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THE ESSENTIAL CONDITIONS OF STEAM DISINFECTION.
1789 centimetres
long and
two broad.
The ulcers showed
of the stomach walls but were shut off from the the gastro-hepatic omentum. In the floor of the largest ulcer the right coronary artery, which was eroded, projected and from this the haemorrhage Dr. Fertig discusses the pathogenesis of had occurred. traumatic ulceration of the stomach, with interesting references to other recorded cases and to experimental researches. He states that the diagnosis is not infrequently made but that it is but rarely established by operation or necropsy, since Jackhl- could only collect eight cases from the literature. The forms of injury which have produced ulceration in these cases include kicks, blows with the fist, falling against the corner of a table, compression between railway buffers, and fall from a height. Dr. Fertig explains the ulceration in the case under his care as follows. At the time of the injury the patient, who had not previously suffered from any gastric disease, was digesting a full meal, the distended stomach was forcibly driven against the vertebral column, and some tears in the mucous membrane resulted. The stomach at the time or shortly after would be at its maximum acidity, and hyperacidity, it is believed, is a factor of importance in the genesis of gastric ulceration. Certain experiments of Vanni suggest that there is also a mycotic factor in the production of gastric ulcers, so that it may possibly be that the trauma of the gastric mucous membrane afforded the opportunity for a bacterial infection. Other investigations also seem to indicate that the lesser curvature is the most frequent site of lesion in the stomach when abdominal injuries are received after a full meal. Dr. Fertig’s case is noteworthy not only for the clearness with which the diagnosis is established but also for the succinct and careful manner in which it is recorded and the critical nature of Dr. Fertig’s discussion of it.
ness
peritoneal cavity by
THE
ESSENTIAL CONDITIONS DISINFECTION.
A VERY instructive and
That system, therefore, which effectually expels all air is the one in which confidence would be naturally placed. At any rate, in practice it has been established that steam under pressure acts more rapidly and more searchingly than streaming steam at 100° C., partly no doubt because the former method more effectually expels non-conducting air and partly because it is more likely to break up greasy envelopes. With exceptionally resistant spores the time taken by saturated steam to sterilise organisms is found to be much shorter than when streaming steam is used. It should be added, however, that if prior to the introduction of current steam a vacuum or a partial vacuum is produced in the apparatus the penetrative power of the team is increased, and concurrently a more rapid and powerful disinfecting action is obtained. There seems to be no reason therefore why, under certain conditions, the two systems should not be made equally effectual.
sharply it.
defined, overhanging edges and involved the whole thick-
OF STEAM
interesting correspondence
on
the
THE
EXETER
DISPENSARY.
IN our issue of Dec. 9th paragraph appeared from our Western Counties Correspondent mentioning that the honorary medical staff of the Exeter Dispensary had resigned. We have now received from the medical staff a letter and some documents as to the origin of the dispute Besides (1) the letter which has led to the resignation. from the staff to ourselves we have before us (2) a letter from the staff to the governors of the dispensary, and (3) a copy of a letter addressed by the committee of the disThe letter from the staff to pensary to the governors. ourselves sums up matters as follows :1. After a charge of unpunctuality and neglect of duty had been preferred against the honorary medical officers no opportunity was given them to answer the accusations but the matter was referred to a
subcommittee. 2. Charges were made against them in the subcommittee based upon statistics showing a complete ignorance of the conditions under which medical work has to be carried out, implying neglect and supported by language of a most offensive character. No attempt was made by the piesident or by members of the subcommittee, with one exception, to protest against the accusation or the language in which it was couched. It was shown by the two members ot the staff present that the statistics were inaccurate and the deductions false but the member making them declared his intention of publishing them if defeated in a
committee.
important subject of disinfection by steam has recently The course of events which have led up to the members appeared in our columns. We are compelled now on con- of the medical staff tendering their resignations can be siderations of space to close this correspondence and we gathered from (2) the letter which has been addressed to venture to think at the same time that sufficient discussion the governors of the dispensary by the medical staff. It has been brought before our readers to guide them as to the minutes of the last court of governors, held what in practice ought to be regarded as the essential con- appears by on Feb. loth, that it was unanimously resolved :ditions of steam disinfection.
The
correspondence practhe relative merits of other of one hand and on the saturated steam under pressure for practical disinfecting purposes. The latter, as might be anticipated from its more powerful mechanical and physical properties, is undoubtedly the most certain agent for the purpose, although streaming steam admits of a much simpler application and for many if not all practical requirements the prolonged exposure of infected articles to a rapid stream of current steam, especially if that steam is kept a few degrees above condensation point, secures disinfection if we are to accept the results of bacteriological experiments made with typical organisms. The condition of efficiency, however, when using streaming steam is the rate at which the steam is generated and the steam velocity in this method is admittedly difficult to control. On the other hand, the use of saturated steam under pressure necessarily supplies a constant and efficient condition which is easy and simple enough to insure. As is well known, it is essential when using steam for the purposes of disinfection to expel the air from the apparatus, as air, being a poor conductor of heat, tends to insulate the material to be disinfected and to prevent the steam from coming into direct contact with
tically resolved itself streaming steam on
1
into the
considering
Langenbeck’s Archiv, Band lxvi.,
p. 938.
That the best thanks of this meeting be given to the medical officers for their zealous, kind, and unremitting attention to the patients of this charity. whereby the poor and suffering classes of society have been so inexpensively relieved.
On Nov. 15th, however, Mr. Knill, a governor, brought a proposal before the committee to consider the desirability of engaging a permanent medical officer to be in daily attendance, so as to relieve the honorary medical staff of part of their onerous duties, and to secure more speedy attention to the patients. This proposal was supported by statistics gravely impugning the efficiency of the medical attendance. Instead, as has hitherto been the custom in any matter referring to the medical staff, of submitting this proposal to the medical staff for
consideration, it was referred to a subcommittee the members of which were nominated by Mr. Knill. The medical staff hearing of this wrote to the chairman of the subcommittee, pointing out that in their opinion the appointment of a paid medical officer would not be desirable and would not obviate the delays complained of. This letter was read at the meeting of the subcommittee on Nov. 23rd, to every member of which Mr. Knill had sent a statement embodying the charges which he had made on Nov. 15th, but, as we learn from (2), the letter from the staff to the governors, the statement was shown by the medical members of the subcommittee to be inaccurate. The refutation printed in pamphlet form was sent to the governors
long and
two broad.
The ulcers showed
of the stomach walls but were shut off from the the gastro-hepatic omentum. In the floor of the largest ulcer the right coronary artery, which was eroded, projected and from this the haemorrhage Dr. Fertig discusses the pathogenesis of had occurred. traumatic ulceration of the stomach, with interesting references to other recorded cases and to experimental researches. He states that the diagnosis is not infrequently made but that it is but rarely established by operation or necropsy, since Jackhl- could only collect eight cases from the literature. The forms of injury which have produced ulceration in these cases include kicks, blows with the fist, falling against the corner of a table, compression between railway buffers, and fall from a height. Dr. Fertig explains the ulceration in the case under his care as follows. At the time of the injury the patient, who had not previously suffered from any gastric disease, was digesting a full meal, the distended stomach was forcibly driven against the vertebral column, and some tears in the mucous membrane resulted. The stomach at the time or shortly after would be at its maximum acidity, and hyperacidity, it is believed, is a factor of importance in the genesis of gastric ulceration. Certain experiments of Vanni suggest that there is also a mycotic factor in the production of gastric ulcers, so that it may possibly be that the trauma of the gastric mucous membrane afforded the opportunity for a bacterial infection. Other investigations also seem to indicate that the lesser curvature is the most frequent site of lesion in the stomach when abdominal injuries are received after a full meal. Dr. Fertig’s case is noteworthy not only for the clearness with which the diagnosis is established but also for the succinct and careful manner in which it is recorded and the critical nature of Dr. Fertig’s discussion of it.
ness
peritoneal cavity by
THE
ESSENTIAL CONDITIONS DISINFECTION.
A VERY instructive and
That system, therefore, which effectually expels all air is the one in which confidence would be naturally placed. At any rate, in practice it has been established that steam under pressure acts more rapidly and more searchingly than streaming steam at 100° C., partly no doubt because the former method more effectually expels non-conducting air and partly because it is more likely to break up greasy envelopes. With exceptionally resistant spores the time taken by saturated steam to sterilise organisms is found to be much shorter than when streaming steam is used. It should be added, however, that if prior to the introduction of current steam a vacuum or a partial vacuum is produced in the apparatus the penetrative power of the team is increased, and concurrently a more rapid and powerful disinfecting action is obtained. There seems to be no reason therefore why, under certain conditions, the two systems should not be made equally effectual.
sharply it.
defined, overhanging edges and involved the whole thick-
OF STEAM
interesting correspondence
on
the
THE
EXETER
DISPENSARY.
IN our issue of Dec. 9th paragraph appeared from our Western Counties Correspondent mentioning that the honorary medical staff of the Exeter Dispensary had resigned. We have now received from the medical staff a letter and some documents as to the origin of the dispute Besides (1) the letter which has led to the resignation. from the staff to ourselves we have before us (2) a letter from the staff to the governors of the dispensary, and (3) a copy of a letter addressed by the committee of the disThe letter from the staff to pensary to the governors. ourselves sums up matters as follows :1. After a charge of unpunctuality and neglect of duty had been preferred against the honorary medical officers no opportunity was given them to answer the accusations but the matter was referred to a
subcommittee. 2. Charges were made against them in the subcommittee based upon statistics showing a complete ignorance of the conditions under which medical work has to be carried out, implying neglect and supported by language of a most offensive character. No attempt was made by the piesident or by members of the subcommittee, with one exception, to protest against the accusation or the language in which it was couched. It was shown by the two members ot the staff present that the statistics were inaccurate and the deductions false but the member making them declared his intention of publishing them if defeated in a
committee.
important subject of disinfection by steam has recently The course of events which have led up to the members appeared in our columns. We are compelled now on con- of the medical staff tendering their resignations can be siderations of space to close this correspondence and we gathered from (2) the letter which has been addressed to venture to think at the same time that sufficient discussion the governors of the dispensary by the medical staff. It has been brought before our readers to guide them as to the minutes of the last court of governors, held what in practice ought to be regarded as the essential con- appears by on Feb. loth, that it was unanimously resolved :ditions of steam disinfection.
The
correspondence practhe relative merits of other of one hand and on the saturated steam under pressure for practical disinfecting purposes. The latter, as might be anticipated from its more powerful mechanical and physical properties, is undoubtedly the most certain agent for the purpose, although streaming steam admits of a much simpler application and for many if not all practical requirements the prolonged exposure of infected articles to a rapid stream of current steam, especially if that steam is kept a few degrees above condensation point, secures disinfection if we are to accept the results of bacteriological experiments made with typical organisms. The condition of efficiency, however, when using streaming steam is the rate at which the steam is generated and the steam velocity in this method is admittedly difficult to control. On the other hand, the use of saturated steam under pressure necessarily supplies a constant and efficient condition which is easy and simple enough to insure. As is well known, it is essential when using steam for the purposes of disinfection to expel the air from the apparatus, as air, being a poor conductor of heat, tends to insulate the material to be disinfected and to prevent the steam from coming into direct contact with
tically resolved itself streaming steam on
1
into the
considering
Langenbeck’s Archiv, Band lxvi.,
p. 938.
That the best thanks of this meeting be given to the medical officers for their zealous, kind, and unremitting attention to the patients of this charity. whereby the poor and suffering classes of society have been so inexpensively relieved.
On Nov. 15th, however, Mr. Knill, a governor, brought a proposal before the committee to consider the desirability of engaging a permanent medical officer to be in daily attendance, so as to relieve the honorary medical staff of part of their onerous duties, and to secure more speedy attention to the patients. This proposal was supported by statistics gravely impugning the efficiency of the medical attendance. Instead, as has hitherto been the custom in any matter referring to the medical staff, of submitting this proposal to the medical staff for
consideration, it was referred to a subcommittee the members of which were nominated by Mr. Knill. The medical staff hearing of this wrote to the chairman of the subcommittee, pointing out that in their opinion the appointment of a paid medical officer would not be desirable and would not obviate the delays complained of. This letter was read at the meeting of the subcommittee on Nov. 23rd, to every member of which Mr. Knill had sent a statement embodying the charges which he had made on Nov. 15th, but, as we learn from (2), the letter from the staff to the governors, the statement was shown by the medical members of the subcommittee to be inaccurate. The refutation printed in pamphlet form was sent to the governors