Popular Science Monthly/Volume 30/April 1887/Infection and Disinfection

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INFECTION AND DISINFECTION.

By ROBSON ROOSE, M.D.

THE enormous variety of subjects contained in medical literature necessitates the use of a corresponding number of terms, the majority of which have a certain and well-known meaning; but it would be difficult to find two words more wanting in the element of precision, and more loosely used, than those placed at the head of this article. The general public, indeed, solve all difficulties by connecting with the word infection the idea of something "catching," i. e., something that can be propagated from one person to another, and disinfection is correspondingly regarded as the means whereby such propagation can be hindered. It must be admitted that this simple view is quite correct so far as it goes. It of course disregards all questions as to the nature of infection, and the reason why some diseases spread from person to person and others do not, and it accepts without doubt the belief that disinfection is generally attainable, and by comparatively simple means. In cases especially where the use of some well-advertised material is found to neutralize or mask an unpleasant odor, the completeness of the disinfection is looked upon as absolutely certain.

In medical writings the confusion has been still further increased by the use of the words "contagion" and "contagious" in describing those diseases which were considered to spread from one person to another by contact. "Infection" and "infectious" were limited to the cases in which the poison of the disease was supposed to be conveyed by the atmosphere from the sick person to those at a greater or less distance from him. Accordingly, we used to hear of a disease being contagious but not infectious, and vice versa. The distinction is, however, a purely artificial one, and is not sustained by facts, for many of the contagious diseases can be propagated indirectly—that is, without actual contact between the person who yields the poison and the person who receives it. Take, for example, diphtheria: it assuredly spreads by contact, and is therefore contagious, and no less positively is the poison capable of being disseminated through the atmosphere and infecting those who inhale it. So, too, with small-pox. If its virus be introduced under the skin of a person unprotected by vaccination or a previous attack, he will almost certainly suffer from the disease, and the same result would follow were such a person to be in close attendance upon a small-pox patient. In the latter case, the poison floating about in the atmosphere would get into the system through the lungs, and this is practically just as much an example of contact as if the poison were artificially introduced through the skin. It is therefore better to consider the terms "infection" and "contagion" as practically synonymous, and they will be so used in the remarks that follow.

To show what is implied by an infectious disease, let me take a typical example and contrast it with another disorder well known to be non-infectious. A young adult, previously in good health, is suddenly attacked by such symptoms as chilliness, soreness of throat, and evidences of derangement of the stomach. There is nothing characteristic about these symptoms; but let us suppose that on the following day there are high fever, dryness of skin, headache, giddiness, etc., and that in a few hours a scarlet rash appears, first on the chest, and then spreads over the body. All the symptoms become worse, and for ten or twelve days the patient is very ill. After this period, in favorable cases, a change takes place for the better, the rash dies away, and all the other symptoms gradually subside. In from four to six weeks, supposing that there are no complications, the patient regards himself as well. Such, in a few words, is the course of a mild case of scarlet fever, which may be considered as a typically infectious disease. Now suppose that our patient is treated in a house where there are several other young people who have never suffered from the disease. We know from experience that unless the most minute precautions are taken, the majority of these persons will exhibit similar symptoms. It is also well known that if any of these patients, supposed to have partially recovered from the disease, change their place of abode and go among other friends, the latter will run great risk of being attacked, and that the disease may thus spread ad infinitum. This capacity of propagation, the possession of which is as certain as anything can possibly be, suggests the inquiry as to the manner in which the original patient of our series became infected. He in his turn must have taken the disease from some one else, but it is quite possible that he has never been within a mile of a scarlet-fever patient. In many such instances it is impossible to get any clew to the original case, but it sometimes happens that evidence is forthcoming to the effect that days or weeks, or even months before, a person convalescent from the disease has occupied a room of which our patient was afterward a tenant, or that some article of clothing which once belonged to patient number one has been handled or worn by the person whose case we are considering. It is evident that there must often be great difficulties in prosecuting such an inquiry.

Let us now take an example of a non infectious disease, and notice how it contrasts with the one we have just described. A young adult, previously in good health, becomes sensible of a feeling of heat, alternating with chilliness, and perhaps shivering, and slight pains in the limbs. In a day or two there is more or less fever and thirst, and some of the larger joints are swollen and very painful, while the skin covering them is much reddened. The pain and fever are the principal symptoms; but there are often others, a description of which is unnecessary for our present purpose. The complaint lasts an indefinite time, but, even in the absence of treatment, usually subsides within six weeks. Such, in a very few words, is the course of rheumatic fever or acute rheumatism.

These two diseases, scarlet fever and rheumatic fever, have much in common, but there are sharp points of difference between them. In both fever is a prominent symptom, and, in addition to the display of local symptoms, the whole system is evidently affected. The differences, however, are still more important. Scarlet fever is eminently infectious. The air which surrounds the patient becomes contaminated and highly charged with the poison, and persons breathing it run great risk of becoming affected. In a case of rheumatic fever, although the secretion from the skin is generally very copious and peculiar in character, so that the sense of smell is strongly appealed to, there is no such risk; the disease can not be conveyed from the patient to those around him, however close the attendance and however defective the ventilation of the room. Infection from a previous case is, therefore, never thought of in connection with rheumatic fever, though the actual nature of the poison which causes the disease is as yet unknown. The attack is often excited by exposure to cold and wet, circumstances which play no part in the causation of scarlet fever. There is at least one more important difference between the two diseases: scarlet fever very rarely, indeed, occurs a second time in the same patient, and the symptoms never become chronic; rheumatic fever, on the other hand, is very prone to recur, and in not a few cases the original attack merges into a chronic state of suffering, which may continue for months or even years.

I have taken scarlet fever as a representative of the class of infectious diseases, the cause of which is the contamination of the system by some specific poison, and I have sketched in a few words the main symptoms which result. For our present purposes the important points are the contagious or infectious character of the disease, and the proofs that the contagious material multiplies within the system which it has invaded, and from which it sallies forth in quest of other victims. There are, unfortunately, not a few diseases belonging to the same category as scarlet fever, the principal being small-pox, measles, typhus, influenza, whooping-cough, diphtheria, typhoid, and cholera. With regard to all these it may be stated that they are all separate and distinct as regards causation. A case of scarlet fever never gives rise to small-pox in those exposed to infection, neither does any one of the above diseases ever pass into another. There are other subordinate distinctions: the poison of scarlet fever, contained presumably in detached particles of skin, clings for months to articles of clothing, especially woolen ones; that of small-pox may be collected from the eruption and preserved for years between pieces of glass; that of typhus is easily rendered innocuous by free ventilation. All these peculiarities—and many more might be cited—point to important differences in the nature of the infectious materials.

What this infectious material really is has often been keenly debated since medicine became a science, and at the present time is the question which most closely occupies the minds of medical investigators. Merely to enumerate the inquiries, and to describe the experiments and the theories based thereon, would fill a volume; but it is not to be wondered at that this subject should have excited so much attention when we reflect upon the prevalence and fatality of the diseases in question, and upon the comparatively slight influence which treatment exercises upon their course. On the other hand, experience clearly shows that their prevention is not only possible, but in some cases easily accomplished. The knowledge of the causes of these diseases would indicate the proper preventive measures, or at any rate the direction which such measures should take, and hence a discovery of the cause in any given case at once yields practical results. When we know what causes infection, we can apply disinfection with every prospect of success. Without such knowledge success, if attained, must be accidental rather than otherwise. The nature of the contagious agencies, and the medium through which they spread, are the most important points in connection with the subject of infection.

There is strong evidence in support of the view that these contagia are actual living things. Formerly the opinion was universally held that infectious diseases were caused by foul air, and the effluvia connected with putrid decomposition were regarded as a sufficient cause for the development of fever, small-pox, etc. It can not be denied that gaseous matters, notably sulphureted hydrogen, may act as poisons and cause many serious symptoms, but it has never been shown that infectious diseases originate in this manner. It is contrary to all that chemistry teaches us, that sulphureted hydrogen or ammoniacal vapors inhaled by the lungs should increase within the body and cause it to become a center of infection; and we know likewise that ordinary poisons—e. g., arsenic or morphia—fatal as their effects may be to one individual, have no power of increase and propagation after being once taken. It is therefore evident that the poisons of infectious diseases must be something of an entirely different nature. We know that they multiply in the system to an almost infinite extent, and that every one of the myriads of atoms thus developed is as potent for evil as the atom from which it originated. The possession of this and other properties clearly indicates that the contagious agencies are independent living organisms, capable of growth and reproduction. It has long been known that certain diseases of the skin—e. g., ringworm—are caused by the presence of parasites, which very rapidly increase, and can be easily recognized under the microscope.

In the case of some three or four of the infectious diseases it would seem that the poison has really been discovered. On examining vaccine matter, the contents of the pocks in small-pox, and discharges in glanders, the microscope shows a vast number of infinitely minute particles, which appear as glistening points. Some of these are even less than the fifty-thousandth of an inch in diameter, and it therefore follows that very high powers are necessary for their detection. Such particles, obtained from vaccine lymph, have been washed in water; the water when inoculated did not produce any effect, but the washed particles were found to have retained their potency. It seems fair to infer that the contagious agents of the other infective diseases would resemble in their physical characters that of vaccine, and the nature of such particles is the important problem that offers itself for solution. They are supposed by some, and notably by Dr. Beale, to be of an animal origin, and to consist of elementary living matter, termed bioplasm. Such particles may be easily transferred from an infected to an uninfected organism, in which they will manifest their own specific powers, and grow and multiply almost indefinitely, exciting in their new home a series of changes resembling those which characterized their presence in the one from which they were derived. This account is certainly correct as regards the virus of vaccine, but it does not precisely define the nature of the particles or tell us anything of their origin. Dr. Beale, however, states that particles of contagious bioplasm are not generated in the organism of the infected animal, but are introduced from without, and were originally derived by direct descent from the bioplasm of the body of man or animal. He regards them in fact as particles of degraded bioplasm. This theory is not in favor, or rather is not fashionable, at the present time. One objection to its validity is constituted by the fact that particles of living animal matter die very rapidly after they have escaped from the body, whereas many contagious germs preserve their vitality and capacity for evil for a very long time.

Another theory which was promulgated some twenty years ago was to the effect that the contagious particles are of the nature of those low vegetable organisms which are termed fungi. This view gains support from the manner in which these bodies increase in number when planted in a suitable soil, and the power which they possess of decomposing many organic substances. The fact, already referred to, that several diseases of the skin and hair in men and animals are undoubtedly due to fungi, also tends to recommend this theory. Recent experiments, however, have shown that these organisms, capable as some of them are of growth and development on the surface of the body, do not possess the power of growth and reproduction within the body, and it is therefore unlikely that they should be the causes of disease in which the system is charged with poisonous materials.

A third theory is one which is extremely popular at the present day, advocated as it is by investigators of the highest repute. It is almost needless to say that I refer to the view which credits certain minute organisms, termed bacteria, with the power of causing the infectious diseases—that is, with being in themselves the poisonous agents. So firm is the hold that this view has obtained that "disease-germs" and "bacteria" are used as though they were synonymous terms. It is, moreover, probable that more experiments have been made with reference to bacteria than on any other subject whatever.

The term "bacterium" signifies a rod, and many of these organisms are minute, rod-shaped bodies. They or their germs are very widely diffused throughout nature; they swarm in the air and in water, especially if containing organic matter, and are likewise found in great numbers within the bodies of men and animals. Any one who possesses a microscope with a magnifying power of five hundred diameters can readily examine a very common form of bacterium. It is only necessary to take a glass of ordinary water from a spring or river, and to leave it in a room exposed for some days to the air. A thin coating, looking like a deposit of fine dust, is formed on the surface of the water; this dust consists of myriads of bacteria, which are readily seen when a drop of the water is examined. The bacteria are found to be in several stages of transformation: some are in long, jointed rods, others represent one or more detached portions of these rods, and others appear as extremely minute, rounded particles. The rods are capable of movement, and they are seen to wriggle through the fluid like small eels or snakes. The minute, rounded particles are the spores, which eventually become rod-shaped bodies.

The peculiar interest connected with this simple experiment is due to the fact that minute organisms closely resembling those just described are found in the bodies of patients suffering from acute infectious diseases, and the question naturally arises as to the relation which exists between the organisms and the symptoms. Are the former the cause of the latter, or is their presence a mere coincidence? Another suggestion is that their presence is the result of the disease. If the symptoms are really caused by the presence and action of the bacteria, it would follow that differences must exist between the organisms found in different diseases. Great and manifold difficulties attend such investigations; it is sufficient here to notice the extreme minuteness of the organisms, necessitating the use of the highest powers of the microscope for their detection. Moreover, as already stated, bacteria are found in large numbers in the bodies of healthy persons, and some of these organisms very closely resemble, if indeed they are not identical with, those that have been found in connection with severe infectious diseases. It is hardly conceivable that minute organisms which abound, for example, in the mouth, and give rise to no changes, should be capable in other parts of causing the most serious symptoms.

In order to prove that a micro-organism is the real cause of a disease, at least three conditions must be fulfilled: In the first place, the same species of micro-organism must be invariably found in the parts affected by the disease in question, at any rate during the early stage, and in no other affection. Secondly, the organism must be cultivated apart from the body in which it has been found, so as to make sure that it has been separated from all other morbid materials to the presence of which the disease might possibly be due. Thirdly, when the organisms thus cultivated have been introduced into the body of an animal capable of being attacked by the disease, similar symptoms ought to be set up, and the same micro-organisms should be found in the newly affected animal. If, in testing any given disease, these conditions are fulfilled, it is scarcely possible to doubt that the micro-organisms are the cause; they certainly can not be the result. It is fair also to argue from diseases in which the conditions are fulfilled, that others in which, owing to circumstances, the tests can not be properly carried out, are due to similar causes.

Very strong evidence is forthcoming in support of the theory that micro-organisms are the cause of infectious diseases. Horned cattle and sheep are subject to a disease termed anthrax, or splenic fever, and more than thirty years ago minute, rod-shaped bodies were found in the blood of animals which had died from this disease, which is also communicable to man. The significance of these rods was suspected only after Pasteur's researches into the part played by minute organisms in fermentation. Guided by these discoveries, Davaine inoculated healthy animals with blood from those diseased, with the result of producing similar symptoms, while myriads of organisms were found in the bodies of those animals which had been inoculated with a very minute quantity of blood. The symptoms are very characteristic, and the disease at one time caused an enormous mortality among cattle in France. By the opponents of the bacterium hypothesis it might, of course, be urged that in the inoculation experiments other morbid materials were simultaneously conveyed, and that the transmission of the disease was due to their presence. To meet this objection, and to fulfill the second condition laid down in the last paragraph, experiments for cultivating the organism were set on foot in the following manner: A drop of blood taken from an animal that had died from anthrax was put into a glass flask containing an infusion of yeast, which had been carefully treated and proved to be free from organisms. In twenty-four hours the liquid, previously clear, was seen to be full of very light flakes, which, when examined under the microscope, were found to be masses of organisms resembling those contained in the blood. A drop taken from this first flask was added to a second and produced the same effect, and a drop from this was added to a third, and so on till a tenth flask was thus charged with organisms. In this way the organism was enormously multiplied and completely freed from the admixture of any other substance. Yet when a drop was taken from the twentieth or even the fiftieth flask of such a series and inserted under the skin of a sheep it caused anthrax or splenic fever, attended by the same symptoms as those produced by the drop of blood taken from the first animal. It is impossible to conceive of any clearer proof that the organism is the sole cause of the disease. So crucial a test, however, can not be applied in every case, for many of the infectious diseases which are the scourge of mankind do not affect the lower animals, and it is therefore impossible to make trial of the organisms found in connection therewith. Besides anthrax, there are other infective diseases in animals which have been proved to be due to bacteria, and these facts strongly support the belief that the infectious diseases of mankind are due to the invasion of similar organisms. It is, however, impossible as yet to dogmatize upon this subject. There have already been too many assertions and inferences drawn therefrom which have turned out to be unwarranted. It is comparatively easy for skilled observers to detect the presence of micro-organisms, and, whenever uniformity of appearance is demonstrable in connection with a given disease, a decided addition has been made to our knowledge. For reasons above given, the next point, viz., the determining whether the organisms are the cause of the disease, is surrounded with great difficulties. The discoveries, however, with regard to splenic fever strongly support the view that bacteria are the efficient agents of contagious diseases.

Space will not permit me to do more than allude to the various theories that have been advanced with regard to the manner in which these tiny organisms produce disease. It was at first thought that they acted like parasites, and exhausted the system during their development. It is now, however, more commonly believed that the organisms elaborate a special ferment or poison, which, when produced in sufficient amount, gives rise to the symptoms of the disease.

One of the most valuable results of the study of these organisms is the discovery that by cultivation the virulence of some, at least, can be so mitigated that when inoculated they produce only slight and non-fatal symptoms, the development of which in a given animal is nevertheless protective against future attacks of the original disease. By cultivating the organisms of splenic fever at a temperature of 108°, it is found that filaments are produced but not spores, and that by repeated cultivation this growth becomes altered as regards its properties of causing disease. When inoculated it sets up a mild form of splenic fever, not dangerous to life, but perfectly protective against subsequent inoculation with the otherwise poisonous organisms. This discovery is worthy of being classed with that of vaccination as a protection against small-pox.

With regard to the channels through which the contagious organisms are spread, a few words will suffice to state what is known on this point, which is intimately connected with the subject of disinfection. Air and water are the chief media for the propagation of infectious disease. In the case of scarlet fever, which has been taken as the type, the scales detached from the skin and similar tissues from the throat contain the germs of the disease, and these find their way into the atmosphere and are received into the lungs. They attach themselves also to articles of clothing and furniture, and are thus often carried long distances. In the cases of cholera and typhoid fever, the discharges from the patient find their way into water, which thus becomes the channel by which the diseases are propagated. Food, too, may become similarly contaminated. Milk, for instance, has been often known to convey the poisons of typhoid fever, of scarlet fever, and of diphtheria. In the case of the first, the contamination has been probably due to adulterating the milk with foul water containing the disease-genns, but it may have arisen in some cases from the typhoid emanations having been absorbed by the milk. The poisons of scarlet fever and diphtheria were probably transmitted to the milk from the skins and throats of persons employed in the dairy and recently convalescent or scarcely recovered from attacks of these diseases. The germs of certain other infectious diseases find their way into the system through abraded surfaces of the body.

The fatal character of many infectious diseases, and the ease and rapidity with which they spread and attack large masses of the population, are sufficient to account for the endeavors that have been made since very early times to arrest their progress. As in many other matters, practice has preceded science, and, centuries before the vaguest ideas were entertained as to the nature of the diseases which seemed destined to be the scourges of mankind, efforts were made to stamp them out. As might be expected, many of these efforts were of the rudest description, but the earliest of them aimed at the object which the most modern science also seeks to achieve, viz., the destruction of the contagious material. The term "disinfection" first occurred in literature toward the end of the last century. A French writer, Morveau, in 1801, published a work on "The Disinfection of the Air," but the word was used somewhat earlier by a few English writers.

The most ancient method consisted in destroying by fire everything that had been in contact with the source of infection, the idea, no doubt, being that as fire consumes what is visible, it likewise destroys what is invisible. It is possible that the practice of burning the dead was in a measure based upon the conviction that a source of danger to the living was thus got rid of. The thirteenth chapter of Leviticus contains the most minute directions for disinfecting cases of leprosy; destruction of suspected articles by means of fire, the copious use of water, and isolation of the leper, are the means prescribed. Inspection by the priest was to decide as to the efficacy of these measures. Among the Egyptians and certain Asiatic peoples, the fumigations used by the priests in exorcising disease were probably neither more nor less efficacious than similar processes in vogue at the present day in some European countries.

In the growth of ideas with regard to the causes of infectious diseases, the theory gradually took shape that the infecting matters were formed as a result of the processes of decomposition, and as these processes are generally attended with the development of more or less unpleasant odors, it seemed only natural to assume that the causes of the latter were also the causes of disease. Instead of regarding foul emanations as generally mischievous, the idea was entertained that there was something quite specific about them, and accordingly we find that attempts to mask or neutralize them were regarded as the best methods of checking the spread of infectious diseases. Deodorization came to be considered as equivalent to disinfection. The idea was the more welcome inasmuch as it could be carried into effect without destroying property and without much difficulty. The attempt was certainly in the right direction, for the destruction of noxious agencies was the object in view. Unfortunately, the means employed absolutely failed to effect their purpose, and belief in their efficacy caused very mischievous results, viz., a sense of false security and neglect of ventilation and cleanliness as regards sick persons and surrounding objects. In fact, the confident adoption of deodorants as a means of checking the spread of infectious diseases was a decidedly retrograde step as compared with the use of fire for destruction and of water as a purifying agent.

Chlorine gas was the deodorant which came into very general use at the beginning of the present century. It was freely employed in hospitals, both civil and military, in prisons, workhouses, etc., and was supposed to be efficacious against fevers, cholera, and small-pox. Whenever its characteristic odor could be perceived, danger of infection was no longer feared. Persons carried about with them small flasks containing chemicals which generated this gas, and inhaled a little when they considered themselves exposed to risk. It soon, however, became evident that these precautions were useless; but even so recently as 1866, during the war between Austria and Prussia, it was thought sufficient to distribute saucers containing chloride of lime throughout the military hospitals, while only feeble efforts were made to insure cleanliness and other important sanitary requirements. In order to act as a real disinfectant, chlorine must be employed in a very different manner. The terrible mortality after surgical operations and severe injuries, a feature of which was that a large majority of patients died with symptoms of blood-poisoning, showed the futility of such attempts at disinfection.

In spite, however, of many similar failures, deodorization has been almost universally regarded as the main object to be accomplished, and other chemical agents have been used in order to combat the gaseous products of decomposition. This object could certainly be attained if the sense of smell were to be the sole judge of success, and the practice of deodorization led also to the discovery and use of many substances which have the power to prevent or retard putrefaction, and were therefore termed antiseptics, and regarded as equivalent to disinfectants. The conclusion, however, was soon forced upon the minds of experimenters that the infective agencies of fevers, small-pox, etc., were neither offensive gases nor the products of putrefaction, but something of an entirely different character. When an infectious disease became associated with the idea of a transportable material which increases and multiplies in its new ground, the discovery was not far off that organisms capable of reproduction are the real causes of the disease.

Definite ideas now prevail as to what is meant by disinfection, and as to the methods by which this object can be attained and the tests whereby their efficacy may be proved. Any substance may be regarded as a true disinfectant which, when added to a quantity of fluid swarming with bacteria, abolishes the reproductive power of these organisms. If the bacteria are capable of producing disease, or the poison of disease, a successful experiment has been made in the way of disinfection. This fact explains the paucity of the real experiences we possess of disinfection proper. Heat, exposure to air and sunlight, and the use of chemical agencies are the means at our disposal; it will be sufficient to point out a few of the methods in which they may be employed.

A very high temperature will, of course, destroy all forms of organized matter, and if we could always isolate the germs of disease and expose them to great heat, our task would be accomplished. Such isolation is of course impossible, but we make use of heat in the destruction of germs which have found a resting-place in clothes and bedding. The articles are placed in ovens or hot-air chambers, the temperature of which can be raised many degrees above the boiling-point of water. A high temperature, however, has less effect upon the spores than upon the mature organisms, but successive heatings are found to effect the desired result. During their development the spores rapidly pass through several stages, in which they become softened and far more amenable to the action of heat. Exposure to a current of steam at a temperature of 212° is a still more satisfactory method than the use of dry heat. It involves less injury to the articles to be disinfected (a very important point when blankets and other woolen goods have to be dealt with), and it is more simple, more rapid, and more certain in its action. When the necessary appliances are not available, washing the clothes with soap and hot water, and then boiling them for several hours, form an effective substitute. Exposure to sun and air will serve to complete the purification.

For the disinfection of the air of rooms many substances are recommended and employed, but the way in which they are generally used causes them to act merely as deodorants. Even at the present day, the fact is very incompletely realized that ventilation—that is, the continual admission of fresh air—is the only safe method of purifying the atmosphere of rooms containing sources of infection. It is simply useless to place saucers containing chloride of lime, carbolic acid, or Condy's fluid in a contaminated atmosphere with the hope that the germs floating about therein will be caught and killed, like mice in a trap. The chlorine, doubtless, will remove some offensive odors and readily diffuse itself throughout a room, but to act as a true disinfectant it must be so much concentrated that the air in the space containing it would be quite irrespirable by human beings. It is, however, when used scientifically, the best disinfectant we possess for purifying the walls, etc., of an empty room. All the openings should be rendered as nearly air-tight as possible, and the evaporation of a large quantity of water in the room aids the action of the chlorine. It is easily generated by adding hydrochloric acid to bleaching-powder. For deodorizing purposes in sick-rooms and passages, a gas called "euchlorine " will be found very serviceable. It is produced when a few crystals of chlorate of potassium are dropped into a little hydrochloric acid. The mixture can be conveniently made in a small widemouthed bottle, which should be placed as near the ceiling as possible, so that the gas may descend into the room. Chlorine and its compounds are much heavier than atmospheric air. Bromide is even more powerful as a disinfectant than chlorine, and both are far superior to sulphurous acid.

Carbolic acid has been much overrated as a disinfectant. The spores of the micro-organisms discovered in cases of splenic fever have been found to be absolutely unaffected after lying for upward of three months in a five-per-cent solution of carbolic acid in oil. It has been also found that vaccine matter mixed with carbolic acid in solution still retains its efficacy, and the question may therefore well be asked whether the highly diluted carbolic vapor used for purposes of aërial disinfection is not powerless to deal with an atmosphere saturated with the germs of infectious diseases.

When compelled to make use of water of a suspicious class, filtration and boiling constitute the most reliable methods of purification. Spongy iron is upon the whole the most efficacious filtering material. The water, especially if passed through sand afterward, comes out quite clear and pure, and may be kept for a long time without showing any signs of the production of living organisms. Charcoal filters, on the other hand, certainly sometimes allow spores or germs to pass through unchanged, and, when they are employed, boiling should always be superadded. It is not sufficient to bring the water once to the boiling-point; in order to be efficacious, repeated boilings are necessary, for the reasons given in a preceding paragraph. Milk of a suspicious character should always be thus thoroughly boiled. Travelers on the Continent do well to provide themselves with small portable filters, now easily procurable, for in many places the drinking-water is highly charged with impurities. It is satisfactory to know than the tannin contained in tea is a purifying agent of some value as regards organic matter present in water.

It would take up too much space and would be foreign to the purpose I had in view to describe all the methods of using the various disinfectants which are now offered to the public. With regard to many of them it is sufficient to say that their power has been absurdly overestimated. It can not be too strongly insisted, upon that deodorization is by no means equivalent to disinfection. My object has been to indicate in the first place what in the present state of our knowledge seems to be the true theory as to the causation of infectious diseases, and to show how obstacles are presented to more rapid scientific progress by the extreme minuteness of the organisms with which we have to deal. With regard to disinfection, I have striven to prove how entirely it must depend for its success on the specific action exercised upon the disease-germs by the means employed. The realization of this necessary relation can not fail to dispel many a fond belief with regard to disinfectants; but it will leave us with a more intelligent and useful appreciation of their true properties, and, by revealing how far we still are from the goal of complete knowledge, may even stimulate the investigator to explore paths of science which are yet unknown. Virgil says, "Felix qui potuit rerum cognoscere causas," and to nothing is this aphorism nowadays more applicable than to a knowledge of those agencies which produce infectious diseases.—Fortnightly Review.