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A voice from the past
306
Editorial
C o m m u n i t y Health Services' remain the responsibility of the Health Authorities. G P ' s however will be required to ensure that Social Services departments are aware of their patients' needs. The joint finance p r o g r a m m e will presumably cease, as Social Services will become responsible for this funding. Such aspects of the current N H S provision as bathing attendants are likely to be transferred to Social Services, and the report also envisages staff of mental or mental handicap hospitals which close being taken on by the Social Services so that they m a y continue to look after the patients they know. H o w this would be done is not explained. The effects on district councils and Housing Associations will be relatively modest. Their responsibility will be confined to 'bricks and m o r t a r ' . Any wardens and other caring staff employed will be transferred to the employ of Social Services, unless the latter pays the district council or housing association to provide the services as their agent. By making an individual officer o f the Social Services responsible for ensuring that an individual receives the care appropriate to his needs, Sir Roy's proposals should close some of the gaps in existing services. Whether their potential for good can be achieved will depend upon the quality o f the staff social services are able to recruit, and upon the adequacy o f the funds made available. Whether the proposed new occupation of ' C o m m u n i t y Carer' will prove attractive, and what range of duties they will provide must remain matters for speculation. Unlike the Griffith report on the N H S which caused needlessly excessive change in upper management (but had little affect upon clinical staff), this report will, if implemented, affect the lowly carer or case-worker to a greater extent than the Directors o f Social Services. Despite the evident belief of successive Secretaries of State to the contrary, it is the personal qualities of the carers rather than the administrative structure within which they work which is the main determinant o f the quality o f care. The success or failure of these proposals will depend on whether they are implemented in such a way as to attract good staff and maintain high morale, or in ways which cause frustration and annoyance.
A V o i c e f r o m t h e Past The following excerpt from the first issue o f 'Public Health' in M a y 1888 gives interesting insights into the state of knowledge at that time. The article was not attributed to any author, and was probably written by Dr. A. Wynter Blyth, who was the first editor.
Disinfection The disinfection of rooms A contribution to our knowledge o f efficient disinfection has been made by Dr. S. E. Crupin, o f the Alexandra Barracks Hospital, St. Petersburgh (Zeitsehrift f. Hygiene 3, Bd., 2 heft 1887). He used chlorine gas for purposes o f disinfection with apparent success until the following incidents occurred which caused doubts as to its efficacy. A ward infected with diphtheria o f 900 cubic metres capacity was disinfected with chlorine gas evolved from the reaction o f 50 kilos o f chloride o f lime and 65 kilos o f hydrochloric acid, the ward was well ventilated and not occupied for seven months. It was then
A Voice from the Past
307
used for the reception of measles for four months; some o f the cases began to show diphtheric complications, the ward was therefore closed and disinfected with chlorine gas, using to each cubic metre 150 grms of chloride of lime and 165 grms o f hydrochloric acid; it was disused for seven months, and then opened for reception of smallpox cases; again diphtheria showed itself, the ward physician, two sisters, and a servant being among those struck down. For the third time, the ward was closed and disinfected with chlorine; it was opened again after a few months and there had been no return. Laboratory experiments have shown the efficacy of chlorine, but Dr. Crupin thought that the conditions o f a laboratory experiment, perhaps, could not be observed in actual practiee. To ascertain this he exposed anthrax spores on threads in a ward and evolved chlorine gas from one kilo o f chloride o f lime per cubic metre. Upon after-cultivation o['the spores out o f seven threads exposed in different parts, the majority were found not to be disinfected at all. He therefore forsook chlorine and experimented with the following solutions: 1. Corrosive sublimate solution, one per thousand. 2. Carbolic' acid solution, .five percent. 3. Equal volumes of both the above. Experimenting on anthrax spores, he found that the carbolic acid solution failed, that the corrosive sublimate disinfected in the majority o f instances but by far the best result was obtained with the mixture. He therefore advises for the disinfection of rooms, washing and spraying with equal volumes o f one per thousand, corrosive sublimate solution and a five percent solution of carbolic acid. According to his experience rooms thus disinfected are not injurious to their subsequent inhabitants. It is noteworthy that he disinfects after pneumonia. The disinfection of cholera discharges N. P. Wasseljew describes and figures in the Zeitschrift f, Hygiene 2, Bd., 2 heft, an apparatus for sterilising cholera excreta. It essentially consists of a reservoir from which the excreta can be discharged into strong iron vessels and heated therein by steam at a pressure o f seven atmospheres. Tenacity o f micro-life Dr. Globig has described under the name o f the red potato bacillus (Zeitschrift f. Hygiene 3, Bd, 2 heft) a motile bacillus with extremely resistant spores. It withstands a steam heat at ordinary pressure for five hours, but may be destroyed at higher temperatures than 100 deg. C. in the following times: At 109 deg. in 75 mins., 113 l l 6 deg. in 25mins., 122-123 deg., in 10 mins., 126 deg., in 3 rains.; at 130 deg. steam heat it destroys it momentarily. Disinfection o f the tubercle bacillus M. A. Yersin (Annales de L'Institut Pasteur No.2, 25th February, 1888,) has experimented on the bacillus o f tubercle by a method first described to the Royal Society o f Edinburgh, 1883.* The method essentially consists in steeping a thread in virus, then submitting the infected thread to the action o f a disinfectant, dissolving out the disinfectant by means of suitable sterile solvents, and then submitting the thread to cultivation in a nutrient medium. Following out this plan, he gives the jollowing as the result o f his experiments with the bacillus of tubercle: *Experiments on the chief disinJectants by A. Wynter Blyth, Proc. Royal Society, Edinburgh, 1883-4;see also Proc. Royal Society London 1885.
308
A Voice from the Past
Substance used Time Phenol 5 percent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 secs Phenol 10 percent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 min. Absolute alcohol .......................................... 5 min. Iodoform in ether 1 percent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 min. Ether . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 min. Mercuric Chloride 1 percent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 min. Thymol ................................................ 2 hrs. Salicylic Acid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 hrs. He also studied the action o f heat, and declares that at a temperature o f above 70 deg., sterilisation is effected. A local Notification o f Diseases Act A curious case occurreda little time ago at Jarrow. Under the Jarrow Improvement Act, 1884, it is made compulsory on every medical practitioner on becoming aware o f cases o f infectious diseases enumerated in a schedule to forthwith fill up, sign and deliver, or send to the Medical Officer o f Health a certificate or declaration' stating the nature o f the disease and other particulars. It appears that the medical practitioner o f the town attended a family for some infectious malady, and that he sent a certificate without giving the name o f the disease, but simply stated that it was "infectious disease o f dangerous character', thereupon the Corporation instituted a prosecution, which, however, completely collapsed because there was no distinct evidence to prove the nature o f the disease the family had been suffering from. The case, although most unsatisfactory, is useful as showing the nature o f the opposition sanitary authorities and their officers will have occasionally to contend with when either local or general acts enforce notification.
Editorial
C o m m u n i t y Health Services' remain the responsibility of the Health Authorities. G P ' s however will be required to ensure that Social Services departments are aware of their patients' needs. The joint finance p r o g r a m m e will presumably cease, as Social Services will become responsible for this funding. Such aspects of the current N H S provision as bathing attendants are likely to be transferred to Social Services, and the report also envisages staff of mental or mental handicap hospitals which close being taken on by the Social Services so that they m a y continue to look after the patients they know. H o w this would be done is not explained. The effects on district councils and Housing Associations will be relatively modest. Their responsibility will be confined to 'bricks and m o r t a r ' . Any wardens and other caring staff employed will be transferred to the employ of Social Services, unless the latter pays the district council or housing association to provide the services as their agent. By making an individual officer o f the Social Services responsible for ensuring that an individual receives the care appropriate to his needs, Sir Roy's proposals should close some of the gaps in existing services. Whether their potential for good can be achieved will depend upon the quality o f the staff social services are able to recruit, and upon the adequacy o f the funds made available. Whether the proposed new occupation of ' C o m m u n i t y Carer' will prove attractive, and what range of duties they will provide must remain matters for speculation. Unlike the Griffith report on the N H S which caused needlessly excessive change in upper management (but had little affect upon clinical staff), this report will, if implemented, affect the lowly carer or case-worker to a greater extent than the Directors o f Social Services. Despite the evident belief of successive Secretaries of State to the contrary, it is the personal qualities of the carers rather than the administrative structure within which they work which is the main determinant o f the quality o f care. The success or failure of these proposals will depend on whether they are implemented in such a way as to attract good staff and maintain high morale, or in ways which cause frustration and annoyance.
A V o i c e f r o m t h e Past The following excerpt from the first issue o f 'Public Health' in M a y 1888 gives interesting insights into the state of knowledge at that time. The article was not attributed to any author, and was probably written by Dr. A. Wynter Blyth, who was the first editor.
Disinfection The disinfection of rooms A contribution to our knowledge o f efficient disinfection has been made by Dr. S. E. Crupin, o f the Alexandra Barracks Hospital, St. Petersburgh (Zeitsehrift f. Hygiene 3, Bd., 2 heft 1887). He used chlorine gas for purposes o f disinfection with apparent success until the following incidents occurred which caused doubts as to its efficacy. A ward infected with diphtheria o f 900 cubic metres capacity was disinfected with chlorine gas evolved from the reaction o f 50 kilos o f chloride o f lime and 65 kilos o f hydrochloric acid, the ward was well ventilated and not occupied for seven months. It was then
A Voice from the Past
307
used for the reception of measles for four months; some o f the cases began to show diphtheric complications, the ward was therefore closed and disinfected with chlorine gas, using to each cubic metre 150 grms of chloride of lime and 165 grms o f hydrochloric acid; it was disused for seven months, and then opened for reception of smallpox cases; again diphtheria showed itself, the ward physician, two sisters, and a servant being among those struck down. For the third time, the ward was closed and disinfected with chlorine; it was opened again after a few months and there had been no return. Laboratory experiments have shown the efficacy of chlorine, but Dr. Crupin thought that the conditions o f a laboratory experiment, perhaps, could not be observed in actual practiee. To ascertain this he exposed anthrax spores on threads in a ward and evolved chlorine gas from one kilo o f chloride o f lime per cubic metre. Upon after-cultivation o['the spores out o f seven threads exposed in different parts, the majority were found not to be disinfected at all. He therefore forsook chlorine and experimented with the following solutions: 1. Corrosive sublimate solution, one per thousand. 2. Carbolic' acid solution, .five percent. 3. Equal volumes of both the above. Experimenting on anthrax spores, he found that the carbolic acid solution failed, that the corrosive sublimate disinfected in the majority o f instances but by far the best result was obtained with the mixture. He therefore advises for the disinfection of rooms, washing and spraying with equal volumes o f one per thousand, corrosive sublimate solution and a five percent solution of carbolic acid. According to his experience rooms thus disinfected are not injurious to their subsequent inhabitants. It is noteworthy that he disinfects after pneumonia. The disinfection of cholera discharges N. P. Wasseljew describes and figures in the Zeitschrift f, Hygiene 2, Bd., 2 heft, an apparatus for sterilising cholera excreta. It essentially consists of a reservoir from which the excreta can be discharged into strong iron vessels and heated therein by steam at a pressure o f seven atmospheres. Tenacity o f micro-life Dr. Globig has described under the name o f the red potato bacillus (Zeitschrift f. Hygiene 3, Bd, 2 heft) a motile bacillus with extremely resistant spores. It withstands a steam heat at ordinary pressure for five hours, but may be destroyed at higher temperatures than 100 deg. C. in the following times: At 109 deg. in 75 mins., 113 l l 6 deg. in 25mins., 122-123 deg., in 10 mins., 126 deg., in 3 rains.; at 130 deg. steam heat it destroys it momentarily. Disinfection o f the tubercle bacillus M. A. Yersin (Annales de L'Institut Pasteur No.2, 25th February, 1888,) has experimented on the bacillus o f tubercle by a method first described to the Royal Society o f Edinburgh, 1883.* The method essentially consists in steeping a thread in virus, then submitting the infected thread to the action o f a disinfectant, dissolving out the disinfectant by means of suitable sterile solvents, and then submitting the thread to cultivation in a nutrient medium. Following out this plan, he gives the jollowing as the result o f his experiments with the bacillus of tubercle: *Experiments on the chief disinJectants by A. Wynter Blyth, Proc. Royal Society, Edinburgh, 1883-4;see also Proc. Royal Society London 1885.
308
A Voice from the Past
Substance used Time Phenol 5 percent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 secs Phenol 10 percent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 min. Absolute alcohol .......................................... 5 min. Iodoform in ether 1 percent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 min. Ether . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 min. Mercuric Chloride 1 percent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 min. Thymol ................................................ 2 hrs. Salicylic Acid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 hrs. He also studied the action o f heat, and declares that at a temperature o f above 70 deg., sterilisation is effected. A local Notification o f Diseases Act A curious case occurreda little time ago at Jarrow. Under the Jarrow Improvement Act, 1884, it is made compulsory on every medical practitioner on becoming aware o f cases o f infectious diseases enumerated in a schedule to forthwith fill up, sign and deliver, or send to the Medical Officer o f Health a certificate or declaration' stating the nature o f the disease and other particulars. It appears that the medical practitioner o f the town attended a family for some infectious malady, and that he sent a certificate without giving the name o f the disease, but simply stated that it was "infectious disease o f dangerous character', thereupon the Corporation instituted a prosecution, which, however, completely collapsed because there was no distinct evidence to prove the nature o f the disease the family had been suffering from. The case, although most unsatisfactory, is useful as showing the nature o f the opposition sanitary authorities and their officers will have occasionally to contend with when either local or general acts enforce notification.