The Extra Pharmacopoeia - Martindale and Westcott 17th Edition 1922
Compiled by Ivor Hughes.
SPHAGNUM. TURF MOSS or BOG MOSS.
Botanical
.�There are numerous varieties of Sphagnum indigenous to Great Britain. Large tracts of it are found in Scotland, the English lakes, Dartmoor and in Ireland.
We are indebted to Mr. Holmes for the following notes on a mixture of Sphagnum sent to him for botanical diagnosis:�
The large concave leaved plant is Sphagnum Cymbifolium. S. Papillosum is only distinguishable under the microscope from it. S. Cuspidatum has long tapering branches and narrow tapering leaves and grows in water- S. Acutifolium is small, usually in compact tufts with small leaves of various tints, the other common species are mostly intermediate in character; S. Contortum like a small Cymbifolium with curved rather stiff branches, S. Reflexum with flat edged leaves and S. Squarrosum with leaves bent back.
The plant consists virtually of a large collection of delicate resilient capillary tubes or perforated cells having the effect of a very fine sponge. These cells readily take in water and hold it firmly � the water can be squeezed out without the cells collapsing � (this is the case even after the application of hydraulic pressure � W. H. M.). In life the plant takes all its water from the atmosphere � it is not dependent on soil water.� Prof. I. Bayley Balfour, quoted by C. W. Cathcart, B.M.J. ii./i5,137.
Chemical Examination.
� An analysis by E. Treffner in 1881 of S. Cuspidatum showed it to contain 7-3% of substances soluble in water. Glucose is present to the extent of 3-05%, Saccharose 1-2% (�? "W. H. M.). Chlorophyll 0-9%, Resin 0-7%, Albuminoid soluble in water 1-4%. Tannin and Mucilage traces, and Ash 1-9%. No evidence of Iodine.� P.j. i./16.125.
Uses
.� For some years past the writer has advocated the use of dried sphagnum as the absorbent dressing par excellence for imbibing discharge of any description.It has no doubt been used for centuries by soldiers to staunch wounds in war � it was used by the Highlanders on Flodden Field, and it is stated (A. McCutcheon, P.J. ii./i6,587) was employed in Ireland, 1014, for this purpose.
It was also brought into service by blast furnace workers as a protective against heat and as a dressing for burns.
The plant in its dry condition will imbibe a large quantity of water or discharge�upwards of 20 times its weight. The variety Cymbifolium is thought to be the most efficacious in this direction, but there is probably not much difference between one variety and another.
Not only for suppurating wounds in war. but for taking up urinary discharge in bladder, kidney and dropsical affections is the material pre-eminently suitable. The dressing is also useful as a bedding for insane persons.
For some early " Experiences with Moss as a Surgical Dressing," vide H. A. Lediard, Surgeon to the Cumberland Infirmary, B.M.J. ii./87,829. See also a paper by Colin G. Campbell and E. Chamberlayne, Manch. Med. Soc., 1881. Colin Campbell was an ardent user of moss. He pointed out that: When cotton wool is placed in contact with a liquid, the fluid seems at once to seize it, its bulk becomes diminished!', and its surface wet, each fibre having become saturated with the moisture. Moss, on the other hand seizes the liquid; its bulk becomes rapidly and enormously increased.
The absorbed liquid does not lie on the surface or between the fibres, but is shut up within the capillary cells of the moss: Thus, though it is full of liquid, it does not feel wet, and though it may be full of pus, it appears clean.
One of the advantages of moss as an absorbent is that the discharge when absorbed by it spreads � diffuses quickly in all directions until the moss is all soaked, rendering it therefore more efficient as a dressing. Cotton wool has not this action�the absorption is relatively local � upwards from the discharging surface. Patients state that the dressing is cool while cotton dressings are not.
Not only are the moss dressings cheap, but they are also deodorant and anti putrescent; hence they are invaluable as applications to foul ulcers or septic abscesses.
Material of this description would naturally contain types of non-pathogenic organisms � moulds for the most part. Some form of sterilisation will therefore be requisite, though we believe we are right in saying that a vast number of the moss dressings used in the war were not sterilised or treated with antiseptic in any way � and this in all probability without untoward infection of the wound.
Sterilisation of Sphagnum.
� Mr. C. W. Cathcart has given the matter a good deal of attention. He states that steam sterilisation is not satisfactory. It hardens the walls of the capillaries of the plant and inhibits the absorbing power.
Sublimated Moss contains 0-25% Mercuric Chloride (the proportion commonly used for sublimating cotton wool). Sublimating the moss has been advocated by this surgeon. The preparation of this involves soaking the dry moss in a sufficiency of Mercuric Chloride solution, pressing out excess and leaving in it enough of the solution to yield the stated proportion of sublimate on drying again.� C. W. Cathcart, L. i./16.820.
Anyone conversant with the extraordinary absorptive and retentive power of moisture exhibited by sphagnum knows the process is, to say the least of it laborious and expensive. It is preferable to wring out the dressing in antiseptic lotion equivalent to a 1% Lysol just prior to use.
The writer has had considerable experience in the preparation of Moss Dressings both in the compressed form, and as muslin covered bags of convenient size for the use of the dresser � in this matter he lays claim to having started the industry in this country to compete with the German moss dressings:�
'Cavendish Moss.' Sheets
compressed size 24 by 15 inches by 1/8th inch approximately in thickness, two of which approximate 1 lb. in weight. These are handy for transit, a cwt. packing into a small case. For hospital use they are appreciated � the sheet is lightly broken up and teased out by the nurse and placed between folds of butter muslin or gauze. If desired the entire dressing so made is rung out in antiseptic lotion as already stated�in many cases it will be quite satisfactory to slip the compressed dressing under the bed sheet as it is.
'Hallam Moss.'
This is similar to the latter, the sheets, however, being more friable and thinner.
Gauze Covered Moss
in the same size and sheet is also prepared ready for use.
Moss (Loose) Dressings in muslin bags
size 12 by S inches, 10 by 6 inches, and 7 by 5 inches.
Moss Towels for menstruation
are made, aiso Moss Accouchement Sheets 36 by 36 inches, and Pillows 18 by 18 inches.
Moss dressings
are especially suitable for wounds suppurating freely. In such wounds the best results will be obtained when the moss is applied damp. A thin layer of gauze is wrung out of a warm antiseptic lotion and laid on the wound; over this, and overlapping it freely, are placed the damp bags of moss as required. After each bag has been wrung out of the warm lotion, the contained moss must be lightly opened out with the fingers; this is done easily owing to the elasticity of the material. Lastly, the bags are held comfortably in position with a bandage. This treatment of the moss-bags is recommended whether the dressings are in the loose or compressed form, and whether they have been sublimated or sterilised by steam.� C.W.Cathcart, B.M.J. ii./15, 137 ; 1./16, 893; i ,'17,752.
Sphagnum pads
very useful, placed under wounds to collect excess of irrigant antiseptic in the Garrel-Dakin method.�B.M. J. ii./17,597.
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