Part 131

KEY: A - Quantity required to prevent Animalcules in six days. B - Number of Days before Life appeared in a solution containing 1 of substance in 500 water and 1/2 drachm of following-- C - Number of Days before Vibrio Life appeared in a solution of Albumen containing 1 of substance in 1000 of solution. D - Beef Juice. E - Sol. of Egg Albumen. F - Reaction of the Solution. G - Infusion of Hay. H - Human Urine. I - Beef Juice and Egg Albumen. J - Average of all. K - Effect on Animalcules in Putrid Beef Juice and Egg Albumen, when added in proportion in third column. L - Animalcules. M - Fungi. N - Animalcules. O - Fungi. P - Effect of the Vapour or Gas during 24 hrs. on Vaccine Lymph. Q - Animalcules. R - Putrid Odour. S - Fungi. T - Mouldy Odour.

+---------------------------------------------------------------------------------------+----------------------- | |EXPERIMENTS BY DR CRACE | EXPERIMENTS MADE BY DR JOHN DOUGALL, OF GLASGOW. | CALVERT. +--------+-------------------+------+-----------------------------------+-------+-------+-------+-------+------- | | A | | B | | C | |----+----+----+----+ +-----------------+--------+--------+ |-------+-------+-------+------- | | | | | | | D | E | | | | | | | | | | | |--------+--------+--------+--------+ | | | | Substances used. | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T -------------------+--------+----+----+----+----+------+--------+--------+--------+--------+-------+-------+-------+-------+------- | |1 in|1 in|1 in|1 in| | | | | | | | | | Acids. | | | | | | | | | | | | | | | Mineral. | | | | | | | | | | | | | | | Sulphurous | Acid. | 250| 50| 50| 117|Death.| 24 | 4 P. | 8 |Over 100|Killed.| 11 |Over 40| 21 |Over 40 Nitric | " | 400| 400| 200| 333| " | 18 | 4 P. | 15 | 5 T. | " | 10 | 50 | 10 | 23 Hydrochloric | " | 500| 400| 100| 333| " | 28 | 4 P. | 9 |Over 100| " | -- | -- | -- | -- Sulphuric | " | 800| 500| 100| 467| " |Over 100|Over 100| 30 | 10 T. | -- | 9 | -- | 9 | 11 Chromic | " |4000|1400|1200|2200| -- | 78 | 38 P. |Over 100|Over 100| -- | -- | -- | -- | -- Organic. | | | | | | | | | | | | | | | Carbolic |Neutral.| 300| 300| 200| 267| None.| 12 | 50 T. | 38 | 36 P. | None. |Over 40|Over 40|Over 40|Over 40 Cresylic | " | -- | -- | -- | -- | " | -- | -- | -- | -- | " | " | " | " | " Acetic | Acid. | 350| 25| 10| 125| -- | -- | -- | -- | -- |Killed.| 30 | -- | 9 | 50 Picric | " | 350| 350| 350| 350|Death.| 44 | 11 P. |Over 100| 44 P. | -- | 17 |Over 40| 19 |Over 40 Benzoic | " | 700| 700| 200| 533| " |Over 100|Over 100| " |Over 100| -- | -- | -- | -- | -- -------------------+--------+----+----+----+----+------+--------+--------+--------+--------+-------+-------+-------+-------+------- Alkalies. | | | | | | | | | | | | | | | Lime | Alk. | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | 13 | 19 |Over 40|Over 40 Potash | " | 300| 50| 10| 120|Death.| -- | -- | -- | -- | -- | 16 | -- | -- | -- Soda | " | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | 23 | 31 | 18 | 29 Ammonia | " | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | 24 | 50 | 20 |Over 40 -------------------+--------+----+----+----+----+------+--------+--------+--------+--------+-------+-------+-------+-------+------- Haloids. | | | | | | | | | | | | | | | Iodine tincture |Neutral.| 400| 400| 50| 283|Death.| 1 | 80 T.| 15 |Over 100| -- | -- | -- | -- | -- Chlorine gas | Acid. | -- | -- | -- | -- | -- | -- | -- | -- | -- |Killed.| 7 | 21 | 21 | -- Chloride lime | Alk. | 200| 200| 25| 142|Death.| 27 | 27 T.| 40 |Over 100| " | 7 | 18 | 16 | -- Chloride zinc | Acid. | 300| 300| 300| 300| " | 4 |Over 100| 18 | " | -- |Over 40|Over 40| 50 |Over 40 Chloride aluminum| " |2000| 500| 300| 933| -- | 19 | 4 P.|Over 100| 8 P. | -- | 10 | " | 21 | 50 -------------------+--------+----+----+----+----+------+--------+--------+--------+--------+-------+-------+-------+-------+------- Sulphates, &c. | | | | | | | | | | | | | | | Bisulphite lime | Acid. | 100| 50| 25| 58|Death.| 4 | 92 T.| 9 |Over 100| -- | 11 | 21 | 14 |Over 40 Sulphate zinc | " | 300| 300| 200| 267| " | 30 | 4 P.| 90 | 70 P. | -- | -- | -- | -- | -- Sulphate iron | " | 500| 500| 100| 367| ? | 14 | 5 T.| 35 | 40 T. | -- | 7 |Over 40| 15 | -- Common alum | " | 800| 500| 100| 467| -- | 14 | 3 P.| 38 | 15 T. | -- | -- | -- | -- | -- Sulphate copper | " |1000|1000| 800| 933|Death.| 86 | 20 P.|Over 100|Over 100| -- | -- | -- | -- | -- -------------------+--------+----+----+----+----+------+--------+--------+--------+--------+-------+-------+-------+-------+------- Permanganate potash|Neutral.| 500| 200| 125| 275| None.| -- | -- | -- | -- | -- | 9 | 50 | 22 |Over 40 Alcohol | " | 350| 50| 20| 140|Death.| 4 | 4 T.| 10 |Over 100| -- | -- | -- | -- | -- Camphor | " | 300| 150| 50| 167| None.| -- | -- | -- | -- | None. | -- | -- | -- | -- Turpentine | " | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | 14 |Over 40| 42 |Over 40 -------------------+--------+----+----+----+----+------+--------+--------+--------+--------+-------+-------+-------+-------+-------

Note.--In the _first_ set of Dr John Dougall's experiments 3 drachms of a solution of the strength mentioned were treated with 1 drachm of a filtered infusion of hay, or with half a drachm of urine or half a drachm of the mixture of beef juice and egg-albumen. In the _second_ set of experiments equal parts of a putrid solution of beef juice and egg-albumen, full of living animalcules, and of the solution of the various substances of the strength known to be preventive of life (as in third column), were mixed together, and the results immediately noted. In the _third_ set of experiments 3-1/2 drachms of distilled water, containing 1 in 500 of the substances named, were treated with half a drachm of filtered beef juice, or half a drachm of a solution consisting of 1 part white of egg to 4 parts water. In the _last_ set of experiments, separate minims of vaccine lymph were exposed to the several vapours for 24 hours, and the dried spot in each case was moistened with glycerin and water, and sealed in a capillary tube until an opportunity for vaccination occurred, when the whole of the diluted lymph was used in one insertion so as to ensure its full effect.

In Dr Crace Calvert's experiments, 0·026 of a gramme of the substance was added to 26 grammes (1 to 1000) of a solution of albumen containing 1 part white of egg to 4 parts _pure_ distilled water.

The Animalcules observed were Monads (microphymes), Vibrios, and their cell segments (microerphymes), Bacteria (microzymes), Am[oe]ba, &c.; and the Fungi were Torula, Mycelium, Penicilium, &c., indicated in Table by letters T and P. Putrefaction was always characterised by a putrid odour, an alkaline reaction, and the presence of animalcules; whereas Mouldiness and Fermentation were distinguished by a mouldy or musty odour, an acid reaction, and the presence of Fungi.

14. LARMANDE'S ANTIMEPHETIC LIQUOR. A solution of the sulphates of zinc and copper.

15. THYMOL. From experiments made with this substance it appears to be a very powerful and valuable antiseptic, and likely, because of its non-poisonous and non-irritant qualities, to supplant carbolic acid in various branches of surgical practice, in which this latter agent has hitherto been employed; such, for example, as a dressing for wounds, ulcers, and as a topical application for certain skin eruptions, &c. Its difficult solubility and price (spite of its much greater antiseptic power), however, for the present at any rate, preclude it from being made available as an ordinary common disinfectant, as this term is generally understood. See THYMOL.

16. SILICATE OF SODA. It is stated that this salt has considerable anti-putrefactive powers.

17. Aluminised CHARCOAL. This is recommended by Dr Stenhouse as a cheap and very efficient decolorising agent. It is made by dissolving in water 54 parts of the sulphate of alumina of commerce in water, and mix it with 92-1/2 parts of finely powdered wood charcoal. When the charcoal is saturated it is evaporated to dryness, and heated to redness in covered Hessian crucibles till the water and acid are dissipated. The charcoal contains 7-1/2 per cent. of anhydrous alumina.

The natural disinfectants are air and water.

Air, when in violent motion, as is the case during a hurricane, has in many instances been known to arrest the course of certain epidemics; whilst in the form of ordinary ventilation, although inadequate alone to destroy the causes (whatever they may be) of contagion or infection, it is nevertheless found to supplement, to a considerable extent, the application of artificial and specific disinfectants. Hence the paramount necessity of perfect ventilation in all apartments in which the sick are placed, and hence also the measures taken in all hospitals to ensure by this means an increasing supply of fresh air to the wards in which the patients are lying.

The diminution in the amount of sickness prevailing in an army caused by the removal of the soldiers from barracks and placing them in sheds or under canvas is another illustration, tending to show the disinfectant properties possessed by an atmosphere in a state of circulation, when, of course, other hygienic precautions are not neglected.

In Hammond's 'Hygiène' for 1863 the author, who was surgeon-general in the United States army, says that he only met with one instance of hospital gangrene in a wooden pavilion hospital, and not a single one in a tent; and the same result is recorded by Kraus, of the Austrian army in 1859, who says he never discovered that gangrene originated in a tent; that, on the contrary, cases of gangrene at once began to improve when those suffering from the disease were sent from hospital wards into tents. In his work on 'Practical Hygiène' Dr Parkes advises all cases of typhus occurring in barracks, whenever practicable, to be sent to tents or wooden huts having badly-jointed walls.

The great solvent power of water, superadded to its being able to hold matters in suspension, renders it a most important disinfectant, and thus enables it in the form of rain to remove from the atmosphere many noxious and pestilential bodies that would doubtless, if allowed to increase, become a source of disease. The air-current which constitutes the ventilation of the House of Commons, before entering the Commons' chamber, is made to pass over a fine spray of water, by which means it has any dust or other organisms washed out of it. The beneficial effect of rain also in flushing drains and canals, and sweetening the superincumbent air, and of washing out of it many solid as well as gaseous objectionable impurities, is well known. The year 1860 was one of the wettest on record, as it was also one of the healthiest. Dr W. Budd recommends that when a room is to be disinfected, a short time before the process is commenced a tub of boiling water should be placed in the apartment, so that the steam may become condensed on the walls, and diffused throughout the air, as he believes there is a greater chance of ensuring the destruction of the disease germs by the aërial disinfectants than if these latter were allowed to act on the germs in the dry state.

We have already enforced in these pages the importance of the habit of personal cleanliness as being one of the greatest aids to the preservation of health; and although the unstinted use of soap and water will alone fail to effect the removal of any infectious or contagious maladies, their use will be found important auxiliaries in assisting recovery. But personal ablution is not the _sine quâ non_. The frequent cleansing of our dwellings, streets,[259] alleys (more particularly culs-de-sac), lanes, and the sheds and habitations of animals, by soap and water, or water alone, as well as the removal of all decaying or refuse materials from our midst, is of equal importance, and must not be disregarded, if we desire to make our sanitary surroundings such as they ought to be.

[Footnote 259: In streets where there is much traffic the air above has been found to contain large quantities of dust composed, amongst other matters, of the remains of horse droppings; hence the great importance of assiduously watering and cleansing the thoroughfares of all large cities and towns. A plan for laying the dust of streets has been suggested by Mr Cooper, and consists in watering them with waste chlorides of calcium and magnesium. Carbolic acid has been employed for the same purpose by many urban authorities for some years past.]

We extract the following from Dr Parkes' valuable and standard work--'Practical Hygiene,'

"_Disinfection of Various Diseases._

"EXANTHEMATA, SCARLET FEVER, AND ROTHËLN. The points to attack are the skin and throat. The skin should be rubbed from the very commencement of the rash until complete desquamation, with camphorated oil, or oil with a little weak carbolic acid. The throat should be washed with Condy's fluid, or weak solution of sulphurous acid.

"Clothes to be baked, or to be placed at once in boiling water, as directed further back. The clothes should not be washed at a common laundry. Chlorine or euchlorine should be diffused in the air, the saucer being put some little distance above the head of the patient. Carbolic acid and ether or carbolic-acid spray may be used instead.

"_Smallpox._--In this, as in all cases, there can be no use in employing aërial disinfectants, unless they are constantly in the air, so as to act on any particle of poison which may pass into the atmosphere.

"The skin and the discharges from the mouth, nose, and eyes are to be attacked. There is much greater difficulty with the skin, as inunction cannot be so well performed. By smearing with oil and a little carbolic acid and glycerin, or, in difficult cases, applying carbolised glycerin to the papules and commencing pustules, might be tried. The permanganate and sulphurious acid solutions should be used for the mouth, nose, and eyes. The clothing should always be baked before washing, if it can be done.

"The particles which pass into the air are enclosed in small dry pieces of pus and epithelial scales; and Bakewell, who has lately examined them, expresses great doubts whether any air purifier would touch them. Still it must be proper to use euchlorine or carbolic acid. Iodine has been recommended by Richardson and Hoffmann.

"_Measles._--Oily applications to the skin and air purifiers, and chlorides of zinc and aluminium in the vessels receiving the expectoration, appear to be the proper measures.

"_Typhus (Exanthematicus)._--Two measures seem sufficient to prevent the spread of typhus, viz. most complete ventilation and immediate disinfection and cleansing of clothes. But there is also more evidence of use from air purifiers than in the exanthemata. The nitrous acid fumes were tried very largely towards the close of last century and the beginning of this in the hulks and prisons where Spanish, French, and Russian prisoners of war were confined. At that time so rapidly did the disease spread in the confined spaces where so many men were kept, that the efficacy even of ventilation was doubted, though there can be no question that the amount of ventilation which was necessary was very much underrated. Both at Windsor and Sheerness the circumstances were most difficult. At the latter place (in 1785), in the hulk, 200 men, 150 of whom had typhus, were closely crowded together; 10 attendants and 24 men of the crew were attacked; 3 medical officers had died when the experiments commenced. After the fumigations one attendant only was attacked, and it appeared as if the disease in those already suffering became milder. In 1797 it was again tried with success, and many reports were made on the subject by army and naval surgeons. It was subsequently largely employed on the Continent, and everywhere seems to have been useful.

"These facts lead to the inference that the evolutions of nitrous acid should be practised in typhus-fever wards, proper precautions being taken to diffuse it equally through the room, and in a highly dilute form.

"Hydrochloric acid was employed for the same purpose by Guyton de Morveau in 1773, but it is doubtless much inferior to nitrous acid. Chlorine has also been employed, and apparently with good results.

"In typhus it would seem probable that the contagia pass off entirely by the skin, at least the effect of ventilation, and the way in which the agent coheres to the body linen seems to show this.

"The agent is not also enclosed in quantities of dry discharges and epidemics, as in the exanthemata, and is therefore less persistent and more easily destroyed than in those cases. Hence possibly the greater benefit of fumigations, and the reason of the arrest by ventilation. The clothes should be baked, steeped, and washed, as in the exanthemata.

"_Bubo Plague._ The measures would probably be the same as for typhus.

"_Enteric (typhoid fever)._ The bowels' discharges are believed to be the chief, if not the sole agents in spreading the disease; the effluvia from them escape into the air, and will adhere to walls and retain power for some time, or the discharges themselves may get into drinking-water. Every discharge should be at once mixed with a powerful chemical agent; of these, chloride and sulphate of zinc have been chiefly used, but sulphate of copper (which Dougall found so useful in stopping the growth of animalculæ), chloride of aluminium, or strong solution of ferrous sulphate (1 ounce to a pint of water), or carbolic acid. After complete mixing the stools must be thrown into sewers in towns; but this should never be done without previous complete disinfection. In country places they should be deeply buried at a place far removed from any water supply; they should never be thrown on to manure heaps or on to middens, nor into earth closets, if it can be possibly avoided. As the bedclothes and beds are so constantly soiled with the discharges, they should be baked, or, if this cannot be done, boiled immediately after removal with sulphate or chloride of zinc. It would be less necessary to employ air purifiers in this case than in others.

"_Cholera._ There can be little doubt that the discharges are here also the active media of the conveyance of the disease, and their complete disinfection is a matter of the highest importance. It is, however, so difficult to do this with the immense discharges of cholera, especially when there are many patients, that the evidence of the use of the plan in the last European epidemic is very disappointing.

"The ferrous sulphate (green vitriol), which has been strongly recommended by Pettenkofer as an addition to the cholera evacuations, was fully tried in 1866 at Frankfurt, Halle, Leipzig, in Germany, and at Pill, near Bristol, and in those cases without any good result. In other places, as at Baden, the benefit was doubtful. It seemed to answer better with Dr Budd and Mr Davies at Bristol; but other substances were also used, viz. chlorine gas in the rooms, and chloride of lime and Condy's fluid for the linen. On the whole it seems to have been a failure. Ferric sulphate, with or without potassium permanganate, has been recommended by Kühne instead of ferrous sulphate, but I am not aware of any evidence on the point. Carbolic acid was largely used in England in 1866, and appeared in some cases to be of use, as at Pill, near Bristol, and, perhaps, at Southampton. It failed at Erfurt, but, as it is believed the wells were contaminated by soakage, this is perhaps no certain case. Chloride of lime and lime were used at Stettin without any good result, and, on the whole, it may be said that the so-called disinfection of the discharges of cholera does not seem to have been attended with very marked results. At the same time it cannot be for a moment contended that the plan has had a fair trial, and we can easily believe that unless there is a full understanding on the part of both medical men and the public of what is to be accomplished by this system, and a conscientious carrying out of the plan to its minutest details, no safe opinions of its efficacy or otherwise can be arrived at. It would be desirable to try the effect of chromic acid or bichromate of potash.

"With regard to air purifiers little evidence exists. Chlorine gas diffused in the air was tried very largely in Austria and Hungary in 1832, but without any good results. Nitrous-acid gas was used in Malta in 1865, but apparently did not have any decided influences, although Ramon da Luna has asserted that it has a decided preservative effect, and that no one was attacked in Madrid who used fumigations of nitrous acid. But negative evidence of this kind is always doubtful. Charcoal in bulk appears to have no effect. Dr Sutherland saw a ship's crew severely attacked, although the ship was loaded with charcoal.

"Carbolic-acid vapour diffused in the atmosphere was largely used in 1866 in England; the liquid was sprinkled about with water, and sawdust moistened with it was laid on the floors and under the patients. The effect in preventing the spread of the disease was very uncertain.

"_Yellow Fever._ In this case the discharges, especially from the stomach, probably spread the disease, and disinfectants must be mixed with them.

"Fumigations of nitrous acid were employed by Ramon da Luna, and it is asserted that no agent was so effectual in arresting the spread of the disease.