- Email: [email protected]
THE COMPARATIVE GERMICIDAL ACTION OF SOME DISINFECTANTS.
1797 The condition in these two cases is probably to be attri- afterwards dried and kept till required for use. After in the emulsion for 10 minutes the threads were buted to arterial degeneration with resulting insufficient blood-supply to the extremities ; in neither was there transferred with sterilised forceps to a Petri’s capsule, in evidence of arterial thrombosis which, as is well known, which they were partially dried in the dark at a temperature of 24° C. for three hours by placing them in the "cool" may be the proximate cause of even gangrene in atheroma. These various affections which simulate acroparsesthesia incubator. They were next transferred to th disinfectant can thus be distinguished by the presence of physical signs solutions to be tested, and after remaining in these for the allotted time were lifted out with a sterilised platinum hook, which are wanting in that disease.
immersion
is
and very washed well in sterilised distilled water in order to remove It may last for years and seriously any trace of disinfectant adhering to them, and placed each incapacitate the sufferer from earning a living. Quinine and in a separate tube of sterilised peptone bouillon. These galvanism have been recommended by Chabot and ergot is tubes were incubated at 370 C. for 10 days, being examined highly praised by Sinkler.4 As far as my experience goes each 12 hours for the first 48 hours, after that daily. If no bromides combined with a small dose of nitro-glycerine were growth occurs the bouillon is perfectly clear at the end of of most service. Under this treatment the first two cases this time ; if it does occur the bouillon begins to show signs of turbidity at a period varying from 12 hours or even less described above completely recovered in six months. to 72 hours. The presence or absence of growth is further Clifton, Bristol. shown by microscopical examination, and by the inoculation of gelatin plates. If no growth had taken place the end of 10 days it was concluded that all the THE COMPARATIVE GERMICIDAL ACTION at bacilli present on the thread had been killed by the disOF SOME DISINFECTANTS. infectant solution. In every case a control experiment was made precisely as above, except that sterilised distilled water BY ARTHUR H. BURGESS, M.B., M.Sc. VICT., replaced the disinfectant solution, and in each instance F.R.C.S. ENG., growth was found to be present at the end of 12 hours. RESIDENT SURGICAL OFFICER, MANCHESTER ROYAL INFIRMARY. Objection may possibly be raised to the above method on the ground that some of the disinfectant solution might be THE following experimental investigation was undertaken carried over on the thread into the bouillon, and so, by its in order to ascertain the relative germ-destroying power antiseptic or inhibitory action, prevent the development of in the thread which were not actually killed by it. possessed by some of the so-called disinfectants in common bacilli To guard against this the threads were, as already stated, use when tested under conditions as precisely similar as it is well washed in sterilised distilled water after removal from possible to obtain. For this purpose their individual action the action of the disinfectant, and as a further precaution was tried upon the same species of germ, of the same degree all those tubes which exhibited no growth at the end of 10 of virulence, under the same general environment, and for days were re-inoculated from an emulsion of bacilli prepared the same length of time, by means of a method which, as above and again placed in the incubator. In every such growth occurred at the end of 12 hours, thus proving briefly stated, is as follows: a pure culture of a germ having case the bouillon in these tubes was still a suitable medium that first been obtained, silk threads are impregnated with this and are afterwards exposed to the action of the disinfectant to for the development of the organism, and that their previous be tested in a solution of known strength for a certain definite sterility was due, not to any transferred disinfectant, but to length of time, at the expiration of which they are removed, the fact that all the bacilli on the thread had been comwell washed in sterilised water, and placed under conditions pletely destroyed. In order to establish a fair comparison between the known to be suitable for the growth and development of the effects of the various disinfectants tested I germicidal in Should occur it is evident that germ question. growth decided to allow the threads to remain in solutions of them the disinfectant in this particular strength of solution has failed to destroy the vitality of the germ ; in other words, for certain definite lengths of time, and to ascertain the weakest strength of any given disinfectant which would that disinfection has not taken place, and vice versa. I The specific germ selected for these experiments was theaestroy au tne Daciiii on tne tnreaas in tnese times respecbacillus coli communis, a bacillus which occurs normally in tively-viz., one minute, five minutes, 10 minutes, 30 the human intestinal tract, and in health appears to be minutes, and one hour. For each strength of a disinfectant acting for a given time (e.g., carbolic acid, 1 in 20 innocuous, but which under abnormal conditions may become solutionfor five minutes) six threads were used, each being acting This bacillus some possesses very markedly pathogenic. distinct advantages for the purpose of this investigation : it subsequently placed in a separate tube of bouillon and is extremely easy to obtain it in large quantity owing to the incubated. In by far the majority of cases the result was the same in each of the six tubes, either positive or negative, profuse nature of its growth on potato ; it has many showing that every care had been taken to prevent conit can be disreactions which characteristic readily by tamination of the threads in the process of transference from bacilli and these at other by applying tinguished different stages in the course of the experiments it is from the disinfectant solution to the bouillon tubes. But when approaching the limit of the germicidal possible to establish the purity of the cultures throughout ; occasionally, of the power particular strength of disinfectant used, there while, since it has, for a non-sporing bacillus, a com- was some five tubes might give a positive discrepancy-e.g., of resistance to germicides, any and one a paratively high power or vice versic, in which case the reaction, negative results obtained with it may be held to apply even more verdict of the majority was taken to be the correct one. If, at the of rate in case other bacilli, any forcibly non-sporing of such as are pathogenic. The bacillus was isolated from however, the discrepancy were more than this-e.g., four the stools of a young girl sufeering from enteric fever by the and two, or three and three-the experiment was repeated method of successive gelatin plates. A pure culture having with a second set of six threads, and the majority taken. The following substances were tested : biniodide of been obtained and proved by means of the characteristic mercury, perchloride of mercury, chlorinated lime, formal reactions to be the bacillus coli communis, a stock culture was made on the sloped surface of agar-peptone bouillon in aldehyde, lysol, carbolic acid, izal. medical izal, creolin, I.X.L. disinfectant fluid, tubes and from these subcultures on potato were taken as Jeyes’ sanitary fluid. Walker’s " and boric acid. "sanitas" fluid. These fluid, Condy’s were These made on the surface of required. freshly prepared involved the inoculation and culture of some experiments sterilised potato medium, and were incubated at 37° C. for 10 tubes of bouillon and were conducted in the laboratory days, when a profuse dark-brown growth, very characteristic 2000 of this bacillus, was found to have formed. This was removed of the Manchester Union Hospital, Crumpsall, during six with a thick sterilised platinum wire (care being taken not months of my tenure of the resident medical officership there. to carry along with it any of the potato medium), and The ultimate results obtained are arranged for ready commixed in a sterilised glass capsule with a little sterilised parison in the accompanying table, where, in addition to peptone bouillon so as to form a thick emulsion, into which stating the weakest strength of each disinfectant necessary the silk threads were immersed. These threads were cut to kill the bacillus coli communis in the allotted times, I from the finest "Turner’s plaited silk," each being exactly have in each case further stated that strength which just one inch long, and were sterilised in a Koch’s apparatus for failed to do so. In interpreting these results I wish it to be clearly underone and a half hours in Petri’s .dishes, in which they were stood that they are merely relative and can only be held to 4 Philadelphia Medical News, 1894. be absolute under the exact conditions laid down for these
Acroparsesthesia
rebellious to treatment.
exceedingly persistent
1798 TABLE SHOWING RESULTS
OF
EXPERIMENTS.
a disinfectant, since its saturated solution failed to destroy experiments-i.e., where the bacilli are freely exposed to the action of the disinfectant in solution, no albuminous matterthe bacillus coli communis in any of the allotted times. °’ being present. In the actual practice of disinfection such Manchester. conditions are never met with, the most important difference being the presence of albuminous material in greater or less quantity. Especially does this apply to the case of ACUTE GLOSSITIS COMPLICATING A CASE perchloride of mercury, which forms a definite combination OF TYPHOID FEVER. with albumin, resulting in the formation of a comparatively inert albuminate of mercury, and thus, to maintain its BY H. CAMPBELL THOMSON, M.D., M.R.C.P. LOND., efficiency, the strength of the solution would require to be ASSISTANT PHYSICIAN AND PATHOLOGIST TO THE MIDDLESEX HOSPITAL; increased in proportion to the amount of albuminous matter PHYSICIAN TO OUT-PATIENTS AT THE HOSPITAL FOR EPILEPSY
’ as
present. Biniodide
______________
AND .
--
-
-
.
PARALYSIS, REGENT’S-PARK.
--
(If mercury.-This was brought into solution by THE patient, a woman aged 34 years, suffering from the addition of iodide of potassium in quantity just sufficient to dissolve it, a stock solution of 1 part of biniodide in 500 fever, was admitted into the Middlesex Hospital on of distilled water being first prepared, from which the more Nov. 17th, 1899, under the care of Dr. J. Kingston Fowler, dilute solutions were afterwards obtained by the addition of to whom I am indebted for permission to make use of the the requisite proportion of ordinary tap-water. It will be noted that the germicidal power of this drug is far superior clinical notes of the case. The early symptoms of the attack to that of any other used in these experiments, and as it consisted of weakness, languor, pain in the back, and shiverdoes not precipitate with albumin the results obtained ing. The bowels were confined at first and later they became should hold good even in the presence of albuminous more freely opened, but diarrhoea was never a troublesome material, thereby contrasting with the perchloride of factor. There was no vomiting. The blood showed Widal’s mercury. Ohlorinated lÍ1ne (commonly calledchloride of lime ").- reaction and the urine gave Ehrlich’s test. There was a This is a white powder which is only partially soluble in well-marked rash on the abdomen. The patient was from the first very seriously ill and in water, and after standing for a little the insoluble portion falls to the bottom. This was kept in suspension in these spite of all treatment her condition became gradually worse experiments by frequent shaking of the glass vessel contain- till on Dec. 16th the pulse was scarcely perceptible and she ing the threads immersed in the solution, but I also found was evidently M extremis. On the 17th, at 7 P.M., the that the germicidal power was not in any way altered by tongue was first noticed to be swollen and examination previously filtering the solution so as to remove this in- showed the swelling to be confined to the left half of the soluble portion. In the stronger solutions of this substance organ. This condition must have arisen very rapidly as the not only are the bacilli on the threads all killed but the tongue had previously been examined at midday and there threads themselves are destroyed and in a short time almost was then no sign of any swelling. The swelling was firm all trace of them disappears. and did not fluctuate, the mucous membrane over it Formal aldehyde.-The solutions of this substanr.e were was reddened, it was tender when touched, and gave prepared from Schering’s formalin, which is a 40 per cent. rise to some difficulty in swallowing. At 10 P.M. on solution of formal aldehyde in water, the latter itself only the same evening the swelling had increased and it now existing in the gaseous state. It must be clearly understood involved the right half of the tongue. The size of the swellthat the proportions stated in the accompanying table refer ing made it advisable to take some steps to try to reduce it, to formal aldehyde and not to formalin. and accordingly after the part had been anaestbetised with .2x< and medical izal.--These two coal prodncts are pre- cocaine a grooved needle was passed into the tumour, but pared by Messrs. Newton, Chambers, and Co., the latter only a little blood escaped. The patient’s general condition, being a refined preparation of the former specially adapted however, was so bad that it was not considered advisable to to medical and surgical use. I found no difference between take any further measures and a few hours later death them as regards their germicidal properties. It should be occurred. A post-mortem examination was made on the stated that the proportions given in the accompanying table following day and extensive intestinal ulceration was found refer to the product as sold for use and not to the proportions which had terminated in general peritonitis from a perfora-
typhoid
of izal oil, of which izal"disinfectant taining 40 per cent. Boric aeid.-This substance has
no
is
an
emulsion
claim to be
con-
regarded
tion at the lower end of the ileum. The tongue was swollen, sspecially the left half, and the mucous membrane over it was reddened ; there were also one or two superficial
immersion
is
and very washed well in sterilised distilled water in order to remove It may last for years and seriously any trace of disinfectant adhering to them, and placed each incapacitate the sufferer from earning a living. Quinine and in a separate tube of sterilised peptone bouillon. These galvanism have been recommended by Chabot and ergot is tubes were incubated at 370 C. for 10 days, being examined highly praised by Sinkler.4 As far as my experience goes each 12 hours for the first 48 hours, after that daily. If no bromides combined with a small dose of nitro-glycerine were growth occurs the bouillon is perfectly clear at the end of of most service. Under this treatment the first two cases this time ; if it does occur the bouillon begins to show signs of turbidity at a period varying from 12 hours or even less described above completely recovered in six months. to 72 hours. The presence or absence of growth is further Clifton, Bristol. shown by microscopical examination, and by the inoculation of gelatin plates. If no growth had taken place the end of 10 days it was concluded that all the THE COMPARATIVE GERMICIDAL ACTION at bacilli present on the thread had been killed by the disOF SOME DISINFECTANTS. infectant solution. In every case a control experiment was made precisely as above, except that sterilised distilled water BY ARTHUR H. BURGESS, M.B., M.Sc. VICT., replaced the disinfectant solution, and in each instance F.R.C.S. ENG., growth was found to be present at the end of 12 hours. RESIDENT SURGICAL OFFICER, MANCHESTER ROYAL INFIRMARY. Objection may possibly be raised to the above method on the ground that some of the disinfectant solution might be THE following experimental investigation was undertaken carried over on the thread into the bouillon, and so, by its in order to ascertain the relative germ-destroying power antiseptic or inhibitory action, prevent the development of in the thread which were not actually killed by it. possessed by some of the so-called disinfectants in common bacilli To guard against this the threads were, as already stated, use when tested under conditions as precisely similar as it is well washed in sterilised distilled water after removal from possible to obtain. For this purpose their individual action the action of the disinfectant, and as a further precaution was tried upon the same species of germ, of the same degree all those tubes which exhibited no growth at the end of 10 of virulence, under the same general environment, and for days were re-inoculated from an emulsion of bacilli prepared the same length of time, by means of a method which, as above and again placed in the incubator. In every such growth occurred at the end of 12 hours, thus proving briefly stated, is as follows: a pure culture of a germ having case the bouillon in these tubes was still a suitable medium that first been obtained, silk threads are impregnated with this and are afterwards exposed to the action of the disinfectant to for the development of the organism, and that their previous be tested in a solution of known strength for a certain definite sterility was due, not to any transferred disinfectant, but to length of time, at the expiration of which they are removed, the fact that all the bacilli on the thread had been comwell washed in sterilised water, and placed under conditions pletely destroyed. In order to establish a fair comparison between the known to be suitable for the growth and development of the effects of the various disinfectants tested I germicidal in Should occur it is evident that germ question. growth decided to allow the threads to remain in solutions of them the disinfectant in this particular strength of solution has failed to destroy the vitality of the germ ; in other words, for certain definite lengths of time, and to ascertain the weakest strength of any given disinfectant which would that disinfection has not taken place, and vice versa. I The specific germ selected for these experiments was theaestroy au tne Daciiii on tne tnreaas in tnese times respecbacillus coli communis, a bacillus which occurs normally in tively-viz., one minute, five minutes, 10 minutes, 30 the human intestinal tract, and in health appears to be minutes, and one hour. For each strength of a disinfectant acting for a given time (e.g., carbolic acid, 1 in 20 innocuous, but which under abnormal conditions may become solutionfor five minutes) six threads were used, each being acting This bacillus some possesses very markedly pathogenic. distinct advantages for the purpose of this investigation : it subsequently placed in a separate tube of bouillon and is extremely easy to obtain it in large quantity owing to the incubated. In by far the majority of cases the result was the same in each of the six tubes, either positive or negative, profuse nature of its growth on potato ; it has many showing that every care had been taken to prevent conit can be disreactions which characteristic readily by tamination of the threads in the process of transference from bacilli and these at other by applying tinguished different stages in the course of the experiments it is from the disinfectant solution to the bouillon tubes. But when approaching the limit of the germicidal possible to establish the purity of the cultures throughout ; occasionally, of the power particular strength of disinfectant used, there while, since it has, for a non-sporing bacillus, a com- was some five tubes might give a positive discrepancy-e.g., of resistance to germicides, any and one a paratively high power or vice versic, in which case the reaction, negative results obtained with it may be held to apply even more verdict of the majority was taken to be the correct one. If, at the of rate in case other bacilli, any forcibly non-sporing of such as are pathogenic. The bacillus was isolated from however, the discrepancy were more than this-e.g., four the stools of a young girl sufeering from enteric fever by the and two, or three and three-the experiment was repeated method of successive gelatin plates. A pure culture having with a second set of six threads, and the majority taken. The following substances were tested : biniodide of been obtained and proved by means of the characteristic mercury, perchloride of mercury, chlorinated lime, formal reactions to be the bacillus coli communis, a stock culture was made on the sloped surface of agar-peptone bouillon in aldehyde, lysol, carbolic acid, izal. medical izal, creolin, I.X.L. disinfectant fluid, tubes and from these subcultures on potato were taken as Jeyes’ sanitary fluid. Walker’s " and boric acid. "sanitas" fluid. These fluid, Condy’s were These made on the surface of required. freshly prepared involved the inoculation and culture of some experiments sterilised potato medium, and were incubated at 37° C. for 10 tubes of bouillon and were conducted in the laboratory days, when a profuse dark-brown growth, very characteristic 2000 of this bacillus, was found to have formed. This was removed of the Manchester Union Hospital, Crumpsall, during six with a thick sterilised platinum wire (care being taken not months of my tenure of the resident medical officership there. to carry along with it any of the potato medium), and The ultimate results obtained are arranged for ready commixed in a sterilised glass capsule with a little sterilised parison in the accompanying table, where, in addition to peptone bouillon so as to form a thick emulsion, into which stating the weakest strength of each disinfectant necessary the silk threads were immersed. These threads were cut to kill the bacillus coli communis in the allotted times, I from the finest "Turner’s plaited silk," each being exactly have in each case further stated that strength which just one inch long, and were sterilised in a Koch’s apparatus for failed to do so. In interpreting these results I wish it to be clearly underone and a half hours in Petri’s .dishes, in which they were stood that they are merely relative and can only be held to 4 Philadelphia Medical News, 1894. be absolute under the exact conditions laid down for these
Acroparsesthesia
rebellious to treatment.
exceedingly persistent
1798 TABLE SHOWING RESULTS
OF
EXPERIMENTS.
a disinfectant, since its saturated solution failed to destroy experiments-i.e., where the bacilli are freely exposed to the action of the disinfectant in solution, no albuminous matterthe bacillus coli communis in any of the allotted times. °’ being present. In the actual practice of disinfection such Manchester. conditions are never met with, the most important difference being the presence of albuminous material in greater or less quantity. Especially does this apply to the case of ACUTE GLOSSITIS COMPLICATING A CASE perchloride of mercury, which forms a definite combination OF TYPHOID FEVER. with albumin, resulting in the formation of a comparatively inert albuminate of mercury, and thus, to maintain its BY H. CAMPBELL THOMSON, M.D., M.R.C.P. LOND., efficiency, the strength of the solution would require to be ASSISTANT PHYSICIAN AND PATHOLOGIST TO THE MIDDLESEX HOSPITAL; increased in proportion to the amount of albuminous matter PHYSICIAN TO OUT-PATIENTS AT THE HOSPITAL FOR EPILEPSY
’ as
present. Biniodide
______________
AND .
--
-
-
.
PARALYSIS, REGENT’S-PARK.
--
(If mercury.-This was brought into solution by THE patient, a woman aged 34 years, suffering from the addition of iodide of potassium in quantity just sufficient to dissolve it, a stock solution of 1 part of biniodide in 500 fever, was admitted into the Middlesex Hospital on of distilled water being first prepared, from which the more Nov. 17th, 1899, under the care of Dr. J. Kingston Fowler, dilute solutions were afterwards obtained by the addition of to whom I am indebted for permission to make use of the the requisite proportion of ordinary tap-water. It will be noted that the germicidal power of this drug is far superior clinical notes of the case. The early symptoms of the attack to that of any other used in these experiments, and as it consisted of weakness, languor, pain in the back, and shiverdoes not precipitate with albumin the results obtained ing. The bowels were confined at first and later they became should hold good even in the presence of albuminous more freely opened, but diarrhoea was never a troublesome material, thereby contrasting with the perchloride of factor. There was no vomiting. The blood showed Widal’s mercury. Ohlorinated lÍ1ne (commonly calledchloride of lime ").- reaction and the urine gave Ehrlich’s test. There was a This is a white powder which is only partially soluble in well-marked rash on the abdomen. The patient was from the first very seriously ill and in water, and after standing for a little the insoluble portion falls to the bottom. This was kept in suspension in these spite of all treatment her condition became gradually worse experiments by frequent shaking of the glass vessel contain- till on Dec. 16th the pulse was scarcely perceptible and she ing the threads immersed in the solution, but I also found was evidently M extremis. On the 17th, at 7 P.M., the that the germicidal power was not in any way altered by tongue was first noticed to be swollen and examination previously filtering the solution so as to remove this in- showed the swelling to be confined to the left half of the soluble portion. In the stronger solutions of this substance organ. This condition must have arisen very rapidly as the not only are the bacilli on the threads all killed but the tongue had previously been examined at midday and there threads themselves are destroyed and in a short time almost was then no sign of any swelling. The swelling was firm all trace of them disappears. and did not fluctuate, the mucous membrane over it Formal aldehyde.-The solutions of this substanr.e were was reddened, it was tender when touched, and gave prepared from Schering’s formalin, which is a 40 per cent. rise to some difficulty in swallowing. At 10 P.M. on solution of formal aldehyde in water, the latter itself only the same evening the swelling had increased and it now existing in the gaseous state. It must be clearly understood involved the right half of the tongue. The size of the swellthat the proportions stated in the accompanying table refer ing made it advisable to take some steps to try to reduce it, to formal aldehyde and not to formalin. and accordingly after the part had been anaestbetised with .2x< and medical izal.--These two coal prodncts are pre- cocaine a grooved needle was passed into the tumour, but pared by Messrs. Newton, Chambers, and Co., the latter only a little blood escaped. The patient’s general condition, being a refined preparation of the former specially adapted however, was so bad that it was not considered advisable to to medical and surgical use. I found no difference between take any further measures and a few hours later death them as regards their germicidal properties. It should be occurred. A post-mortem examination was made on the stated that the proportions given in the accompanying table following day and extensive intestinal ulceration was found refer to the product as sold for use and not to the proportions which had terminated in general peritonitis from a perfora-
typhoid
of izal oil, of which izal"disinfectant taining 40 per cent. Boric aeid.-This substance has
no
is
an
emulsion
claim to be
con-
regarded
tion at the lower end of the ileum. The tongue was swollen, sspecially the left half, and the mucous membrane over it was reddened ; there were also one or two superficial