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TYPHUS AND TYPHUS.
817 TYPHUS AND TYPHUS. THE Weekly Return of Infectious Diseases, issued by the Registrar-General for the week ended Oct. 4th, contains an announcement of one case returned as typhus fever, and a cross reference shows that the notification came from the metropolitan borough of Bethnal Green. Dr. G. E. Oates, medical officer of health for the borough, informs us that this case was not one of typhus at all, but was notified from the German Hospital as typhus abdom-inalis, which is the German term for typhoid fever. We are not concerned to inquire particularly how the misunderstanding developed into a slightly alarming entry in the Weekly Return. It may, however, be well at a time when international thought for ,infectious diseases is overstepping national and political boundaries to make sure of a nomenclature which is generally understood. It is now long since with the aid of Jenner and Murchison a group of dangerous febrile illnesses of long duration was finally split up into typhus and typhoid, and it was, no doubt, wise to introduce names of markedly distinct tone. The word typhus, however, continued to do service in the Germanspeaking countries for the whole group, a qualifying adjective being added : abdominalis corresponds to our typhoid ; exanthematicus to typhus fever ; recurrens to relapsing fever. It would probably be a safeguard for us also to qualify the term typhus with the adjective exanthematic and so, as we become more polyglot, avoid a source of confusion which has here shown itself in high places. It is the less to be regretted that the Nomenclature of Diseases issued by the Royal College of Physicians of London in its latest edition dropped the foreign equivalents, since its place may be filled by the International List of Causes of Death, revised at a Paris conference in 1920.
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THE CLINICAL THERMOMETER AS NOXA. THERE is a pleasant theory, largely justified by practice, that the doctor lives a charmed life and, as he goes about his daily work, does not become infected himself with the many infective agents with which he comes in contact, nor does he carry these with him home or to other patients. This professional immunity seems also to include that faithful instrument of general practice, the clinical thermometer. We know of no exact inquiry into the usual habit of the practitioner, but no doubt a large proportion simply cleanse the bulb of the thermometer with water or soap-and-water before replacing it in the case. In THE LANCET of August 23rd (p. 406) Major H. C. Brown, I.M.S.. demonstrated that this method of cleansing the clinical thermometer is ineffective in the case of intentional contamination with a laboratory and he documented his statement with abundant cultures of the bacillus from clinical thermometers which had been washed in water and wiped with a clean cloth. This is the bacteriologist’s challenge. Now, there is every reason that the clinical thermometer should be freely used on all possible occasions, and that no unnecessary formality should stand in the way of such use ; experience of general practice is in the final issue the best criterion of how to use it. The practitioner who has to adapt clinical means to clinical ends need only observe the aseptic code in so far as it is of proved necessity. The mouth is evidently provided with efficient measures, whether natural or acquired, to Otherwise prevent infection of modest intensity. what infant would escape whose comforter is replaced in its mouth or what adult who consumes ripe cheese ? Nevertheless, more attention should be paid to the avoidance of conveying living germs by the clinical thermometer. Instrument makers have already made it small and convenient for us in a way unfamiliar to the Continent, where a thermometer is often the size of a long cigar ; the reservoir has been arranged so that the thermometer reads quickly and the mercury shakes down easily; it is apparently too much
germ,
l
to ask for a glass thermometer which can be dipped in boiling water without bursting. The Immisch thermometer, which consists essentially of metal, is as yet a pleasant scientific toy. It is true that manufacturers have of recent years made glass which can be heated red hot and dipped in cold water without breaking, but so long as the constricted neck remains an essential part of the mechanism of the clinical thermometer, any sudden application of heat must continue to burst the bulb. We are driven, therefore, to fall back on the more prolonged action of antiseptics. Antiseptic thermometer cases without number have been devised. One was described in our columns more than 20 years ago, in which the case could be filled two-thirds with strong carbolic solution. Other instruments provide an absorbent lining which can be moistened with antiseptic lotion ; the evolution of formaldehyde vapour within the case has also been effected. There are a number of simple devices now on the market, and the St. Dunstan’s case, to which we have already called attention, is highly ingenious in conception and quite satisThe practitioner might in factory in practice. many cases, as a correspondent has reminded us, put the onus of providing a clean thermometer on the patient, remembering that a family is much less susceptible to its own bacterial flora. But Major Brown’s warning is a word in season.
THE Final Report of the Departmental Committee the use of Preservatives and Colouring Matters in Food is being printed and will shortly be issued from I-LM. Stationery Office. The terms of reference to the Committee have been extended to include the question of the treatment of flour with chemical substances, and the Committee will now proceed to inquire into this question. on
A MEETING is being arranged by the Royal Society of Medicine at 1, W’im,pole-street, London, W., on Nov. 6th, at 8 P.M., between the Section of Obstetrics and Gynaecology and the Section of Epidemiology and State Medicine and the Society of Medical Officers of Health, to discuss the notification of puerperal sepsis. Those engaged in general practice, who are not members of the Sections and Society mentioned, will be welcomed as visitors and are invited to take part in the discussion, as it is thought to be very desirable that the views of the general practitioner should be put forward as well as those of the obstetrician and medical officers of health. AT the second session of the Royal Commission on Lunacy the Board of Control was again under examina-
tion. Sir Frederick Willis informed the Commission that of the 5525 patients sent out on trial during a recent year a large proportion had to return again to institutional care. The insufficiency of accommodation for mental cases would, he said, in a short time become serious. The Chairman of the Commission remarked that workhouses were not proper places for the reception of patients likely to improve under treatment, a point on which the Board of Control would welcome discussion. In answer to a representative of the National Society for Lunacy Reform, Sir Frederick Willis said that not more than six cases a year of cruelty to patients occurred in which dismissal or other disciplinary action was taken instead of prosecution, and all allegations of cruelty were followed up. The present machinery of certification and detention, he thought, adequately safeguarded Sir George Schuster the liberty of the subject. described the legal position of the Lord Chancellor in lunacy matters. The next meetings of the Commission will be held at 5, Old Palace Yard on Oct. 21st and 22nd, beginning at 10.30 A.M. each day, when evidence will be taken from the Ministry of Health. 1 Issued by St. Dunstan’s (registered under Blind Persons Act, 1920), who receive half the inventor’s royalty on all cases sold. Manufactured and distributed by J. J. Hicks, 8, Hattongarden, London, E.C.
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i
THE CLINICAL THERMOMETER AS NOXA. THERE is a pleasant theory, largely justified by practice, that the doctor lives a charmed life and, as he goes about his daily work, does not become infected himself with the many infective agents with which he comes in contact, nor does he carry these with him home or to other patients. This professional immunity seems also to include that faithful instrument of general practice, the clinical thermometer. We know of no exact inquiry into the usual habit of the practitioner, but no doubt a large proportion simply cleanse the bulb of the thermometer with water or soap-and-water before replacing it in the case. In THE LANCET of August 23rd (p. 406) Major H. C. Brown, I.M.S.. demonstrated that this method of cleansing the clinical thermometer is ineffective in the case of intentional contamination with a laboratory and he documented his statement with abundant cultures of the bacillus from clinical thermometers which had been washed in water and wiped with a clean cloth. This is the bacteriologist’s challenge. Now, there is every reason that the clinical thermometer should be freely used on all possible occasions, and that no unnecessary formality should stand in the way of such use ; experience of general practice is in the final issue the best criterion of how to use it. The practitioner who has to adapt clinical means to clinical ends need only observe the aseptic code in so far as it is of proved necessity. The mouth is evidently provided with efficient measures, whether natural or acquired, to Otherwise prevent infection of modest intensity. what infant would escape whose comforter is replaced in its mouth or what adult who consumes ripe cheese ? Nevertheless, more attention should be paid to the avoidance of conveying living germs by the clinical thermometer. Instrument makers have already made it small and convenient for us in a way unfamiliar to the Continent, where a thermometer is often the size of a long cigar ; the reservoir has been arranged so that the thermometer reads quickly and the mercury shakes down easily; it is apparently too much
germ,
l
to ask for a glass thermometer which can be dipped in boiling water without bursting. The Immisch thermometer, which consists essentially of metal, is as yet a pleasant scientific toy. It is true that manufacturers have of recent years made glass which can be heated red hot and dipped in cold water without breaking, but so long as the constricted neck remains an essential part of the mechanism of the clinical thermometer, any sudden application of heat must continue to burst the bulb. We are driven, therefore, to fall back on the more prolonged action of antiseptics. Antiseptic thermometer cases without number have been devised. One was described in our columns more than 20 years ago, in which the case could be filled two-thirds with strong carbolic solution. Other instruments provide an absorbent lining which can be moistened with antiseptic lotion ; the evolution of formaldehyde vapour within the case has also been effected. There are a number of simple devices now on the market, and the St. Dunstan’s case, to which we have already called attention, is highly ingenious in conception and quite satisThe practitioner might in factory in practice. many cases, as a correspondent has reminded us, put the onus of providing a clean thermometer on the patient, remembering that a family is much less susceptible to its own bacterial flora. But Major Brown’s warning is a word in season.
THE Final Report of the Departmental Committee the use of Preservatives and Colouring Matters in Food is being printed and will shortly be issued from I-LM. Stationery Office. The terms of reference to the Committee have been extended to include the question of the treatment of flour with chemical substances, and the Committee will now proceed to inquire into this question. on
A MEETING is being arranged by the Royal Society of Medicine at 1, W’im,pole-street, London, W., on Nov. 6th, at 8 P.M., between the Section of Obstetrics and Gynaecology and the Section of Epidemiology and State Medicine and the Society of Medical Officers of Health, to discuss the notification of puerperal sepsis. Those engaged in general practice, who are not members of the Sections and Society mentioned, will be welcomed as visitors and are invited to take part in the discussion, as it is thought to be very desirable that the views of the general practitioner should be put forward as well as those of the obstetrician and medical officers of health. AT the second session of the Royal Commission on Lunacy the Board of Control was again under examina-
tion. Sir Frederick Willis informed the Commission that of the 5525 patients sent out on trial during a recent year a large proportion had to return again to institutional care. The insufficiency of accommodation for mental cases would, he said, in a short time become serious. The Chairman of the Commission remarked that workhouses were not proper places for the reception of patients likely to improve under treatment, a point on which the Board of Control would welcome discussion. In answer to a representative of the National Society for Lunacy Reform, Sir Frederick Willis said that not more than six cases a year of cruelty to patients occurred in which dismissal or other disciplinary action was taken instead of prosecution, and all allegations of cruelty were followed up. The present machinery of certification and detention, he thought, adequately safeguarded Sir George Schuster the liberty of the subject. described the legal position of the Lord Chancellor in lunacy matters. The next meetings of the Commission will be held at 5, Old Palace Yard on Oct. 21st and 22nd, beginning at 10.30 A.M. each day, when evidence will be taken from the Ministry of Health. 1 Issued by St. Dunstan’s (registered under Blind Persons Act, 1920), who receive half the inventor’s royalty on all cases sold. Manufactured and distributed by J. J. Hicks, 8, Hattongarden, London, E.C.
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