Report of Progress in Laryngology

A. COOLIDGE
1903 Boston Medical and Surgical Journal  
When the price of thermometers has been much reduced, most of our patients will have their own thermometers ; this will render the care much easier thiin if one be used for different patients. But even in those ideal days, the practitioner will always have his transient patients who do not possess such an article, and some practical method is necessary to keep the thermometer as near surgically clean as possible. Not much, to my knowledge, has been written on this subject in standard
more » ... standard text-books. Perhaps the importance of cleansing the instrument is so evident to physicians that it may be the reason why so little is written pertaining to it. In consulting several standard modern surgical works, in only one did I find mention of this subject, and then but three lines were devoted to the matter. In another work, about fifty pages were given to an admirable monograph on antisepsis, but no reference made to the thermometer ; yet this instrument plays an important, part in the care of the surgical as well as the medical patient. It seems to me that the best method to keep the thermometer free from germs is to copy the hospital method of placing it, while not in use, in an antiseptic solution ; this necessitates carrying the agent used. It is not practicable to carry antiseptic solutions except in a thermometer ease. I have found from experience that alcohol is the best basis for the antiseptic agent. For several mouths I carried the case filled with alcohol ; before and after using the thermometer, it was washed in cold water, preferably running water from faucet, and after use placed in alcohol in the case. For the past two years, I have used corrosive sublimate, and alcohol 1-5000. The only objection to alcohol is the odor, but this objection is overcome to some extent by flavoring the solution with ol. gaultherioe (one drop to four ounces of solution is sullicient). If the thermometer is carefully handled, no alcohol being spilled, there will be no perceptible odor. The bichloride solution is not as suitable for metallic cases as it is for the ordinary hard rubber, but may be used. Alcohol with some suitable antiseptic that has no effect on the metal, such as ¡i solution of thymol, soda salieylatc and alcohol of required antiseptic strength, is preferable. The objection to plain alcohol is its doubtful cllicacy as an antiseptic. I have had an ordinary cheap thermometer immersed in 1-5000 bichloride in absolute alcohol, in a hard rubber case, several weeks at a time, and found no appreciable effect on markings of the thermometer. It, may in time impair the markings on glass, but as yet I have had no difficulty in this direction. The solution has apparently no injurious effect on the hard rubber case. No doubt the strength of corrosive sublimate could be increased to 1-2000. Possibly alcohol increases the antiseptic effect of corrosive. I do not consider the other antiseptic agents, as I deem this the best for the purpose. Alcohol if spilled on the clothing dries quickly ; it is so volatile that the odor rapidly disappears. It has no special injurious effect on ordinary fabrics, which cannot be said of carbolic, permanganate and other ordinary antiseptics. When convenient, other antiseptics may bo used to supplement the solution for cleansing the thermometer before and after use, and the thermometer should at least be cleansed in clear cold water before and after using. Solution in the thermometer case should be changed quite frequently. The antiseptic effect of bichloride is so well known that we need not discuss its qualities as compared with other antiseptic agents. The " United States Dispensatory," the eighteenth edition, says that " corrosive sublimate is one of the most powerful of known germicides, a solution of one part of it in twenty thousand of water being sufficient to kill micrococci and bacilli in active growth ; whilst a solution of one thousand will rapidly destroy bacterial spores. According to Koch, as little as one part of corrosive sublimate in three hundred thousand of a proteid solution will prevent the generation of the spores of the bacillus of anthrax." The temperature should never be taken by mouth in diphtheria, syphilis, pulmonary tuberculosis, typhoid and many other contagious cases unless the most rigid antisepsis be employed ; in fact, I think the, temperature should never be taken by mouth or rectum unless one is sure that the thermometer is practically sterile. I have never known of disease being transmitted by the thermometer, but transmission of disease from unclean thermometers is within the range, of possibility. While I do not claim that the method advocated procures thorough sterilization, I think it is far safer than the ordinary method used. To Bum up, I would say that the practical methods of eliminating transmission of disease by thermometer are : (1) Separate instrument for each patient. (2) The hospital method of keeping the thermometer immersed in antiseptic solution, when not in use. (3) Keeping in the thermometer case a solution of bichloride and alcohol (1-5000 to .
doi:10.1056/nejm190302121480707 fatcat:kgtyg3w6tzecvim256gqqnzhm4