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A New Method for Cleansing and Sterilizing Ureteral Catheters with Special Reference to the Tubercle Bacillus
A NEW METHOD FOR CLEANSING AND STERILIZING URETERAL CATHETERS WITH SPECIAL REFERENCE TO THE TUBERCLE BACILLUS JULIUS H. WINER
AND
FREDERICK W. LA CAVA
From the Department of Urology of Dr. A. J. Greenberger and the Department of Bacteriology of Dr. S. A . Petroff, Sea View Hospital, Staten Island, New York
Individual kidney urines are examined in our patients1 (1) when symptoms or findings suggest renal disease or (2) whenever acid-fast bacilli are found in routine 24 hour specimens. Most studies may have been accurate but some positive reports appeared unwarranted, especially when accompanying bladder specimens showed no acid-fast bacilli and there was no cystoscopic or urographic evidence of ulcerative renal tuberculosis. Such positive urines were reported in many cases whose previous 24 hour specimens were negative, and subsequent attempts to find the organisms continually failed. Possible contamination of urine during its collection and examination, and consideration of urologic equipment, especially ureteral catheters, appeared important. Although the acid-fast bacilli may be killed by the usual disinfectants, they might not be entirely removed, nor their acid-fastness changed. The errors would result if the organisms remaining in the catheters passed into specimens at future catheterizations. The ureteral catheter's coating has many crevices where sediment may collect. Belgorod and Schain showed that acid-fast bacilli were not removed by the ordinary methods of washing and boiling from the rubber tubes and glassware used in collecting specimens for gastric analyses. Soap and water, mercury cyanide or bichloride, formaldehyde or formalin vapor, and short periods of boiling are most commonly used for disinfection and cleansing of ureteral catheters. The bacteria may be killed, but are not morphologically changed by these methods. The United States Department of Agriculture, Food and Drug Division, in condemning the mercurial germicides, states: "Mercury bichloride and certain other mercury compounds .. . fail to kill the common pusforming organism, Staphylococcus aureus. Actually a solution of mercury bichloride as strong as 1 per cent does not kill this organism in 5 minutes at room temperature." We found that mercury bichloride has 1 The 1,800 patients in Sea View Hospital have pulmonary and extra-pulmonary tuberculosis. 611
612
JULIUS H. WIN]i:R AND FREDERICK W. LA CAVA
very little solvent action on tuberculous pus in ureteral catheters. Boiling of catheters for 3 minutes affects them only slightly, but it does not kill the tubercle bacilli nor remove purulent material. After many examinations, we could find nothing to destroy acid-fast bacillus morphology without ruining catheters so a substance was sought which would remove the bacilli. Petroff and Schain described the excellent properties of "Tergitol" as a digester of tuberculous sputum and purulent empyema fluids, showing that it satisfactorily digests pus containing tubercle bacilli, inhibiting growth of all other organisms, it has powerful wetting penetrant action and is a potent surface tension depressor of water solutions. This preparation is excellent for dissolving pus and kills non-acid-fast bacteria in sputum. We used the tergitol compound favored by Petroff and Schain, the Tergitol penetrant No. 08, but the neutral tergitols and their mixture containing sodium hydroxide have a destructive effect on ureteral catheters. When acidified with sulphuric acid, the solvent action remains almost as effective for our purpose and is harmless to catheters immersed for periods up to 24 hours. The most satisfactory and inexpensive formula contains 100 cc Tergitol penetrant No. 08 and 600 cc distilled, Berkf~ld filtered, water which are mixed and filtered. Five cubic centimeters of 6 per cent sulphuric acid are added to each 100 cc of the mixture which is again filtered and kept in a cool place until used. Its phenol coefficient is .4 by the FDA method. Experimental tests with ordinary catheter antiseptics and tergitol. In Tests No. 1 and No. 2, 4 No. 6 F. Porges ureteral catheters were irrigated with urine which was a freshly voided specimen containing human tubercle bacilli from an active broth culture and some thick empyema pus containing a mixture of acid-fast bacilli and pyogenic bacteria. To prevent contamination of our testing equipment, distilled, filtered water was used and glassware and rubber was cleaned by Belgorod and Schain's method for removal of acid-fast bacilli. The various solutions were siphoned quantitatively through the catheters into test tubes which were then centrifuged at 3,500 r.p.m. for 15 minutes. The supernatant fluid was decanted, and the test tubes were inverted over filter paper to drain thoroughly. 2 The amount of 2 This step is most important as it particularly is necessary to have the sediment dry enough to make a small concentrated smear, because a dilute sediment spreads out, covering a large thin area on the slide. A concentrated sediment is more easily located microscopically, and gives a greater possibility of finding the organisms.
NEW METHOD FOR STERILIZING CATHETERS
613
sediment of pus and bacteria found in each test tube and the number of acid-fast bacilli on each smear were evaluated. Test No. 1. Through the catheters, contaminated in the above manner, 100 cc portions of sterile water, mercury cyanide 1-1000, and acidified tergitol were passed in that order. The remaining tergitol was then flushed out with sterile water. The mercury cyanide failed to completely remove the tubercle bacilli and sediment. However, after 50 cc of tergitol, the subsequent specimens were free of acid-fast bacilli and pus. SEDIMENT (PUS-BACT,)
Contaminant urine (control smear) .... ....' .... . Sterile water-two 50 cc specimens .... ...... . . . Mercury cyanide-two 50 cc specimens ... . .... . . Acid tergitol-lst 50 cc ....................... Acid tergitol-2nd 50 cc . . ........ ... . ........ Sterile water-SO cc ..... . ............ . .......
++++ ++ ++ ++++ None None
ACID-FAST BACILLI
100-200 per field 25-50 per field 5-10 per field 100-200 per field Negative Negative
Test No. 2. A 2 per cent formalin solution was used in a similar manner. The commonly used formalin vapor should have less local mechanical action in removal of organisms and pus than liquid formalin. However, tergitol cleansing revealed a retained sediment of erythrocytes, leucocytes, acid-fast bacilli and other bacteria. SEDIMENT
(PUS-BACT.)
Tuberculous urine (control) ............... ... . . Sterile water-two 50 cc specimens ..... .. .. . .. . Formaldehyde 2%-two 50 cc specimens ...... . Acid tergitol-lst 50 cc ........ ... .. . .. ... ... . Acid tergitol-2nd 50 cc . . .. ... . . . .. ...... .. . . Sterile water-SO cc ..... . .. ......... .. . . .. . . . .
++++ ++ ++ ++++ None None
ACID-FAST BACILLI
100-300 per field 25-50 per field 1-10 per field 100-200 per field None None
Formalin has a marked coagulating effect as observed and undoubtedly the same action occurs in catheters. The use of more concentrated formalin solutions require a longer subsequent period of cleansing of the catheters with tergitol. Test No. 3. To determine when adequate amounts of the acid tergitol had been passed through catheters containing pus and acid-fast bacilli, we used a less positive urine into which had been mixed some purulent fluid aspirated from a mixed infection empyema. We tested No. 6 and No. 7 catheters, with and without preliminary siphonage, with mercury cyanide and 1 per cent and 10 per cent formalin. Each solution required 30-40 minutes for 100 cc to pass through the No. 6 whistle-tip
614
JULIUS H . WINER AND FREDERICK W. LA CAVA
catheters, while olive-tip catheters were slower, and larger caliber catheters were much faster. Neither compound removed all of the sediment of pus cells, red cells, pyogenic bacteria or acid-fast bacilli, while the acid tergitol completely removed these contaminants when 100 cc were siphoned through the catheters. (See table 1.) Test No. 4. Sixteen ureteral catheters of all sizes, from the Sea View Hospital cystoscopic room, were used. These had been cleaned and supposedly sterilized immediately after use by washing, with soapy water, both inside and outside, and then siphoned with mercury cyanide (1: 1000) for 3 hours, afterwards being siphoned with sterile water overnight. Sediments were obtained from all 16 with acid tergitol siphonage. These contained pus cells, red cells, and bacteria of all varieties, ,and in the sediments from eleven catheters, we found acid-fast bacilli, morphologically identical to tubercle bacilli. These catheters had been ready for use but the sediment had not been removed during the supposed adequate sterilization. In future manipulations, the contaminants in the lumina could have passed into specimens to give erroneous reports of cellular elements and bacteria. This danger is perceptible to those who depend on smears of urine sediment due to lack of methods for culture of tubercle bacillus or to eliminate delay of treatment during the period necessary for guinea-pig inoculation. Technique. The following routine has been adopted at Sea View Hospital: Following use, the catheters are soaked in acidified tergitol for 10 minutes, siphoned with 100 to 150 cc of this solution, rinsed with sterile distilled water, and then dried. Before use again, the catheter should be soaked in acidified tergitol and the lumen filled with the preparation for a period of 10 minutes. The tergitol should be removed by rinsing with sterile distilled water before introduction into the cystoscope since its presence may inhibit growth of organisms which pass through the catheter. The 24 hour urine bottles show acid-fast bacilli in a film on the inside of the container in spite of frequent and rigorous washing. We remove this organic material with potassium dichromate and sulphuric acid solution followed by rinsing with distilled water. Cultures and animal inoculations for identification of the tubercle bacillus are important. Animal inoculation is most satisfactory. Each specimen should be inoculated into the testes of two guinea pigs. Both should be skin tested prior to inoculation and again in twelve to fourteen
TABLE 1 CATHETER SIZE
No. 6
No. 7
No. 6F
No. 7F
No. 6F
No. 7F
SOLUTIONS (SIPHON-IRRIGATION)
SEDIMENT (PUS, BLOOD)
Acid tergitol, 1st 25 cc Tergitol, 2nd 25 cc Tergitol, 3rd 25 cc Tergitol, 4th 25 cc Sterile water (flush), 100 cc
++++ ++ +
Acid tergitol, 1st 25 cc Tergitol, 2nd 25 cc Tergitol, 3rd 25 cc Tergitol, 4th 25 cc Sterile water (flush), 100 cc
++++ ++ +
Mercury cyanide 1: 1000, 1st 25 cc Cyanide, 2nd 25 cc Cyanide, 3rd 25 cc Cyanide, 4th 25 cc Acid tergitol, 1st 25 cc Tergitol, 2nd 25 cc Tergitol, 3rd 25 cc Tergitol, 4th 25 cc Sterile water, 100 cc Mercury cyanide 1: 1000, 1st 25 cc Cyanide, 2nd 25 1:c Cyanide, 3rd 25 cc Cyanide, 4th 25 cc Acid tergitol, 1st 25 cc Tergitol, 2nd 25 cc Tergitol, 3rd 25 cc Tergitol, 4th 25 cc Sterile water, 100 cc Formalin 10 per cent, 1st 25 cc Formalin, 2nd 25 cc Formalin, 3rd 25 cc Formalin, 4th 25 cc Acid tergitol, 1st 25 cc Tergitol, 2nd 25 cc Tergitol, 3rd 25 cc Tergitol, 4th 25 cc Sterile water, 100 cc Formalin 1 per cent, 1st 25 cc Formalin, 2nd 25 cc Formalin, 3rd 25 cc Formalin, 4th 25 cc Acid tergitol, 1st 25 cc Tergitol, 2nd 25 cc Tergitol, 3rd 25 cc Tergitol, 4th 25 cc Sterile water, 100 cc_
615
None None
l l l l l l l l
ACID-FAST BACILLI
Many per field Few per field None None None
None None
Few per field None None None None
None
Few
+
Few
++
Few
None
None
None
None
None
Few
+
Few
++
Few
None
None
None
None
None
None
None
None
++++
Many per field
None
None
None
None
None
None
None
None
+++
Few per field
None
None
None
None
616
JULIUS H . WINER AND FREDERICK W. LA CAVA
days. At this time the testis from one animal is removed, sectioned, and stained for acid-fast bacilli. This animal is autopsied in 6 weeks if the skin test is positive. The second animal is killed after the 3 months regulation period. Comment. The question presents itself whether the diagnosis of "tubercle bacilluria" without evidence of tuberculous involvement of the kidney was possibly made by observers who unwittingly introduced the organisms in contaminated catheters and equipment and later found positive urine after careful examination of the smears. Caution. The tergitols should not be used on cystoscopes as they dissolve the cements supporting the lamps and lenses. SUMMARY
A new method for cleansing and sterilizing ureteral catheters is presented, using acidified 12½ per cent Tergitol Penetrant No. 08. Mercury cyanide and formalin solutions are unsatisfactory for removal of pus, blood and bacteria from catheters. Diagnosis of renal tuberculosis requires animal inoculation or culture for recognition of the organisms. We wish to thank the Carbide and Carbon Corporation for cooperation in this problem by supplying us with a number of "Tergitols" and other organic solvents. REFERENCES BEER, E.: J. A. M.A., 92: 1912-1917, 1929. BELGOROD, S. H., AND SCHAIN, P.: Quart. Bull. Sea View Hosp., 4: 182-188, 1939. GREENBERGER, A. J., AND GREENBERGER, M. E.: Quart. Bull. Sea View Hosp., 1: 43-51, 1935. PETROFF, S. A., AND SCHAIN, P.: Quart. Bull. Sea View Hosp., 4: 145-152, 1939. THOMAS, G. J., KINSELLA, T. J., AND VAN WINKLE, C. C.: Trans. Am. Assoc. Genito-Urin. Surg., 865-70, 1934.
AND
FREDERICK W. LA CAVA
From the Department of Urology of Dr. A. J. Greenberger and the Department of Bacteriology of Dr. S. A . Petroff, Sea View Hospital, Staten Island, New York
Individual kidney urines are examined in our patients1 (1) when symptoms or findings suggest renal disease or (2) whenever acid-fast bacilli are found in routine 24 hour specimens. Most studies may have been accurate but some positive reports appeared unwarranted, especially when accompanying bladder specimens showed no acid-fast bacilli and there was no cystoscopic or urographic evidence of ulcerative renal tuberculosis. Such positive urines were reported in many cases whose previous 24 hour specimens were negative, and subsequent attempts to find the organisms continually failed. Possible contamination of urine during its collection and examination, and consideration of urologic equipment, especially ureteral catheters, appeared important. Although the acid-fast bacilli may be killed by the usual disinfectants, they might not be entirely removed, nor their acid-fastness changed. The errors would result if the organisms remaining in the catheters passed into specimens at future catheterizations. The ureteral catheter's coating has many crevices where sediment may collect. Belgorod and Schain showed that acid-fast bacilli were not removed by the ordinary methods of washing and boiling from the rubber tubes and glassware used in collecting specimens for gastric analyses. Soap and water, mercury cyanide or bichloride, formaldehyde or formalin vapor, and short periods of boiling are most commonly used for disinfection and cleansing of ureteral catheters. The bacteria may be killed, but are not morphologically changed by these methods. The United States Department of Agriculture, Food and Drug Division, in condemning the mercurial germicides, states: "Mercury bichloride and certain other mercury compounds .. . fail to kill the common pusforming organism, Staphylococcus aureus. Actually a solution of mercury bichloride as strong as 1 per cent does not kill this organism in 5 minutes at room temperature." We found that mercury bichloride has 1 The 1,800 patients in Sea View Hospital have pulmonary and extra-pulmonary tuberculosis. 611
612
JULIUS H. WIN]i:R AND FREDERICK W. LA CAVA
very little solvent action on tuberculous pus in ureteral catheters. Boiling of catheters for 3 minutes affects them only slightly, but it does not kill the tubercle bacilli nor remove purulent material. After many examinations, we could find nothing to destroy acid-fast bacillus morphology without ruining catheters so a substance was sought which would remove the bacilli. Petroff and Schain described the excellent properties of "Tergitol" as a digester of tuberculous sputum and purulent empyema fluids, showing that it satisfactorily digests pus containing tubercle bacilli, inhibiting growth of all other organisms, it has powerful wetting penetrant action and is a potent surface tension depressor of water solutions. This preparation is excellent for dissolving pus and kills non-acid-fast bacteria in sputum. We used the tergitol compound favored by Petroff and Schain, the Tergitol penetrant No. 08, but the neutral tergitols and their mixture containing sodium hydroxide have a destructive effect on ureteral catheters. When acidified with sulphuric acid, the solvent action remains almost as effective for our purpose and is harmless to catheters immersed for periods up to 24 hours. The most satisfactory and inexpensive formula contains 100 cc Tergitol penetrant No. 08 and 600 cc distilled, Berkf~ld filtered, water which are mixed and filtered. Five cubic centimeters of 6 per cent sulphuric acid are added to each 100 cc of the mixture which is again filtered and kept in a cool place until used. Its phenol coefficient is .4 by the FDA method. Experimental tests with ordinary catheter antiseptics and tergitol. In Tests No. 1 and No. 2, 4 No. 6 F. Porges ureteral catheters were irrigated with urine which was a freshly voided specimen containing human tubercle bacilli from an active broth culture and some thick empyema pus containing a mixture of acid-fast bacilli and pyogenic bacteria. To prevent contamination of our testing equipment, distilled, filtered water was used and glassware and rubber was cleaned by Belgorod and Schain's method for removal of acid-fast bacilli. The various solutions were siphoned quantitatively through the catheters into test tubes which were then centrifuged at 3,500 r.p.m. for 15 minutes. The supernatant fluid was decanted, and the test tubes were inverted over filter paper to drain thoroughly. 2 The amount of 2 This step is most important as it particularly is necessary to have the sediment dry enough to make a small concentrated smear, because a dilute sediment spreads out, covering a large thin area on the slide. A concentrated sediment is more easily located microscopically, and gives a greater possibility of finding the organisms.
NEW METHOD FOR STERILIZING CATHETERS
613
sediment of pus and bacteria found in each test tube and the number of acid-fast bacilli on each smear were evaluated. Test No. 1. Through the catheters, contaminated in the above manner, 100 cc portions of sterile water, mercury cyanide 1-1000, and acidified tergitol were passed in that order. The remaining tergitol was then flushed out with sterile water. The mercury cyanide failed to completely remove the tubercle bacilli and sediment. However, after 50 cc of tergitol, the subsequent specimens were free of acid-fast bacilli and pus. SEDIMENT (PUS-BACT,)
Contaminant urine (control smear) .... ....' .... . Sterile water-two 50 cc specimens .... ...... . . . Mercury cyanide-two 50 cc specimens ... . .... . . Acid tergitol-lst 50 cc ....................... Acid tergitol-2nd 50 cc . . ........ ... . ........ Sterile water-SO cc ..... . ............ . .......
++++ ++ ++ ++++ None None
ACID-FAST BACILLI
100-200 per field 25-50 per field 5-10 per field 100-200 per field Negative Negative
Test No. 2. A 2 per cent formalin solution was used in a similar manner. The commonly used formalin vapor should have less local mechanical action in removal of organisms and pus than liquid formalin. However, tergitol cleansing revealed a retained sediment of erythrocytes, leucocytes, acid-fast bacilli and other bacteria. SEDIMENT
(PUS-BACT.)
Tuberculous urine (control) ............... ... . . Sterile water-two 50 cc specimens ..... .. .. . .. . Formaldehyde 2%-two 50 cc specimens ...... . Acid tergitol-lst 50 cc ........ ... .. . .. ... ... . Acid tergitol-2nd 50 cc . . .. ... . . . .. ...... .. . . Sterile water-SO cc ..... . .. ......... .. . . .. . . . .
++++ ++ ++ ++++ None None
ACID-FAST BACILLI
100-300 per field 25-50 per field 1-10 per field 100-200 per field None None
Formalin has a marked coagulating effect as observed and undoubtedly the same action occurs in catheters. The use of more concentrated formalin solutions require a longer subsequent period of cleansing of the catheters with tergitol. Test No. 3. To determine when adequate amounts of the acid tergitol had been passed through catheters containing pus and acid-fast bacilli, we used a less positive urine into which had been mixed some purulent fluid aspirated from a mixed infection empyema. We tested No. 6 and No. 7 catheters, with and without preliminary siphonage, with mercury cyanide and 1 per cent and 10 per cent formalin. Each solution required 30-40 minutes for 100 cc to pass through the No. 6 whistle-tip
614
JULIUS H . WINER AND FREDERICK W. LA CAVA
catheters, while olive-tip catheters were slower, and larger caliber catheters were much faster. Neither compound removed all of the sediment of pus cells, red cells, pyogenic bacteria or acid-fast bacilli, while the acid tergitol completely removed these contaminants when 100 cc were siphoned through the catheters. (See table 1.) Test No. 4. Sixteen ureteral catheters of all sizes, from the Sea View Hospital cystoscopic room, were used. These had been cleaned and supposedly sterilized immediately after use by washing, with soapy water, both inside and outside, and then siphoned with mercury cyanide (1: 1000) for 3 hours, afterwards being siphoned with sterile water overnight. Sediments were obtained from all 16 with acid tergitol siphonage. These contained pus cells, red cells, and bacteria of all varieties, ,and in the sediments from eleven catheters, we found acid-fast bacilli, morphologically identical to tubercle bacilli. These catheters had been ready for use but the sediment had not been removed during the supposed adequate sterilization. In future manipulations, the contaminants in the lumina could have passed into specimens to give erroneous reports of cellular elements and bacteria. This danger is perceptible to those who depend on smears of urine sediment due to lack of methods for culture of tubercle bacillus or to eliminate delay of treatment during the period necessary for guinea-pig inoculation. Technique. The following routine has been adopted at Sea View Hospital: Following use, the catheters are soaked in acidified tergitol for 10 minutes, siphoned with 100 to 150 cc of this solution, rinsed with sterile distilled water, and then dried. Before use again, the catheter should be soaked in acidified tergitol and the lumen filled with the preparation for a period of 10 minutes. The tergitol should be removed by rinsing with sterile distilled water before introduction into the cystoscope since its presence may inhibit growth of organisms which pass through the catheter. The 24 hour urine bottles show acid-fast bacilli in a film on the inside of the container in spite of frequent and rigorous washing. We remove this organic material with potassium dichromate and sulphuric acid solution followed by rinsing with distilled water. Cultures and animal inoculations for identification of the tubercle bacillus are important. Animal inoculation is most satisfactory. Each specimen should be inoculated into the testes of two guinea pigs. Both should be skin tested prior to inoculation and again in twelve to fourteen
TABLE 1 CATHETER SIZE
No. 6
No. 7
No. 6F
No. 7F
No. 6F
No. 7F
SOLUTIONS (SIPHON-IRRIGATION)
SEDIMENT (PUS, BLOOD)
Acid tergitol, 1st 25 cc Tergitol, 2nd 25 cc Tergitol, 3rd 25 cc Tergitol, 4th 25 cc Sterile water (flush), 100 cc
++++ ++ +
Acid tergitol, 1st 25 cc Tergitol, 2nd 25 cc Tergitol, 3rd 25 cc Tergitol, 4th 25 cc Sterile water (flush), 100 cc
++++ ++ +
Mercury cyanide 1: 1000, 1st 25 cc Cyanide, 2nd 25 cc Cyanide, 3rd 25 cc Cyanide, 4th 25 cc Acid tergitol, 1st 25 cc Tergitol, 2nd 25 cc Tergitol, 3rd 25 cc Tergitol, 4th 25 cc Sterile water, 100 cc Mercury cyanide 1: 1000, 1st 25 cc Cyanide, 2nd 25 1:c Cyanide, 3rd 25 cc Cyanide, 4th 25 cc Acid tergitol, 1st 25 cc Tergitol, 2nd 25 cc Tergitol, 3rd 25 cc Tergitol, 4th 25 cc Sterile water, 100 cc Formalin 10 per cent, 1st 25 cc Formalin, 2nd 25 cc Formalin, 3rd 25 cc Formalin, 4th 25 cc Acid tergitol, 1st 25 cc Tergitol, 2nd 25 cc Tergitol, 3rd 25 cc Tergitol, 4th 25 cc Sterile water, 100 cc Formalin 1 per cent, 1st 25 cc Formalin, 2nd 25 cc Formalin, 3rd 25 cc Formalin, 4th 25 cc Acid tergitol, 1st 25 cc Tergitol, 2nd 25 cc Tergitol, 3rd 25 cc Tergitol, 4th 25 cc Sterile water, 100 cc_
615
None None
l l l l l l l l
ACID-FAST BACILLI
Many per field Few per field None None None
None None
Few per field None None None None
None
Few
+
Few
++
Few
None
None
None
None
None
Few
+
Few
++
Few
None
None
None
None
None
None
None
None
++++
Many per field
None
None
None
None
None
None
None
None
+++
Few per field
None
None
None
None
616
JULIUS H . WINER AND FREDERICK W. LA CAVA
days. At this time the testis from one animal is removed, sectioned, and stained for acid-fast bacilli. This animal is autopsied in 6 weeks if the skin test is positive. The second animal is killed after the 3 months regulation period. Comment. The question presents itself whether the diagnosis of "tubercle bacilluria" without evidence of tuberculous involvement of the kidney was possibly made by observers who unwittingly introduced the organisms in contaminated catheters and equipment and later found positive urine after careful examination of the smears. Caution. The tergitols should not be used on cystoscopes as they dissolve the cements supporting the lamps and lenses. SUMMARY
A new method for cleansing and sterilizing ureteral catheters is presented, using acidified 12½ per cent Tergitol Penetrant No. 08. Mercury cyanide and formalin solutions are unsatisfactory for removal of pus, blood and bacteria from catheters. Diagnosis of renal tuberculosis requires animal inoculation or culture for recognition of the organisms. We wish to thank the Carbide and Carbon Corporation for cooperation in this problem by supplying us with a number of "Tergitols" and other organic solvents. REFERENCES BEER, E.: J. A. M.A., 92: 1912-1917, 1929. BELGOROD, S. H., AND SCHAIN, P.: Quart. Bull. Sea View Hosp., 4: 182-188, 1939. GREENBERGER, A. J., AND GREENBERGER, M. E.: Quart. Bull. Sea View Hosp., 1: 43-51, 1935. PETROFF, S. A., AND SCHAIN, P.: Quart. Bull. Sea View Hosp., 4: 145-152, 1939. THOMAS, G. J., KINSELLA, T. J., AND VAN WINKLE, C. C.: Trans. Am. Assoc. Genito-Urin. Surg., 865-70, 1934.