ON FUNGOUS GROWTHS IN SOLUTIONS FOR HYPODERMIC MEDICATION, AND THEIR PREVENTION BY

SALICYLIC ACID.

BY

JOS. G. RICHARDSON, M.D.,

ATTENDING PHYSICIAN TO THE PRESBYTERIAN HOSPITAL, PHILADELPHIA.

AMONG the minor inconveniences of medical practice, few are more annoying to the careful physician than a failure to afford the hoped or prayed-for relief from pain, by the subcutaneous injection of morphia. I therefore venture to occupy a few minutes of the time of the Section with a brief account of a new method for preventing diminution in the strength of morphia solutions, in so far as it is due to the common cause of such deterioration, namely, the formation in the fluid of fungous growths, which necessarily develop at the expense of the contained solid ingredients.

If we examine under a microscope of high power one of the white flocculent masses which appear after a week or two of warm weather in our ordinary Magendie's solution of morphia, we will commonly find it made up of an immense number of branching threads, on an average about o of an inch in diameter, often distinctly septate, and probably recog nizable as the mycelial condition of one of the genera of the Mucorini or siphonaceous plants.

Complete identification of the exact species is only possible, even for the professed mycologist, by investigation of its aerial fructification. We, however, often find, as it develops entirely beneath the fluid, an evident attempt towards the formation of some sort of reproductive body, and in many cases are to be seen in active motion, near the filaments, sporelike bodies, analogous to the antherozoids of the unmistakable algae and fungi, which have doubtless escaped from broken fragments of the aquatic mycelial threads.

The atoxic quality of salicylic acid, as demonstrated by the moderate and even large doses administered in thousands of cases of acute rheumatism, etc., suggests at once its employment for the purpose of preventing the growth of these fungi; and I think it quite probable that it has already been so used by others of my fellow-practitioners as well as by myself. No exact observations upon this subject have, however, I believe, as yet been published, at least in our own country.

In order to determine the precise amount of this antiphytic agent required to produce the desired effect, I prepared on the first of August last, now five weeks since, one dozen two drachm vials, each containing one fluidrachm of a solution of acetate of morphia (gr. xvj to f3j), such as is usually employed for hypodermic medication. These samples were numbered from 1 to 12, and after the acetate, except impurities, had been dissolved by the aid of a small quantity of acetic acid, I added to Nos. 2 and 4 each one-sixteenth of a grain of salicylic acid, to Nos. 6 and 8 each oneeighth of a grain of the same substance, and to Nos. 10 and 12 each one

quarter of a grain of the like material. Nos. 1, 3, 5, 7, 9, and 11 were left unmixed with other ingredients, and all were corked tightly and equally exposed to the light, and to the unusually elevated temperature of our Centennial summer. At the end of one week, small whitish flocculi, evidently composed of filamentous tufts, were visible in the bottles the contents of which were unmixed with salicylic acid, and similar minute specks, in much less quantity, had made their appearance in Nos. 2 and 4, which contained each one-sixteenth of a grain of salicylic acid.

Under the microscope, specimens of these tufts were seen to be made up of mycelial threads, probably of some species of physomycetous fungi, such as I have already described. At the present time, after five weeks have elapsed, those vials which were not protected by salicylic acid present every one large masses of fungous growth, as each member of the Section may see for himself by inspecting them upon the table. Nos. 2 and 4, in each of which it will be remembered that one-sixteenth of a grain of the acid was dissolved, display small tufts of mycelial threads. No. 8 shows a mere trace of fungous growth, whilst Nos. 6, 10, and 12 exhibit to the naked eye (as they do also under a one-fifth objective) no indication of living fungi in the slight deposit of brownish impurities let fall at the bottom of the glass.

In specimens of similar morphia solution, containing one-eighth of a grain of salicylic acid to the fluidrachm, carried in the hypodermic syringe case, and used from time to time in my daily practice during three months of cooler spring weather, no flocculi of living fungi were discoverable with the naked eye or under the microscope. Further, no unusual effects of any kind were observable in patients, some of whom received as much as m viij at a dose. Injections made into my own arms for the purpose of testing the fluids in Nos. 10 and 12, produced but little smarting sensation, and afforded the ordinary anodyne, with no uncommon nauseating, depressing, or disagreeable effects of the drug.

I therefore recommend the preparation of a fluid for hypodermic injections according to the following formula: Morphiæ acet. vel sulph. gr. xvj; acid. acetici (No. 8), gtt. ij; acid. salicylic. gr. iss; aq. destillat. f3j. If a sediment is left undissolved, this liquid should be filtered, or, after standing a few days in a vial, or preferably a conical glass, the clear fluid may be drawn off by means of the hypodermic syringe itself, and preserved for use. By employing such a preparation, the practitioner is almost certain to avoid the disappointment in the relief of pain liable to arise from injecting a solution, the strength of which has deteriorated, and he will also escape that danger of producing abscess by the insertion of fungous elements beneath the integument, against which we have been cautioned by some authorities, although perhaps without sufficient cause for the warning.

In conclusion, I would suggest that a similar application of salicylic acid to the preservation of watery preparations of quinia, atropia, etc., to solutions of bromide of potassium, citrate of potassium, etc., and to vegetable infusions, when it is desirable to avoid the employment of even small quantities of alcohol, may prove of great value to the pharmaceutist as well as to the physician.

DISCUSSION ON DR. RICHARDSON'S PAPER.

After the reading of the preceding paper, the President, Dr. JOHN C. DALTON, of New York, said:-Dr. Richardson has referred to two disadvantages that might result in the hypodermic use of solutions of morphia without this precaution, but in language which leads us to suspect that perhaps he does not think much of the danger of producing an abscess. I would like to inquire whether there is any definite information in regard to the danger, or whether in his opinion the danger exists at all?

Dr. RICHARDSON said :-Theoretically I have felt inclined to suppose that danger would exist, but in order to test the theory I have tried several experiments, injecting my own arm with a solution containing fungi, and in no case has an abscess been produced.

Dr. DALTON said: Of course it would be more agreeable to inject a fluid not containing fungous growths; at the same time ought we to anticipate that these growths would continue their development in a subcutaneous tissue? My attention was once very directly called to the difficulty that might arise from such development. I made a series of observations in order to determine how many definite kinds of microscopic fungi might be derived from ordinary atmosphere. Taking fresh slices of boiled potato, I placed them on a plate that had been immersed in boiling water, and covered them with a bell-glass, under which also a moist sponge was placed. A considerable variety of these microscopic growths showed themselves from time to time, of various colors; and notwithstanding their minute size and apparent want of specific character, they had differences in form and size and structure. A few weeks after finishing the experiment, 1 found one day on the back of my hand a spot which was irritable and itching; this spread, two or three other spots appearing, until finally I was compelled to give attention to the matter, and on examination I found that my hand was the seat of a tricophyton, which was finally removed after treatment for four or five weeks. It then occurred to me that perhaps I had inoculated myself while engaged in the experiments. I had been raising microscopic fungi, and I had unknown to myself been infected with them. Further, upon the same subject, Dr. Vandoren told me that in a series of experiments he had demonstrated that the ovum of the mosquito is not deposited directly in the water, but floats in the atmosphere, and is brought down by the rain. So it would seem that in reality there are a larger number of germs, both vegetable and animal, that may arrive at their destinations through the elements. My impression is that this fact in regard to the ovum of the mosquito is new.

Dr. RICHARDSON said:-My recollection is that our natural histories gave us pictures of the mosquito in the act of laying eggs in the form of a boat which floated upon the surface of the water for some days or weeks before hatching. I think the experiments mentioned are entirely novel.

Dr. DALTON said:-In regard to the boat in which the eggs are contained, is it barely possible that Dr. Richardson may be thinking of the mosquito itself coming out from the integument of the larva?

Dr. RICHARDSON said:-No, sir; that is a subsequent performance. But I wish to ask Prof. Dalton in respect to the infection of which he spoke, whether his health had been deteriorated in any way? I make this inquiry because one of the most difficult questions in regard to the development of these entophytic and epiphytic diseases is whether the health is first deteriorated, so that a suitable nidus for the fungi to grow in is afforded, or whether, on the contrary, the fungi are the primarily active agents which deteriorate the health. Dr. DALTON said :-I can testify, with the greatest confidence, that I was in perfect health.

Dr. RICHARDSON said:-Some years ago I had an interesting case bearing upon this point in my own family. On the chin of my little daughter appeared

a small pimple, which became inflamed, and seemed to have a yellow head upon it. In examining it I was struck with its remarkably dry appearance, and its sulphur-yellow rather than brownish hue. I placed a portion of it under the microscope, recognized the presence of the fungus of Favus, and soon cured the disease with corrosive sublimate solution. The child was in perfect health, and I could only account for the attack by supposing that she had leaned her chin on the sill of a car-window, where some person infected with achorion Schonleinii had accidentally left a few spores of the disease. I would like to ask another question, whether there has been any corroboration or disproof of the experiments described by Simon in regard to the dependence of ocular diphtheria upon micrococci developing in the cornea of rabbits; where two punctures were made, in the one side with a diptherized needle, and in the other side with a clean needle, in every case the result having been that the cornea infected was marked with brownish streaks, which under the microscope displayed minute fungus spores. I look upon it as exceedingly important to know whether the fungi can develop in an internal portion of the system, secluded from the air, and that in a previously healthy part of the organism.

Dr. DALTON said :-I am not familiar with any corroboration of those experiments. I tried some experiments of a similar kind, two or three years ago, with results which convinced me that it did not require for such parasitic growths the previous existence of a morbid condition of the recipient. The experiments were with regard to the ordinary decomposition or rotting of fruit. It can no longer be maintained that rotting is a continuation of the ripening process. An external wound is absolutely necessary to the rotting of any fruit with a hard integument, such as the apple and the pear, though it is not absolutely necessary with other fruit, like the orange. I tried the experiments with apples, and proved that they could be kept for any length of time, if uninjured, and also that rotting was contagious. The rot could plainly be seen to spread away from the point of contamination. I have exposed a dozen apples, half sound and half broken, to the ordinary atmosphere, and the rot always began at the point of injury. The spores came in from the atmosphere. Indeed, an injured apple can be kept from rotting by being protected from the atmosphere. I have taken a sound apple, and made a little cut in it, and then put it under a bell-glass, and kept it an indefinite time. The experiments can be easily tried, and are most convincing.

Dr. RICHARDSON said:-You speak about the rot starting from the wound in the integuments of the apple in a way that resembled the spread of erysipelas from the edges of a wound in the human body. Did it ever occur to you to cover the wound in the apple with carbolized putty before exposing it to the infection of the fungi which cause decay, and thus throw a ray of light upon one of the great surgical problems of the day?

Dr. DALTON said :-I never did so, but I think that it might be an interesting experiment.

Dr. RICHARDSON said:-I would ask Prof. Rudnew whether these experiments of Oertel and Nassiloff (the latter, I believe, a Russian observer), narrated in Prof. Simon's report, have been confirmed or disproved by others of his countrymen ?

Prof. RUDNEW, of St. Petersburg, said:-I have studied these investigations, but have made no similar researches myself, and believe that the views of those gentlemen are still considered sub judice.

THE MECHANISM OF JOINTS.

BY

HARRISON ALLEN, M.D.,

PROFESSOR OF COMPARATIVE ANATOMY AND ZOOLOGY IN THE UNIVERSITY OF PENNSYLVANIA, SURGEON TO THE PHILADELPHIA HOSPITAL, SURGEON TO ST. JOSEPH'S HOSPITAL, ETC.

THE' limb being subservient to both support and motion, it is reasonable to expect that in certain joints the former function should be observed, and in others the latter. When the apparatus for support is conspicuous, the joint may be said to be of static value. But when this purpose is subordinate to flexion (i. e. deviation from the axial line of the limb), the joint may be said to be of dynamic value.

The most striking distinctions between the static and dynamic articulations lie in the relations of the opposed surfaces. To explain this por tion of my remarks a few words of a general character are necessary. I premise that the typical "ball and socket" joints consist of well-defined balls embraced by perfect sockets. No such joints are found outside of the vertebral column. The articulations between the bodies of the vertebræ, although spoken of as amphiarthroses, are in truth "balls and sockets." The central intervertebral mass is the "ball;" the opposed vertebral surfaces and the peripheral interlacing fibrous bands of the disk make up the "socket." I also premise that the simplest forms, or at least the first forms, of joints appear in the vertebral column, since this structure answers to the axial line of the body. The movable union between any pair of segments or bodies of this axis may be taken as typical of what is possible under more complex conditions elsewhere. If it is remembered that a rod or axis cannot be projected far without segmenting, the best basis is secured upon which to rest any consideration of arthrosis. Obviously motion between a pair of bony segments is the main fact to consider in every problem. The questions which I believe can be asked with reference to further development of this theme are, in what way is support secured through a series of such mobile joints, and how can the apparatuses of motion be varied?

The limb is a special structure appended to the body. It moves chiefly at the joint between its first and second bones. This joint, in both the anterior and posterior extremities, is a ball and socket, as usually described. But it evidently in each instance is a portion of a ball opposed to a partial socket; since only small portions relatively of the head of the humerus or femur can be brought in relation to the socket at one time. So generally throughout the limbs (although in less marked degree), it is found that segments of spheroids play within concave surfaces. I propose to call all such surfaces modified balls and sockets (the type of which is exhibited only in the vertebral column), and proceed to define the two main varieties, named above, to wit: (1) Where the rela

[This paper is an abstract of a more elaborate study which the author reserves the right of publishing hereafter in a separate form.-EDITOR.]