0
ARTICLE |

CHEMOTHERAPY IN THE MANAGEMENT OF WOUNDS FREE

CHAMP LYONS, M.D.
[+] Author Affiliations

Read in the symposium on "Wound Management" before the Section on Surgery, General and Abdominal, at the Ninety-Fifth Annual Session of the American Medical Association, San Francisco, July 5, 1946.


New Orleans

From the Department of Surgery, Tulane University School of Medicine and the Section on General Surgery, Ochsner Clinic.


JAMA. 1947;133(4):215-216. doi:10.1001/jama.1947.02880040001001
Text Size: A A A
Published online

It is important to emphasize the limited role of chemotherapy in the management of wounds.1 The basic tenet of the current philosophy in this regard is sound surgical care.2 Blood transfusion and chemotherapy are important features of a supportive program designed to expedite the surgical treatment of the wounded. Of all the measures devised to prevent infection, only active immunization with tetanus toxoid may be said to have achieved its purpose completely. The only other prophylactic procedure of comparable value is initial surgical management of the wound. The greatest usefulness of antibacterial drugs has been in the therapy of impending or established infection complicating the surgical management of the wound.

One of the more important recent advances in the management of wounds is a renewed appreciation of the clinical distinction between invasive infection and localized suppuration of the wound.3 With the help of the bacteriologist it has

REFERENCES

(a) MacFarlane, J. A.:  Wounds in Modern War , J. Bone & Joint Surg. 24:739-752 ( (Oct.) ) 1942;.
(b) Lyons, C.:  Penicillin Therapy of Surgical Infections in the U. S. Army , J. A. M. A. 123:1007-1018 ( (Dec. 18) ) 1943;.
(c) Rankin, F. W.:  Current Trends in Military Surgery , Kentucky M. J. 42: 11-15 ( (Jan.) ) 1944;.
Rankin, F. W., and others:  War Wounds and Burns , Clinics 2: 1194-1218 ( (Feb.) ) 1944;.
Kirk, N. T., and McKeever, F. M.:  The Guillotine Amputation , J. A. M. A. 124: 1027-1030 ( (April 8) ) 1944;.
(d) Meleney, F. L., and Whipple, A. O.:  A Statistical Analysis of a Study of the Prevention of Infection in Soft Part Wounds, Compound Fractures and Burns with Special Reference to the Sulfonamides , Surg., Gynec. & Obst. 80:263-296 ( (March) ) 1945;.
(a) Churchill, E. D.:  Surgical Management of the Wounded in the Mediterranean Theater at the Time of the Fall of Rome , Ann. Surg. 120:268-283 ( (Sept.) )1944;.
(b) Lyons, C.:  The Philosophy of Wound Management in the United States Army , Bull. Am. Coll. Surgeons 30: 13-14 ( (Feb.) ) 1945;.
(c) DeBakey, M., and Carter, B. N.:  Current Considerations of War Surgery , Ann. Surg. 121:545-563 ( (May) ) 1945;.
(d) Cutler, E. C.:  Military Surgery: United States Army; European Theater of Operations, 1944-1945 , Surg., Gynec. & Obst. 82:261-274 ( (March) ) 1946;.
(a) Lockwood, J. S.:  Definition of Objectives and the Importance of Controls in Evaluating the Local Use of Sulfonamides in Wounds , Surg., Gynec. & Obst. 79: 1-9 ( (July) ) 1944;.
Harvey, S. C.:  Treatment of Infection with Particular Reference to Peritoneum , New York State J. Med. 44: 1883-1886 ( (Sept. 1) ) 1944;.
Churchill, E. D., cited by Whipple, A. O., in foreword to Meleney and Whipple.1d
(b) Lyons, C.:  Role of Chemotherapy in Wound Management in the Mediterranean Theater , Ann. Surg. , to be published.
(c) Rustigian, R.: Bacteriology of War Wounds, to be published.
(d) DeBakey and Carter.2c
MacLennan, J. D.:  Anaerobic Infections of War Wounds in the Middle East , Lancet 2:63 ( (July 17) ), 94 (July 24), 123 (July 31) 1943;.
Lyons, C., and Rustigian, R.: Chemotherapy and the Reparative Management of Battle Wounds: Report, to the Surgeon General, October 1944.
Smith, L. DeS., and George, R. L.:  The Anaerobic Bacterial Flora of Clostridial Myositis , J. Bact. 51:271-279 ( (March) ) 1946;.
Pool, E. H.:  War Wounds: Primary and Secondary Suture , J. A. M. A. 73:383-388 ( (Aug. 9) ) 1919;.
Beebe, T. C.:  Wound Bacteriology at Evacuation Hospital No. 1, American E. F., France , War Med. 2: 1023-1036 ( (Jan. 19) ) 1919;.
Bentley, F. H., and Thomson, S.:  Control of Infection in Recent Wounds by Surgery and Local Chemotherapy , Brit. M. J. 1:471-474 ( (April 7) ) 1945;.
Lyons, C.:  The Use of Chemotherapy in the Secondary Closure of War Wounds of Soft Parts , Surgery 19:275-276 ( (Feb.) ) 1946;.
Ackman, D., and Smith, F.:  The Role of Chemotherapy in Wounds and Surgical Infections , Ann. Surg. 123: 70-95 ( (Jan.) ) 1946;.
Lister, J.:  Relation of Microorganisms to Inflammation , Lancet 2: 695-698 ( (Oct. 22) ) 1881;
 An Address on the Treatment of Wounds , ListerLancet 2:863-866 ( (Nov. 19) ), 901-903 (Nov. 26) 1881;
 On a New Method of Treating Compound Fracture, Abscess, etc., with Observations on the Conditions of Suppuration , ListerLancet 1:326-329 ( (March 16) ), 357-359 (March 22), 387-389 (March 30), 507-509 (April 27) 1867;
2:95-96 (July 27) 1867.
Kirtley, J. A., Jr., and Trabue, C. C., IV.:  Report on Delayed Primary Closure of Wounds , M. Bull. North African Theat. Op. 1: 10-11 ( (June) ) 1944;.
Wilson, H., and Threadgill, F. D.:  Secondary Suture of War Wounds , Bull. U. S. Army M. Dept. , November 1944;, no. (82) , pp. 77-80.
Rawles, B. W., Jr.:  Repair of Soft-Tissue War Wounds , Ann. Surg. 123:209-220 ( (Feb.) ) 1946;.
Bornemeier, W. C., and Parsons, L.:  The Treatment of Burns: Report of One Hundred and Fifty-Five Cases , Surg., Gynec. & Obst. 82: 311-318 ( (March) ) 1946;.
Lawrence, K. B., and Sturgis, S. H.:  Secondary Suture of War Wounds: A Study of Methods and Results in an Overseas General Hospital , Surg., Gynec. & Obst. 82:543-548 ( (May) ) 1946;.
Ferrer, J. M., Jr.:  Role of Penicillin in the Management of Infection , J. Bone & Joint Surg. 26:522-531 ( (July) ) 1944;.
Hampton, O. P., Jr.:  Reparative Surgery of Compound Battle Fractures in the Mediterranean Theater of Operations , Ann. Surg. 122:289-332 ( (Sept.) ) 1945;.
McKissock, W.; Logue, V., and Bartholomew, I.:  The Need for Asepsis in Local Penicillin Therapy , Brit. M. J. 2:551-555 ( (Oct. 28) ) 1944;.
United States War Department, Technical Bulletin (TB Med 172), Treatment of Infectious Diseases with Sulfonamide Drugs, Washington, D. C., Government Printing Office, 1945.
Streptomycin:  A Review of Current Experience, Surgical Consultants Division, Surgeon General's Office , Bull. U. S. Army M. Dept. 5:531-537 ( (May) ) 1946;.
Porrit, A. E.: Penicillin Therapy and Control in Twenty-One Army Groups , Printing & Stationery Service, British Army of the Rhine, (May) 1945;.
Circular Letter Orders 160, United States War Department, Washington, D. C., Government Printing Office, June 1, 1945, par. 5.
"Sulfonamide Therapy.—1. The general policies regarding the local use of chemotherapeutic agents have been enunciated in paragraph 21, WD Technical Bulletin Medical 147 (TB Med 147), March 1945.... Experience in wound management justifies the abandonment of local use of any chemical agent in a wound for its supposed antiseptic effect in the prevention or treatment of infection. "2. The practice of routine local application of crystalline sulfonamides to wounds as an emergency aid measure and prior to initial wound surgery will be discontinued. The local application of this agent to wounds not involving serous cavities following wound involving surgery will also be discontinued and its local use in wounds involving serous cavities is not recommended."

First Page Preview

First page PDF preview

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

(a) MacFarlane, J. A.:  Wounds in Modern War , J. Bone & Joint Surg. 24:739-752 ( (Oct.) ) 1942;.
(b) Lyons, C.:  Penicillin Therapy of Surgical Infections in the U. S. Army , J. A. M. A. 123:1007-1018 ( (Dec. 18) ) 1943;.
(c) Rankin, F. W.:  Current Trends in Military Surgery , Kentucky M. J. 42: 11-15 ( (Jan.) ) 1944;.
Rankin, F. W., and others:  War Wounds and Burns , Clinics 2: 1194-1218 ( (Feb.) ) 1944;.
Kirk, N. T., and McKeever, F. M.:  The Guillotine Amputation , J. A. M. A. 124: 1027-1030 ( (April 8) ) 1944;.
(d) Meleney, F. L., and Whipple, A. O.:  A Statistical Analysis of a Study of the Prevention of Infection in Soft Part Wounds, Compound Fractures and Burns with Special Reference to the Sulfonamides , Surg., Gynec. & Obst. 80:263-296 ( (March) ) 1945;.
(a) Churchill, E. D.:  Surgical Management of the Wounded in the Mediterranean Theater at the Time of the Fall of Rome , Ann. Surg. 120:268-283 ( (Sept.) )1944;.
(b) Lyons, C.:  The Philosophy of Wound Management in the United States Army , Bull. Am. Coll. Surgeons 30: 13-14 ( (Feb.) ) 1945;.
(c) DeBakey, M., and Carter, B. N.:  Current Considerations of War Surgery , Ann. Surg. 121:545-563 ( (May) ) 1945;.
(d) Cutler, E. C.:  Military Surgery: United States Army; European Theater of Operations, 1944-1945 , Surg., Gynec. & Obst. 82:261-274 ( (March) ) 1946;.
(a) Lockwood, J. S.:  Definition of Objectives and the Importance of Controls in Evaluating the Local Use of Sulfonamides in Wounds , Surg., Gynec. & Obst. 79: 1-9 ( (July) ) 1944;.
Harvey, S. C.:  Treatment of Infection with Particular Reference to Peritoneum , New York State J. Med. 44: 1883-1886 ( (Sept. 1) ) 1944;.
Churchill, E. D., cited by Whipple, A. O., in foreword to Meleney and Whipple.1d
(b) Lyons, C.:  Role of Chemotherapy in Wound Management in the Mediterranean Theater , Ann. Surg. , to be published.
(c) Rustigian, R.: Bacteriology of War Wounds, to be published.
(d) DeBakey and Carter.2c
MacLennan, J. D.:  Anaerobic Infections of War Wounds in the Middle East , Lancet 2:63 ( (July 17) ), 94 (July 24), 123 (July 31) 1943;.
Lyons, C., and Rustigian, R.: Chemotherapy and the Reparative Management of Battle Wounds: Report, to the Surgeon General, October 1944.
Smith, L. DeS., and George, R. L.:  The Anaerobic Bacterial Flora of Clostridial Myositis , J. Bact. 51:271-279 ( (March) ) 1946;.
Pool, E. H.:  War Wounds: Primary and Secondary Suture , J. A. M. A. 73:383-388 ( (Aug. 9) ) 1919;.
Beebe, T. C.:  Wound Bacteriology at Evacuation Hospital No. 1, American E. F., France , War Med. 2: 1023-1036 ( (Jan. 19) ) 1919;.
Bentley, F. H., and Thomson, S.:  Control of Infection in Recent Wounds by Surgery and Local Chemotherapy , Brit. M. J. 1:471-474 ( (April 7) ) 1945;.
Lyons, C.:  The Use of Chemotherapy in the Secondary Closure of War Wounds of Soft Parts , Surgery 19:275-276 ( (Feb.) ) 1946;.
Ackman, D., and Smith, F.:  The Role of Chemotherapy in Wounds and Surgical Infections , Ann. Surg. 123: 70-95 ( (Jan.) ) 1946;.
Lister, J.:  Relation of Microorganisms to Inflammation , Lancet 2: 695-698 ( (Oct. 22) ) 1881;
 An Address on the Treatment of Wounds , ListerLancet 2:863-866 ( (Nov. 19) ), 901-903 (Nov. 26) 1881;
 On a New Method of Treating Compound Fracture, Abscess, etc., with Observations on the Conditions of Suppuration , ListerLancet 1:326-329 ( (March 16) ), 357-359 (March 22), 387-389 (March 30), 507-509 (April 27) 1867;
2:95-96 (July 27) 1867.
Kirtley, J. A., Jr., and Trabue, C. C., IV.:  Report on Delayed Primary Closure of Wounds , M. Bull. North African Theat. Op. 1: 10-11 ( (June) ) 1944;.
Wilson, H., and Threadgill, F. D.:  Secondary Suture of War Wounds , Bull. U. S. Army M. Dept. , November 1944;, no. (82) , pp. 77-80.
Rawles, B. W., Jr.:  Repair of Soft-Tissue War Wounds , Ann. Surg. 123:209-220 ( (Feb.) ) 1946;.
Bornemeier, W. C., and Parsons, L.:  The Treatment of Burns: Report of One Hundred and Fifty-Five Cases , Surg., Gynec. & Obst. 82: 311-318 ( (March) ) 1946;.
Lawrence, K. B., and Sturgis, S. H.:  Secondary Suture of War Wounds: A Study of Methods and Results in an Overseas General Hospital , Surg., Gynec. & Obst. 82:543-548 ( (May) ) 1946;.
Ferrer, J. M., Jr.:  Role of Penicillin in the Management of Infection , J. Bone & Joint Surg. 26:522-531 ( (July) ) 1944;.
Hampton, O. P., Jr.:  Reparative Surgery of Compound Battle Fractures in the Mediterranean Theater of Operations , Ann. Surg. 122:289-332 ( (Sept.) ) 1945;.
McKissock, W.; Logue, V., and Bartholomew, I.:  The Need for Asepsis in Local Penicillin Therapy , Brit. M. J. 2:551-555 ( (Oct. 28) ) 1944;.
United States War Department, Technical Bulletin (TB Med 172), Treatment of Infectious Diseases with Sulfonamide Drugs, Washington, D. C., Government Printing Office, 1945.
Streptomycin:  A Review of Current Experience, Surgical Consultants Division, Surgeon General's Office , Bull. U. S. Army M. Dept. 5:531-537 ( (May) ) 1946;.
Porrit, A. E.: Penicillin Therapy and Control in Twenty-One Army Groups , Printing & Stationery Service, British Army of the Rhine, (May) 1945;.
Circular Letter Orders 160, United States War Department, Washington, D. C., Government Printing Office, June 1, 1945, par. 5.
"Sulfonamide Therapy.—1. The general policies regarding the local use of chemotherapeutic agents have been enunciated in paragraph 21, WD Technical Bulletin Medical 147 (TB Med 147), March 1945.... Experience in wound management justifies the abandonment of local use of any chemical agent in a wound for its supposed antiseptic effect in the prevention or treatment of infection. "2. The practice of routine local application of crystalline sulfonamides to wounds as an emergency aid measure and prior to initial wound surgery will be discontinued. The local application of this agent to wounds not involving serous cavities following wound involving surgery will also be discontinued and its local use in wounds involving serous cavities is not recommended."
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.