The Use of Pyoctanin, an 
Antiseptic, in Diseases of 
the Upper jAir-passages. 
J BY 
R. P. LINCOLN, M. D. 
REPRINTED FROM 
Neto ¥01* fUeUIcal journal 
for October 31, 1891. Reprinted from the New York Medical Journal for October 31, 1891. 
THE USE OF PYOCTANIN, 
AN ANTISEPTIC, 
IN DISEASES OF THE UPPER AIR-PASSAGES* 
By R. P. LINCOLN, M. D. 
TH E question has often been proposed, Why do we find so much 
more work to do in the nasal passages than formerly ? This 
thought is especially emphasized by inspecting the list of papers 
offered at this meeting of our association. 
It is true we not only attempt, but we accomplish, much more 
than we thought possible ten or even five years ago. The explana- 
tion is not that naso-pharyngeal affections are more common now, 
not that we did not recognize abnormities that we now attack with 
confidence, but it is that we have learned, from our own and the 
experience of co-laborers in the same field, that we can with impunity 
almost undertake operations the possible unpleasant consequences of 
which were greatly magnified and acted to effectively deter us. 
We are further encouraged not only by the primary and immedi- 
ate relief that follows many operations, but also by secondary advan- 
tages, sometimes even general, that are often of greater importance 
than the removal of the local trouble. 
The advantage from the use of cocaine has greatly facilitated our 
operations. But the element that has contributed not the least to 
our success and to extending our achievements is the discoveries and 
improvements in antiseptics. 
In determining the utility of a drug and defining its uses, we aim 
not only to restore the ailing, but to fortify our patient against the 
liability to disease ; and it must be remembered that every applica- 
* Read before the American Laryngological Association at its thirteenth an- 
nual congress. 
Copyright, 1891. by D. Appleton and Company. 2 
THE USE OF PYOCTANIN IN 
tion of such knowledge becomes an important experiment, either 
yielding confirmation of or casting doubt upon some hypothesis not 
yet crystallized into acknowledged doctrine. Evolution in our art is 
being rapidly developed. The almost countless new remedies or sub- 
stances that the diligent chemist or the indefatigable herbalist is con- 
stantly presenting to us for testing make it impossible that any one 
person or school should definitely pass judgment on them all. To 
prove the cause of an effect in even one instance is a contribution to 
this end. A contribution toward the solution of any such equation 
is work in the direction of ameliorating or curing disease. Cherished 
fallacies that often sway the laity must be guarded against by the 
investigator; such is the idea, prominent in the public thought, 
calculated to mislead because not consistently discountenanced by 
the profession, that remedies heal-that certain atmospheres, for 
example, heal the diseased mucous membranes. 
The healing process is from a higher power and pertains to the 
germ of our growth, intrinsic. At war with this are extrinsic ele- 
ments. The air, I repeat, does not heal, but some atmospheres con- 
tain fewer disease-promoting germs than others. To destroy those 
present, to fortify our patient against their deleterious effects, is, 
then, one of our objects. 
Further, we must not lose sight of the fact that man never manu- 
factured living tissue. Our aim must be to assist Nature. This, in 
surgery, we do in three ways-by co-apting solutions of continuity, 
by removing obstacles, and by shielding a fresh or granulating sur- 
face from bacteria prejudicial to its healthful progress. In nasal 
surgery unexpected constitutional symptoms occasionally present 
themselves that we recognize as due to septic poisoning. I think 
the practice is not yet -definitely settled on the point whether the 
nostrils should be sealed, so to speak, with a pledget of lint after an 
operation, or whether an effort should be made to keep the passages 
freely open. Whichever plan is adopted, we must recognize the 
necessity of an effective antiseptic. We thus see there are so many 
contingencies that interfere with the theoretical use of remedies, that 
a true estimate of their value can only be determined by experience, 
and I apprehend that the efforts of the rhinologist and laryngologist 
will hereafter find their greatest advantage in studying the action of 
remedies whose province is chiefly aseptic. There are many that 
have been used, each with enthusiastic advocates, such as boric acid, 
antipyrine, bichloride of mercury, iodoform, iodol, aristol, peroxide 
of hydrogen, and others; but there is one that has been but little DISEASES OF THE UPPER AIR-PASSAGES. 
3 
tried, but which, from my present experience, seems destined to be- 
come a valuable addition to the list. 
With the foregoing plea for investigation in the direction of 
antiseptic methods, I invite your attention to a remedy that E. 
Merck, the chemist, has brought forward within a short time. I 
refer to pyoctanin, the methyl-violet. The efficacy of the remedy 
seemed so pronounced in the limited number of instances where 1 
have used it that I hope to elicit observations by others and hasten 
the determination of its place in our pharmacopoeia. Whatever be 
the final verdict, 1 am convinced it has merit, and I now recognize 
but one disadvantage. 
For the convenience of any that may not be familiar with its 
attributes, 1 compile here the essentials of whatever I have been able 
to find on the subject, and also present some samples. Pyoctanin is 
a chemical preparation of the class of aniline colors, there being two 
kinds, the blue and the yellow, the former, according to Pohl,* hav- 
ing the greater germicidal power. It is offered in the market in the 
form of powders, tablets, and sticks. It is odorless, almost tasteless, 
non-poisonous, slightly anodyne^ and non-irritating. It does not 
coagulate albumin, has great penetrating and disseminating power, 
and hence does not form a protecting shield about diseased germs. 
It destroys bacteria quickly; even a weak solution prevents the 
development of all micro-organisms. It is freely soluble in water 
and petroleum products. Its disadvantage is its staining quality, 
which is an offense to the sight, but which can be avoided on ex- 
posed parts by exercising reasonable care. 
It may be used without unpleasant consequences in any degree of 
strength, from the pure substance to a weak solution. It can be 
applied to the part to be treated in the. form of a spray, by means 
of a pledget of lint saturated with a solution, in the form of an oint- 
ment, as a powder or by crayon. 
Its Method of Action.-W. Pohl,J of Berlin, reports in his inau- 
gural thesis the results of the study of the effect of pyoctanin on 
different bacteria. Putrefactive J ones showed the greatest resist- 
ance. A solution of the strength of 1 in 2,000, however, stopped 
their evolution, while a solution of 1 in 1,000 killed them in half an 
hour. It is found by increasing the proportion of the chemical 
that this action is hastened. The rapidity of this action on all 
* W. Pohl, Darmstadt, 1891., 
f Op. cit. 
| Stilling. Anilin. Farbstoffe ah Antiseptica. Strassburg, 1890. 4 
THE USE OF PYOCTANIN IN 
other micro-organisms is much greater. Janicke* showed that a 
total stoppage of development took place in streptococcus with a 
solution of 1 to 333,000, whereas a solution of 1 to 5,000 killed it 
in half a minute. 
Professor Stilling, f who appears to have been the first to have 
introduced and systematically experimented with pyoctanin, applied 
a strong solution to the eyes of his patients without much discom- 
fort. 
Bresgen, J who was the first to systematically usepyoctan in in 
the nose, noticed a distinctly anodyne faculty on its being applied 
to the mucous membrane. 
♦ 
Thus we learn that while its effect varies much in degree with the 
strength of the remedy, we need not be deterred, by fear of pain or 
too much irritation, from a free use of the substance, undiluted if 
it seems indicated, when we wish to destroy suppuration or prevent 
it if impending. 
When used in solution it is said that it is best to keep it in 
colored glass and have it freshly prepared every three or four days. 
My own observations date from July, 1890. One of my first cases, 
which was as follows, seemed to me at that time most remarkable: 
The patient was a well-nourished single woman, thirty-five years of 
age. About a year before I had operated upon her for an abscess of the 
left frontal sinus, the early effect of which trouble had been most serious. 
At the operation the necrosed outer wall was in large part removed-as 
much, in fact, as seemed justifiable, yet not completely, so that small pieces 
were removed with forceps, curette, etc., for a period of several months 
following. A style was worn for a long time, and injections of various 
remedies were frequently made through the external opening into the 
nostril. In fact, the patient herself operated this method successfully. 
Notwithstanding the many different remedies thus applied for months, 
after all evidence of necroses or caries had disappeared some suppuration 
continued, with slight swelling and redness of the upper eyelid. It was 
not till after I had made a few injections of a ten-per-cent, solution of 
pyoctanin in water that a new impetus to the healing process began 
which was speedily completed. In less than three weeks, the strength of 
the solution being gradually reduced, all discharge, either external or 
through the nostril, ceased, and the patient was relieved of a trouble that 
had caused physical and mental distress for nearly two years. 
While this patient was under treatment 1 had an opportunity to 
use the remedy in a case of suppuration of the antrum with equally 
* Fortschritte der Medicin, 1890, No. 12, p. 460. 
f Loe. cit. 
J Deutsche med. IKocA., 1890, No. 24. DISEASES OF THE UPPER AIR-PASSAGES. 
5 
gratifying results. Four cases of this disease where the suppuration 
has been pronounced have been relieved more promptly than ordi- 
narily by other methods.* In cases of suppurative ethmoiditis, 
where I have been able to reach the parts in consequence of some 
fortuitous malformation especially, comparatively prompt relief has 
been secured, unless necrosis existed, in which case, after removal of 
detritus, the disease was readily corrected. Whenever ulceration of 
the mucous membrane and suppuration are present, I think the 
remedy most useful. 1 have seen several instances where there was 
erosion and unhealthy granulation on the septum nasi smoothed and 
healed in a short time. The granulations on the border of a per- 
forated septum cicatrize more readily when kept coated with an oint- 
ment of twenty grains of pyoctanin with an ounce of vaseline. Like 
Bresgen,f I have found it useful after cauterizations, but I am not 
prepared to say, with my present experience, that it has a great 
advantage over iodol, iodoform, and some other remedies we are 
familiar with, except for the fact that septic poisoning has been 
escaped by patients operated on when I have used it. It quickly 
heals all aphthous ulcerations in the mouth. 
It is useful as a local remedy in all acute follicular inflammations, 
and especially in those chronic follicular diseases of the tonsils and 
soft palate where we find inspissated mucus often crowded with 
micro-organisms, as Leptothrix buccalis. The effect of a fifty-per- 
cent. solution applied in instances of this last-named affection is im- 
mediately evident to the observer. 
I have applied the remedy in but two cases of unquestionable 
diphtheria. Both recovered without sequelae. One case was very 
severe and one only moderately so. In the former, a little girl five 
years old, the disease began in the right nostril, extended to the left, 
the membrane gradually involving a part of the pharynx, the whole 
of the right tonsil and part of the left. Before I used pyoctanin, 
besides administering internally tonics and chlorate of potassium, I 
had used locally in the nostrils, one after another, sprays every two 
or three hours of bichloride of mercury, benzoate of sodium and 
wine of pepsin, chlorate of potassium, and iodoform. The same had 
* In the -Journal of Laryngology and Rhinology for September, 1891, I find, in 
the report of the May and June meetings of the Berlin Laryngological Society, that 
Cholewa recommends pyoctanin for diseases of the frontal sinus, and Meyer reports 
two cases of antrum disease improved. In the same report Scheinmann says it 
can only help when combined with other remedies, and Katzenstein and Herzfeld 
never saw any effect from it. 
+ Imc. cit. 6 
PYOCTANIN IN DISEASES OF THE UPPER AIR-PASSAGES. 
been used in the throat, and here, in addition, a mixture of com- 
pound tincture of iodine and carbolic acid. There was great physi- 
cal depression, but no albumin in the urine. The disease, which 
must have been present three or four days before 1 saw the child, 
continued to increase and extend for three days, when I determined 
to leave in the nostrils through the night rolls of absorbent cotton 
saturated with a ten-per-cent, solution of pyoctanin. So much im- 
provement was found the following morning that the remedy was 
used more freely, and its use extended to all parts involved, with the 
result that in forty-eight hours all trace of the membrane had disap- 
peared. The other case was an adult, when a strong application 
started an improvement at once. 
Three cases of diphtheria were treated in the early summer and 
encourage me to give the remedy further trial.* Its effect on a 
single instance of membranous rhinitis was, as should be expected, 
prompt and salutary, the plastic deposit being quickly destroyed and 
not reproduced after three or four applications. My experience with 
the remedy in laryngeal phthisis does not cover a period sufficient 
to justify me in expressing a conclusive opinion, but 1 note f that 
T>r. Capart, of Brussels, presented at the Annual Assembly of Bel- 
gian Laryngologists, May, 1891, a case of ulceration and perforation 
of the soft palate, occurring after an ulceration of the tonsil, in 
which Koch's bacilli were found, healed rapidly under pyoctanin. 
He also exhibited two patients with laryngeal tuberculosis in whom 
the ulcerations had improved under pyoctanin. I have used pyoc- 
tanin with most satisfactory effect in both syphilitic and non- 
syphilitic ozaena. At the present time a child, three years old, with 
a very offensive, non-specific ozaena, having much tumescence of the 
nose and frequent epistaxis, is markedly improved after only a week's 
treatment. Peterson J reports cases of syphilitic ozaena deodorized 
and cured in a short time by a one-per-cent, solution. 
* Pohl reports nine cases of diphtheria, not selected, treated successfully, 
f Journal of Laryngology and Rhinology, August, 1891, p. 343. 
\ St. Peter sb urge medizin. Woch 1890, No. "24. & REASONS WHY 
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