Typhoid bacilluria / by C.J. Lewis.

Date:
1901
Catalogue details

Licence: In copyright

Credit: Typhoid bacilluria / by C.J. Lewis. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

    9/14 (page 265)
    means of the urine, is to be accomplished by efficient disinfection— inefficient disinfection is worse than useless, since it engenders a false feeling of security. The best disinfectant in typhoid bacill- uria is heat. The urine should be boiled to insure destruction of the bacillus, though it is killed even at lower temperatures than boiling point. This method is impracticable in all cases, but in a fever hospital it would be possible to provide a cauldron in which urine could be boiled, allowed to cool, and then discharged into ordinary drains. All vessels and urine receptacles should likewise be disinfected, and for these, as well as for the urme itself, where heat is not available, disinfectants must be used. Admixture of the urine with the disinfectant must be thorough to be effectual; and, after mixing, it must be allowed to stand for half an hour before discharge into drains, to give the disinfectant time to act. Equal quantities of 1-20 carbolic acid and urine should be mixed together, to obtain steriUty in that time, or, if perchloride of mercury be used, a sufficient quantity must be added to give, with the urine, a solution of strength 1-1000. After this has been allowed to act, the mixture may be diluted before discharging it down ordinary drains. Izal is also useful, if used as directed for carbolic acid. The quantities of disinfectant required, and the intelligent labour required in their use, contribute to render disinfection by heat preferable. Finally, let us consider the question. Should disinfection of the urine be a routine practice in all cases of enteric fever ? and answer it in the light of our present knowledge of the condition of typhoid bacilluria. Looking to the fact that the majority of cases of enteric fever never have bacilluria, the routine disinfection of all enteric urines would entail a large amount of unproductive labour, and may be omitted; hut, on the other hand, looking to the fact of its occur- rence and infectivity, detection of all cases must be aimed at, and then the urine must be rendered innocuous. The detection of the condition lies, in the first instance, in the hands of the general practitioner and those in charge of fever hospitals. I recommend that, for one fortnight before the return of all enteric patients to communal life, the doctor should each day inspect the urine for cloudiness, and satisfy himself that there is no bacilluria, before allowing the patient to leave his supervision. In this way the chances of the spread of enteric fever by this method may be greatly minimised. If, in any case, the medical attendant suspects bacilluria, it would be well to send a specimen for examination by a bacteriologist; it is not necessary here to go into the distinctions between the B. ti/phosus and the numerous organisms which closely resemble it, microscopically and culturally. It is sufficient to say that the organism must answer to a large