Medical Journal CONTINUING { THE CLEVELand MedicaL GAZETTE and MONTHLY The Official Organ of the Academy of Medicine of Cleveland Entered March 7, 1902, as Second-Class Matter, Post-Office at Cleveland, Ohio, under Act of Congress of March 3, 1879. EDITORIAL Requirement for Clean Milk Milk is by far the filthiest food partaken of by man. The chief gross contamination is cow-dung. Improperly cleansed milking pails, bottles, dust from the stables and dirt from the milkers' hands are other frequent sources of contamination. The insufficient cooling of milk and the consequent multiplication of the bacteria introduced does the rest. In 48 hours milk may contain as many bacteria as sewage! Is it any wonder that the infant mortality in large cities approximates in one year 50%? Is it pleasant to think of the nature of the fluid we are injesting even if purified by pasteurization so called? Dirty milk means dirtier cream, butter and cheese. What is the remedy? Education by the general practitioner; to do it effectively we must cooperate. Everyone should be willing to do his share, talk about it at home and in his private practice, write about it and do something about it for one day, or a week, once or twice a year, if not every day. The standard of cleanliness of the milk of a city or a community is just as much an index of the intelligence and foresightedness of its citizens as is the proper disposal of its sewage or the purity of its water supply. Every physician should take enough interest in the production of milk, not only for the sake of his own family and his patients, but for the community at large, to visit the dairy and farm once or twice a year from which he obtains his milk. After making one or two such visits let him visit a model farm and note the contrast. Likewise taste the milk and learn once for all what it is that gives some milk a "Cowy" taste. The following conditions are offered as a standard to which all milk dealers should approach: (1) The herd should be examined and pronounced healthy by a competent veterinarian and should be tested with tuberculin by him at least once a year. (2) The barn should be large, well ventilated and clean. (3) The cows should be scrupulously clean and the udders and teets washed before milking. (4) The milker should wash his hands with soap, water and a brush just before milking. (5) The foremilk should be discarded. (6) The milking pails should be scalded thoroughly or sterilized. (7) The milk should be strained, and cooled to 40° within 15 minutes of milking and should be kept at that temperature until used. Milk produced under such conditions can be given to babies raw with perfect safety in the hotest weather. Should any one of these fundamental requirements for the production of clean milk be omitted, it had better be pasteurized. Experience has shown that milk produced under the best hygienic conditions and kept cold will not deteriorate in weeks. Bodily Weight and Longevity The influence of overweight and underweight upon vitality is usually not sufficiently emphasized and as a rule we fail to realize its importance and the dangers which beset those who are far removed from the correct standard of weight. Unless there is a very marked variation in weight of an individual from what would be normal as compared with the age and weight it is seldom taken into account except by insurance companies in estimating the probable duration of life in the case of an applicant for life insurance. Some very interesting data have been collected by Symonds (Medical Record, Sept. 5, 1908) from the mortality records of one of our largest insurance companies. The correct weight of a person as compared with his age and height has been determined by tabulating the measurements of large numbers of applicants for insurance and taking averages. As an example of the accuracy of these tables it was found that one, compiled from the measurements of 74,162 accepted male applicants when compared with another from 133,940 similar cases, agreed in 111 out of 112 possibilities. Overweight is considered a departure of 20% or over from the average normal weight and as this percentage increases so does the mortality. In younger people below 30 years of age overweight is not nearly so detrimental as in those above this age, since in young persons it seems to offer some protection against tuberculous processes and in many cases the weight remains stationary as the age increases. In these latter instances the percentage above normal weight therefore becomes steadily less and more nearly normal since the average person will steadily gain in weight with advancing age. Underweight so long as it does not exceed 20% below the standard seems to produce but small effect and even among those who are not more than 30% below the standard the mortality is not excessive. Underweight in the younger ages is of more concern than overweight in the same ages and also it is more detrimental than underweight in those over 30 years of age. The association of dyspepsia or a tuberculous family history in people below the standard of weight adds to the seriousness of the proposition, possibly because they may at the time of examination have an unrecognized tuberculous process. In looking over the causes of death in this class of cases, upon the whole overweight proves more dangerous than underweight. Those above the normal weight seem to possess a marked degree of immunity to tuberculosis but they are five times as liable to diabetes as those below the standard. The relatively large number of fatalities from carbuncle in the overweight class may be due to the existence of unrecognized diabetes. The liability of those below the standard weight to tuberculosis has been already mentioned, there are also twice as many fatalities from pneumonia among them as compared with those who are overweight. Digestive disturbances, hepatic cirrhosis and Bright's disease are more fatal to those overweight, probably due to their greater intemperance in the matter of food and drink. The overweight class are therefore much less desirable as insurance risks than those who are below the standard of weight, as the writer says: "The old idea that an overweight had a reserve fund to draw upon in case there was a run on his bodily bank was prevalent, although it was recognized that excessive fat might be harmful and should exclude the risk, on the ground, perhaps, that it was a form of capital which was not active. Similarly, an underweight was considered to be undercapitalized, and if his bodily bank had to go through a panic like pneumonia, or hard times like organic heart disease, he would become insolvent and bankrupt. As a result of this method of thought, our underweight mortality is rather better, and our overweight mortality rather worse than if both sets had been accepted under exactly the same conditions. But, even if we make full allowance for the difference in selection, I am convinced that the same percentage of overweight is a more serious matter than if it were underweight. The excessive weight, whether it be fat or muscle, is not a storehouse of reserve strength, but is a burden which has to be nourished if muscle, and which markedly interferes with nutrition and function if fat. This does not apply to the young, those below 25 years of age. Here a moderate degree of overweight is much more favorable than underweight. In fact, up to age 25 an overweight not to exceed 10% of the standard is upon the whole good for the individual. It seems to indicate a certain hypernutrition and robustness of physique which is favorable to the subsequent life. Underweight among these young people, on the other hand, is unfavorable, and in some cases indicates commencing disease or the tendency thereto. But when we pass the age of 30 these conditions are reversed and the difference between overweight and underweight in their influence upon vitality becomes more marked with each year of age." Department of Therapeutics Serumtherapy: CONDUCTED BY J. B. McGEE, M. D. In the Proceedings of the Royal Society of Medicine for June, E. C. Hort states concerning the internal administration of horse serum (normal) that in the past 14 months he had been directly responsible for the administration of more than 50,000 c.c. in over 150 cases of different diseases. His experience showed: (1) Its action when given internally was more restricted than when applied locally; its mode of action in the former could be indicated at present only by its more easily observed action in the latter. In this it seemed to combine a stimulant action, with the paralyzing influence it could be demonstrated to exert on autolytic and heterolytic enzymes. (2) It might be given by the mouth for weeks in daily doses of 30 c. c. to 40 c. c. with impunity but it must be fresh and sterile and should be given directly after food when absorption is at its height. If these conditions were observed the collapse, serum rash, pyrexia, and other by-effects noted by Latham would not appear. (3) In such generally infective conditions as pulmonary tuberculosis and pneumonia, it was apparently of little value. He has had little experience in giving it with tuberculin. (4) In many cases of so-called simple anemia, a rapid rise of hemoglobin and corpuscular content followed its internal administration, though in pernicious anemia it was useless. (5) In hemoptysis, purpura, hemophilia and the hemorrhage of typhoid ulceration, it was often of very material benefit. (6) In such conditions as chronic gastric and duodenal ulcer, ulcerative colitis, extensive varicose ulcer, etc., it was with few exceptions of high value. (7) When applied locally in the form of constant dressings in such chronic conditions as surgical tuberculosis and staphylococcus infections it gave excellent results. It is beyond dispute that the normal serum of many animals, including man, and notably that of the horse, has strong antitryptic, and antiautolytic power. By administering serum, as in the cases referred to, we are of course transferring this protective body to the seat of cell-destruction; the clinical effects are significant and may explain many hitherto unexplained conditions of which non-bacterial ulcerations of all kinds seemed to be good examples. In bacterial lesions, the effect of the serum appeared to be, amongst other things, stimulation to repair, and inhibition of bacterial proteolysis. Self-Repair : In the American Journal of the Medical Sciences for July, S. J. Meltzer treats of the therapeutics of self-repair. He asserts that therapeutics is the most important part of medicine, and the fact that the living organism is provided with means of self-repair does not relieve us of the duty to strive to discover, and procure also, artificial remedies. Evidently nature's store of reparative agents is insufficient, otherwise there would be no suffering and no premature deaths. The study of immunity means the study of the natural therapeutics of the body, with the view of employing it artificially also, |