Hypothesis of Functions
The inflammation on the mesodermal soft parts shows a tendency towards necrosis at an early stage. The necrosis is the seat of the bacterial culture. Its surroundings show thrombosed vessels. Access to it by chemo-therapeutic reagents is very difficult.
Directives for the Application of Sulfanilamides
Experiments (Gebhardt-Fischer) showed the following results: Even the immediate internal and external application of sulfanilamide preparations cannot prevent a suppuration of the soft parts due to ordinary suppurative organisms. It could not be proved that the course of the inflammatory disease caused by anaerobions is influenced by sulfanilamides. The sulfanilamides seemed to have an easing effect on the course of combined gangrene therapy.
Disorders caused by sulfanilamides (Randerath) are relatively rare. They occur directly as liver disorders including acute yellow liver atrophy, as kidney disorders, and as agranulocytosis. Therefore, as far as is possible under front-line conditions, the white and red blood count should be controlled. The decrease of the body temperature caused by an infection of the central regulatory system may be looked upon as an indirect disorder, so that the temperature curve permits no conclusions as to the development of the wound infection. Furthermore, local powder treatment may lead to an occasional increase in the depth of the wound infection. Direct injury to the tissue at the spot where the preparations were applied was not observed.
The endolumbal application of the sulfanilamides (Mueller) must also be rejected for the treatment of meningitis, since it leads to serious disturbances in the region of the spinal cord and may result in paralysis.
The clinical discourse (Frey) emphasized the decrease of optimistic and the increase of critical opinions. The clinical doctor considers the principal disorders to be anorexia, nausea, and increasing exhaustion. Early application in the wound itself is essential for the efficacy. The enteral or parenteral inducing of sulfanilamide drugs cannot prevent wound infections, but can favorably influence its course.
The following rules for practice therefore result: All surface wounds, that is, grazing shot wounds, sulcus-shaped wounds and large gaping wounds of the soft parts should be sprinkled as soon as possible with sulfanilamide powder. The powder treatment is of no use if the depths of the wound are not reached. It is ineffective to powder the small wounds caused by the penetration and exit of the bullet. The powdering of the skin is senseless and may cause eczema. Deeper wounds must be treated in the quickest and most thorough manner. After this, the wound can be additionally treated with sulfanilamide powder which must reach the deepest cavities. It is not advisable to powder granulating wounds.
If the powder treatment cannot be applied during the first hours or does not seem to suffice, a pororal application of sulfanilamides should take its place or be performed supplementarily. Front-line conditions will not always allow intravenous injections. According to the danger of a wound infection, the wound should be treated for a short time with large doses of sulfanilamides (6-10 grams during 3-4 days, not more than a total of 50 grams). On the whole, small doses are insufficient and therefore have no influence on the course of an infection, but if applied too long they may be injurious. Suitable preparations are preferably eleudron, cibazol, and globucide. If possible, the treatment should be applied by a medical officer.