(From the Southern California Practitioner for August.) 
ACETANILID AS AN ANTISEPTIC 
SURGICAL DRESSING. 
BY WM. A. EDWARDS, M. D., SAN DIEGO, CALIFORNIA. 
FELLOW OF THE COLLEGE OF PHYSICIANS OF PHILADELPHIA; FORMERLY INSTRUCTOR 
IN CLINICAL MEDICINE IN THE UNIVERSITY OF PENNSYLVANIA; 
PHYSICIAN TO ST. JOSEPH'S HOSPITAL; ASSOCIATE 
PATHOLOGIST TO THE PHILADELPHIA 
HOSPITAL, ETC., ETC. 
For the past five months, since the appearance of Morton's paper, (The Phila. 
Polyclinic, Feb., 1895), I have been employing acetanilid in surgery as a substi- 
tute for iodoform and its various combinations. Its use has been so satisfactory 
that it is with pleasure this little clinical note is written and my testimony is 
added to that of others who have written in laudatory terms of the drug. 
When applied to a wound it produces intense dryness, but no complaints have 
been made of a burning sensation when the drug has been applied alone; but when 
boracic acid is added this sensation is often complained of to a marked degree. 
We have used the drug in the following combinations: various percentages 
of acetanilid with boracic acid, from 25 per cent to 80 per cent of the former; the 
pure powdered acetanilid; five and ten percent gauze; alcoholic solution and the 
drug suspended in normal salt solution. 
I have not used it with liquid petroleum, 4o grs. to the ounce, or with ether or 
chloroform. Suspended in water it serves well for injection into abscesses or 
sinuses. In ordinary cocoa-butter suppositories it is very efficacious in rectal 
affections, ulcers, or inflamed hemorrhoids. 
In the following cases we have observed most gratifying results: A tuberculous 
abscess in Scarpa's triangle in a boy: tuberculous abscess of cervical glands; an ex- 
tensive breast amputation for carcinoma in which it was necessary to sacrifice a great 
deal of tissue; gunshot wound of the gastrocnemius; subra-pubic lithotomoy in 
which a necrotic fat abscess formed on the thirteenth day; hemorrhoids, rectal 
ulcerations and fissures. It will be seen by this list that the drug has been freely 
tried under many different conditions with success. There are, however, 
a small minority of cases in which acetanilid cannot be used just as some persons 
will not tolerate iodoform or any of the iodine compounds. In my experience I 
have met with two such cases. One was an amputation of the ear for epithelioma of 
the helix and the other was an abscess of the maxillary sinus (empyema of the an- 
trum of Highmore). These were both elderly men, the former was aged seven- 
ty-three and the latter eighty-four. In these men acetanilid seemed to produce a 
deal of irritation and to delay granulation. I have had a similar experience 
several times with iodoform. 
We use the powder very freely and in a large number of cases have not observed 
any toxic effects; Morton in a much larger series has noted toxic effects but 
twice. One case in an infant aged fourteen months, in whom excision of hip had 
been performed for tuberculosis and the wound packed with acetanilid; in four 
hours the temperature dropped five degrees; great pallor and feeble pulse. The 
temperature rose and symptoms disappeared upon withdrawal of the drug. The 
second case was one of extensive suppurative superficial scald. At twelve o'clock eight grammes of finely powdered acetanilid was dusted over the surface; at five p. 
m. the patient presented grave toxic symptoms; all acetanilid was at once remov- 
ed, digitalis and whiskey were exhibited and by midnight he was in a normal 
condition. 
Soper, (Medical World, Vol. XIII, No. VI, 1895, p 216) of the Sydenham Dispen- 
sary, New York, has used it with a very free hand and has observed no effect upon 
the temperature. He calls attention to the fact that it appears to do well up to a 
certain point, and then, as it were, to lose its grip, as he expressed it; he also 
states that the necessity of forcibly removing the crust and finding a collection of 
pus under it is unfavorable. 
I have as already stated, observed the first condition as stated by Soper, but 
considered it due more to the advanced age of the subjects than to any want of 
response on the part of the drug. The latter condition I have never met with; 
when the crust was removed the granulating surface was always intensely dry as 
stated by Morton. In the cases in which the drug seemed to lose its grip this 
dryness persisted but the wound area did not decrease. 
Harrell, Medical News, Oct., 1893; Hand, Ibid, Vol. LXIV, p 269; and Knowles 
Ibid, Vol. LXIV, p 419, all speak in the strongest terms of the efficacy of the 
drug, the former states that the wounds heal quickly even after coal dust and 
other foreign matter had gained entrance. 
It will be seen that the drug has a very wide application, and in most cases it 
will prove so satisfactory that it is difficult to restrain one's self from speaking too 
enthusiastically. It is, however, entirely safe to say that in acetanilid we have an 
addition to our surgical armamentarium which is quite equal to and indeed superior 
to iodoform without its objectionable odor; that is no more dangerous than iodo- 
form and that it may possess the ability to render the skin sterile preparatory to 
operative procedures. This, however, will require further study and microscopic 
investigation into the ability of acetanilid to destroy the staphylococcus epider- 
mitis albus. 
ADDENDUM.-Since hastily writing the above the recent laboratory work of 
Frothingham and Pratt (Amer. Jour. Med. Sci., August, 1895,) upon the anti-bacte- 
rial action of acetanilid has come to my notice. These experiments show that the 
inhibitory action of acetanilid is much more marked in the one per cent, than in 
the 5 per cent, tubes. The growth of the bacillus pyocyaneus is much more af- 
fected by the presence of acetanilid than the other organisms. 
The experimenters conclude as follows: Although acetanilid has not been very 
widely employed as a surgical dressing, in the cases where it has been used the 
results have been so successful that its superiority over iodoform seems very 
probable, and its use instead of the latter indicated. 
Laboratory experiments uphold the clinical proof of its value as a surgical 
dressing, and the conclusions which the experiments teach are: 
1. That acetanilid is probably to a very slight extent a germicide. 
2. That acetanilid is decidedly an antiseptic.* 
3. That, as an antiseptic, acetanilid is far superior to iodoform, and that cer- 
tainly from a laboratory, and probably also from a clinical, standpoint its substi- 
tution for the latter seems warranted. 
Their experience is contrary to that of some other observers, in that they state 
that there is no danger of poisoning from the absorption of acetanilid. 
1854 Fourth Street, San Diego, Cal. 
*In this connection it is perhaps well to remember Sternberg's definition: "Antiseptics restrain the 
growth of micro-organisms which produce septic decomposition without destroying their vitality. 
Disinfectants destroy the germs of infectious diseases. Germicides are an extended term of the latter 
agents that kill non-pathogenic bacteria as well as disease germs."