The question arises as to the value of sterilization as a complete solution of the problem of unsanitary milk. If in the stream or in the spring whence you draw your water is a dead hog, you do not solve the problem by boiling the water, you remove the hog. So with milk. The sterilization of "dirt" is but a poor makeshift. Better that by purification the milk be prepared for sterilization. Two cans of cream made from the same dairy of cows; one is machine-separated (and purified) cream; the other is skimmed from the milk by hand. When the can of hand-skimmed cream it bitter and sour, the machine-separated can of cream is yet sweet and wholesome. There must be a good cause for this and it can be accounted for by the machine-clarification or purification ejecting material that would ferment the cream. The remedy of purification may take some study to apply it to the milk supplies of large cities, but the problem must be met. Sterilizing filth simply changes the condition slightly, the filth is still there. The problem of milk purification can be met only by centrifugal clarification. No strainer, no other process will so exterminate the "dirt" from milk. I have called the attention of the Board of Health of one of the largest cities in the land to this matter, but no attention has been paid to my communication sent nearly two years ago. Either there is no filth in milk or, if so, it is "good for the stomach's sake," or sterilization is presumed to meet the problem, or the process of purification by centrifugal means is impractical. But the fact stands that cow's milk is the filthiest food that comes upon our tables, that it is a subtle vehicle for cow-manure, blood, pus, hairs, seeds and dust and dirt generally, from the unclean hands of the milker to that precipitated in the milk pail from the general environment. Who will "bell the cat"? It needs it very badly for it is a very unsanitary cat. The Cleveland 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 The New Laboratory of Experimental Medicine The dedication of the II. K. Cushing Laboratory of Experimental Medicine on November 30, 1908, was an event of unusual importance from a medical standpoint, not only for this city but for all this section of the country, since it establishes a milestone in the progress of medical education. By means of it the strictly laboratory work and the practical bedside clinical work will be more closely correlated than has been possible in the past. It is planned that Dr George N. Stewart, the Director of the laboratory, shall have an official position upon the staff of the Lakeside Hospital, so that he and his assistants shall be closely in touch with the clinical work in the wards. The institution will be not only a clinical laboratory, in the usual acceptance of the term, but its scope will be wider, it will furnish facilities for research work which, it is hoped, may lead to the solution of some of the innumerable problems in medicine today. The work will be similar in character to that followed out in the Rockefeller Institute in New York City, which has already been productive of such excellent results. In all probability the "unit plan" of research will be followed, a group of workers taking up some special line of investigation and bringing to bear upon it their special training in different lines of work, so that the subject may be attacked from various standpoints. The establishment of the laboratory was made possible, thanks to the generosity of Colonel Oliver H. Payne and Mr. H. Melville Hanna, who donated first $200,000 and later an additional $17,000, the income from which is to be devoted to the purchase of additional apparatus from time to time. The annual income from the total endowment will amount to about $13,000.00. With characteristic modesty they disclaim the credit for themselves and refer it to Dr Edward F. Cushing for his suggestion of the plan. As they aptly put it, they represented "his committee on ways and means" for the carrying out of this project. The building has been named by the donors after Dr Henry Kirk Cushing, who has exercised such a remarkable influence for good in professional circles in this city. The dedication exercises were attended by some 36 representatives from local and out-of-town universities, including Harvard, Johns Hopkins, Chicago, Rush, Northwestern, Indiana, Pennsylvania, Toronto and McGill. The presence of these delegates, many from a considerable distance, is some indication. of the importance which these institutions ascribe to the new laboratory. The address was delivered by Dr William H. Welch, of Baltimore. This will appear in full in the JOURNAL at an early date. Foot and Mouth Disease After a period of six years immunity in this country the so-called "foot and mouth disease" has appeared in New York, Pennsylvania and more recently in Michigan. For a period of many years, but especially since 1886, the disease has been the cause of great economic losses throughout Europe, the estimated money loss in Germany in one year being 100,000,000 marks. The disease affects animals of most species but especially those with the cloven hoof, cattle, goats and sheep. It is characterized by the appearance of small vesicles in the mouth and on the lips, which rupture, leaving a reddened sore place which extends till the individual ulcers may reach the size of a dollar. In severe cases the mucous membrane is so undermined that the whole surface of the tongue may come off under handling. Similar lesions appear in the clefts between the hoofs, more frequently in such animals as are walked over rough ground or made to stand in wet stalls, and may reach a degree of severity causing the loss of the hoof. At first there is dryness of the mouth with a decrease in the amount of saliva followed by marked salivation, so that there is a sort of fringe of mucus hanging from the animal's jaws. There may be so much fluid that the stall is actually saturated. Fever, loss of appetite and progressive emaciation are the general symptoms. In light cases the cure takes place spontaneously in two to three weeks, but this outcome is comparatively rare. In the severe epizootics there is a death rate of from 10 to 50% in adults, and as high as 80% in sucklings, the latter usually dying within a day or so of birth. Even in the cases which tend to recover, there is frequently severe lameness, the udder is often infected resulting in extensive abscess formation with permanent loss of function for dairy purposes, so that the total loss to the farmer is from 30 to 50% of the total value. In very severe cases there may be the apoplectic form, with nasal hemorrhages and sudden death. In rare cases there is no eruption and the case may simulate anthrax. The exudates from the lesions are highly contagious and infection from the milk is a ready means of spread if the milk is not boiled. In the advanced stages of the disease the milk loses its characteristics, being more like colostrum. The contagium succumbs readily to disinfectants, to heat and to drying, but is very resistant to cold as evidenced by the Massachusetts epizootic, which took place in the depths of winter. It may be transferred indirectly by hides, ropes, halters, forage, bedding, etc., and it is probable that the present infection was brought into the country in some such way, as cattle are quarantined for a time sufficiently long to cover the incubation period. The actual contagium has never been isolated nor even seen, all that is known about its morphology being that it is small enough to pass the pores of a Berkefeld filter and not those of a Kitasato filter. That it is not a toxin has been definitely proved by the experimental fact that it is self propagating. The extreme readiness with which the infection is carried makes it dangerous to study, and the Government has for this reason permitted no study in this country. In Germany there is a suit for damages by the farmers in the neighborhood of one of the experimental laboratories which they claim has been instrumental in the spread of the disease. Treatment of the individual cases is not satisfactory, the best than can be done being to treat the symptoms as they arise. The only available means of combatting the disease are segregation with absolute quarantine, both as to entrance of cattle into the infected district and exit from it, with the immediate slaughter of all animals which show any signs of the disease. By the policy of purchase and destruction the infections which have reached England have been extirpated, and the New England epizootic of 1902 was similarly stamped out. Slaughter of the animals and deep interment must be followed by thorough cleaning of the stables, with the burning of all manure and fodder, followed by the exclusion of new animals for a period of several weeks. Animals allowed to live are constant sources of menace, the more because the disease may be transferred by the smaller animals such as cats, dogs and pigeons, and in a counry like the United States, where transportation is so extensive and rapid, there is much danger of the disease passing bounds as it has done in Europe. Human beings are also susceptible, though in a less degree. The symptoms are usually slight, though there may be diarrhea of so severe a type as to cause death, especially in children who have been given the infected milk before it has been boiled. Human beings may again transmit the disease to cattle and keep up the circle of infection. It is probable that the Government will act with great vigor in the present epizootic, as was done in the one in 1902, and that it will be stamped out in a few months at most. The chief danger lies in concealment of cases by the farmers, a short sighted policy which in 1902 prolonged the epizootic for several months, and cost the very farmers who concealed the cases far more than if they had aided the Government in its efforts. The Disposal of Soiled Dressings The ultimate destination of discarded dressings is seldom considered by the attending physician, and yet it is of the greatest importance that orders be given that they be burned or otherwise rendered harmless unless they are to be washed, sterilized and |