In this connection an observation by Stoeber is of interest. He says that it is not uncommon to have bladder disturbances among the men who work in the manufacturing of dyes. This trouble is principally among the workmen occupied in the manufacture of amido combinations of benzol and naph- thalin, or in factories where these products are used. The disease is characterized by cyanosis,, vertigo and weakness, strangury and bloody urine. In addition to the above symp- toms, in long continued handling of these dyestuffs, hemor- rhages and tumor formations in the bladder are observed. None of these symptoms have been noted following the clini- .cal use of scarlet red or amidoazotoluol, except as noted above.

The consensus of opinion is that there is no danger of pro- ducing malignant growths by the clinical use of these sub- stances. My own experience has convinced me of this, and although occasionally there is an overgrowth of epithelium, this soon assumes the level and the appearance of the normal skin.

Some authors have gone so far as to state that by the use of scarlet red and amidoazotoluol the majority of skin grafting can be eliminated. This is too broad a statement, but there is no doubt that wounds can be healed by these compounds which could not otherwise be satisfactorily closed except by grafting.

Scarlet red and amidoazotoluol will not heal every wound, but in the majority of cases, when applied with the proper technic, they will cause epithelial stimulation in the edges of the most sluggish wounds, and give a rapid healing which is stable and resistant, and which has the macroscopic and mi- croscopic appearance of the normal skin. There is no ten- dency to subsequent contraction, and the skin becomes movable on the underlying tissues in a reasonable time. Any one of these characteristics would make the use of these substances well worth trying.

BIBLIOGRAPHY.

1. Auerbach: Ueber den therapeutischen Wert der Scharlach- salbe bei Haut und Geschlechtskrankheiten. Klin. therap. Wchnschr., 1909, p. 594.

2. Beyer: Discussion of Grossmann's paper. Deutsche med. Wchnschr., 1910, p. 777. 3. Borst: Atypische Epithelwucherungen. Deutsche med.

Wchnschr., 1910, p. 1586.

4. Bruhl: Discussion of Grossmann's paper. Deutsche med. Wchnschr., 1910, p. 777.

5. Cernezzi: Dell' influenza eccitatrice svolta dallo scarlatto R (Michaelis), sulla rigenerazione dell' epitelio cutaneo. Gazz. d. osp., 1909, p. 145.

6. Cone: Zur Kenntnis der Zellveränderungen in der normalen und pathologischen Epidermis der Menschen. Frankfurt Ztschr. f. Pathologie, Festschr. ... J. C. Senckenberg, Wiesb., 1907, p. 37. 7. Cords: Experimentelle und klinische Erfahrungen über die Wirkungsweise des Scharlachrot bei Hornhauterkrankungen. Klin. Monatsbl. f. Augenh., 1910, p. 1.

8. Dauthuile: Epidermisation rapide d'une vaste escarre gan- greneuse de la face antero-externe de la cuisse gauche, par des applications de scharlachrot: Action remarquable de cette sub- stance colorante sur les plaies atones. Nord med., Lille, 1909. p. 169.

9. Dixon: Proliferations of the Epithelium Induced by Soudan III, Scharlach Roth, and Paraffin: and the Effects of Roentgen Irradiation on the Same. J. Infec. Dis., 1909, p. 205.

10. Dreifuss: Behandlung granulierender Wundflächen mit & per cent Scharlachrotsalbe. Deutsche med. Wchnschr., 1910, p. 52.

11. Ducros: Ueber die Behandlung granulierender Wunden mit Scharlachrot. Deutsche med. Wchnschr., 1909, p. 1294.

12. Enderlen: Empfehlung der Scharlachrotsalbe zur Be schleunigung der Epitheliserung granulierender Flächen. Würz- burger Aerzteabend, February 20, 1908. München. med. Wchnschr., 1908, p. 2066.

13. Enroth: Epithelisation of Granular Tumors by Scarlet Red. Finska lak .- sallsk. handl., Helsingfors, 1909, II, p. 217.

14. Fischer: Die experimentelle Erzeugung atypischer Epithel- wucherungen und die Entstehung bösartiger Geschwülste. Münch- en. med. Wchnschr., 1906, p. 2041.

15. Geipel: Artefiziell erzeugten Geschwülsten. München. med. Wchnschr., 1907, p. 1057.

16. Gottheil: Scarlet Red. Progress Med., 1910, p. 131.

17. Grimani: Studio sperimentale sulle proliferazioni dell epi- telio cutaneo. Riv. Veneta di sci. med., 1909, p. 289.

18. Grossmann: Erfahrungen über die Anwendung der Schar- lach-R-Salbe (Schmieden), Scharlachsalbe (Hayward), und der Amidoazotoluolgaze (Epidermolgaze), in der Ohrenheilkunde. Deutsche med. Wchnschr., 1910, p. 777.

19. Gurbski: Betirag zur giftigen Wirkung der Scharlachsalbe. Zentralbl f. Chir., 1910, p. 1550.

20. Halle: Discussion of Grossmann's paper. Deutsche med. Wchnschr., 1910, p. 777.

21. Hartmann: Discussion of Grossmann's paper. Deutsche med. Wchnschr., 1910, p. 777.

22. Hayward: Weitere klinische Erfahrungen über die An- wendung der Scharlachfarbstoffe und Komponenten zur be schleunigten Epithelialisierung granulierender Flächen. Münch- en. med. Wchnschr., 1909, p. 1836.

23. Helmholz: Experimental Epithelial Proliferations of Skin and Mucous Membranes. Johns Hopkins Hosp. Bull., 1907, p. 365. 24. Hertzler: The Etiology of Epithelioma; A Laboratory and Clinical Study. J. Am. M. Ass., 1908, p. 425; 1910, p. 2290.

25. Heermann: Scharlachrot bei Trommelfellperforationen. Deutsche med. Wchnschr., 1909, p. 977.

26. Hübner: Demonstration of a patient. Aerztlicher Verein zu Marburg, December 16, 1908. München. med. Wchnschr., 1909. p. 424.

27. Jores: Ueber Art und Zustandekommen der von B. Fischer mittels Scharlachöl erzeugten Epithelwucherungen. München. med. Wchnschr., 1907, p. 879.

28. Kaehler: Epithelisierung von Wundflächen unter Schar- lachsalbe (Nach Fischer-Schmieden). Med. Klin., 1908, p. 836. 29. Katz: Ueber die Behandlung granulierender Wunden mit Amidoazotoluolsalbe. Deutsche med. Wchnschr., 1910, p. 1665. 30. Krajca: Zur Epithelisierung granulierender Flächen durch Scharlachrotsalbe. München. med. Wchnschr., 1908, p. 1962. 31. Levy: Discussion of Grossmann's paper. Deutsche med. Wchnschr., 1910, p. 777.

32. McConell: The Experimental Production of Epithelial Proliferation. J. Am. M. Ass., 1907, p. 1498. 33. Meyer: Experimentelle Epithelwucherungen. Ziegler's Beit. z. path. Anat. u. allg. Path., B. 46, H. 3, 1909. München. med. Wchnschr., 1910, p. 538.

34. Michaelis: Quoted by Reinhardt. Biebricher Scharlach R. Apotheker-Zeitung, 1909, p. 90.

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inerap. Monats.,

1909, p. 479.

36. Nietzki: Chemie der organischen Farbstoffe, 1901.

37. Pein: Ueber die Behandlung des " ulcus cruris " mit Schar- lachrot. Die Therapie der Gegenwart, 1910, p. 121.

38. Pleth and Pleth: The Use of Fluorescent Salts (Eosin, Scarlet Red, etc.), in the Practice of Surgery. Am. J. Surg., 1909, p. 162.

39. Rammstedt und Jacobsthal: Ueber Schädigung der Haut durch Roentgenstrahlen. Fortschr. auf d. Gebiete d. Roentgen- strahlen, 1909-1910, p. 14.

40. Rebaudi: Intorno alle utili applicazioni therapeutiche dello Scharlachrot. Ginecologia moderna, 1909, p. 217.

41. Reinhardt: Biebricher Scharlach R. Apotheker-Zeitung, 1909, p. 90.

42. Ritter: Atypische Epithelwucherungen die durch Injection von Scharlachöl am. Kaninchenohr hervorgerufen sind. München. med. Wchnschr., 1907, p. 542.

43. Scharezki: Zur Frage von der Bedeckung von Hautdefkten (Russki Vrach, Nr. 21, 1910). Zentralbl. f. Chir. 1910, p. 1061. 44. Schmieden: Epithelwachstum unter Einwirkung Scharlach R. Zentralbl. f. Chir., 1908, p. 153.

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45. Schreiber und Wengler: Ueber Wirkungen des Scharlachöls auf die Netzhaut. Mitosenbildung der Ganglienzellen. München. med. Wchnschr., 1908, p. 1854. Also Arch. f. Ophth., 1910, p. 1.

46. Schultz and Julius: A Systematic Survey of the Organic Coloring Matters, 1904.

47. Seckel: Ueber experimentell-erzeugte atypische Epithel- wucherungen. München. med. Wchnschr., 1908, p. 199.

48. Simin: Das Scharlachrot als ein Epithelisation verstark- endes Mittel. Zentralbl. f. Chir., 1910, p. 1641.

49. Snow: An Attempt to Produce an Atypical Epithelial

1907, p. 385.

50. Sonntag: Discussion of Grossmann's paper. Deutsche med. Wchnschr., 1910, p. 777.

51. Sprecher: Sul valore terapeutico del scharlachrot. Gazz. d. osp. e d. clin., XXX, No. 28, 1909, p. 289. Also Klin. therap. Wchnschr., 1909, p. 325.

52. Stahr: Atypische Epithelwucherungen und Karzinom. München. med. Wchnschr., 1907, p. 178.

53. Stein: Ueber die Verwendbarkeit der Scharlachrotsalbe bei Ohrenerkrankungen. Monatsschr. f. Ohrenh. u. Laryng .- Rhinol., 1910, p. 214.

54. Stoeber: Experimentelle Untersuchungen über die Erzeug- ung atypischer Epithelwucherungen. München. med. Wchnschr., 1909, p. 129.

54. Stoeber: Die Erzeugung atypischer Epithelwucherungen durch Injektion von Scharlachrot und Amidoazotoluolöl in das subkutane Gewebe des Menschen. München. med. Wchnschr., 1910, p. 739.

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Twentieth Century History of Findlay and Hancock County, Ohio, and Representative Citizens, Part 122

Author: Jacob Anthony Kimmell Publication date: 1910 Publisher: Number of Pages: 1189

Author: Jacob Anthony Kimmell
Publication date: 1910
Publisher:
Number of Pages: 1189