DISINFECTION.
By disinfection is meant the destruction of the active cause of each
infectious disease. A disinfectant is therefore synonymous with a
_germicide_. Disinfectants must be distinguished from _deodorants_
or deodorisers, such as charcoal, and from _antiseptics_, which are
antagonistic to the growth of bacteria, without necessarily killing
them, _e.g._ common salt. Disinfection may be effected by chemical or
physical means.
CHEMICAL DISINFECTANTS.
A chemical disinfectant should fulfil the following conditions: 1. It
must be an efficient germicide. 2. Its germicidal power should not
be destroyed by the fæcal or other polluting matter, with which the
bacteria of infection are associated. 3. For many purposes, it must
not be destructive to or liable to stain the skin, or fabrics, or
other articles to which it is applied. 4. It should preferably not be
a virulent poison; and should be moderately cheap. The search for a
completely non-poisonous disinfectant is a chimera.
There are three great =classes of chemical disinfectants=.
1. Oxidising agents, as the halogens (chlorine, etc.) and permanganates.
2. Deoxidising agents, as sulphurous acid (SO₂) and formic aldehyde
(CH₂O).
3. Other disinfectants, which act by coagulating protoplasm or
otherwise, as carbolic acid, corrosive sublimate.
The number of disinfectants is legion. Only the chief ones can be
mentioned and their chief properties described. It is a good rule to
eschew the use of all disinfectants of which the exact composition is
not given; and all disinfectants which are described by “fancy” names,
which are not descriptive of their composition.
A. OXIDISING AGENTS.
=Chlorine= has been most commonly used as chloride of lime (CaCl₂,
Ca(ClO)₂). This is somewhat unstable in composition. A solution of
sodium hypochlorite containing 10 per cent. of available chloride is
preferable. Chloride of lime for sprinkling on decomposing matter
should contain at least 10 to 15 per cent. of available chlorine.
Sulphuretted hydrogen and other offensive gases are decomposed by it.
Thus
SH₂ + Cl₂ = S + 2HCl. Its chief action is as an oxidising agent. Thus
H₂O + Cl₂ = 2HCl + O.
A large excess must be used in disinfecting, otherwise the chlorine
may simply oxidise fœcal or other organic matter, and not effectually
destroy contagia.
_Methods of Use_—(_a_) As a gas, by the action of hydrochloric acid on
strong chloride of lime. The molecular density of chlorine is 35·5, of
formic aldehyde 15, of sulphurous acid 32; and the rate of diffusion of
gases being inversely to the square-root of their densities, clearly
chlorine does not compare favourably as a gas with formic aldehyde.
The bleaching effect of chlorine on coloured articles of apparel is a
disadvantage.
(_b_) As a liquid: used thus chlorine is very efficient, applied either
as a spray or brushed on walls and other surfaces. Delépine found
that a solution of one part of chloride of lime in 100 parts of water
applied to wall paper impregnated with tubercular matter, disinfected
it in a few hours, or in a few minutes if the layer of infected matter
was not thick.
=Bromine=, =Iodine=, and =Euchlorine= (a mixture of chlorine and Cl₂O₄)
are efficient disinfectants.
=Iodine Trichloride= (ICl₃) was found by Behring to share with
corrosive sublimate (HgCl₂) carbolic acid and cresol mixed with acids
(see page 327), the halogens (Cl, Br, and I), and chloride of lime a
superiority over other disinfectants in their power of killing anthrax
spores in a short time.
=Permanganates= have been largely used as disinfectants, but their
value is small. Impure sodium manganate (Na₂MnO₄) with much common salt
(NaCl) containing some permanganate is known as “Condy’s Green Fluid.”
“Condy’s Red Fluid” consists of permanganate and sulphate of soda. To
be of any use it must be employed in 5 per cent. solution. It stains
fabrics brown, and it exhausts its feeble disinfecting power in first
oxidising decomposing organic matter.
B. DEOXIDISING AGENTS.
=Sulphurous Acid= (SO₂) acts chiefly as a reducing agent on organic
matter. It is used chiefly as a gaseous disinfectant, and for this
purpose is generated (_a_) by burning 1 lb. of sulphur for every 1,000
cubic feet of space in the room (which will equal 1·12 per cent.
of SO₂). The windows and chimney of the room are first closed; the
sulphur is placed in a saucepan supported over a bucket of water, and
its ignition is aided by a small quantity of methylated spirit. The
door of the room is then sealed, and the room left until the next
morning. (_b_) Carbon disulphide may be burned in a benzoline lamp.
(_c_) SO₂ liquefied under pressure is supplied in cylinders available
for convenient use. The experimental results of the action of SO₂
on various bacteria are somewhat discrepant. It probably is fairly
efficient for some diseases, but not in tuberculosis.
=Formaldehyde= or Formic Aldehyde (CH₂O) is produced by the slow
and incomplete oxidation of methyl alcohol (CH₃OH) under access of
air. A saturated solution in water containing 40 per cent. of the
formaldehyde gas is known as =formalin=. The simple evaporation or
heating of formalin is liable to produce the polymeric _paraform_ which
is solid and inert. To prevent the formation of paraform when formalin
is evaporated, Trillat adds to it a solution of calcium chloride
(C_a_C_l_₂), the mixture being known as _formochloral_. It is stated
that when the air of a room is charged with less than one per cent. of
the vapour, rapid and complete disinfection of surfaces occurs, and
that it possesses a certain amount of penetrating power into loose
fabrics. No damage is done to textile fabrics; and disinfection by this
means possesses the advantage over disinfection by sulphurous acid
or chlorine that the room can be entered without serious discomfort
soon after the disinfection is carried out. In solution formalin is
undoubtedly a powerful disinfectant, and in the gaseous condition it is
at least equal in value to SO₂, probably better. Formaldehyde is used
as a disinfectant.
(_a_) By evaporating a 60 per cent. solution of CH₂O in methyl alcohol
(trade name _holzine_) over pieces of glowing coke placed under an
asbestos plate (Opperman-Rosenberg apparatus). (_b_) By subliming
tabloids of paraform by the heat of a lamp. A methylated spirit lamp
is employed, and the moisture from the combustion in this causes
the transformation of a considerable proportion of paraform into
CH₂O vapour. It is doubtful if the quantity of the latter evolved
is sufficient for efficiency. (_c_) In Trillat’s apparatus formalin
(_i.e._ the 40 per cent. solution in water of CH₂O) with CaCl₂ solution
is heated in an autoclave worked at a pressure of 40 lbs., provided
with a pressure gauge and thermometer. In all these methods the room
must be carefully sealed, as the tendency for the disinfectant to
escape is greater than with SO₂ or C_l_. (_d_) The best method is to
spray a solution of formalin 4 oz. to one gallon of water on all the
surfaces of the room (see page 333). This is equal to a strength of 1
in 40 of formalin, or 1 in 100 of formic aldehyde.
C. OTHER DISINFECTANTS.
TAR ACIDS.—When coal tar is treated by acids and alkalies in
succession, it becomes separated into (1) hydrocarbons, (2) phenols
or tar acids, carbolic, cresylic, etc., (3) aniline and other basic
substances. The hydrocarbons are known in commerce as “neutral tar
oils.” They are brown and syrupy, turning milky with water, and feebly
disinfectant. The two most important “tar acids” are phenol or carbolic
acid (C₆H₅OH) and methyl-phenol, also called cresol or cresylic acid
(C₆H₄(CH₃)OH). The higher members of this same group yield milky
emulsions with water, and are less poisonous than phenol. Various
mixtures of them are used as disinfectants, and sold as creolin, Jeye’s
and Lawes’ fluids. Izal belongs to the same series.
=Carbolic Acid= (phenol) did not kill anthrax spores until a 3 per
cent. strength of its solution was used for 7 days (Koch), but
sporeless anthrax bacilli were destroyed in a few minutes by a 1 to 2
per cent. solution. The disinfecting power of carbolic acid is greatly
increased by adding mineral acids. Carbolic acid and lysol are superior
to creolin for disinfecting stools. A 5 per cent. solution of carbolic
acid destroys tubercle bacilli in sputum in 24 hours. _Carbolic acid
powders_ are in common use. In my opinion quicklime is more valuable.
=Cresol= is obtained from “crude carbolic acid” by fractional
distillation at a temperature between 185° and 205° C. A one-half per
cent. solution has equal disinfecting power to a 2 or 3 or sometimes a
5 per cent. of phenol (carbolic acid).
=Creolin= consists of cresol emulsified in a solution of hard soap.
Behring classifies the comparative germicidal power of phenol, cresol,
and creolin on bacteria in broth as 1, 4, and 10 respectively. When
albumen is present, creolin loses a part of its disinfectant power.
=Lysol= contains 50 per cent. of cresol, dissolved by means of neutral
potash soap. It is completely soluble in water and does not turn milky
as creolin does when water is added. It is more effective than creolin,
and still more than HgCl₂ in albuminous liquids.
=Soap= has, owing to its alkalinity, disinfectant as well as cleansing
action. A temperature of 55°-75° C. greatly aids its action.
_Antiseptic soaps_ possess no special value as germicides, but carbolic
soap is a useful insecticide.
=Lime= in a one-tenth per cent. solution destroys typhoid and cholera
microbes.
=Mercuric Chloride= (HgCl₂, corrosive sublimate) was found by Koch
to destroy anthrax bacilli in a dilution of 1 in 20,000. Others have
obtained less favourable results, but it is certainly a powerful
germicide. The germicidal effect is greatly diminished by contact with
organic matter, an insoluble albuminate of mercury being produced. For
this reason HgCl₂ is not the best disinfectant for fæces unless mixed
with acid, as in the following solution: HgCl₂ ½ oz., HCl 1 oz.,
aniline blue 5 grains to three gallons of water. This gives a solution
of 1 in 960. The colouring is added to avoid accidental poisoning.
HgCl₂ is not a good disinfectant for linen. Stains are apt to be fixed
by it, and if linen soaked in it is subsequently washed with soap,
without first carefully washing out the HgCl₂, it is darkened in
colour. It attacks metals, and must not therefore be placed in metal
receptacles.
=Chloride of Zinc= in a solution containing 25 grains to the fluid
drachm is known as “Sir William Burnett’s solution.” It is a good
deodorant, but an inefficient disinfectant.
=Chinosol= (C₉H₆NKSO₄) belongs to the quinoline group. It is an almost
inodorous powder, very soluble in water, noncorrosive, and does not
stain. A solution of 1 in 1200 forms an efficient germicide.
DISINFECTION BY PHYSICAL MEANS.
Natural processes tend to the destruction of pathogenic microbes after
their elimination from the patient. Of these desiccation, sunlight, and
fresh air are the most potent. Heat and cold have a similar effect.
Filtration or mechanical separation deprives a contaminated liquid of
its microbes.
=Desiccation= attenuates the virulence of and finally kills most
microbes. In laboratory experiments the vibrio of Asiatic cholera
when dried dies in from three hours to two days, according to the
degree of desiccation. The bacilli of enteric fever, tuberculosis,
and diphtheria only die after drying for a few weeks or even months.
The anthrax bacillus may retain its vitality for several years in a
desiccated state. Clearly, therefore, desiccation has no administrative
value in the prevention of disease, and on the contrary it aids the
dissemination of the microbes of tuberculosis, small-pox, scarlet
fever, etc.
=Direct Sunlight= kills a large proportion of the sporeless pathogenic
microbes. Diffuse is less energetic in its action than direct sunlight.
The bacillus of diphtheria is destroyed by a half to one hour’s
exposure to sunlight. As to tubercle bacilli, see page 316. Downes
and Blunt showed that diffused sunlight retards the putrefaction of
organic infusions, and that direct sunlight inhibits putrefaction.
Sunlight cannot, however, be trusted as an efficient disinfectant. It
only secures _surface_ disinfection, and could not be relied upon for
pillows, mattresses, etc. M. Ward’s experiments showed that the actinic
rays of the sun are germicidal, independent of the heat.
=Fresh Air=, like sunlight, should be employed as a valuable auxiliary,
not as an agent to be depended upon apart from systematic disinfection.
The experiments of Downes and Blunt showed that light and oxygen
together accomplished what neither alone could do. The presence of
air in anthrax increases danger. The anthrax bacillus does not form
spores in an animal suffering from this disease, and does not do so
_post mortem_, unless the animal is dissected. Hence the importance of
keeping the skin unbroken in this disease, only examining a drop of
blood to establish the diagnosis.
=Filtration= is a means of separating microbes from the gases or
liquids containing them. For the filtration of water see page 96.
The carbolic sheet outside a sick-room is supposed to filter the air
leaving the room from microbes. It is probably useless except as a
reminder to the nurse to change her dress and adopt other precautions
on leaving the sick-room.
=Settlement of dust= also acts as an aerial disinfectant. If a room be
locked up, its air next day is almost free from particles, and all that
is then required is _disinfection of the surfaces_ of the room and of
the articles in it. Whatever method of disinfection is employed, it is
not disinfection of the air, but of the surfaces of a room which is the
end in view.
=Washing= is the most efficacious means of removing infection. It is
a mechanical means of removing the particular matter of which the
contagium consists from the person or article to which it adheres into
the water, which subsequently enters the drain, in the same way as do
urine and fæces. Washing is an absolutely efficient means of purifying
articles that can be completely submitted to it. A consideration of the
=physical laws governing the spread of infection= will make this clear.
The contagia are passive. When contained in a liquid they cannot escape
from it under ordinary circumstances. Thus foul smelling gases may
escape from sewage, but bacteria do not escape, except rarely during
bubbling, or from dried portions of the invert of the sewer. Barring
rare accidents “microbes submerged are imprisoned.” Contagia are
harmless until they become dust. Hence the danger associated with the
use of pocket handkerchiefs in such diseases as influenza and phthisis;
and the importance of keeping all infectious discharges wet, until they
can be finally disposed of.
DISINFECTION BY HEAT.
Heat may be applied in various ways: (1) Prolonged boiling in water of
materials which are not spoilt by this means. (2) Destruction by fire
of infected articles. (3) Dry hot air. (4) Steam.
=Boiling= kills most pathogenic microbes. The cholera vibrio is
killed in four minutes at a temperature of 52° C. (126° F.); the
typhoid bacillus at 59°.4 C. (138°.8 F.) in ten minutes. If boiling
be continued for five minutes, the spores of pathogenic microbes are
killed. The addition of one to two per cent. of washing soda to the
water hastens this effect. For infected linen nothing beyond this is
required.
=Destruction by Fire= is to be recommended for comparatively worthless
articles, such as toys, straw from beds, rags, old clothing and bedding.
=Dry Hot Air= has been largely used in the past in ovens, for the
disinfection of bulky bedding. It is now entirely superseded by steam.
Its disadvantages are that (_a_) heat penetrates very slowly into
the interior of bedding. Disinfection in test experiments was not
accomplished in the interior of small bundles of clothes in three
or four hours. (_b_) Scorching of articles often occurs. The sole
advantage of this method is that bound books and leather goods are
less liable to be damaged by it than by steam. If no other apparatus
is available a baker’s oven will serve to kill the non-sporiferous
microbes of cholera, enteric fever, and diphtheria, as well as animal
vermin. If, however, we accept the proper test proposed by Buchanan of
the efficacy of disinfection, the “destruction of the most stable known
infective matter,” dry heat is unsatisfactory.
=Steam= may be employed as a disinfectant either (_a_) _superheated_,
or (_b_) _saturated_, _i.e._ close to the temperature at which
condensation occurs. This temperature depends upon the pressure under
which the water has been boiled. At ordinary atmospheric pressure
it is 100° C. (212° F.). The temperature of boiling is raised by
subjecting the water to pressure. Consequently boiling water and the
steam produced from it may be at any temperature. Thus steam may be
(_a_) Under pressure, with a temperature above 212° F.
(_b_) Not under pressure, at a temperature of 212° F.
[Illustration: FIG. 57.
EQUIFEX SATURATED STEAM DISINFECTOR.
=A=—Disinfection chamber. =B=—Partition wall separating infected from
disinfected side. =C=—Door on disinfected side. =D=—Door on infected
side. =EE=—Safety-locking bolt for securing door. =FF=—Stiffening
rings on doors. =G=—Steam inlet from boiler. =H=—Steam separator for
arresting water condensed in =G=. =I=—Valve controlling admission
of steam to disinfecting chamber. =K=—Valve controlling admission
of steam to coils. =LM=—Safety valves regulating steam pressure in
chamber and coils respectively. =NU=—Pressure guages indicating steam
pressure in chambers and coils respectively. =OO=—Objects after
disinfection. =P=—Wheeled carriage and cradle for =OO=. =Q=—Hinged
rails on which =P= runs. =R=—Exhaust pipe for steam and air on first
admission. =S=—Thermometer showing rise of temperature (to control
complete air evacuation). =T=—Valve for closing exhaust pipe =R= when
air is completely evacuated. =V=—Sluice valve to cause sudden escape
of steam. =W=—Cock to admit steam to ejector. =X=—Exhaust pipe fitted
with ejector for escape of steam before and of air during drying.
=Y=—Valve for admission of air for drying under suction of ejector.
[In some types of this machine this valve is placed on the lower part
of =C=.]]
Steam when admitted into a disinfecting stove comes into contact with
cold objects. _If the steam is saturated_, immediate condensation to
1∕1600 part of its original volume occurs. Its latent heat is at the
same time evolved. The condensation causes enormous shrinkage in bulk.
More steam is thus insucked into the partial vacuum produced, and this
is repeated, until in every part of the mattress or other material
undergoing disinfection equality of temperature is reached, when
condensation of steam will cease, and disinfection is complete. _If the
steam is superheated_ and no condensation allowed, disinfection occurs
by the relatively slow method occurring with dry heat. In practice
at the early stage cooling causes some conversion of superheated
into saturated steam, though subsequently the much slower process of
disinfection by conduction of heat goes on. Hence superheated steam is
a less efficient disinfecting agent than saturated steam.
Superheating is produced in disinfecting stores in two ways: (1) By a
jacket around the stove, which is kept at about double the pressure
and about 20° to 30° F. hotter than the interior of the stove; as
in the older patterns of the Washington Lyon stove. (2) By having a
jacket containing a solution of calcium chloride, which is heated by a
furnace under the stove. This solution is kept at a constant strength
by an automatic supply from a cistern. The temperature of the boiling
water is thus raised without pressure to 225° F. This is the principle
of Thresh’s stove. The object of superheating steam is to assist in
rapidly drying materials; but this object can equally well be secured
by periodically allowing the sudden escape of the steam confined under
pressure, in pressure disinfectors. This last method is the best, as
it can not only be utilised at the last stage of the disinfection for
drying the articles; but at the earlier stage for sweeping the air out
of the stove, and thus removing what, owing to its low conductivity
for heat is one of the most serious obstacles to rapid and efficient
disinfection.
In the above description it has been assumed that the steam, whether
saturated or superheated, is =confined=, except when the exhaust is
employed for drying purposes. Steam may also be employed as =current
steam=. Current steam disinfectors are initially cheap, but more steam,
and therefore more fuel, is required in their use; and unless pressure
is used by impeding the escape of the steam a temperature of only 212°
F. can be secured. Accepting Buchanan’s dictum, a stove supplying
saturated steam under pressure at a temperature in the interior of the
stove of 234° F. is to be preferred. This temperature with saturated
steam destroys the spores of the most resistant known microbe (that
of symptomatic anthrax). With superheated steam or hot air stoves on
the same basis a temperature of 280° F. would be required, which is
damaging to most textiles, except horsehair.
THE PRACTICE OF DISINFECTION.
The =Management of the Sick-room and Patient= requires careful and
conscientious attention to detail. Certain details are given on page
319. All unnecessary furniture, carpets, and hangings should be removed
as soon as the nature of the illness is known; but unless these
articles have been contained in close trunks or drawers, and not opened
since before the onset of the illness, they must be disinfected. Food
left over from the patient’s meals must be burnt, if solid, in the
patient’s room; if liquid, emptied down the water-closet. Dry sweeping
of the floors is to be avoided, only wet brushing or cloths being used.
Volatile aerial disinfectants during the sickness are valueless.
The =Treatment of Discharges from the Patient= is the most important
point in the management of infection. The stools should be received
into a bed-pan containing a 5 per cent. solution of carbolic acid,
a 3 per cent. solution of cresol or lysol, or a 5 per cent. solution
of chloride of lime. Milk of lime (20 per cent. strength) is very
reliable, when added like the preceding solutions in bulk equal to that
of the stool to be disinfected. The urine and vomit, if any, should
be treated in exactly the same way. The infection of enteric fever is
often spread by undisinfected urine.
Discharges from the =throat, nose and mouth= of patients should be
received into a solution of
lysol 5 oz. to 1 gallon of water, or
carbolic acid 7 oz. „ „ „
The efficacy of the carbolic acid solution is increased by adding 2 oz.
of NaCl, or 12-14 oz. of NaCl to each gallon. Pocket-handkerchiefs must
be avoided, linen rags being employed instead, and placed at once in
one of the above solutions or burnt.
The =skin= may scatter infection, especially in small-pox and scarlet
fever. Frequent baths and inunction with vaseline or oil are useful.
The =disinfection of hands= is most important for all attendants on
the infectious sick. A solution of corrosive sublimate 1-1000, or one
of the above solutions may be used for this purpose; but this is to be
supplemented by the free use of the nail-brush and soap and water. The
treatment of =linen= has been described (page 329).
=Woollen articles= of underclothing, and =blankets= can be disinfected
by steam, which shrinks them less than boiling water. The ordinary
laundry processes appear, however, to suffice to rid them of infection,
without boiling.
=Bedding=, curtains, and carpets should be disinfected by steam.
Certain precautions are required in removing these to the disinfecting
station. Surface disinfection of the room must have been first effected
(see below); and the infected bedding should be encased in canvas bags
or sheets. When a steam disinfector is inaccessible, the mattress
and pillows should be taken to pieces, the covers washed, and their
contents disinfected by spraying with formalin solution (1 in 40) or
HgCl₂ solution (1 in 1,000), and subsequently exposing to sun and air.
For disinfection of suits of clothes, current steam may be improvised
as follows:—Over two bricks at the bottom of the kitchen “copper” thin
floor-boards are placed, above the level of 2 or 3 inches of water
previously placed at the bottom of the copper. The cover of the copper
is put on, and by means of a brisk fire steam is kept streaming through
the clothes. This is continued for an hour, and the clothes then hung
out to dry.
=Furniture=, when wooden, can be washed. If upholstered it can be
disinfected by spraying (see p. 333), and then beating and dusting in
the open air.
=Furs, Boots, and Shoes= are spoilt by steam. For the first, spraying
freely with formalin (1 in 40), or exposure over a formalin lamp (page
326) is recommended. Boots and shoes should be filled and washed with a
solution of HgCl₂, chinosol, or formalin.
[Illustration: FIG. 58.
EQUIFEX SPRAY DISINFECTOR IN USE.]
The =sick-room= can only be efficiently disinfected after the patient
has left it. The aim is _surface disinfection_. Aerial disinfection is
sufficiently effected by open windows. Four chief methods of surface
disinfection are practised. (_a_) _Fumigation_ by SO₂, formalin,
cresol, or other vapours (see page 326). (_b_) _Spraying_ the ceiling,
walls, floor, and furniture with a disinfectant solution is probably
the most convenient method of disinfection. It is more effectual than
fumigation, less laborious than rubbing down walls, etc., by bread
or wet cloth, and less likely to damage wall-papers than brushing
a disinfectant solution on them. Solutions of HgCl₂ 1 in 1,000, or
chinosol 1 in 1,200, or formalin 1 in 40 are efficient. A special spray
apparatus (Fig. 58) is usually employed. A practical point is to spray
the wall from below upwards, to prevent the solution running down the
wall and producing streaks of discolouration. (_c_) _Washing_ ceiling
and walls with the disinfectant solution may be substituted. A one
per cent. solution of hypochlorite of lime is largely used for this
purpose, applied by a long-handled whitewash brush. (_d_) _Attrition_
of walls, etc., by means of bread or dough sterilises them by
mechanically removing microbes. The bread is cut into pieces suitable
for grasping in the hand, the cut surface being applied to the wall.
The crumbs must afterwards be burnt in the room. This is the official
method in Germany.
=Floors= may be treated like walls and ceiling after the patient has
left the room. During his occupancy of the room, tea-leaves or sawdust
thoroughly impregnated with lysol or cresol should be sprinkled on
the floor before it is swept, or washing substituted for sweeping.
Scrubbing with soap and water constitutes the best disinfectant for
floors and all other washable surfaces.
=Books= are difficult of disinfection. Steam damages leather. The
penetrating power of dry heat is doubtful. Cheap books should be burnt.
Abel discovered virulent diphtheria bacilli on toys six months after
the patient, to whom they belonged, had diphtheria. Formalin and phenol
vapours have been used to disinfect books in closed chambers, the books
being stood on end. Letters can be rendered safe by steam disinfection.
=Corpses= of infectious patients should be placed in the coffin and
buried as early as possible. A thick layer of sawdust saturated with
lysol or cresol should be placed at the bottom of the coffin, and the
corpse enveloped in cotton wool. Cremation is better than burial.