A CASE OF GANGRENE OF BOTH NIPPLES OCCURRING IN THE PUERPERIUM

Ralph Vincent
1902 The Lancet  
The bete noire of nose, throat, and ear practice is the ver difficulty of successfully accomplishing amelioration of of aridity of the mucous linings of these organs and the fact Eli is that to such aridity all the other intractable, disagreeable, nef and distressful symptoms are due-namely, incrustation, dr( foetor, ulceration, hæmorrhage, and pain. The lessened str, mucous flow by causing desiccation causes also the loss of Eu the essential and special nasal functions of smell and the of
more » ... ell and the of filtration and warming of the inspired air. I claim for an' mucin that it does more than anything that has yet been qu tried to relieve the discomfort in mild cases and to mitith gate the distress and suffering in the more severe. It is of a natural remedy which restores the moisture and maintains wr it in virtue simply of its hygroscopic properties. I have ar had ample opportunities of testing the efficacy of mucin in Er the very extensive and mixed out-patient department of the are Central Nose, Throat, and Ear Hospital. st] As usual when the pathology of disease is obscure there or have been much speculation and many theories put forward to ha explain the causation of atrophic and dry rhinitis and pharyn-th gitis, and the treatment is, consequently, very unsatisfactory. m I will not attempt to solve the pathological problem as to how the dryness and atrophy in these conditions are to be E accounted for but will briefly indicate how mucin acts in is remedying them. Two researches that I had carried out by tv Dr. G. L. Eastes of the Laboratory of Clinical Pathology, to Queen Anne-street, W., the first two years ago and the second m last year, throw much light on how mucin acts. In the first m research it was conclusively shown that mucin has a retard-bE ing influence on bacterial growth, that sterilised solutions a1 containing mucin remained sterile for a long time on exposure bi to the air, and that bacteria ceased to grow in culture media CE when mixed with mucin. This is a very interesting and p important fact, as it indicates that nature has in the secretion c: poured'ou't on 'mucous 'membranes: provided a ready means o: for the suppression and retardation of growth of bacteria, a In the British Medical Journal of March 8th last in the si pathological column of recent literature (see Epitome) so there is an account (quoted from the Lyon Medical) of a tl research by Professor Fernand Arloing in which this work is s repeated in an investigation of the action of I I mucidine "e a solution of the mucus of red snails-upon the bacillus of s Lotller. From this he concludes that mucidine possesses a b bactericidal action and that it retards the growth of other bacteria. The second research proved that mucin is hygror scopic in its action, being about one-fourth as absorbent for c water as glycerine is, and that in this way it will act as a t moistening agent-gently, slowly, and with lasting effect. c According to this investigation 100 parts of mucin absorbed c 3'8 parts of water in four hours, while 100 parts of glycerine absorbed 16 '3 parts of water in the same time. ! When applied locally to the interior of the nose and pharynx S mucin has a soothing and emollient action ; it moistens the surface and softens incrustations, readily facilitates ] their removal and prevents their re-formation ; it thus also obviates foetor, which is one of the best points in its favour as a local remedy. Mucin also restores the nasal g function of smell by its hygroscopic effect and the filtration and warming functions 'are also resumed, because in a dry condition the mucous membrane is functionless. Messrs. Burroughs, Wellcome, and Co. have prepared ior me a soloid composed of five grains of mucin, five grains of sodium bicarbonate, and one grain of menthol. This is prepared for use by dissolving it in one ounce of sterilised warm water. or, more thoroughly to get more of the mucin into solution I am in the habit of dissolving the soloid in equal parts of sterilised warm water and sterilised warm lime water. This solution may be used to spray, to douche, or to syringe the nose and throat twice daily. The spray should be a coarse one, as otherwise it is liable to get clogged with particles of undissolved mucin. A very good plan to obviate this is to spray warm water at least once a day. through the instrument and thus wash it out. If much incrustation has to be got rid of it is well to rub it off with cotton-wool saturated in I the warm mucin solution on a mounted prop. In severe and very old-standing cases of atrophic trouble I supplement the local treatment by giving the patient tabloid mucin co. containing five grains each of mucin and sodium bicarbonate internally before and after meals and thus relieve the concomitant gastric irritation and constipation. I have had very good results in the treatment of dry conditions of the larynx and in cases where there have been incrustations on the laryngeal lining from the use of a spray of warm soloid mucin solution, the discomfort and hoarseness y soon being much relieved. I have at present 10 cases dry catarrh of the middle-ear with narrowing of the stachian tubes and varying degrees of tinnitus and deafs under treatment. 1 am injecting twice a week a few 'ps of a solution of the soloid mucin co. of the same ength-1 in 1 ounce of sterilised warm water-into thestachian tubes. While the constant and terrible tinnitus some of these patients has certainly been much relieved-1 in some instances this has existed for years and proved ite unamenable to every form and variety of remedy-and i hearing has also improved, I can speak only tentatively my results as I have not had the cases regarding which I ite long enough under observation. The results, however, ; distinctly encouraging, especially as the narrowing of thestachian tubes has become less evident. Where patients very sensitive to the solution of the soloid of the usual ength (1 in 1 ounce) I either dilute the solution mor& substitute for the soloid the tabloid for internal use. This s no menthol in its composition but I prefer the soloid, as e menthol serves to stimulate the remaining -unatrophiecl acous glands to secrete. The substance most generally used at present for intraistachian injection and as a nasal spray in these affections a liquid oily paraffin with menthol in the proportion of '0 and a half grains to the fiuid ounce. I object entirely liquid grease in any shape or form for softening and oistening purposes. It is certainly absolutely useless as a oistening agent ; indeed, such preparations act inimically, >,cause they clog and paint over the still remaining and half-,rophied mucous glands. Such oily substances should never ; thought of for the purposes of relieving a similarly dry )ndition of the oral cavity and yet they are commonly rsisted with in the treatment of nose and throat and ear ases. What is required is a warm alkaline watery solution : mucin as a substitute for the deficient natural secretion nd this is just what the solution of the soloid mucin co. ipplies. The more potent penetrating effect of the watery )lution is proved by the fact that menthol when used to ie amount of only one grain to the ounce of the mucin solution is, by some patients, felt to be quite pungent nough in its stimulating action, as compared with the lution of menthol in liquid oily paraffin, in which it can be orne even to five times the strength. I have found that even long-standing cases of atrophic asal and pharyngeal trouble do very well, and that the rusts soon cease to accumulate, after regular douching wice daily with solution of soloid mucin co., and that no ther irrigations are ordinarily necessary ; but there arecertainly instances when pus is present in the discharge in vhich it is advantageous to use just before the mucin douche-. lotion of sodium sulphate or a combination of sodium ulphate and bicarbonate for cleansing purposes. I have )atients who, after years of suffering from typical atrophic 'hinitis with all its horrors of fcetor and discomfort have, after continuous and persistent application of the mucin rrigation, now been able to dispense with treatment to a greater extent than two or three times weekly.
doi:10.1016/s0140-6736(01)83542-x fatcat:aioh3qdr7jbvdin7yq2pah3l5e