1035

which can then be sterilised. Steam was used for this

purpose in the 1914-18 war, but it reduces the absorptivepower by hardexxiing the walls of the cells. A later method,described in detail at the time,6 was to impregnate themoss with corrosive sublimate. The bags were thenusually flattened in a hydraulic press, the thin sheetsthus produced being easier to pack and handle. The

absorptive power of the moss, however, was impaired bythe pressure ; and it is best used in the form of loose

pads. These should be peculiarly convenient for theuse of the incontinent, and for patients without bedsoressterilisation of the moss should hardly be necessary.Cushions of sphagnum, capable of taking up 12-19 timestheir own weight in fluid, would not only reduce the workof the nurses, but would restore to patients some of theconfidence and self-respect which lying in a wet bed, evenfor a few minutes at a time, so quickly destroys.

6. Ibid, 1916, i, 820.

THE TREASURES OF BARTS

St. Bartholomew’s Hospital for its first four hundredyears was an ecclesiastical institution, and for its secondfour hundred years a Royal Hospital administered byits own board of governors. Under the Act of July, 1946,it started a new career as part of the national hospitalorganisation ; which seems to augur well for the dura-

bility of the National Health Service. In the splendid18th-century great hall was displayed last weekan exhibition of fine portraits, ancient documents,prints, and archives, and as well as the superb 17th-

century flagons, chalices, and patens of St. Bartholomew’sthe Less, the parish church of that unique parish, thehospital. It is a collection that spans much of the storyof medicine. The earliest document is a deed sealed in1137 by Rahere, founder of the hospital and priory,and himself first prior and master of the hospital ; hisvery bones lie just outside the precincts in his own

priory church, St. Bartholomew’s the Great. A fewcenturies after he sealed it-some time between 1420and 1468-Brother John Cok, the hospital renterer, satdown to copy exquisitely into his illuminated Cartularyall the deeds in the possession of the hospital in histime; and more than half of these original deeds arestill in the hospital’s care. How much he would havevalued-if he had lived another hundred years to see it-the indenture signed and sealed by Henry VIII givingthe hospital to the Mayor and Commonalty and Citizensof London and their successors for ever, for the reliefof the " poor, aged, sick and impotent people...." Theseals on ancient Royal documents are things to marvelat, so rich are they in design, so finely coloured and sovery large-about as big as a Camembert cheese. St.Bartholomew’s has documents sealed by Edward II,Elizabeth I, Edward III, and a good many others. Inthis exhibition James I, in armour, mounted and wavinghis sword, gallops across a flowery mead, a hound athis side, and a Tudor rose at his back. Next to himQueen Victoria sits sedately bolt upright on a stoutVictorian horse.Thomas Vicary, William Harvey, Sir James Paget,

and many other famous old Barts’ men appear here ;and the portraits of Percival Pott by Sir Joshua Reynoldsand of John Abernethy by Sir Thomas Lawrence arenational treasures, quite apart from their medicalinterest. Then there are prints showing the hospitalin former times, Rowlandson’s cartoon of BartholomewFair (which was still being held less than a centuryago), and records of martyrdom in Smithfield market,just outside the hospital gates. From the last centurybills and ward reports have survived, and records of

patients-including the case of Elizabeth Brookes, whohad led a seafaring life and been used to drink raw rumin the West Indies. Somehow she makes modern patientsseem rather tame.

BRUSH AND PASTE

SOME years ago a favourite slogan in dental propagandawas : Clean Teeth Do Not Decay. Much depends onwhat was meant by " clean," but the inference presum-ably was that brushing would ward off caries. This isnot true, as any dental surgeon-and many patients-will admit. A patient with a mouth never touched bya brush, although he probably has gingivitis or perhapspyorrhoea, may have caries-free teeth, while anotherwhose oral hygiene is beyond reproach may need con-servative treatment every three months. Nevertheless,for aesthetic reasons if for no others, cleaning the teethseems desirable-at any rate for civilised man, whosediet might have been designed to leave the maximumamount of debris on and around the teeth.The practice of cleaning the teeth by mechanical

means is not new : Hindu writings dating from about400 years ago refer to the use of myrtle twigs 1 for thispurpose-a method still used in some parts of the world,especially among Mohammedans. The bristle brush seemsto have been introduced about 1640.2 The earlier adver-tisements for these brushes often referred to them as gumbrushes ;

" toothbrush " is a much newer appellation-and a worse one, since the brush can play a most usefulpart in massaging the gums. Now, however, one of theleading firms of brush manufacturers has adopted theterm " mouthbrush," which, though sounding strange,at least indicates the brush’s function.

Present-day views on the shape and material ofbrushes are described by Bryan vVade,3 who cites theresults of a postal survey by a manufacturing company.The dental profession favour a medium-texture bristle(rather than nylon) brush set on either a bayonet-shaped- or an angled handle. At least two smallersizes of brush should be made for children, and allbrushes should be narrow to avoid laceration of thebuccal mucosa, which may result from enthusiasticapplication of a wide brush. A suggested maximumwidth is 9 mm. The dental profession’s preference forbristle seems to have little rational foundation.4 In

experiments in which extracted teeth were brushed

mechanically with water alone for the equivalent of

thirty years’ normal brushing, the teeth showed no

macroscopic signs of wear with either a hard bristle ora medium nylon brush. When, however, a popularbrand of dentifrice was used grooves appeared on theteeth after the equivalent of a year’s brushing ; therewas no difference in depth between the grooves producedby nylon and those from bristle. The results of suchan experiment in vitro cannot perhaps be appliedclinically without reservation ; but it seems fairly safeto assume that, while there is little to choose betweenbristle and nylon, the composition of dentifrice shouldbe further investigated. Wade suggests that patientswith gingival recession should be told to use plain whitetoilet soap rather than a proprietary dentifrice whichmay be abrasive. It has been suggested that nylonbrushes may cause gingival recession, but there is nodefinite clinical evidence of this. In fact, patients withthe troublesome condition of sensitive dentine at thecervical margin are often relieved of their pain byreasonably hard brushing. The reason is obscure, butit may be that keratinisation is induced by the frictionof the brush.

Obviously, if a brush is to be used on the gums andteeth, it must be used intelligently : it is worse thanuseless to attack the teeth as if one were getting downto a dirty floor with a scrubbing-brush-nor, for thatmatter, is the liabit of a patient who used a well-knownbrand of scouring powder to be recormniended. For

1. See Miller, S. C. Text Book of Periodontia. London, 1950.2. See Asgis, A. J. Dent. Dig. 1929, 35, 307.3. Wade, A. B. Brit. dent. J. 1953, 94, 204.4. Wade, A. B. Ibid (in the press).