I would therefore recommend that the State Board of Health take such action as may be deemed best to bring about united action of all interested in an effort to secure the legislation required to enable the municipalities concerned to rid themselves of a grievous nuisance. Respectfully submitted, BYRON STANTON. Pathology of Empyema. The Dr. Bovaird (Med. News) says: points in the pathology of empyema upon which he would lay emphasis are: 1. Its frequency in children. 2. The frequency of bilateral cases. 3. The impossibility of drawing a sharp distinction between serofibrinous pleurisy and empyema. 4. The creamy consistency of the exudate in many cases. 5. The frequency of sacculated effusions. 6. The frequency of pneumonia, especially bronchopneumonia, as a preceding or accompanying lesion. 7. So far as concerns the bacteriology of empyema, the pneumococcus is present in the great majority of cases in children, especially in the thick creamy exudates. The streptococcus or staphylococcus pyogenes is found in a much smaller percentage of cases, especially in those not associated with pneumonia and characterized by thin purulent exudates. 8. Tuberculosis is present in but a small percentage (6 per cent.) of cases.-Archives of Pediatrics. IN intestinal obstruction never give purgatives, for they are a source of distinct danger. If three or four copious high enemata do not produce the desired result, every minute of delay in performing an abdominal section becomes an additional risk.—International Journal of Surgery. NEVER pass a sound for the first time through a patient's urethra without having his head low, and take care to observe his countenance frequently. Patients once in a while will have an attack of syncope as a result of this procedure, which has been shown to be able to rapidly lower the blood pressure.-International Journal of Sur gery. Current Literature. Bacteria in Milk. The efforts being made to improve the milk supply of our cities and to establish standards of its purity or wholesomeness, have brought out considerable information as to the bacterial contents of milk and raised interesting questions as to its significance. Most of the investigations along this line have dealt only with the number of bacteria found in a cubic centimeter of a given sample of milk, and such emphasis has been laid upon the numbers found, that it seems not improbable that we have learned to attach undue importance to this particular phase of the matter. We have come to believe that a low bacterial content indicates a wholesome milk, and that a high content belongs only to milk that is unwholesome or dangerous. Professor Conn, in the chapter of Chapin's 66 Theory and Practice of Infant Feeding," devoted to the bacteriology of milk, makes it clear that such assumptions are not altogether warranted. It is not a new thing to us that bacteria are not all hostile or dangerous to man, but it takes an effort to accept the idea that even in milk some of them may be harmless or even beneficial. The bacteria usually found in milk are of three varieties. (1) Those producing lactic acid fermentation. (2) Those producing albuminoid decomposition. (3) Those having no noticeable action on milk. The great number of those ordinarily met with belong to the first class, and are probably not pathogenic to man. It is this class which under usual conditions multiplies rapidly in milk and is most largely responsible for the high counts made when the milk is twenty-four or forty-eight hours old. The lactic acid resulting from their growth checks the development of many other organisms in the milk, and even in the intestine of man seems to have a favorable action in a similar way. Furthermore, the rapid increase in number of the lactic acid bacteria tends to limit or check the growth of other varieties, and in this way is not an unmixed evil. The organisms of the second class are much rarer and fewer in number than the lactic acid bacteria. While themselves non-pathogenic to man, they may by their growth in milk produce substances which are detrimental or even poisonous. Their growth is ordinarily checked by the action of lactic acid. In the third class are grouped many varieties of organisms for the most part harmless to man. Of pathogenic organisms the tubercle, typhoid, and diphtheria bacilli have been demonstrated in milk. Certain varieties of streptococci are found in a large percentage of ordinary samples of milk, but the question of their relations to disease is not settled. The infective agent of scarlet fever can be carried in milk, but, as its identity is unknown, it cannot enter into consideration. We have long attributed the acute diarrheas of children to the bacteria present in milk, but just which ones were the active agents we have not known. It may be that the discovery of the relation of the Shiga bacillus to some of these cases may lead to definite demonstration of the part played by the bacteria in milk. The known pathogenic organisms are found in milk not infrequently, but as a rule in very small numbers. It appears, however, that it makes a great difference just which one of these pathogenic varieties gets entrance to milk, not alone by reason of their different actions in the human organism, but because one may increase and multiply in milk while another fails, or it may even be, dies out. Milk is good ground for the typhoid bacillus, but stony soil for his brother, the tubercle producer. A few typhoid bacilli finding entrance to milk soon after the milking may mean millions to the consumer, while on the other hand it may be that the few tubercle bacilli in the milk of a tuberculous cow may be largely deprived of their powers for harm by the time the milk is used. The latter proposition suggests a possible explanation of the relatively rare infection resulting from the use of the milk of tuberculous cows. Excluding the possible use of chemicals. or other methods of preservation, the counting of the number of bacteria in the milk offered for consumption is of value. in indicating, first, the care taken in the milking process to prevent contamination; secondly, the care to prevent contamination from outside sources after the milking, and thirdly, the the conditions under which the milk has been kept. If no care is taken in these respects the milk will inevitably contain great numbers of bacteria. Proper care at the milking will limit the number of organisms to a few hundred to the cubic centimeter, but if such milk be allowed to stand at summer temperature, at the end of twenty-four hours the hundreds will have grown to millions. If, on the other hand, the milk is promptly chilled and then kept at a temperature of 40° C., at the end of twenty-four hours the number of bacteria may actually be lower than at the milking-time. Carelessness at any step in handling of the milk, such as the use of infected cans or utensils, exposure to dust or dirt of any kind, uncleanliness on the part of those engaged in the process, etc., will naturally result in increasing the bacterial content of the milk. It is in this stage of the process that contamination with the most important of the pathogenic organisms, the typhoid bacillus or diphtheric bacillus, is most likely to occur. If such contamination has occurred, then the increase or decrease of these organisms will doubtless. be determined, in largest part, by the temperature at which the milk is kept and the time that elapses before it is consumed. A low bacterial count after natural milk has been kept twenty-four or forty-eight hours, must therefore mean that care has been exercised in all the several particulars indicated above. A high count under such circumstances may mean a break in any one, or two, or all of the links of the chain. The most important questions from the standpoint of health, the presence, number and varieties of pathogenic organisms, are not answered directly in either case. The problem would be somewhat simpler, if all micro-organisms inoculated into milk behaved in the same way. We might then infer that the higher the bacterial count, the greater the number of pathogenic organisms, if any be present. This, as has already been suggested in speaking of the growth of non-pathogenic forms, is not at all the case. The low count may, however, be taken as an assurance that due care has been exercised in every step of the business and, at present, constitutes the best practicable certificate of the purity and wholesomeness of the milk in question. The high count may or may not mean a harmful contamination of the milk. Incidentally it is interesting to note the difference of views between authorities as to what number of bacteria is permissible in good milk. The Milk Commission of the Medical Society of the County of New York allows not more than 30,000 bacteria to the cubic centimeter; Hewlett in his recently published manual suggests 1,000,000 as a practicable figure. The next step forward in this work must be the differentiation of the varieties of bacteria commonly met with in milk, especially with relation to the frequency and numbers in which pathogenic bacteria are found. Considerable work has been done, especially in England, by Kanthack, Sladen, Delépine, Hope and others on the frequency with which tubercle bacilli may be found in the milk supply of cities. In an examination of one hundred samples of country milk E. Klein (Journal Hygiene, 1901, i, p. 79) found the tubercle bacillus seven times, pseudodiphtheria bacilli eight times, once the diphtheria bacillus, and once a pathogenic yeast. This is work of the very greatest importance at the present time. The labor involved is great and the difficulties to be met seem insurmountable, but doubtless the importance which attaches to the subject will inspire the enthusiasm necessary to further advance. We have long enough rested content with counting the colonies of bacteria found in our milk. We need to know the individuals in the colony, to learn exactly where they come from, what effects their presence has upon the milk itself, and what it portends to the consumer of milk.-Pediatrics. troduction of lymph from the calf or heifer. Another reason for the change existed in the rapid increase of the population of large cities, whereby during sudden outbreaks of smallpox much greater quantities of vaccine material were demanded than could possibly be obtained from the arms of infants. The method of procuring vaccine from the heifer was practiced at Naples as early as 1810 by Galbiati and continued by his pupil Negri, and was introduced into France by Lanoix, who went to Naples to study the method in 1864. It was employed to a limited degree in the United States during the Civil War for the production of vaccine material for the army and still more generally by Dr. H. A. Martin in 1871. The question has recently arisen whether the bovine lymph produces an immunity from smallpox which is as thorough and lasting as that which was formerly produced by the Jennerian method of vaccination from the arms of healthy infants. At the meeting of the American Public Health Association last year, a committee was appointed to report upon the comparative value of these two methods of producing vaccine, with reference to the immunizing power of the product obtained. This committee reported at the meeting at New Orleans. While the report contains some very good suggestions as to the causes of abnormal results of vaccination during the recent unusual prevalence of smallpox in this country, no very definite conclusions appear to have been reached as to the relative value of these two kinds of vaccine lymph. Undoubtedly this defect is due to the absence of information or of observations on a large scale upon this subject. If it were possible to compare the results obtained in two thoroughly vaccinated nations, one vaccinated with humanized and the other with bovine lymph, an answer to the question might be expected, but such nations do not exist. Germany is the only large nation wholly vaccinated with bovine vaccine lymph at the present day, although some neighboring countries are manifesting a disposition to adopt German methods. In England the practice of employing humanized lymph for the greater portion of the vaccinations prevailed until a comparatively recent period. Moreover, the English population is not thoroughly vaccinated, in consequence of the general neglect of re-vaccination. It is, however, true in regard to Germany that as the population became more and more thoroughly vaccinated after the enactment of the compulsory law of 1874, smallpox has gradually disappeared, almost the only cases which have occurred being those of unvaccinated immigrants, or those of a few who had in some way escaped vaccination. In this connection the following figures are suggestive as showing the rapid displacement of humanized lymph in Germany in the public vaccinnations : It appears from the foregoing figures that during the last four years nearly all the vaccinations in Germany have been made with bovine lymph. These vaccinations have averaged more than two and a half millions in number yearly since 1890, and the positive success of this national system of vaccination is too well assured to admit of doubt. Another peculiarity of the German system is that of public control of the entire production of vaccine lymph. The Imperial Board of Health assumes a general control over the whole system, the number of separate vaccine plants being at present twenty-two in as many separate cities. Each one furnishing the requisite vaccine material for the population, not only of the city in which it is located, but also for the entire neighboring district, so that the product of these twenty-two establishments suffices for the entire population of the empire. The example thus furnished by Germany has undoubtedly had a favorable effect upon contiguous countries, especially Austria and Italy, in which the conditions as to vaccination have considerably im proved in recent years.-Boston Med. and Surg. Journal. To Drink or Not to Drink? Great prominence has been given lately, in the lay as well as in the medical press, to the everlasting liquor problem. The vexed question whether or not alcohol is ever a food has been studied scientifically as never before, and Prof. Atwater, of Wesleyan University, has stirred up a veritable hornet's nest in "temperance circles" by answering that question in a fearless affirmative. Into the merits of the argument we need not now go. Suffice it to rejoice that the falsity of alcohol physiology, as taught in the schools under the sanction of law, has been exposed by that careful and conscientious chemist. Science and pseudo-physiology cannot Occupy the same bed. "Exaggeration born of enthusiasm may have had its proper place, but the time has come for more of judicious moderation." That alcohol as a beverage is unnecessary few will gainsay, but whether some of its agreeable indirect effects can be as well produced by other fluids is open to question. Without posing as the champion of drinking as a social custom, with one's food, or at formal dinners, one may at least ask soberly whether the sum of human happiness would not undergo appreciable subtraction if alcoholic liquors were banished from the table. Here the question is not so much one of chemistry as of the art of living. The wise man does not feel his pulse while a meal is in progress or ask his vis a vis to examine his tongue. Rien ne doit déranger l'honnete homme qui dine. Solids have their chemistry as well as fluids and the influence of the former upon the processes of digestion is as important a consideration as that of the latter. Altogether too much is said of intemperance in drink as a cause of disease and too little of the part played by excessive eating in that result. It may be said of us as a people that we take too little exercise and that our bodily furnaces which make heat are not always able to destroy all the food fuel. But nobody finds fault with the glutton if and when he is a total abstainer. We imagine that it would not be difficult to prove that the world's best work is done by the moderate drinker and, furthermore, that the truly temperate man gets more pleasure out of life, without shortening it, than his totally abstinent brother. Indeed, the blue riband army is composed in the main of persons of inferior physical development who are not remarkable for intellectual power or especially enjoyable as companions. This we say not in any way to the disparagement of sincere propagandists, but merely in passing as an interesting and significant fact in human psychology. As a rule such men are so constituted that they have no taste and therefore no use for alcohol themselves. Of course, as physicians we all recognize the danger of drinking in the case of the weak brother of neuropathic taint to whose tissues alcohol is always a poison and who, for safety of body and soul, must be a total abstainer at any cost. The truth is that we Americans can boast the distinction of being among the soberest of peoples. President Roosevelt was right, we think, when, in his recent message to the Congress, he attributed. the efficiency of this country to the high individual average of intelligence. And self-restraint, self-respect and many other factors that make for civic righteousness are just so many expressions of that high average. It is the nation's greatest asset. Men who possess these self-governing qualities can always be trusted to exercise dominion over their baser instincts and passions. Happily drunkenness is everywhere under a social ban. We live on a higher plane than when the Bishop of Bath and Wells, once Master of St. John's College, Cambridge, sang: "I cannot eate but lytle meat, But sure I think that I can drink I stuff my skyn so full within which President Wayland set himself to correct was the abolition of the free alebarrel in the cellar of Brown University, to which every under-graduate who cared to tap it had access. The average man of the twentieth century can be trusted not to make a fool of himself in this free land of ours, and coercion as a temperance measure can only weaken that self-reliance which is one of his proudest characteristics. Vivimus et vivamus.-Providence Med. Journal. Alcoholic Neuritis. In railroad accidents, blows on the back of the head of trivial character are followed by most severe symptoms. A muscular strain, as in jumping from a wagon or falling on a stony pavement, has developed symptoms of great severity not easily explained. In an examination of a number of these cases it appeared that a large proportion of these persons were secret alcoholic drinkers, and the severe symptoms following were due to alcoholic neuritis. The following is a typical case: J., a respectable merchant, supposed to be in good health and temperate, was thrown off the car seat in an accident and suffered a slight bruise on the arm and shoulder. Following this there was intense pain and great rigidity and tenderness. over the shoulder and arm. There was loss of muscular power and later derangement of digestion, with some fever and great sensitiveness to surroundings. This condition lasted some time and was finally diagnosed as acute alcoholic neuritis. The patient had been a secret drinker for a long time and the blow on the shoulder was the exciting cause of acute nerve inflammation. In a second case a passenger, who fell while stepping off a moving train, bruising his thigh and leg, had symptoms of paralysis, great pain and fever, which lasted a long time. There were some symptoms of malingering until finally it was discovered that he had been a constant drinker for a long time, and this was simply neuritis following the fall. Some of the so-called spinal concussion cases can be traced to similar conditions. Persons arrested on the street, receiving a blow on the head from a policeman's club or a fall, may have very severe symptoms of inflammation of the nerves and cords, which can be traceable to a long period |