Tuesday, April 22, 2014

Historical Contribution: 1919, HH Young, Mercurochrome


Young HH, White EC, Swartz EO. A New Germicide for the Use in the Genitourinary Tract: "Mercurochrome-220". JAMA. 1919;73:20:1483-91.

At the turn of the 20th Century, one of the urologists biggest tasks was the treatment of urinary tract  and sexually transmitted infections; and their sequelae (including abscess, strictures, etc.).  Hugh Hampton Young and other urologists were in search of a sufficient urinary antiseptic, especially after World War I where venereal disease accounted for an estimated 7 million person-days lost and 10,000 discharges in the US army; and 416,891 hospital admissions among British troops accounting nearly 5% of the entire British force.[1]

In 1919, HH Young reported results from Johns Hopkins in the Journal of the American Medical Association (JAMA), where mercurochrome-220 was used to sterilize the bladder.  Dr. Young wrote:
"The speed with which some old infections of the bladder and kidney pelvis have disappeared after its use is striking, and the absence of irritating and toxic qualities, together with the ability of the patient to retain a 1 per cent, solution for hours without discomfort, are sufficiently proved to establish the possibilities of the drug in these conditions." 
This work earned Young and colleagues a grant from the Interdepartmental Social Hygiene Board.

Young detailed the important properties needed for a new "urinary germicide":

  1. ready penetration of the tissues in which the infection exists
  2. lack of irritation of the drug to tissues
  3. high germicidal activity
  4. ready solubility in water and stability of the solution
  5. freedom from precipitation in urine
  6. sufficiently low toxicity to avoid systemic effects from the small amount of the drug that may be absorbed. 

Young and colleagues then demonstrated the ability of mercurochrome to kill a variety of bacteria including Balantidium Coli and Staphylococcus aureus; and compared its efficacy to other, known antimicrobial compounds.

In Dr. Young's typical meticulous fashion, the authors report the outcomes of 10 patients treated for cystitis, 14 treated topically for chancroid and comment on the outcomes of 51 patients treated for gonorrheal urethritis - all of which responded to treatment.

Read the entire manuscript using the link above or here.

HISTORICAL CONTRIBUTIONS highlight the greatest academic manuscripts from the Brady Urological Institute over the past 100 years.  As the Brady Urological Institute approaches its centennial, we will present a HISTORICAL CONTRIBUTION from each of the past 100 years.  In the most recent experience, the most highly cited article from each year is selected; older manuscripts were selected based on their perceived impact on the field.  We hope you enjoy! 

[1] Mitchell, T.J, & Smith, G.M. (1931) Medical Services: Casualties and Medical Statistics of the Great War, History of the Great War, Based on Official Documents (London: HMSO).


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