A Physiological Solvent in the Treatment of Pus Gases

CARL E. MUNGER
1901 Boston Medical and Surgical Journal  
typical bile-pigment reaction we may conclude that the bowels are pervious, and that peristaltic action is continuous throughout the whole tract." Lead poisoning has been mistaken for intestinal obstruction. Here the diagnosis must be derived chiefly from the history. In syphilis the obstruction, according to Mr. Bryant, is caused by ulcération, especially of the rectum. The most important differential diagnosis from the point of view of treatment lies between strangulation and impaction or
more » ... nd impaction or closure of the intestines, occluding the lumen, whether from within or from without. When palpation under ether fails to disclose the nature of the tumor, the, anamnesis is of importance. The family tendency, the fact of injury or of surgical operations, of previous attacks of similar nature, of hernias, reduced or not, of the ingestion of indigestible substances, poisons, etc., should be inquired into. The clinical history usually enables one to decide between the acute and the chronic, the febrile and non-febrile, complete and partial forms. Examination per rectum should never be omitted, and much may be accomplished in certain cases by the persistent use of high-up injections. The . employment of purgatives or opium is both misleading and dangerous, and the only word to say about treatment is this, namely, that whenever the diagnosis of intestinal obstruction, acute or chronic, whether by invagination, occlusion or strangulation, is made, a surgeon should be called to the case. The operation of celiotomy in experienced hands is comparatively safe, and may be the means of saving many lives. The fatal result comes usually from overdistention of the gut above the seat of obstruction. None of the means pointed out should be neglected, so that one may arrive without delay at a correct diagnosis. No positive and definite line can be drawn, however, which will apply to all cases, and death has been known to occur from intestinal obstruction in forty-eight hours and even less, without severe pain, marked distention or much vomiting. Clinical Department. The physiological function of gastric juice is to break down and dissolve all the alimentary proteids, converting them into soluble albumoses and peptones. The gastric juice is also antiseptic and bactericidal, and thus not only enables us to appropriate food, but confers in health a certain immunity against sources of infection in food and drink. These are no doubt familiar facts ; but when my attention was recently called to the use of an artificial gastric juice as a solvent for pus and broken down tissue, they took on a new significance. The technical employment of artificial digestion in vitro in the production of peptones from various food proteids is already long established. The proteid matter of suppurating tissue is in its nature quite as responsive to the enzymic action, and is even more penetrable than ordinary masses of food. I was, therefore, impelled to give consideration to this suggestion, new to me, of gastric juice as a physiological solvent, as presenting on a priori grounds obvious advantages over chemical agents. In H202, for instance, which is of undoubted value, there is the disadvantage of its creating much gas, which produces pressure, which pressure may be beyond our power to control. Whilst the broken down tissue is not destroyed, the soluble substances into which it is converted by enzymic action are readily removed by irrigation, and the artificial gastric juice itself is incapable of producing systemic poison. The product which I have used, enzymol, is a sterile fluid, which, when diluted with an equal volume of water, has about the acidity of normal gastric juice, and is then suitable for use in most cases. It possesses great proteolytic energy. It exhibits marked action as an antiseptic and deodorizer, offensive odors yielding to a few applications. It has agreeable qualities, and does not produce irritation except in cases of sensitive mucous membrane. In some cases the matter readily yields to the solvent; in others it is necessary to keep the solvent in prolonged contact, with repeated washing and renewed application. In every case the procedure is based upon the fact that the action is essentially physiological, not at all similar to that of a chemical which instantly attacks the surface it touches. Case I. The first case that I used this on was an old middle ear and mastoid case in which there had been a foul-smelling discharge from the external ear, and also behind the ear through a fistula in the mastoid bone. Three injections of a 50% solution of enzymol at intervals of twenty-four hours stopped the discharge entirely. There has been no further discharge, now seven weeks after its usethis without any other treatment. This ear had been continually running for two years in spite of frequent cleansings and treatments with H202, boracic acid in powder and solution, corrosive-sublimate solution, aristol, iodoform, iatrol, etc. Case II. Acute purulent otitis media. The patient, a girl twelve years of age, came to my office January 11th with a typical case of otitis media acuta purulenta. The ear had been running ten days. The discharge was copious but not foul smelling. This was treated with injections of hot boracic-acid solution, followed by instillations of H202, into the ear three times a day for twelve days. I then injected a
doi:10.1056/nejm190101031440104 fatcat:dkpojy3v2zdv7k5urijtzr4uf4