Books seem well adapted for carrying small-pox, measles, scarlet fever, trachoma, diphtheria, erysipelas, dysentery, typhoid and tuberculosis. Yet so far as I have been able to find, no satisfactory method for the disinfection of books is being used anywhere in this country. Books are a particular diversion of invalids and convalescents, therefore they are in much danger of becoming infected. If a person sneezes or coughs, he is very apt to hold his book in front of him. By placing petri dishes around tubercular patients, Fliigge (14) found that tubercle bacilli are thrown as far as a yard in the coughing, sneezing or even speaking of such persons. Besides the danger of contamination in these ways and in the ordinary handling of a book, many people persist in the uncleanly habit of moistening their fingers in their mouths when turning the leaves.
Scarlet fever has been carried to distant places by letters (11). A case is known where a mother and baby were fatally infected with septicemia from a book (11). In Bordeaux several people were attacked by a feverish lumbago after having rearranged the library books of the Faculty of Medicine (6). Letters written by small-pox patients infected the post-office officials in Kent, England (29). Most serious of all, an epidemic of tuberculosis occurred among the officials in the archives of Kharkow, Russia (11). The excise officer had been in the last stages of tuberculosis and had been in the habit of moistening his fingers with saliva as he handled the documents.
The length of time that the different pathogenic bacteria can withstand drying varies greatly. Krausz (15) placed bacteria from 48-hour-old cultures in books and kept them in the dark at room temperature. He found' that cholera lived only 48 hours, whereas diphtheria lived 28 days, Staphylococcus 31, typhoid 40-95 days and tubercle bacilli 80-103 days. Other investigations confirm his results except in the case of tuberculosis and diphtheria. Abel (29) found that diphtheria bacilli retained their virulency on toys for six months and this is the length of time that Von Schab (27) gives. Lion (17) and Von Schab both say that tubercle bacilli withstand drying for six to nine months.
The number of bacteria that may be found on much used books was investigated by Lion (17). A novel from a public library varied from 250 bacteria per 100 square centimeters on the middle of a clean page to 1,250, 1,875 and 3,350 on the dirty edges. A college atlas showed from 650 to 1,075 per 100 square centimeters; an anatomy book 2,275 to 3,700. The bindings were by far the richest in bacteria, yielding on an average 7,550 per 100 square centimeters.
As to the pathogenic bacteria that may occur on books, the following investigations are of great interest. Krausz (15) inoculated seven guinea pigs with dirty pieces of paper from much used books and they all died of peritonitis. Copyrighted by the author, 1911. This investigation was made at Clark University, Worcester, Mass. 61 The eighteen inoculated with pieces from clean books remained healthy. Du Cazal and Catrin (6) found staphylococcus pyogenes on an old book in a hospital. Most striking of all are Mitelescu's (20) experiments. He took 60 much used books that had been in a public library from six months to two years; he cut out the dirtiest parts, soaked them in salt solution, centrifuged the liquid and inoculated guinea pigs with the sediment. Nineteen died of septicemia and twelve of streptococcus infection. He repeated the experiment with thirty-seven books from three to six years old. Fourteen of the guinea pigs died of septicemia and fifteen contracted tuberculosis. The damp dirt on the older books was a good medium for tubercle bacilli.
A book is a very difficult thing to disinfect. The method used must kill all the bacteria, must not injure the books and finally must be as easy to use and cheap as possible. The disinfectants that have been tried for books are steam, Pictet's gas mixture, formalin, carbo-gasoline, steaming formalin vapor under vacuum, dry hot air and moist hot air.
Steam fulfills the first requirement by killing all the bacteria, but unfortunately it is very injurious to books, especially to leather. It is recommended, however, by Abba (1), Du Cazal and Catrin (6), Krausz (15), Petruschky (22) and Rickards (23) who suggest that all school and library books should be stitched instead of glued and have as cheap covers as possible so that steam disinfection would not injure them very seriously. Letters on the other hand do not suffer any bad effects from being autoclaved. This was the experience in the aforementioned small-pox epidemic in Kent; the letters were autoclaved, no more small-pox was disseminated and the letters themselves were uninjured. This was confirmed by experiments of my own.
Pictet's gas mixture-sulphuric acid and carbonic acid in equal parts-was tested as a book disinfectant by Von Schab (27), but he found it ineffective. On account of the convenience of formalin as a disinfectalnt it has been adopted in many cases for books without due regard to its effectiveness for this purpose; Lehman (16), Englund (7), Lion (17) and Miquel (19) had apparently satisfactory results with formalin.
However more exhaustive investigations by Du Cazal and Catrin (6), Van Ermengen and Sugg (26), Knopf (14), Von Schab (27), Barbe (3), Ballner (2) and Rickards (23) have proved conclusively that formalin will not kill bacteria in books. A gas will not penetrate between the leaves of a book no matter how ingeniously the book is held open.
In this country a device for general fumigation is the DePree formaldehyde fumigator. Mr. DePree told the writer that he recommends no penetrative qualities for formaldehylde gas and that it is therefore not adapted for book disinfection.
A new method has recently been suggested by Beebe (3) for disinfecting books by immersing them for 20 minutes in a 2% solution of carbolic acid in 88 Bauime gasoline. He smeared a small amount of a bouillon culture on the leaves, 50 pages apart, of previously autoclaved books. One book was infected and immediately immersed for 20 minutes in carbo-gasoline; then the infected areas were placed in bouillon. Two other books were allowed to dry for an hour after being infected; they were then immersed for 20 minutes, and cultures made immediately from one of them, whereas the other was allowed to dry over night before they were made. 18 inoculations were made of bacillus diphtheriae, 7 of staphylococcus pyogenes aureus, 18 of bacillus coli conimiunis and 19 of bacillus 62 tvphosus-a total of 62-without growth in any case. He also placed tuberculous sputum between the pages of books and immersed them in carbo-gasoline for 20 minutes. Three guinea pigs were inoculated with this sputum, and one contracted tuberculosis.
I tested this method using 88 Baiime gasoline saturated with carbolic acid (about a 2% solution). Books thoroughly dry after having been autoclaved were inoculated 20 pages apart with a loopfull of agar or bouillon cultures. The inoculated books were then placed in a sterile chamber for 48 hours so that the cultures would thoroughly dry to prevent any danger of their being washed off. Instead of 20 minutes they were left in the carbo-gasoline for one hour. They were then removed and allowed to dry for 96 hours to make sure that the gasoline would all evaporate. Cultures were then drawn off. 80 inoculations were made, 28 of bacillus diphtheriae, 27 of staphylococcus pyogenes aureus, and 25 coli communis. 55 of these grew: 25 of the diphtheria, 17 of the staphylococcus and 15 bacillus coli.
The next step was to determine whether saturated carbo-gasoline solution will kill bacteria when placed directly in contact with them. Nine test tubes containing slant agar cultures of bacillus diphtheriae, staphylococcus pyogenes aureus, and bacillus coli communis-3 of each-were filled with carbo-gasoline. This was removed after one hour and ten minutes. After 96 hours cultures were drawn off. Growth occurred in two of the staphylococcus cultures, one of the diphtheria and two of the bacillus coli.
By repeated tests it was found impossible to make a stronger solution of carbolic acid in gasoline than about 2%. So there seems to be no hope of modifying Beebe's method so as to make it effective. The only way that I can explain the lack of growth in Beebe's experiments is that his bouillon cultures must have been washed off by the gasoline since he did not thoroughly dry them. This is confirmed by my own experiments; for although they were well dried, only 25% of the bouillon cultures grew while 80% of the agar grew.
The three factors of formalin, vacuum and heat are combined by Kister and Trautman (12 and 13) in their method of disinfecting books. The books have to be held open; the temperature is 700 C. for two hours with a vacuum of 450 millimeters. This was further tested by Xylander (28) and also by Sobernheim and Seligman (25) and was found to disinfect books satisfactorily without injuring them. The apparatus consists of a formalin vaporizer, a disinfection chamber, a vacuum cylinder and an air pump. Although this method is effective, it is not very practicable; for only a few books can be disinfected at a time and the apparatus is complicated, expensive and difficult to manage.
Dry hot air at 140℃., when employed for a long time, will kill non-sporing bacteria, but such a high temperature is injurious to books. Mosebach (21) had good success in a few tests with dry air of 70°-80° for 14 to 24 hours, but Xylander (28) found that the least time necessary was 32 hours and that moisture supplied eithier by water or formalin shortened the disinfection time to 25 hours.
Moist hot air fulfills all the requirements for an ideal book disinfectant; for it kills all the bacteria, it does not injure the books and it is inexpensive and convenient to use. Several investigators worked along this line: Schuiiberg (24), who found that hot air of 100℃. and 55-65% moisture will kill bacteria without injury to leather; Ballner (2) who adopted this method for single closed books using a temperature of 950 C. and 40-60% moisture; and Berlioz (5) who, with a temperature of 95℃., supplied his moisture by a dish of formalin 63 and ethyl aldehyde (le. The perfecting of the moist hot air disinfection of books is due to Xylan(ler (28) and Findel (9 and 10). Xylander's work was especially thorough and convincing, for he made' considerably more than a thousand tests. 78 ℃to 80° C. and 30 to 40% moisture for 32 hours will kill all non-sporing bacteria in closed books, even tubercle bacilli in thick layers, and does not injure the most delicate binding in any way, even after mouths of disinfection. Greater heat than 80℃. and more moisture than 40% is injurious to the books. When disinfecting a pile of books a small thermometer should be placed in a rather thick book in the middle of the pile. When this thermometer registers 70° C., which may take 11 hours, the disinfection may be counted as begun. It must continue for 32 hours in order to kill all the bacteria. I tested this method making 73 inoculations and obtained perfect success.
In order to find out the condition of affairs in this country, letters were written to the Boards of Health of all the states and of all cities with a population over 100,000. They were asked what disinfectants and what methods they use in disinfecting contaminated school and library books. Only six answers mentioned library books; three of these said infected library books are destroyed; two, that they are fumigated with formalin, and one Board makes " daily reports to both school and libraries of all contagious disease matters," but it failed to state what action is then taken. As to school books 12 states and 10 cities do nothing at all; 9 states and 22 cities burn all contaminated books; 17 states and 25 cities use formalin; 2 states and one city use dry' heat; 3 cities use steam and one state and 3 cities are trying carbo-gasoline. Of those using dry heat, one says merely " we use dry heat sterilizing," a second uses 14℃. for one hour, which according to all authorities is too short a time to kill the bacteria and besides injures the books. The third uses 80 ℃ for 2 hours.
I tested this and the cultures grew in ever' case. Only 9 states and 25 cities-those who burn and those who use steam are taking proper precautions in regard to the danger of infection from scarlet fever, (liphtheria, small-pox and occasionally measles. This is being done, however, at the sacrifice of the books. A significant fact is that not one of the 100 letters mentioned tuberculosis.
1. Books are known to have infected people with septicemia, feverish lumbago and tuberculosis. Letters have carried scarlet fever and small-pox.
2. Staphylococcus is able to withstand drying 31 days, typhoid bacilli 40 to 95 days, diphtheria one to 6 months, and tubercle bacilli 3 to 9 months.
3. Well used books have been found to have from 3,350 to 7,550 bacteria per 100 square centimeters.
4. Seven guinea pigs died of peritonitis when inoculated with pieces of dirty books. Guinea pigs were inoculated from 60 well used books that had been in a public library 6 months to 2 years. 31 died from septicemia and streptococcus infection.
Other guinea pigs were inoculated from 37 books from 3 to 6 years old; 14 died from septicemia and 15 contracted tuberculosis.
5. Steam is an effective disinfectant but ruins the books.
6. Formalin is entirely untrustworthy as a disinfectant for books.
7. Dry hot air is not a satisfactory niethod.
8. Carbon-gasoline is absolutely inefficient as a book disinfectant.
9. Moist hot air at 80 ℃. and 30-40% humidity for 32 hours will kill all non-sporing bacteria in closed books, even tubercle bacilli in thick layers. However, it is difficult to operate and takes the librarians so much time in disinfection.
10. Boards of Health should make daily reports to the schools and libraries of all contagious diseases, including small-pox, measles, whooping cough, scarlet fever, typhoid, erysipelas, dysentery, diphtheria, venereal diseases and tuberculosis. Books that have been in the hands of such patients should be disinfected.
11. As a matter of precaution, especially against tuberculosis, it would be well if public library books that are much in use and all school books were disinfected by this method at regular intervals. Public school books should always be disinfected before given out to a new set of pupils.
12. When using a public library book one should realize that it may have been in the hands of some one suffering from tuberculosis or other disease.
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29. pp. 288-312. 29. YOUNG, A. S. The disinfection of books. The Sanitary Record. London, Nov. 25, 1898. 22. pp. 561-562.
30. L. B. NICE. Harvard Medical School. Disinfection of books.