eMJA: Ferson, Books as carriers of disease

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Books as carriers of disease

In the early years of bacteriology, librarians, microbiologists and public health physicians were much exercised by the question of whether books could transmit infectious diseases.

Mark J Ferson

MJA 2001; 175: 663-664

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Surveys and experiments on transmission - Attempts to sterilise books - Public health responses - Australian responses - Acknowledgements - References - Authors' details
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Given the current concern about transmission of anthrax spores via the mail, it may be instructive to revisit early research on whether books can transmit other infectious diseases. As the theory of spontaneous generation gave way to ground-breaking discoveries in the new science of bacteriology by Pasteur, Lister, Koch and others,¹ it was perhaps not surprising that this question was posed at an 1879 meeting of librarians in Chicago.² Although there was no evidence that bibliophiles had ever expressed a "fear of books as vehicles of pestilence",³ the question seemed to exercise greatly the minds of librarians, microbiologists and public health physicians, and numerous articles were published on the subject in medical and library journals over the succeeding 60 years. These articles sought to determine whether books could transmit infectious diseases and how library books could best be sterilised without damage.

Surveys and experiments on transmission

An early survey of United States boards of health elicited some notable and bizarre cases of infectious diseases acquired from books.⁴ These included scarlet fever transmitted by a book in which a young sufferer had inserted strips of his peeling skin as bookmarks, diphtheria in two children acquired through handling school books from a farmhouse where six cases of the disease had occurred 42 years previously, and smallpox in a man who borrowed books from a circulating library in a neighbouring town affected by a smallpox epidemic.⁴

An 1896 issue of The Lancet drew attention to a French study demonstrating isolation of streptococci, pneumococci and Corynebacterium diphtheriae, but not Salmonella typhi or Mycobacterium tuberculosis, from books soiled with the secretions of infected patients.^5,6 However, the obviously cynical author felt that fear of contagion would be insufficient to drive readers to buy rather than borrow books.⁵ A later study found that washings from library books which had been borrowed by people with tuberculosis failed to transmit infection when inoculated into the peritoneal cavity of guinea pigs.⁷

Attempts to sterilise books

A 1911 report sought alternatives to gaseous methods of disinfection, which are unable to penetrate closed books, and to steam, which damages books. Immersing books for 20 minutes in petrol containing 2% carbolic acid sterilised all inoculated cultures of C. diphtheriae, S. typhi, Escherichia coli and Staphylococcus aureus, but did not reliably destroy the infectivity of books contaminated with sputum containing M. tuberculosis.⁸ Thankfully, the author provided a recipe for a mixture of essential oils to hide the strong odours of petrol and carbolic acid and, perhaps rather obviously, exhorted the reader "to keep . . . the book until dry away from the fire".

The following year, an evidence-based review was published, drawing on references in English, German, Italian and French.⁹ On balance, formalin vapour was concluded to be ineffective, as the gas cannot penetrate the pages of a closed book. The author was unable to replicate the results of the previous study on petrol and carbolic acid, but supported earlier studies showing that the application of hot, moist air (78º-80ºC and 30%-40% humidity) to closed books for 32 hours destroys non-sporing bacteria and mycobacteria without injuring the books. For those not requiring immediate results, several studies found that storing books for a month in a warm, dry room minimised risk of transmission of tuberculosis,^7,10 streptococci^11,12 and staphylococci.¹² Finally, there was concern about the lack of knowledge of virus survival, with a clear statement that books used by a smallpox sufferer should be burned.¹³

Public health responses

In Britain, the government introduced specific provisions into public health legislation through the Public Health Act Amendment Act 1907. This required that a library book borrowed by a member of a household with a notifiable disease be returned to the local authority for disinfection or destruction, with failure to do so attracting a fine of up to Ł2. These provisions were continued in later versions of the Public Health Act and remain in force today. As the local authority was required to compensate the library for destroyed books, there was some incentive to disinfect them. However, well after introduction of the legislation, discussion continued among members of the Society of Medical Officers of Health as to whether books could transmit infectious diseases,^14,15 with much difference of opinion.

Australian responses

In Australia, public health legislation does not specifically refer to libraries but does mention books. Regulations in the Victorian Health Act 1890 for preventing spread of contagious diseases require that "The room occupied by the patient . . . in all cases, whenever possible, all hangings . . . shall be removed, together with books . . . and sunshine and fresh air in current allowed full play."¹⁶ On the other hand, 1896 guidelines provided by the New South Wales Department of Public Health for householders concerned about diphtheria or scarlet fever stated that the "only articles which must always be burnt are books, papers and toys; they cannot be safely disinfected".^17,18 Public health laws of the other States made no reference to books.

This lack of official guidance did not prevent libraries making their own rules about the handling of books borrowed by individuals with infectious diseases. The clearest manifestation of this concern was the fashion for private lending libraries, particularly in Melbourne, to promote themselves as "hygienic" (Box) because of their practice of placing books in cabinets with formalin vapour (Dr Richard Travers, Rheumatologist, Royal Melbourne Hospital, VIC, personal communication, Sep 2001). This was despite the fact that formalin vapour had already been shown to be an ineffective disinfectant of books. By the 1950s and 1960s, the proliferation of public libraries had largely killed off private lending libraries, and the declining risk of infectious diseases and consequent public interest meant that the concept of books as transmitters of disease was no longer worthy of serious consideration.

Acknowledgements

I wish to thank Brenda Heagney and Donna Mendrawi of the History of Medicine Library of the Royal Australasian College of Physicians, Sydney, for assistance in obtaining historical references.

References

Lechevalier HA, Solotorovsky M. Three centuries of microbiology. New York: Dover, 1974.
McClary A. Beware the deadly books: a forgotten episode in library history. J Library History 1985; 20: 427-433.
Winterich JT. A primer of book-collecting. Revised edition. New York: Greenberg, 1935: 114-120.
Reinick WR. Books as a source of disease. Am J Pharm 1914; 86: 13-25.
Books as disseminators of disease. Lancet 1896; 1: 180.
From our own correspondent. Paris. Lancet 1896; 1: 388.
Kenwood H, Dove EL. The risks from tuberculous infection retained in books. Lancet 1915; 2: 66-68.
Beebe WL. Carbo gasoline method for the disinfection of books. J Am Public Health Assoc 1911; 1: 54-60.
Nice LB. The disinfection of books. Bull Med Library Assoc 1912; 1: 61-66.
Smith CR. Survival of tubercle bacilli in books. Am Rev Tuberculosis 1942; 46: 549-559.
Balmain AR. Recovery of Streptococcus scarlatinae from experimentally infected books. Lancet 1927; 2: 1128.
Smiley HE. Books — shall they be sterilized? Rhode Island Med J 1933; 16: 5-6.
McCartney JE. Infection by books. Lancet 1925; 2: 212.
Society of Medical Officers of Health. Home Counties Branch. Public Health 1923-24; 37: 265-266.
Society of Medical Officers of Health. North Western Branch. Public Health 1923-24; 37: 295-296.
Cole HS, Morris H. The Health Act, The Infant Life Protection Act, The Margarine Act, with regulations, notes of English cases and index. Melbourne: Charles F Maxwell, 1894.
Department of Public Health, New South Wales. Suggestions to householders for the prevention of scarlet fever (or scarlatina), on the domestic isolation and disinfection, and on the law on infectious diseases. (Public Health Act, 1896, part III.). Sydney: WA Gullick, Government Printer, 1898.
Department of Public Health, New South Wales. Suggestions to householders for the prevention of diphtheria, on the law on infectious diseases, and on isolation and disinfection. (Public Health Act, 1896, part III.) Sydney: WA Gullick, Government Printer, 1898.

(Received 23 Oct, accepted 29 Oct, 2001)

Authors' details

South Eastern Sydney Public Health Unit, Sydney, NSW.
Mark J Ferson, MD, FRACP, FAFPHM, Director, and Conjoint Associate Professor, School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW.

Reprints will not be available from the author.
Correspondence: Dr M J Ferson, South Eastern Sydney Public Health Unit, Locked Bag 88, Randwick, NSW 2031. fersonmATsesahs.nsw.gov.au