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Contaminated Milk as a Disseminator of worry them into extremes of fear or anger; the Disease.
milk from cows in such condition has been The majority of authors and observers appear known to cause gastro-intestinal troubles, fever, to pay their entire attention to the bactericidal and headache-ample evidence of a mild toxside of this question, yet other contamination emia. The cow, even in the pasture, will aside from bacteria often renders the milk un- often lie down in manure in such manner as to wholesome, if not distinctly pathological. foul the legs, loins, and udders, and this filthy Admitting that the contamination by bacteria condition is ten fold intensified when she is is the most frequent cause of unwholesome forced to lie down in the filthy winter stable. milk, it is wise to look into the subject to a Those familiar with dairy countries will recall greater depth. Every practician is concerned the fact that throughout the winter the accumulain this matter. We hear a great hullabaloo ted manure of many weeks always forms a when some epidemic sweeps thru a city because thick coating on the loins of the cows, and is of contaminated milk, yet for one serious result only removed when the hair is shed in the in an epidemic we believe a thousand occurs in spring. Many cows, in this filthy condition, isolated cases. It is the isolated case, seldom are milkt without even so much as a thought recognized or investigated, that should receive about cleansing the udder. The hands and a greater proportion of study and notoriety, clothing of the usual stable attendant are hardly until all practicians in both city and country to be called aseptic. The motion of the arms, get a true conception of the gravity of the in milking, causes the clothing to rub over the whole matter, and raise such a storm of pro- loins of the cow, and the particles cannot help test at the present filthy and ignorant methods but fall in the pail directly underneath. To of handling milk as will compel greater clean- remove this excess of hair and manure, it is a liness and care.
common practise to reinforce the strainer with There is no more subtile culture media for one or more thicknesses of cheesecloth, and certain bacteria than milk, nor will any other we have witnest the “emptying" of a confluid food become so quickly contaminated. siderable amount of fertilizer from such cloths Not only do bacteria find welcome lodgment several times in the course of a milking, bein milk, but it will absorb noxious odors with cause the cloth became so clogged that the great avidity. The nature of the fluid, and milk would not run thru. the methods of milking and marketing, expose Cattle in poor health cannot give wholesome it to numerous chances for absorbing filth and milk, even if no great excess of bacteria be becoming contaminated. In itself so very un
present in the fluid. It is a well known fact stable, it speedily undergoes decomposition, and that scarlet fever can be disseminated by milk, develops within itself under suitable conditions, yet we have not as yet isolated or recognized one of the deadliest poisons known to chem the bacterium responsible. A cow suffering -tyrotoxicon. As if nature had not provided from any of the common diseases is not in fit enuf perils, man adds to these by the addition of condition to furnish marketable milk. Tuber“preservativs,” which may in themselves be culosis, anthrax, foot and mouth disease, garpoisonous, and by a neglect of proper methods of get, rinderpest, digestiv disturbances, ulcerated cleansing the receptacles employed. The cow, udders, open and running sores, etc., make herself, is often the original source of danger, animals unsuitable to furnish milk to the pubmainly because of man's ignorance and inhu: lic; yet such animals may be seen supplying manity, but other times because of her inher- such milk in almost any dairy. ent taste for anything green. In the summer Even if the milk be drawn from the udder in season, when water is scarce, she will drink a reasonable state of cleanliness, it is often from any pool within reach, however filthy; contaminated as soon as it touches the recepnumberless bacteria thus absorbed cannot fail tacle, for these are usually constructed of tin to reach the milk ducts. She will eat poison- with seams which afford admirable and inacous plants, a common example of which is the cessible lodging-places for decomposed milk consumption of poison ivy, which produces and multitudes of germs. The cans in which the symptom known as “trembles," and when the milk is shipt are generally washt by male milkt in this condition the milk is poisonous. help, and consequently the cleansing is very There are many other plants eaten by cows imperfectly performed; the seams are here too, which render the milk unfit for use, even if not and another influx of some other bacteria actually poisonous. It is a question whether occurs. We have smelled many noxious and the ensilage, which is now so commonly fed strenuous odors, but the most heinous smell thruout the country during the winter, is a food that ever assailed our nostrils came from a of proper composition from which to derive tightly closed can that was “cleaned" so well milk. . Cattle are often handled by brutal and that it fairly shone, both inside and out, yet ignorant men who chase them with dogs, or had been allowed to stand in the sun a few
hours on the depot platform after being re- The Glorious Fourth ; but How About the turned empty to the shipper. This is not the
Fifth ? exception; it is the rule. Another nauseating If an enemy to our country would punish us fact: The colostrum corpuscles are demon. every Fourth of July as much as we punish ourstrable in the milk after the birth of the calf selves, what would we think of it? The record up to the fifteenth day, at least, and such milk for last Fourth of July, which was about an is distinctly able to produce pathological re- average, was 466 deaths and 3,983 injuries, results. Did one ever know of milk being sulting from “celebrating !" A battle which thrown away, or the calf being allowed to suck results in 466 killed and 3,983 wounded, ranks for fifteen days? We have repeatedly observed as a great battle; the American loss at Bunker its being marketed on the third day, mixt with Hill was 449. Every year we have a battle other milk.
(or rather the results of a battle) in which our The commoner diseases disseminated by loss is much greater than at Bunker Hill. If milk are scarlet fever, diphtheria, cholera infan- the English were still our enemies, don't you tum, typhoid fever, etc. The typhoid bacillus think the above facts would give them a peculwill retain all its virulence in milk for forty iar satisfaction? It is one thing to gain a vicdays, and it has been discovered after even four tory, and another to use the results of victory months. The bacillus coli communis is an with prudence. Many a victory leads to the almost universal constituent of milk. We need final defeat of the victor. We gained a notable not reiterate the devious and multitudinous victory over a century ago ; shall we indulge ways in which the contamination occurs. in annual self slaughter in celebrating it?
Another important point: Those who write The Journal of the A. M. A. gives the folmost upon this subject insist upon pasteuriza- lowing details : "406 deaths from lockjaw, 60 tion or sterilization of the milk as a safeguard. from other causes, and 3,983 injuries that were It is now definitly establisht that such treat- not fatal.” The latter include loss of fingers, ment makes the milk more difficult of diges- hands, arms, legs and eyes. tion; moreover, it is questionable if the ordi- The following practical remarks are also nary degree of heat employed in cooking has taken from the same source : anything more than a temporary effect on the Last year 64 percent of the total injuries and over bacilli present. We do know that chemic 80 percent of the fatal injuries were the results of
blank cartridges. Nearly all cities, it would seem, change (as in the formation of tyrotoxicon) is have at some time passed ordinances that control their not modified by any degree of heat or cold, sale, or the sale of the pistols in which they are used, and we firmly believe the chemic contamina
but, as a rule, the ordinances have remained on the
books unconsulted and non-enforced. It would not be tion is oftentimes more important than the bac- a difficult matter to reduce this source of mortality terial invasion, grievous as that generally is. greatly; the pistols and cartridges are sold usually by As to the common use of preservativs: We
dealers in sporting goods or in notion stores," and know that their use not only works a chemical
every policeman knows all such places on his beat.
Confiscation of pistols from boys on the Fourth would change in the constituents of the milk, but also
also be of some service. Enforcement of the law is the has a definit effect upon the digestion of the
chief thing that is needed. In Washington, where
these matters seem to be controled better than in ordmilk. It is yet early to assert what the extent inary municipalities, Fourth of July tetanus is exof the injury may be, some observers taking
tremely uncommon, altho there is a fair number
during the year from other causes. the ground that the formaldehyde and boric acid are harmless in themselves, and by The Clinical Importance of the Appearance inhibiting the growth of bacteria, work posi
of the Tongue. tiv good. It is possible that the medical pro- The importance of the symptomatology of fession, with their well known tendency to be the lingual mucous membrane has been recogradical in everything, have acted too hastily in nized by physicians from the earliest recorded condemning without complete investigation date of the practise of clinical medicin. Whatthe preservativs used in milk.
ever other attentions may be expected by the The remedy, for the contamination of milk
average patient on the approach of a physical is, however, not in the addition of preservativs examination, he always anticipates that his or antiseptics, not in sterilization or any other doctor will feel his pulse and look at his form of cooking, but in absolute cleanliness of tongue. One of those items of research rethe animal and attendant, the stable, food, vealed the state of the circulatory, the other of and containers, and the sterilization of all ves- his digestive organs. The physicians of olden sels by heat after use and before again being times also lookt at the urin; but, it need filled.
hardly be added, the further chemical and phyDo not put the turpentine in the water when prepar
sical examination was absolutely defectiv. ing a turpetine stupe ; wring the cloth from the hot Having regard to the state of the physical water, and then sprinkle the turpentine on the cloth. Twice the beneficial effect of the turpentine is thus
sciences down to within less than a century secured.
ago, it was a very natural consequence that the physician of former times attacht an undue excluded. Severe lacerations of the cervix are importance to the value of these three series of perhaps the next most frequent causativ factor. phenomena, on which his diagnosis and prog- Another class of cases often presents this feanosis—and, of course, his treatment-were in- ture: Those where the mother or father, or evitably based. For him the tongue was the both, are in a poor state of health—where the mirror of the stomach. Its mucous membrane vital forces of both are at a low ebb at the being an essential and a specially sympathetic time of conception and subsequent to such portion of the lining of the digestiv tube, its conception; and, also, where there is an uncondition unfailingly indicated that of the questionably “strumous" diathesis. In the latter-more particularly of the stomach, to latter case no better proof of the actual causawhich was attacht the leading role in the proc
tiv factor could be desired than the therapeuess of digestion. If the tongue was heavily tical test; i. e., a thoro course of “anti-strufurred, the gastric surface was also loaded with mous" medicin. This generally produces a detritus, and an activ emetic was required to complete absence of the accident if the attack free it of its objectionable coating. This often has been energetic enuf and properly managed. gave considerable relief, but when it failed to In the syphilitic cases it may be noted that the do so, as frequently happened, the process was tendency is toward a spontaneous relief from repeated again and again, sometimes with grue- the misfortune. After a number of abortions, some consequences. In a recent communica- it will be noted that the product of conception tion (Gazette des Hôpitaux, September, 1903), is allowed to remain longer in the uterus before Drs. Mathieu and Roux have critically exam- the expulsiv efforts are set up, however more ined the value of lingual diagnosis, and clearly deplorable may be the physical condition of pointed out the reasons of its frequent failure. the later fetus. In the strumous type the age They point out, following Laségue, that the of the fetus becomes progressivly less at each tongue is really a muscular mass, covered by abortion, unless some radical treatment lookmucous membrane. And they further proceeding toward the upbuilding of the health of the to indicate the important fact that the invest- parents is undertaken. in the syphilitic type, ment of this organ is really a false mucous the abortions are usually accomplisht with difmembrane, derived from an invaginated proc. ficulty or with some such complication as an ess of the external layer of the blastoderm, adherent placenta,obstinate hemorrhage, failure and not, like that of the gastro-intestinal sur- of contractil power in the uterus, etc.; in the face, from the inner layer of that structure. strumous type the abortions are easy and quickly Accordingly, in pathologic processes, it com- completed as a rule. ports itself more like a portion of skin than of In recurrent abortions the possibility of memucous membrane. On this account, the chanical interference is always to be thought of physician must be guarded against attaching whenever the causes enumerated can be exclutoo much importance to the information ded. Many women will repeatedly induce yielded by the time honored examination of abortion on themselves, even when they have the tongue.
The general conclusions at which begun to feel the baleful effects of such pracDrs. Mathieu and Roux have arrived are: (1) tises upon their weakened constitutions, rather The lingual mucous membrane is really a pro- than undergo the throes of labor or think of cess of the cutaneous investment of modified “sacrificing themselves" (?) to maternal cares. structure ; (2) its furred condition is the result A properly stern demeanor on the part of the of an “ excessiv abundance" of filiform papil. physician will often bring these cases to a las, which form a dense thicket over its sur- prompt confession when warnings of the evils face; (3) its (raw or) desquamated condition to come would have no effect. If they are is usually the result of a form of superficial allowed to see that the physician suspects that dermatitis.
they have been guilty of producing the repeated
abortions and of deceiving him as to the cause, Habitual Abortion : A Misnomer. an accusing conscience will oft-times work an Habitual abortion, as a medical term, should amazing change of heart. be allowed to drop out of use. It represents In those cases which will not in any measure a theory which is no longer tenable; i. e., that conform to any of the classes given above, and the uterus falls into a “ habit” of emptying it- in many of them which fall in direct line with self at a certain period of gestation. The term such classes, ten grain doses of chlorate of “ recurrent abortion," as suggested by Taylor, potash, three times daily, continued from the is much better. There is always a cause for third month of pregnancy until its termination, recurrent abortion, and it is generally a cause is declared by Taylor to be efficient in checkamenable to a remedy. Syphilis is the great ing the “habit." and most frequent cause, yet many of us see
Calcium chlorid, 30 grains to the ounce, is one of many cases where syphilis can be absolutely our most efficient local applications in hemorrhage.
grs. iij grs. ivss
A Common Fault.
Hoff's Prescription for Consumption. There is a habit common among the profes- We have met the gentleman who made the sion which is a relic of the darker days of med- first
first “batch” of this preparation in this icin. We refer to the habit of prescribing such country. When he saw the article on page drugs as we know will derange digestion and 246, June WORLD he said, “Give it to those assimilation, without having fully considered fellows; they are frauds." When he saw the whether the exigencies of the case demand such prescription on the above mentioned page he harmfully meddlesome procedures. In the said,
said, "The prescripton is all right. Dr. Hoff times when knowledge of physiology, of the lives in Vienna, and that accounts for the diffirules governing digestion, of the manner in culty of an American deciphering the prescripwhich drugs really acted when ingested was tion as written." Here is the prescription in very limited-in short, in the days of pure em- plain English as he gave it to us. Turn to the piricism, the physician was not expected to above mentioned page and compare with the think of these things. His entire duty ceast following: when he had made an attempt at diagnosis, and had prescribed his crude drugs in sufficient
Arsenious acid .
Potassium carbonate quantity. But it is not so now. With our in- Cinnamic acid. creast knowledge our responsibility has in
m. lxxv creast. Now the thinking man realizes that Boil until a perfect solution is obtained, and add drug giving, without full consideration of the
m. xxxviij ultimate effect of such drugs on the various pro- Aqueous ext. of opium cesses of the body, is often a very injurious
Mix and filter. plan. We know that study of the dietetics, physiology, and the hygienic considerations
Of course this is not made in separate preinfluencing a given case, is frequently of greater scriptions as above, but it is made in large importance than the mere giving of drugs. quantities, keeping the above proportions, After diagnosis has been made, and remedies bottles being filled by the dozen or gross from prescribed, it is yet necessary to consider what the tank, and sold like any “patent." The effect the "6 indicated remedies will have special feature is the cinnamic acid. The genbeside that of relieving or masking the symp
tleman referred to above gave as the cost of toms. The thoughtless practician who pre
each bottle, about two cents; retail price $1.00 scribes opium in every case of diarrhea, while
-worse in this respect than the copyrighted he may often succeed in checking the diarrhea, acetanilid mixtures. will often fail ignominiously, and will often have a much sicker patient after the medicin has been taken than before. A little bit of
Speculations Again. thought would have suggested that, inasmuch Did you ever know of a single instance as this case of diarrhea is due to intestinal in- where anyone who took “a flyer" in any of digestion, very probably accompanied by the numerous speculativ schemes that are advermasses of undigested food and putrefying feces tised in circulars sent to doctors, in which the within the intestinal canal, the logical proced- "small investor" did not lose his money? ure would have been to give a flushing purga- In short, did you ever know of a single instance tion. In certain acute cases of rheumatism we that succeeded according to promises ? Did admit that it is necessary to give salicylic acid you ever know of a single instance in which in enormous quantities, for it is then a question the investor even got his money back? Did of saving the heart before the rheumatic poison you ever know of an instance that was not a has permanently destroyed it; in malignant total loss? Yet some people think it is malarial infection enormous doses of quinin “smart” to “ dabble in stocks," and “take a must be given; in a few other instances seem- flyer" occasionally! Isn't it a supremely ingly reckless therapeutics is justifiable, but the foolish thing to do? instances are rare.
I must quote here a sentence in a letter from We plead for a more rational practise along one of our subscribers: “A pen made from a such lines We have all been taught that “if quill pluckt from the wing of an angel and doubtful of being able to do good, make certain dipt in the colors of the rainbow, could not of doing no harm.'
induce me to part with another $."
And this from another subscriber. " MinIf you are afraid of the forceps because you do not
ing stocks are generally more worthless, and know how to employ them, you will fail to "fill the
even more fraudulent, than lottery promises bill” in many cases. If you fear them because you But here is something rich. Among the know what they have done in inexperienced hands, and yet can use them when necessary, your patients are
many things sent to me is a large, four-page fortunate.
circular, one page of which is occupied by an
imitation type-writer circular to doctors; here want more. To show you what a good return is a part of it:
it is, suppose you try paying it awhile ; you will DEAR DOCTOR :-Some time since, while the writer
find it to be quite a burden. But the main was chatting with the business management of the
thing is safety. When you earn your money, New York office of the U. S. I. of Boston, the local you want to get the good of it yourself. Think management, Mr. B, as he was running over a quan, tity of recent mail, remarkt “ Doctor, Doctor," and
of you trudging around in the rain, mud and turning to the writer, he said: “I have more inquiries darkness earning more money, while some from men of the medical profession than any other swindler is drinking champagne on the money class of people, and I believe that they are the greatest buyers of mining stock.” Being imprest with the
that you previously saved. remark, at the first opportunity I ran thru the stock ledger of the
Mining and Commercial Company, of which company I was and still am the secre
The Removal of Skin Cancers. tary, with a view of ascertaining how the medical profession was represented in my own company, and I The general practician must continually found it as a class to have the greatest representation. Prominent among them are (a number of doctors are
strive to perfect himself in every branch of here named) and many others. The thought occurred practise, or progressivly lose prestige and see to me: Why does this class take more kindly to the his patients drift to the quack or to the spepurchase of investiv securities? I found this answer to the query–First the ratio of their earning from
cialist. Perhaps there is no simple procedure their profession rank high among the professional more generally ignored than the removal of incomes; secondly their employment and profession gives them little time to study or look after the
growths upon cutaneous surfaces. The markt average business venture ; thirdly, the returns from
tendency to recurrence of malignant growths, loans and real estate investments are so slight, aver- and the possibility of benign lesions assuming aging about 3 percent per year, that there is little incentiv to make such investments. For these reasons
a malignant form, seem to have so horrified the they look kindly upon stocks that are safe, offer a average practician that he is anxious to refer greater return in dividends and are accompanied with the patient to the specialist, or willing to see no personal anxiety or risk. I then askt myself the question: Why not go
them writhe in the horrors of the quack's treatwith my investment direct to that class most willing
ment. to give it consideration? (Then the letter goes on with If the real facts were known and appreciated its argument.)
by the profession, such conditions could not This gives doctors a chance to
see them- mantain for any length of time. Moles and selves as others see them.” Look again at warts are easily removed by simple measures, those three reasons, the second one, partic- and, even epitheliomas yield gracefully to the ularly: “Their employment and profession strong caustics. Shrewd men study the tactics gives them little time to study or look after the of their enemies even more than they consider average business venture." How true! This their own, and it is the duty of every pracis why they are so easy." A business man tician to learn all he can of the means and would look into the matter and see the bottom methods employed by both the specialist and of it, and then he wouldn't go in; and what a the quack; of the specialist that he may imbusiness man does go into, he “looks after prove and perfect his own knowledge, and of to see that there is no cheating. That's the the quack that he may save himself loss of kind of men that the usual mining company patients and be able to explain their reckless doesn't want. They want easy ones,
treatment and nefarious schemes. like doctors; and it is sad to say, they get
It is along such lines that the general practhem. Are you one of them? If not yet, tician must do battle for existence. how soon do you think it will be before you not hope for relief in legislation or diminisht are roped in. Promises will be bright and competition. Competition will gradually grow positiv; will you “tumble"'? The chances more stern, and the struggle for supremacy are that you will, unless you keep the counsel yet more bitter, until even a modest living will of THE MEDICAL WORLD before you all the not be within the reach of the inefficient practime, particularly at the critical moment. tician. And when will I ever get paid for saving all of The patient must always risk the results of this money to the medical profession? In treatment, and the chances are that he will heaven, I suppose ; but if the few rag-tag tail take vastly lessei chances in skilful hands than enders will pay up their subscriptions, I will be under the ministrations of the quack. The satisfied here--and also if our many friends qualified specialist will handle the case scienwill influence new subscriptions for us.
tifically, and if you mantain your position, you Now look again at the third reason.
You must learn to do as well. Neither your conought to be able to lend your money in your science nor the law require more of you than community, with good real estate security, at “reasonable knowledge and skill." Any an interest of at least 5 or 6 percent. True, graduated physician may attain to vastly more you can't "get-rich-quick" at that rate, but it than such a degree by study, attention, and is a fair rate of interest, and you shouldn't work. If you do the studying and give due