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Vol. 5.

No 2.

Disinfection, Disinfectants, Germicides, and Deodorants.

The Medical Review of Reviews published in the December number, 1902, a paper on disinfection and disinfectants, by Dr. A. H. Doty, health officer of the port of New York, read at Albany, N. Y., Oct. 30, 1902, before the conference of sanitary officers, which thoroughly explains the different agents in use to purify infected houses, ships, and individuals after attacks and exposure to contagious diseases. The paper is instructive and valuable, coming as it does from one who has had ample practical experience in the matters whereof he speaks.

"The term 'Disinfectant,' the Dr. says, "is frequently confounded with antiseptics and deodorants, but a true disinfectant is an agent which destrovs infection organisms with which it

comes in contact, whereas an antiseptic only holds in check the propogation of these germs, but does not necessarily destroy them; while deodorants neutralize offensive odors and may or may not act as germicides." In fact, deodorants may furnish an additional odor, more agreeable to the olfactory organs, and dominate the disagreeable. without removing any danger from what may be infectious in the other offensive smells. Scientific investigation has proved the worthlessness of many agents advertised as disinfectants, having no power of destruction to germs, and none of these should be used when the composition and strength of the materials are unknown.

Dr. Doty gives the six disinfectants that are practically all that are reliable in modern disinfection, and names them in the following order: Steam, sulphur dioxide, formaldehyde, corrosive.

sublimate, carbolic acid and lime. The salts of copper and lime and other agents are used, but their germicidal power is feeble. The doctor notes that while steam, sulphur, dioxide, etc., are our own creation, nature supplies disinfectants of greater importance, viz.: sunshine and air, which are destructive to pathoganic organisms with sufficient exposure. These are potent allies in preventing infectious diseases, but we cannot always wait for the process to insure safety, and other means must be employed to assist nature in its work. Proper and sufficient disinfection of rooms cannot be obtained while occupied by patients, and the burning of small amounts of sulphur, or the release of a small amount of formaldehyde, the placing of saucers of carbolic acid about the rooms, or the spraying of the apartments with socalled disinfecting solutions, the doctor thinks, are worse than useless, as they do not disinfect, but do interfere with the comfort of the patients. "All such efforts combined," the Dr. says, "would not equal in value good ventilation." It was found in one epidemic of typhoid fever in New York that with patients treated in tents the results were more favorable than in those remaining in the hospitals.

It is generally believed that the stools of typhoid cases are more thoroughly disinfected with 1-5000 or 1-1000 solution of bichloride of mercury, or a five per cent. solution of carbolic acid, the carbolic acid being the best; but if the bichloride is freely used and exposure prolonged, it will be found equally effective.

For the disinfection of all bed linen, dressings, etc., the Dr. favors a stock solution of bichloride 1-1000, which costs only one cent per gallon, and kept ready for use in a glass recep

tacle with a conspicuous poison label; also a label stating the strength of the solution, and a formula for making the different solutions needed. The materials to be disinfected should be left in solution for two hours immediately after removal from patients, and not stored for future disinfection. Boiling water will disinfect bed linen and other materials in an hour; but the process should be carried on in or near the sick room, as such articles should not be sent to a laundry.

The treatment of infected apartments depends upon the materials in the rooms. Clothing, hangings, carpets, etc., should be rolled up in clean sheets and removed, if possible, for steam disinfection. The woodwork of the rooms should be thoroughly washed with soap and water, then made as close as possible to exclude the air, and then treated with fumes of sulphur dioxide, or formaldehyde; the former will destroy all vermin and animal life, and also all gilding or wall paper and picture frames, while the latter, not so destructive to animal life, is preferred, as it is harmless to all decorations containing gilt, and does not bleach, or otherwise injure fabrics of any kind. School rooms, holds of vessels, and apartments that do not contain delicate furniture, or hangings, may be disinfected with sulphur dioxide, using four pounds of sulphur for each 1,000 cubic feet of space. Whether formaldehyde or sulphur dioxide are used, the apartment should remain under disinfection for eight hours, and then be well aired for two days, the time required for this purpose being longer for formaldehyde than for sulphur dioxide.

should not be air slacked. These may be used for the disinfection of fecal matter if carbolic acid and bichloride of mercury are not available. These are also valuable deodorants, and should be used in the proportion of one quart of freshly slacked lime to four or five quarts of water, and the chloride of lime in the proportion of eight ounces to a gallon of water.

For health officers and others who are called upon to neutralize offensive odors, and in all cases where the decomposition of organic matter is in process, lime may be used, but Dr. Doty recommends bromine as the most practical and efficient deodorant. Bromine is sold in solution in tightly sealed bottles, packed in whiting in tin boxes. It is so irritating to the respiratory tract that the bottle should always be broken under water. Four ounces of bromine to sixty gallons of water, or a little stronger if necessary, is generally sufficient to act as a deodorant, and can be best applied with a garden sprinkling pot, once or twice in twenty-four hours.

In closing his paper, Dr. Doty says: "In practical disinfection and in public

sanitation, too little attention has been given to the value of soap and water; for instance, the scrubbing of the floor, walls and desks in school rooms, combined with thorough ventilation is, I believe, superior to the ordinary disinfection. Woodwork which is constantly used or handled, soon becomes greasy and dirty, and it is not improbable that this may protect specific organisms against the action of a disin

fectant. Furthermore, I do not believe that the value of air and sunlight as disinfectants is fully appreciated and I am quite sure that modern sanitation will demand that these agents, as well as cleanliness, shall receive greater consideration in our efforts to preserve the public health."

Gunshot Wound of the Stomach with Report of Case.

By J. W. Andrews, M. D., president of the Minnesota State Medical Society. Read before the Western Surgical and Gynecological Association, at St. Louis, Mo., Dec. 29, 1902.

On March 7, 1902, little Joe Reichel, aged 11 years, returned to his home at 930 Marsh street, city of Mankato, from school, about 4:30 p. m. Like most boys of that age he returned from school hungry, and went to the pantry and ate a substantial luncheon of meat, potatoes, bread and cake. He then went out to play with a neighbor boy who had a revolver of, I think, 32-caliber. About 6 o'clock p. m., or possibly a little later, the revolver, in the hands of the neighbor boy, was accidently discharged, and the bullet passed into little Joe's body. The boys were but a few feet apart. The bullet entered the body at the junction of the seventh rib with its cartilage, passed backward and a little toward the right to the back, passing through the left lobe of liver, stomach, and burrying itself in the musthe anterior and posterior walls of the cles of the back. The wounded boy was at once taken to his home, and the family physician, Dr. E. D. Steel, was called. Dr. Steel, a well known and very able physician of our city, at once recognized the gravity of the case, and sent for the writer in consultation.

It was 8 o'clock before we reached the injured boy. We found him with at pulse of 120, temperature sub-normal, some perspiration, and other symptoms of shock. There was almost no bleeding from the external wound. The boy was restless, appeared distressed, and had vomited two or three times, each time vomiting blood, together with some of his half-past 4 luncheon. St. Joseph's hospital is about one-half mile

from the residence, and it was II o'clock before we could get the consent of the parents for an operation, convey the boy to the hospital, and get him ready to put on the operating table. We had administered strychnia hypodermically and also morphia, so that his condition at II o'clock was not materially worse than at 8 o'clock.

An incision was made in the median line, beginning one and one-half inches. below the ensiform cartilage. The first thing which caught my eye when I made the abdominal incision was the quantity of clotted blood; largely. I think, blood from the wounded liver, as this was still bleeding. The wound in the liver was found to be cone-shaped, with the base of the cone on the under surface. I closed this wound from the under surface with fine cat gut sutures deeply buried and loosely drawn. As at this time there was very little bleeding from the anterior wound in the stomach, I turned my attention as rapidly as possible to removing all blood clots in view, ably seconded by my assistant, Dr. Lida Osborn. A small quantity of the stomach contents was found mingled with this blood. I next closed the perforation in the anterior wall of the stomach with fine silk, using only the Lembert suture. The bullet had not inflicted so large an opening in the anterior wall of the stomach as in the under surface of the liver, that is, it did not remain, the reason for which is apparent to all. An exploratory incision through the gastro-colic omentum at once disclosed the fact that the bullet had not remained in the stomach, but had passed through the posterior wall, as was evidenced by the clots of blood in the Bursa Omentalis. The exploratory opening in the gastro-colic omentum was enlarged, the lesser sac cleansed from blood clots, with which

were mingled some stomach contents. I then grasped the posterior wall of the stomach and brought it down so I had easy access to the posterior perforation which I closed with Lembert silk suture, in the same manner as I had closed the anterior wound. I did not flush the abdomen, but contented myself with mopping it out as well as possible by the use of sponge pads wrung out of warm normal saline solution. The abdominal wound was closed with silkworm gut in the usual manner.

The little patient rallied nicely from the shock, and did real well for the first three days, when he began to fail, and died on the fifth day. The post-mortem showed that he died from septic peritonitis.

He was nourished entirely by rectal alimentation for the first three days, and then I began giving him light nourishment upon the stomach, for example, lime water and milk and malted milk. Co-incident with the beginning of stomach alimentation the patient began to grow worse.

Two questions: First, would it have been better to have cleansed the peritoneal cavity by a thorough flushing with warm normal salt solution, instead of simply mopping it out as best we could?

Second: Was the stomach alimentation begun on the third day, in any way responsible for the boy's death?

To the first question, I cannot be clear in my answer.

To the second, I would give a negative answer. I do not believe milk and lime water and malted milk taken into the boy's stomach did him any harm.

In civil practice, gunshot wound of the stomach is exceedingly rare. The surgeon is frequently called upon to treat gunshot wound of the head and chest, but rarely of the stomach. There