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BLANKETS AND INFECTION
801
mylamine and chlorothiazide the tremor rapidly diminished, although it was still detectable ten days after withdrawal. The addition of chlorothiazide did not appear to potentiate the hypotensive effects of mecamylamine, but it may have facilitated the appearance of an untoward reaction to this drug. I am grateful to Dr. T. D. Kellock for permission to report this case.
Central Middlesex Hospital, London, N.W.10.
A. M. CONNELL.
BLANKETS AND INFECTION SIR,-Your issue of Oct. 4 contains many views hospital bedding. All are very interesting and show awakening interest in this subject.
with pernicious anaemia in relapse. 11 consecutive in one study received 5-15 jHg. of vitamin B12 by mouth daily for five months; there was an almost regular occurrence of remission, with 3 of the patients showing a maximal response. All this, it must be noted, was without added peptide or any other substance. There are two mechanisms of vitamin-B12 absorption,89 one of which is intrinsic-factor-dependent, and the other independent of intrinsic factor. It is this latter mechanism which is primarily responsible for the absorption of significant amounts of vitamin B12 when oral doses in excess of 2 ug.
patients patients
are
on an
Taken as an economic proposition, most hospitals have a great store (in hospital beds) of blankets. To replace them all at once would be very costly. As the woollen blankets wear out, new ones can be made of other materials. The process of replacement must necessarily be slow, and in the meantime cross-infection must be prevented. We have found that a most effective process consists in the routine of dirt removal by ’Lissapol’ (which also removes traces of soap which might neutralise the activity of the next-stage chemical) followed by thorough rinsing and partial drying in a centrifuge (spin-dryer) preparatory to soaking for twenty minutes in ’Fixanol C ’, and then complete drying, without further rinsing. The blankets are not damaged and the fibres adsorb some of the quaternary ammonium compound, and retain their antibacterial properties for four weeks. In our experience ’Cirrasol 0 D’, although much vaunted, is inferior to fixanol C. Although the lissapol and fixanol C routine is very satisfactory from the viewpoint of the prevention of cross-infection, the procedure involves much manual labour; and labour is very costly. For some years
we have been looking for a means of reducing these labour costs. We had in mind a chemical which would " combine the operations of " cleansing " and " sterilisation in we were in one process. Until quite recently unsuccessful our search. A few weeks ago we gave a trial to blanket washing and sterilising-in one operation-withHytox’, a proprietary preparation marketed by Domestos. Hytox has now been tried at one of our hospitals with great success. The blankets emerge very white, soft, and clean, and the fibres have antibacterial properties and are sterile. Hytox also is inactivated by traces oi ordinary washing-soap in the blanket or in the crevices of the washing-machine; so the first time a used blanket is washed tht results may be disappointing. However, the second time tht blankets are washed in a clean machine the results are ver
satisfactory. St. Margaret’s Hospital
Epping, Essex.
FRANK MARSH.
ORAL TREATMENT OF PERNICIOUS ANÆMIA SIR,-We judge from the reply of Dr. Mooney and
Dr. Heathcote (Aug. 16) to Professor Castle’s comments (Aug. 2) on their recent article1 that they are unwilling to accept certain data which, in our opinion, completely invalidate their conclusions with respect to their " vita-
lmin-B2 peptide complex ". The fundamental criticism remains that their study lacked controls: they failed to use patients who were to receive only vitamin B12 without the peptide or any other additives. This lack of a control makes any conclusions untenable. Many studies 2-7 have shown that small oral amounts of vitamin Bl2’ from 5 f.1g. to 100 fA-g. daily, will often produce remission in 1. Heathcote, J. G., Mooney, F. S. Lancet, 1958, i, 982. 2. Estren, S., Wasserman, L. R. Proc. Soc. exp. Biol., N.Y. 1956, 3. Hall, B. E. Brit. med. J. 1950, ii, 585. 4. Glass, G. B. J., Boyd, L. J. Blood, 1953, 8, 867. 5. Glass, G. B. J., Boyd, L. J., Rubinstein, M. A., Svigals, C. S. 6. 7.
1952, 115, 101. Chalmers, J. N. M., Hall, Z. M. Brit. med. J. 1954, i, 1179. Ungley, C. C. ibid. 1950, ii, 905.
91, 499. Science,
ingested.
There is the slight possibility that a peptide may stimulate gastric secretion of the slight residual intrinsic factor still present in some patients with pernicious ansemia" in a manner similar to carbachol," and perhaps d-sorbitol.12
Their comments with respect to the existence of intrinsic factor are pure speculations, unrelated either to their own studies or the many studies on which the concept of existence of Castle’s intrinsic factor firmly rests.
Mount Sinai Hospital, New York.
VICTOR HERBERT SOLOMON ESTREN EUGENE BRODY LOUIS R. WASSERMAN.
WATER FLUORIDATION
SiR,—Iam rather surprised at the attitude taken by your correspondent (Oct. 4, p. 741). A few facts are essential for consideration. (1) Waters containing fluorides at 1 part per million do not taste, smell, or appear different from that with a trace. (2) All waters in this country, so far as I know, contain some fluoride. (3) Water treatment often causes a slight reduction in the fluoride level. (4) Populations living in areas containing fluoride at levels of 2, 3, or more parts per million do not suffer from ill health or disease. (5) The amount of suffering in children which is avoidable is immense. (6) The ordinary person’s attitude (and having discussed this with a considerable number of members of the public I think I know their attitude) is that he is all for it if aware of the facts. (7) If some members of the public have been frightened by a thoroughly dishonest campaign then they are against it. (8) The " freedom of choice " argument also applies to chlorination and all aspects of water treatment. (9) The lies and half-truths put out by the opposition would not be used if there was a genuine case. The methods used have been exposed in the New Zealand report. -
surprised, indeed amazed, that your correspondent that the public (mothers of 8 children included!) suggests would administer fluoride tablets. Does he know that this would have to be done for years and years and years ? Most patients have difficulty in persisting with any treatment lasting for more than a few days. (11) Is your correspondent aware of the present accident-rate from children taking tablets in the home ? (12) If those who want lower fluoride water (e.g., the more usual 0-2 p.p.m.) live in a fluoride area, they can install a defluoridator. After all, I prefer private education for my child, so I pay for it. If there is a demand for defluoridators they will, doubtless, be produced by private enterprise for the few who want them. (10)
I
am
It is, Sir, I know, possible fluoridation without contrary
to
get
votes.
Council to approve It does take a lot of
a
8. Ross, G. I. M., Mollin, D. L., Cox, E. V., Ungley, C. C. Blood, 1954, 9, 473. 9. Doscherholmen, A., Hagen, P. S. J. clin. Invest. 1957, 36, 1551. 10. Goldhamer, S. M. Amer. J. med. Sci. 1936, 191, 405. 11. Mollin, D. L., Booth, C. C., Baker, S. J. Brit. J. Hœmat. 1957, 3, 412. 12. Herbert, V. Amer. J. clin. Nutr. 1958, 6, 547.
mylamine and chlorothiazide the tremor rapidly diminished, although it was still detectable ten days after withdrawal. The addition of chlorothiazide did not appear to potentiate the hypotensive effects of mecamylamine, but it may have facilitated the appearance of an untoward reaction to this drug. I am grateful to Dr. T. D. Kellock for permission to report this case.
Central Middlesex Hospital, London, N.W.10.
A. M. CONNELL.
BLANKETS AND INFECTION SIR,-Your issue of Oct. 4 contains many views hospital bedding. All are very interesting and show awakening interest in this subject.
with pernicious anaemia in relapse. 11 consecutive in one study received 5-15 jHg. of vitamin B12 by mouth daily for five months; there was an almost regular occurrence of remission, with 3 of the patients showing a maximal response. All this, it must be noted, was without added peptide or any other substance. There are two mechanisms of vitamin-B12 absorption,89 one of which is intrinsic-factor-dependent, and the other independent of intrinsic factor. It is this latter mechanism which is primarily responsible for the absorption of significant amounts of vitamin B12 when oral doses in excess of 2 ug.
patients patients
are
on an
Taken as an economic proposition, most hospitals have a great store (in hospital beds) of blankets. To replace them all at once would be very costly. As the woollen blankets wear out, new ones can be made of other materials. The process of replacement must necessarily be slow, and in the meantime cross-infection must be prevented. We have found that a most effective process consists in the routine of dirt removal by ’Lissapol’ (which also removes traces of soap which might neutralise the activity of the next-stage chemical) followed by thorough rinsing and partial drying in a centrifuge (spin-dryer) preparatory to soaking for twenty minutes in ’Fixanol C ’, and then complete drying, without further rinsing. The blankets are not damaged and the fibres adsorb some of the quaternary ammonium compound, and retain their antibacterial properties for four weeks. In our experience ’Cirrasol 0 D’, although much vaunted, is inferior to fixanol C. Although the lissapol and fixanol C routine is very satisfactory from the viewpoint of the prevention of cross-infection, the procedure involves much manual labour; and labour is very costly. For some years
we have been looking for a means of reducing these labour costs. We had in mind a chemical which would " combine the operations of " cleansing " and " sterilisation in we were in one process. Until quite recently unsuccessful our search. A few weeks ago we gave a trial to blanket washing and sterilising-in one operation-withHytox’, a proprietary preparation marketed by Domestos. Hytox has now been tried at one of our hospitals with great success. The blankets emerge very white, soft, and clean, and the fibres have antibacterial properties and are sterile. Hytox also is inactivated by traces oi ordinary washing-soap in the blanket or in the crevices of the washing-machine; so the first time a used blanket is washed tht results may be disappointing. However, the second time tht blankets are washed in a clean machine the results are ver
satisfactory. St. Margaret’s Hospital
Epping, Essex.
FRANK MARSH.
ORAL TREATMENT OF PERNICIOUS ANÆMIA SIR,-We judge from the reply of Dr. Mooney and
Dr. Heathcote (Aug. 16) to Professor Castle’s comments (Aug. 2) on their recent article1 that they are unwilling to accept certain data which, in our opinion, completely invalidate their conclusions with respect to their " vita-
lmin-B2 peptide complex ". The fundamental criticism remains that their study lacked controls: they failed to use patients who were to receive only vitamin B12 without the peptide or any other additives. This lack of a control makes any conclusions untenable. Many studies 2-7 have shown that small oral amounts of vitamin Bl2’ from 5 f.1g. to 100 fA-g. daily, will often produce remission in 1. Heathcote, J. G., Mooney, F. S. Lancet, 1958, i, 982. 2. Estren, S., Wasserman, L. R. Proc. Soc. exp. Biol., N.Y. 1956, 3. Hall, B. E. Brit. med. J. 1950, ii, 585. 4. Glass, G. B. J., Boyd, L. J. Blood, 1953, 8, 867. 5. Glass, G. B. J., Boyd, L. J., Rubinstein, M. A., Svigals, C. S. 6. 7.
1952, 115, 101. Chalmers, J. N. M., Hall, Z. M. Brit. med. J. 1954, i, 1179. Ungley, C. C. ibid. 1950, ii, 905.
91, 499. Science,
ingested.
There is the slight possibility that a peptide may stimulate gastric secretion of the slight residual intrinsic factor still present in some patients with pernicious ansemia" in a manner similar to carbachol," and perhaps d-sorbitol.12
Their comments with respect to the existence of intrinsic factor are pure speculations, unrelated either to their own studies or the many studies on which the concept of existence of Castle’s intrinsic factor firmly rests.
Mount Sinai Hospital, New York.
VICTOR HERBERT SOLOMON ESTREN EUGENE BRODY LOUIS R. WASSERMAN.
WATER FLUORIDATION
SiR,—Iam rather surprised at the attitude taken by your correspondent (Oct. 4, p. 741). A few facts are essential for consideration. (1) Waters containing fluorides at 1 part per million do not taste, smell, or appear different from that with a trace. (2) All waters in this country, so far as I know, contain some fluoride. (3) Water treatment often causes a slight reduction in the fluoride level. (4) Populations living in areas containing fluoride at levels of 2, 3, or more parts per million do not suffer from ill health or disease. (5) The amount of suffering in children which is avoidable is immense. (6) The ordinary person’s attitude (and having discussed this with a considerable number of members of the public I think I know their attitude) is that he is all for it if aware of the facts. (7) If some members of the public have been frightened by a thoroughly dishonest campaign then they are against it. (8) The " freedom of choice " argument also applies to chlorination and all aspects of water treatment. (9) The lies and half-truths put out by the opposition would not be used if there was a genuine case. The methods used have been exposed in the New Zealand report. -
surprised, indeed amazed, that your correspondent that the public (mothers of 8 children included!) suggests would administer fluoride tablets. Does he know that this would have to be done for years and years and years ? Most patients have difficulty in persisting with any treatment lasting for more than a few days. (11) Is your correspondent aware of the present accident-rate from children taking tablets in the home ? (12) If those who want lower fluoride water (e.g., the more usual 0-2 p.p.m.) live in a fluoride area, they can install a defluoridator. After all, I prefer private education for my child, so I pay for it. If there is a demand for defluoridators they will, doubtless, be produced by private enterprise for the few who want them. (10)
I
am
It is, Sir, I know, possible fluoridation without contrary
to
get
votes.
Council to approve It does take a lot of
a
8. Ross, G. I. M., Mollin, D. L., Cox, E. V., Ungley, C. C. Blood, 1954, 9, 473. 9. Doscherholmen, A., Hagen, P. S. J. clin. Invest. 1957, 36, 1551. 10. Goldhamer, S. M. Amer. J. med. Sci. 1936, 191, 405. 11. Mollin, D. L., Booth, C. C., Baker, S. J. Brit. J. Hœmat. 1957, 3, 412. 12. Herbert, V. Amer. J. clin. Nutr. 1958, 6, 547.