THE TREATMENT OF DIPHTHERIA CARRIERS WITH IODIZED PHENOL
WILLIAM O. OTT
1916
Journal of the American Medical Association
greatly increased burden thrown on respiration and circulation, more especially when the restriction is on the expiratory movement. Before a breathing tube is inserted, the patient must be sufficiently anesthetized so that the pharyngeal reflex is abolished, or else the patient will gag and cough, thereby retarding the induc¬ tion or disturbing the anesthesia. In ether adminis¬ tration, also, the prevention of partial obstruction of the air passages is greatly neglected. Anesthesia is much
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... r and more smoothly maintained when the respiratory movement is free and unrestricted. Preliminary medication in nitrous oxid administra¬ tion is a very important matter. Morphin tends to allay preoperative fear, and renders the induction smoother. Gatch has shown that struggling during induction is very detrimental to the heart, and all observers agree that patients who have struggled do badly under anesthesia. Besides, morphin blocks both afferent and efferent impulses, thus preventing shock and rendering the anesthesia deeper and smoother. Nitrous oxid anesthesia is so evanescent that very often an opiate is required for the postoperative pain immediately after the anesthetic is withdrawn, if no opiate has been administered as a preliminary. It is advisable to have the opiate administered before the trauma is produced, for otherwise larger amounts will be required to relieve the pain. Most, if not all, of the trouble arising from the use of preliminary morphin has been caused from too large dosage. Larger amounts than one-sixth grain morphin, or its equiva¬ lent, should be used only in vigorous subjects, and the larger amounts should always be fortified with atropin. The use of a local anesthetic to block off the trau¬ matized areas is not nearly so general as its merit warrants. There is no question but that this procedure, when properly carried out, prevents shock and permits a lighter general anesthesia, and this is especially shown when nitrous oxid is administered. The removal of the gallbladder requires the deepest type of anesthesia, yet when the local anesthesia is perfect, I have not had to add any ether whatever to nitrous oxid, even in this class of work. The credit, more¬ over, for this achievement belongs entirely to the surgeon, for it is his technic that renders it possible to have such a light general anesthesia in procedures that ordinarily require the deepest type of general anes¬ thesia. Bretton Hall, Eighty-Sixth Street and Broadway. Results of a Psychologic Examination of Criminals in Massachusetts.-In Bulletin 17, issued by the Massachusetts State Board of Insanity, there is presented a tabulated report of the results obtained from the psychologic examination of 300 criminals who had been selected alphabetically from the prison records in the Massachusetts State Prison. They were examined by the "point scale" method, which has been worked out for norms to the age of 15 plus for English speaking subjects and to 14 plus for non-English speaking subjects. When persons grade up to these figures, they are considered to be outside the feebleminded class. From the results of the examination it was ascertained that of these 300 cases, 22 per cent, were feebleminded, 9.6 per cent, were borderline cases, and 3.3 per cent, were probably psychotic. It was shown that the highest percentage of feebleminded persons is found among prisoners who are guilty of sex offenses, and the lowest is found among prisoners who are guilty of crimes against property, while the percentage of probably psychotic subjects is highest among those prisoners who are guilty of crimes against life. Diphtheria carriers have always been a serious problem, and many methods to rid the unfortunate individuals of diphtheria organisms have been tried. The multiplicity of the forms of treatment advocated is proof of the unsatisfactory results obtained with any one method. Spraying the throat with cultures of Staphylococcus pyogenes aureus was at one time much in vogue. This proved to be too dangerous a procedure,1 and has been abandoned generally. Wood2 suggested and used a spray of Bacillus acidi lactici in the throat with good results. C. Hampsen Jones3 used Bolton's solution in the throat of carriers with some benefit. Hektoen and Rappaport4 advocate the use of kaolin in the nose and throat, and assert that the mucous membrane of these passages is almost rendered sterile by the use of this substance. Good results have been reported with the use of autogenous vaccines by some,5 but others have found them disappointing. The most common practice, and the one that has stood the test of time, has been the application of various chemicals, such as silver nitrate and hydrogen peroxid, to the throat and nose. But this often fails to rid the carriers of the diphtheria organisms, and the patient remains isolated for months. The method of treatment described below has given good results in the relatively small number of cases in which we have had the opportunity of using it. It is suggested, therefore, with the hope that further experi¬ ence with this method will prove it to be of real value in the treatment of diphtheria carriers. The cases reported consist of carriers convalescent from clinical diphtheria in the infectious ward of the Charity Hospital, and some that did not have diph¬ theria but were persistent carriers. In some cases, other methods had been persistently tried with failure to obtain negative cultures. In all cases reported here, iodized phenol (acidum carbolicum iodatum) of the National Formulary was used. It contains 60 per cent, phenol (carbolic acid), 20 per cent, iodin crystals and 20 per cent, glycerin. In pharyngeal cases, the tonsils, uvula and posterior wall of the pharynx were swabbed every forty-eight hours until negative cultures were obtained. In nasal cases, the entire anterior part of the nasal cavity was swabbed with iodized phenol every forty-eight hours. Care was taken not to allow the preparation to run over the face or drop into the larynx. Cultures were always made a few minutes before the local applica¬ tion. In this way, forty-eight hours elapsed after each application of iodized phenol before another culture was made. Seventeen cases were treated. Negative cultures were obtained after one application of iodized phenol 1. Davis, Clara M.:
doi:10.1001/jama.1916.02580370020008
fatcat:bhz2ordrvvawxlltsi6om6ya4q