Part 132
"_Dysentery._ It is well known that dysentery, and especially the putrid dysentery, may spread through an hospital from the practice of the same close stool or latrines being used. As long ago as 1807, fumigations of chlorine were used by Mojon to destroy the emanations from the stools, and with the best effects. The chlorine was diffused in the air, and the stools were not disinfected; but this ought to be done as in enteric fever, and especially in the sloughing form. It is probable that carbolic acid in large quantity would be efficacious.
"With respect to _Erysipelas_, _Diphtheria_, _Syphilis_, _Gonorrh[oe]a_, _Glanders_, and _Farcy_, local applications are evidently required, and carbolic acid in various degrees of strength, and the metallic salts, are evidently the best measures.
"_Cattle Plague._ The experiments made by Mr Crookes on the disinfectant treatment of cattle plague with carbolic acid vapour have an important bearing on human disease. Although the observations fall short of demonstration there are grounds for thinking that when the air was kept constantly filled with carbolic acid vapour, the disease did not spread.
"So also euchlorine was employed in Lancashire by Professor Stone of Manchester, with apparent benefit. Dr Moffat employed ozone (developed by exposing phosphorus to the air), and he believes with benefit. As such experiments are very much more easily carried out on the diseases of animals than on those of men, it is much to be wished that the precise effect of the so-called disinfectants should be tested by continuing the experiments commenced by Mr Crookes, not only in cattle plague in the countries where it prevails, but in epizootic diseases generally.
"It may be said, in conclusion, that although positive evidence is so deficient, yet, taking into consideration the decidedly great and known effect of many so-called disinfectants, and air-purifiers on organic matters, and the fact that the infectious organic agencies are certainly easily destroyed in most cases (since free ventilation renders many of them inert, and few of them retain their power very long), it is highly probable that the specific poisons of the so-called zymotic diseases are destroyed by some of these chemical methods, and at any rate the careful and constant use of chemical agents for the destruction of the specific poisons in the excreta and discharges from the body, and when they pass into the air, is not only warranted, but should be considered comparative.
"_Purification of rooms after infectious diseases._ In addition to thorough cleansing of all woodwork with soft soap and water, to which a little carbolic acid has been added (1 pint of the common liquid to 3 or 4 gallons of water), and to removal and washing of all fabrics which can be removed, the brushing of the walls, the room should be fumigated for 3 hours with either the fumes of sulphurous or nitrous acids. Both of these are believed to be superior to chlorine, especially in smallpox. All doors and windows, and the chimney being closed, and curtains taken down, the sulphur is ignited as directed in our article FUMIGATION.
"In white-washed rooms the walls should be scraped, and then washed with hot lime to which carbolic acid is added.
"Mortuaries and dead-houses are best purified with nitrous acid."
These directions may be supplemented by the following:--The towels, sheets, articles of clothing, &c., should be boiled in water, or plunged in boiling water containing one to two handfuls of soda to the gallon, before being taken from the room, after which treatment they should be steeped in water containing 4 fluid ounces of carbolic acid to a gallon of water.
Fabrics soiled by the discharges, &c., such as rags, bandages, and dressings, if of little value should be immediately consigned to the flames; but if this be not convenient, they may be treated with carbolic acid and water, in the same manner as directed for towels, sheets, &c.
As soon as any infectious disease sets in, the room of the patient should be at once stripped of curtains, carpet, bed-curtains, valances, and all unnecessary garments, whether in a wardrobe or drawers, as well as of all superfluous furniture, especially chairs stuffed with wool or covered with fabric of any kind.
Disinfections of the apartment by fumigations must be postponed until it is vacated; as before such a time thorough disinfection is impossible.
Infected bedding, &c., should be removed in the boxes made for the purpose, and subjected to the heating process. In most towns provision is made by the Board of Guardians, and under the directions of the medical officer of health, for the disinfection process to be efficiently carried out. See DISINFECTING CHAMBERS.
The disinfection of articles of food is accomplished by thorough cooking, boiling in the case of milk, boiling and filtration in the case of water, and complete roasting, stewing, and frying of meat.
The experiments of Mr Crookes (to which reference has been made in the extract taken from Dr Parkes' 'Practical Hygiène') with carbolic acid during the cattle plague possess great practical interest both for the chemist and physiologist.
Of the use of carbolic acid as a disinfectant Mr Crookes, in the Appendix to the Report of the Cattle Plague Commissioners, writes as follows:
"According to the principles laid down, the air must be treated, and where there is no disease there is only a secondary use in treating anything besides the air. Several cowhouses have been treated with carbolic acid with very excellent results. The mode has been, first, to remove from the floor the mass of manure, which too often adheres to it; secondly, to sprinkle the floor with strong carbolic or cresylic acid; next, to wash the walls, beams, and rafters, and all that is visible in the cowhouse, with lime, in which is put some carbolic acid, 1 to 50 of the water used, or with strong carbolic acid alone. Next, to make a solution containing 1 of carbolic or cresylic acid to 100 of water, or, perhaps still better, 60 of water, and to water the yard and fold until the whole place smells strongly of the acid. Only a few farms have been treated in this way, so far as I know, but in each it has been successful. It may be well to give the cattle a little of the weak solution of carbolic acid, but this has not been so fully tried as the external use. The washing of the mouth and of the entire animal with the weak solution may be attended with good results, especially in the early stage of disease; but I know nothing of cure, and speak only hopefully of prevention.
"The animals seem to have an instinct for disinfection, and lick substances touched with this acid. They must not be allowed to drink it, as when strong it blisters the skin, and especially the mouth and tongue."
Mr Crookes also tried the effect of the acid by injecting it into the veins of the animals, and thus details the results of his experiments:--"It appeared evident that if harm were to follow the injection of carbolic acid, the mischievous effect would be immediate; but that if the fluid could pass through the heart without exerting its paralysing action on that organ, and could get into the circulation, no present ill effects need be anticipated. I therefore determined to push these experiments as far as possible, increasing the quantity of carbolic acid, until it produced a fatal result.
The next operation was on cow No. 11, in which 3 oz. of solution (containing 52-1/2 gr. of pure carbolic acid) were very slowly injected; no bad effect followed. Increasing the dose, cow No. 12 had injected into her vein 4-1/2 oz. of solution (equal to 78-3/4 gr. of carbolic acid); this also was followed by no immediate ill effect. Cow No. 13 was then treated with 6 oz. of solution (containing 105 gr. of pure carbolic acid), in two portions of 3 oz. each, five minutes' interval elapsing between each injection. The first 3 oz. produced a slight trembling, but not so severe as in the case of cow No. 10, as she seemed better in a few minutes. The second dose of 3 oz. was injected. This proved too much, or was pumped in too hurriedly, for almost before I had finished the animal trembled violently, its eyes projected, its breathing became laborious, it fell down and expired. The result could scarcely be attributed to the accidental injection of air into the vein, for the distress began with the injection of the first syringeful, and was only increased by the second; nor is it likely that this accident would happen twice consecutively. I was particularly careful on this point, and the construction of the instrument rendered such an occurrence scarcely possible with ordinary precaution. It is probable that the injection was performed too rapidly, or that the vital powers were lower than usual. In the case of the remaining animal, No. 14, I decided to inject as large a dose as it would bear, stopping the operation at the first sign of trembling, and delivering the liquid very gradually. The first syringeful caused no bad symptoms, and I had just finished injecting the second dose when trembling commenced. It was rather violent for a short time, but soon went off, and in five minutes the animal appeared as well as before.
This cow, therefore, bore without inconvenience the injection of 6 oz. of a 4 per cent. solution, containing 105 gr. of pure carbolic acid. Careful observations with the thermometer were taken before each operation. There were no more diseased beasts on the farm, or I should have carried my experiments still further. On visiting the farm the next day I was told that all the animals seemed better, and on testing them with the thermometer that statement was confirmed. I gave directions that each animal was to be drenched with half a wine-glassful (1 oz.) of carbolic acid in a quart of warm water every morning, but in other respects they might be treated as Mr Tomlinson, a skilful cow doctor, should direct.
"Business now calling me to London, I was unable to watch the further progress of these cases.
"This is to be regretted, as a series of daily thermometric observations would have been of great value in suggesting further experiments. I had, however, frequent accounts sent me. Cow No. 14 continued to improve slowly until convalescent; she is now quite well. Nos. 10, 11, and 12 remained apparently in the same state for four days; they then changed for the worse, and died. It is not improbable that had I been able to inject a further quantity of carbolic acid during the four days in which they were thus hovering between recovery and relapse, it would have turned the scale, and some of them at all events would be now alive and well.
The following table gives the thermometric observations;--
_Table showing the results of injecting carbolic acid into the blood of animals suffering from the cattle plague._
+-----+------------+-------------+---------+--------+-----------+ | | Grains of | Temperature | | | | | No. | Carbolic | before | Second | Third | | | | Acid | Injection | Day. | Day. | | | | Injected. | | | | | +-----+------------+-------------+---------+--------+-----------+ | | | F. | F. | | | | 10 | 26-1/2 | 105·4 | 103·8 | Better.| Died on | | | | | | | 6th day. | | 11 | 52-1/2 | 103·8 | 102·8 | " | Died on | | | | | | | 6th day. | | 12 | 78-3/4 | 104·8 | 104·4 | " | Died on | | | | | | | 6th day. | | 14 | 105 | 103·7 | 103·1 | " | Recovered.| +-----+------------+-------------+---------+--------+-----------+
If future experiments prove that injection of carbolic acid or other antiseptic will do good, it is an operation very easily performed. I have injected five animals, and taken thermometric observations within an hour. Sulphite or bisulphite of soda apparently occasions some pain, as the animals struggle very much; with carbolic acid I found them tolerably quiet. I have calculated the proportion which the carbolic acid bore to the whole quantity of blood in these operations. Taking the whole amount of blood in the animal at 150 lbs., there were injected into--
No. 10, 1 part of carb. acid, in 40,000 of blood. " 11, " " 20,000 " " 12, " " 13,300 " " 14, " " 10,000 "
It is worth mentioning incidentally, that in the case of cow No. 14 (which recovered) the proportion of carbolic acid injected into the blood would have been enough to keep from decomposition the whole quantity of that liquid for a considerable time. In Nos. 10, 11, and 12 the proportion of carbolic acid would probably not have been sufficient for that purpose. I am informed by Dr Calvert that cresylic acid has much less coagulating power on albumen than carbolic acid, and my own experiments entirely confirm this statement."
We have described under "CHARCOAL" the disinfecting properties of that substance. These properties have been turned to excellent account by Dr Stenhouse, who has invented a charcoal respirator, which, causing the wearer to breathe air drawn through a layer of that substance, and by thus depriving the air so inspired of any noxious gases or exhalations, if present, becomes, if worn in an infected atmosphere, a great safeguard against disease. Dr Letheby was accustomed to use a charcoal respirator when analysing dead bodies and other putrid matters of suspected poisoning, and by so doing never experienced any ill effects, nor was he conscious of the offensive odour which but for its adoption he must have encountered.
Professor Tyndall has suggested for the same purpose a respirator of cotton wool, by means of which the air, being filtered before it enters the lungs, becomes deprived of minute particles of various substances suspended in it, as well as of the germs, which so many pathologists believe to be always present during the prevalence of epidemic maladies, and the cause, when inhaled, of the maladies themselves.
=DISINFECTING CHAMBERS.= The sanitary authorities of most large cities have made provision for the purification of mattresses, linen, wearing apparel, &c., by means of disinfecting chambers or ovens, in which receptacles the infected articles are subjected for a certain time to hot air. The simplest form of apparatus for this purpose, and one that could be used on an emergency, provided the articles to be disinfected were not too bulky, is a baker's oven. The drying closet of a good laundry would be so far unsafe, because it would occasionally fail to give a heat sufficient for the destruction of the noxious principles.
The disinfecting chambers employed in Liverpool are arched ovens of solid brickwork, having a depth of 7 feet from front to back, a width of 5 feet from side to side, and a height of 6-1/2 feet from the floor to the crown of the arch. The doors are made of wrought iron, tightly fitting into cast-iron framework. The floors are made of double iron gratings, having alternate openings, so arranged as to admit at pleasure hot air into the chamber. At the top of the arch there is an opening fitted with an iron valve, by which the air of the chamber escapes into an exhausting shaft which is connected with the chimney. The heating is accomplished by means of a cast-iron cockle, the smoke from which escapes by two cast-iron smoke flues, which, after forming a coil for the purpose of affording as great a heating surface as possible, pass along the hot-air passage under the chamber, into a chimney situated at the opposite end.
The cold air is drawn into a brick flue placed underneath the floor of the stokehole into a cavity on each side of the cockle, and thence into a space underneath the chamber, whence it becomes heated by the radiation from the surface of the two cast iron flues. From this cavity or passage it is conveyed at will through the gratings as already described. At the entrance of the cold air flue there is a damper, by which the temperature of the air may be regulated. A heat equal to 280° F. has been registered in this chamber, and as high as 380° in a drying closet over the cockle. Dr French, the medical officer of health for Liverpool, says "that, if necessary, a temperature reaching 500° F. can be attained in these chambers; but this temperature is of course never employed. Experience has proved that from 220° to 250° F. is the most suitable. Instances have been known where fabrics, after being exposed for some length of time to a temperature above 212° F., have sustained injury from being scorched.
In some of the chambers, carbolic acid powder is sprinkled on the floor.
We have taken the liberty of transcribing the following description and plates illustrative of the disinfecting stove used in the Royal Victoria Yard, Deptford, from that very useful publication, 'Chemistry, Theoretical, Practical, and Analytical,' published by Mr W. Mackenzie.
"This stove consists of a brick chamber with a slightly arched roof, and an iron movable floor in two pieces. The chamber is 7 feet deep, 6 feet 9 inches wide, and 5 feet 8-1/2 inches high in the centre of the arch. It is heated by a flue below the iron floor passing round 3 sides of the chamber and up a chimney. There is an opening in the upper part of the chamber in its centre, which passes along in the roof to the side, from thence down in the wall entering beneath the fire; this carries away any of the foul air of the clothes from the chamber through the fire and up the flue. This proceeding takes place after the clothes have been in the chamber say an hour and a half in the following manner:--The damper in the foul air shaft is withdrawn, and the furnace door is shut; any draught that gets to the fire comes to the chamber. Over the opening into the furnace is a square opening, fitted with a glass, inside of which is a fixed thermometer. When this shows a temperature of 200° F., the interior of the chamber is at 250° F., the highest point at which it is allowed to be. In the interior of the chamber at the sides there are little movable cranes, three rows of three supporting rods of iron on which wooden trays rest, and on which the clothes are placed when the iron cart is not used. The cranes move fore and aft to be out of the way when the cart is used. The cart is of iron on wheels, and runs into the chamber on tramways to keep it in position; in the interior of the cart are three iron trays for laying the clothes on. The lowest tray is always the hottest, so that it is prudent to use the cart, the iron bottom of which prevents burning. The iron ends of the cart are removed when it is placed in the chamber; so is the handle. It is usual to keep the clothes at the temperature of 250° F. for two hours.
There is a trap door 8 inches square about 14 inches above the upper edge of the furnace, and on a level with the iron floor of the chamber, for disinfectants. Carbolic acid and sulphur are used; the former is placed on a flat plate, the latter is sprinkled over the floor. These are used as the last, and after that has been the clothes are fit to be used without danger to any one.
_Elevation plan_ (fig. 5) shows the front of the chamber with the doors closed; the openings (Nos. 1, 2, and 3) are for inserting the long thermometer, which is pushed into the clothing to be disinfected; they correspond with the three trays. The thermometer can be withdrawn and examined without allowing much cold air to enter; plugs fit into these three openings when not used for the thermometer.
_Section._--The chamber is shown about the centre of its depth; the foul-air shaft (B) passes along the roof down the side wall, and beneath the fire (C); the opening where the fixed thermometer is placed is marked with dotted lines. The damper for the foul-air shaft (E) is represented as shut, and the damper for the chimney (F) is also shut.
_The ground plan_ shows the flue beneath the iron plates, which form the floor of the chamber, the dotted lines showing the foul-air flue (B), as it passes beneath the fire. In the flue (C) there are openings at D, D, D, for the purpose of cleaning it.
Another form of disinfecting chamber is that invented by Dr Esse, of Berlin, and employed in that city. The apparatus consists of two iron cylinders, one fitted within the other, with a space between, into which steam under pressure is introduced. The outer cylinder is surrounded with wood and the top with felt, to prevent the escape of heat. The articles to be disinfected are put in at the top of the inner cylinder, the inside of which soon becomes heated up by the surrounding steam. A pulley is used to lift the lid of the inner cylinder, around which the clothes are hung on pegs, not being allowed to touch the side of the cylinder. At the top of the inside cylinder is a brass box pierced with holes at the bottom, which dips a little way down, through which the air from the interior can rise. In this box the bulb of a thermometer being placed, the temperature of the inner chamber can be registered.
When the steam condenses in the space between the cylinders it is carried off by means of a valve, which is lifted when the water reaches a certain point in the condenser. In an hour's time the temperature of the interior cylinder can be raised to 235° Fahr.
For heating mattresses another apparatus has been devised by Dr Esse. It consists of an iron case with a spiral steam pipe in the centre, the steam inside the pipe being compressed to two atmospheres.
Dr Ransome has invented, for the use of the Nottingham hospital, a gas stove in the form of an iron box, well packed with a non-conducting material, which surrounds the outside. A channel leads to the interior of the box, and inside this channel gas is kept burning in such a manner by a modification of Kemp's regulator, that the temperature of the box shall range day and night between 235° and 255° Fahr.
An apparatus put to great use by the Holborn District Board during the epidemic of smallpox in 1871 was one made by Fraser's patent. Mr Fraser's disinfecting chamber consists of an oven or receptacle made of brick, with doors in front. Situated on the lower portion of this chamber is a covered furnace connected with flues, by means of which the interior space is heated to the desired temperature. By a particular arrangement the air laden with the noxious vapours given off by the tainted clothing is conveyed into the furnace, and so consumed. Belonging to the apparatus is a covered truck or cart, fitted with doors and dampers, and provided inside with racks and shelves for holding the materials to be purified, which are thus brought from the infected dwelling and placed, truck and all, inside the chamber. The infected materials, as well as the truck containing them, are then heated to the necessary point, disinfection being assisted by sulphurous acid gas, or some other material adapted for the purpose. When the process is finished the carriage with its contents is drawn back to the house from which they were originally taken, and the purified articles are restored to the owners. It will be seen that by this arrangement the vehicle is disinfected as well as the clothes it contains.