SHALL TERMINAL DISINFECTION BY FUMIGATION BE DISCONTINUED?*

DR. JOHN H. LANDIS, Health Officer, Cincinnati, first speaker. The title to this Round Table Discussion as printed in the program is misleading, and everyone here would vote "no" to the question.

There is a world of difference between disinfection and fumigation, the one indicating destruction of pathogenic organisms, the other, a method of accomplishing this end, which is very seriously questioned by public health officials of wide experience.

Fumigation is probably the oldest method employed to control the spread of epidemic diseases. It had its origin at a time when comparatively little was known concerning the cause and methods of distribution of the acute communicable diseases. Its efficacy has been under fire for a number of years, Dr. Chapin being the leader and most emphatic of the forces arrayed against fumigation.

Dr. Chapin based his decision against disinfection by fumigation on experience and sound reasoning, refusing to accept anything as true that was simply a matter of belief based on tradition and custom.

From 1902 to 1905, 1,457 families in which diphtheria occurred, and in which fumigation was employed, showed recurrences within sixty days after disinfection, of 25 or 1.71 per cent. From 1905 to 1911, in 3,000 infected families without terminal fumigation, there were 54 recurrences, or 1.80 per cent. Dr. Chapin compared these results with those obtained in Baltimore where fumigation was very carefully done.

"In order to make the Providence figures comparable with those of Baltimore, it was necessary to include recurrences in other families in the house as well as the family first invaded and to calculate the percentage of total cases rather than on invaded households." Baltimore shows the following:

The scarlet fever situation in the matter of recurrences is set forth in the following table:

Scarlet Fever With Fumigation.
Years. Infected Recurrences.

Families.

Ratio.

*Summary of discussion at conference of municipal health officers and the State Board of Health, Columbus, January 18 and 19, 1917.

The Health Commissioner of Buffalo reports, as illustrating the efficacy of disinfection, that after 3029 cases of scarlet fever where terminal fumigation was practiced and tested, there were 117 recurrences or 3.8 percent. This percentage of recurrences is over one hundred per cent higher than in Providence where no terminal disinfection by fumigation is done.

With our present knowledge concerning the methods of distribuof communicable diseases, the employment of fumigation aption to many to be not only a waste of money but an actual aid in pears their distribution, because it encourages people to neglect the things that are worth while through the creation of a false sense of security, Measles, whooping cough, diphtheria, scarlet fever, cerebrospinal meningitis, infantile paralysis, influenza and acute colds in the nose throat are spread chiefly through personal contact with those actually sick or carriers.

and

When distributed through an infected food supply, fumigation of the rooms occupied by the patient could do no possible good, and fur fumigation of patients is out of the range of possibilities.

The logical method of disinfection is a continuous process. during the period that a patient is capable of transmitting the disease. either by direct or indirect contact. It includes sterilization of discharges containing the infectious element and the sterilization of all articles coming in contact with the patient.

Last week a health officer in a neighboring state informed me that two cats left in a room by mistake during the time the fumigation being done, went through the ordeal safely.

was

The facts developed by Dr. Chapin have been verified by Dr. Goler of Rochester and Drs. Goldwater and Emerson of New York City.

With these facts as a basis for action, it is recommended that the health officers of Ohio go on record as favoring changes in the laws governing disinfection in this state, which will place this important branch of preventive medicine on a plane harmonizing with our knowledge of the methods of distribution of communicable diseases.

Discussion.

DR. FRANK G. BOUDREAU, State Board of Health. - Terminal disinfection by fumigation might be an effective measure if carried out in the manner prescribed by the State Board of Health, but as usually performed in Ohio it is absolutely useless. Some health officers are attempting to fumigate whole houses with one candle. Others do not properly seal the room or fail to provide for enough moisture to make the fumigation effective. I am in favor of doing away with terminal fumigation as we have it in Ohio, but would substitute some other method of disinfection. I would recommend

that more attention be given to concurrent disinfection. I do not know of any disease in which fumigation, as performed at present, is of any value at all.

DR. LOUIS KAHN, Health Officer, Columbus.-Fumigation is a well established custom that has come down to us. The question as to whether it is effective or not is probably one of the things that has always presented itself to every man who has done any health work. We do certain things because they have been done before. Because our laboratories have in times past instructed us that fumigation by formaldehyde, sulphur, etc., would destroy certain forms of bacterial growth, we have gone through the process of fumigation.

Every man who has practiced medicine any great length of time has sometimes had cases in which the question of the distribution of contamination to other individuals has made him sceptical even of all our modes of destroying bacteria. I recall reading of a case in which children contracted scarlet fever by playing with the hair of a child who had died of the disease twenty years before. I believe that if there is danger of a germ remaining in a room in a virulent state for even a day and formaldehyde fumes will destroy it, formaldehyde should be used.

If there is some body which is able to determine this question for us, it should do so and instruct us, and if we are instructed that the practice has no value it should be discontinued. If there is any value in fumigation then it should be up to those in authority to see that it is properly done. Someone in authority should investigate the matter and give us their findings; that is, the United States Public Health Service, or the State Board of Health should investigate the mater thoroughly and if they believe there is no value in it, they should have the law changed. The effect on the public should be considered. There should be a uniform rule. The matter ought to be thoroughly studied before any radical step is taken.

DR. LOWER, Marion. We believe in fumigation as a result of practical experience. After we began the practice of fumigating thoroughly, rooms occupied by patients, others were not infected. I don't know whether fumigation was the cause of it or not. I do know that it did occur before fumigation and did not occur after fumigation. We had an epidemic of smallpox in Marion some time.

We fumigated carefully. In less than two months every trace of the disease was eradicated from the city.

I do not believe that one formaldehyde candle will fumigate a room. A sufficient amount of moisture and a large enough quantity of formaldehyde will, however, prove effective. I found it to be such and the board of health of Marion has found it so. Fumigation, if thoroughly done, will prevent reinfection. This is not what I have found out by laboratory work, but by simply noticing the results. We have been getting the results and that, I believe, is what every one in the room wants.

I think the practice should be continued unless something is substituted. And we must consider the effect upon the public of

discontinuing this system. If we discontinue it we must substitute something else and teach the people that it is more effective than fumigation.

DR. W. A. MANSFIELD, Health Officer, Barberton. -I wish to sanction all that Dr. Kahn has said in this matter. As you probably well know a great many health officers and boards of health throughout the state use these commercial fumigators. Formaldehyde and some other materials have raised to such a price that they are almost prohibitive. For years, in Barberton, we have been using commercial fumigators. The manufacturers claim that each candle will disinfect 1000 square feet. However, we do not trust to that but use two and sometimes three. I think at one time I wrote to the Board of Health in regard to these commercial fumigators. It seems that the Board of Health could not recommend or disrecommend. I have wondered why the State Board of Health has not, to my knowledge at least, investigated this matter of fumigaion and made a report and some recommendation. It seems to me a bacteriologist could go into the house and take up matter from the floor or bed and ascertain whether the particles did or did not contain germs. It seems to me that after fumigation, they could make another examination to find out whether the fumigation had been effective. I am always in doubt as to whether fumigation is effective or not. I believe with Dr. Kahn that it is something that should be thoroughly and scientifically investigated, that we may know whether a proper fumigation is effective or not, before we end the process.

--

DR. A. L. LIGHT, Dayton. For a number of years I was in favor of fumigation, primarily because I had learned from experience that in cases of ordinary colds and grippe, it usually runs through the family. I felt that I was able to check the recurrence of the disease in the family by fumigation. When I came into the public health office one of the first things I found there was my secretary who was locked in a room with a representative of a manufacturer, and he gave the representative an order for fumigators at $72.00 a gross. I canceled the order at first opportunity and bought the same fumigators at $42.00 a gross.

Various makes of disinfectors were supplied by six firms. These were tested fairly. We have raised the temperature. We have sealed the rooms. We have put in 11⁄2 times as much fumigator as they recommended per thousand cubic feet and then doubled it, with the result that 20% or one in five of the fumigators that we have. tested have been effective.

I think it is generally known that we get these contagious diseases from the patients themselves. We cannot fumigate the patient and must depend upon fumigating the house where we know no disease germs exist, and spend our money for fumigators, four-fifths of which is wasted. I think we might as well discontinue it. I do not see that it has any value at all. If we have to fumigate to make it legal we shall go through with it, but just as soon as the patient is safely recovered, we will hire three or four scrub women and have

them go into the house and use soap and water and a little disinfectant and clean up the house from top to bottom. I think that will do more good than fumigatin.

MR. TIMOTHY SHEA, Fumigating Officer, Columbus. — I am a man of twenty years' experience in fumigation and if there is a city in the United States that shows results it is Columbus. I do not believe the evidence of Dr. Chapin, based on statistics regarding Baltimore and Providence is conclusive on account of differences in population and other conditions existing between the cities. My own experiences in a number of cases (cited) prove to me the efficacy of fumigation when properly performed.

DR. W. H. KNAUSS, Health Officer, Newark. The members of this conference do not disbelieve in terminal disinfection. It should rather be emphasized that they are in favor of terminal disinfection of some sort. I. believe that some of this fumigation has not been carried out as it ought to have been. I am not a believer in fumigating one room in a house and I believe that liquid should be used where gas cannot be used.

We must keep the public from getting the idea that we do not believe in disinfection. A lot of townships will refuse to spend a nickel for fumigation if they can get out of it.

DR. LOWER, Marion. I frankly state that I am one of those who do not know what to do. I have taken diphtheria swabs myself. Now if germs can be carried on a swab, why can they not be carried on furniture, etc. If formaldehyde gas is not sufficient, we should get a method that is sufficient.

DR. CUNNINGHAM, Girard. There are some practical difficulties encountered in fumigation. Take for instance a nine-room house, the thermometer at 10° below zero. When you go to fumigate the whole family goes to the kitchen. What can you do about it? You can't run them out into the cold.

Instead of fumigating school houses we send a scrub woman and clean them up. I believe the best fumigation is a little more sunlight and the use of soap and water.

C. C. PEARL, Norwalk. I recall a case of scarlet fever. Two children in the same house, one had scarlet fever and the other child who stayed in the house with him did not take it. The doctor came in and went out without changing his garments. Do physicians carry the germs of disease or are they immune?

DR. Lowe, Health Officer, Piqua. In a case of scarlet fever which I remember a mother was sick and there were three children, one a baby, in the house. Neither of the children who were in the room took scarlet fever. I believe that some people are naturally immune to various diseases.

Those who favor fumigation have not brought forth any proof that fumigation has accomplished anything, that is, terminal fumiga

I question the value of fumigation in any room, where there is an opening for a stove pipe, where ceilings are not air-tight, etc.