meter. The absence or presence of certain other bacteria had a great influence upon the life of the typhoid bacillus. The typhoid bacilli in stools, added to the liquid drainage from a privy, were found to have entirely disappeared within forty-eight hours, although many plate cultures were examined. The sewage, before the addition of the specific bacilli, contained 1,500,000 bacteria and had a slight acid reaction. Some of the same sewage, sterilized, preserved the typhoid bacilli a month, though not in large numbers. Mixed with a portion of the contents of privy vault, alkaline in reaction, the bacilli diminished in numbers and disappeared in forty-five days. Mixed with river water in a large flask and kept at a temperature of from 52.7° to 61.7° F., their numbers gradually diminished and none could be found after ninety-six hours. In cistern water at 57° F., they had disappeared in seventy-two hours. In other experiments with a mixture of typhoid excreta and normal stool, the bacillus was preserved more than one hundred days. Typhoid stools mixed with sterilized garden earth, preserved the bacilli at least three months at variable temperatures, although the earth had become entirely dry. Mixed in the same way with earth but sprinkled with rain water every five days, the baccilli endured only thirty-one days; in river mud, only three weeks; in dried typhoid stool, over one month. Karlinski at the suggestion of Pettenkofer sought to determine the fate of the typhoid bacillus when added to well water. He made use of a well in the yard of the Hygienic Institute in Munich, by adding a sufficient quantity of the bacilli to the water and making daily plate cultures with quantities of the water. The water of the well, before the addition of typhoid bacilli, contained from 730 to 1,120 bacteria of from five to eight different kinds. Five litres of bouillon, of which one cubic centimeter contained seventy-two million of typhoid bacilli, were added to the water. Two hours later one cubic centimeter of the water was found to contain 500,000 typhoid germs; on the next day 130,000; on the third day 18,000; fourth day 9,400; seventh day 200; eleventh day five; and on the fourteenth day the water had returned to the same condition as before the experiment. The water of the well was stirred up each time before the sample was taken. As this report is going through the press, a communication comes to hand giving the results of some experimental studies on the typhoid bacillus made by Holtz* in the Hygienic Institute at Greifswald, at the suggestion of Professor Loeffler. By the use of a potato gelatin with the addition of a slight quantity of carbolic acid, he has apparently an advantageous method of excluding colonies of unsought for bacteria and of recognizing the bacillus of typhoid fever. Holz shows that the life of this bacillus in water is longer than is admitted by most observers. In well water inoculated with typhoid bacilli, these germs could be demonstrated with certainty as late as the eighteenth day, and in the highly polluted water of a drain similarly inoculated the bacilli were found as late as the fourteenth day. Dr. W. Hesset has tested a great variety of food stuffs, cooked and uncooked, as they are found in the kitchen, to determine their suitability as culture media for the bacteria of typhoid fever and cholera. After sterilization they were inoculated with the germs of these diseases, each species of bacterium in reagent glasses by itself. Testing the contents of the glasses four or five weeks after inoculation, he found that the specific bacteria were alive in by far the greater number. Thirty food substances were used, and among them the typhoid fever bacilli had died out in only hydrant water, string beans, cow's milk cheese, and mushrooms. The cholera bacilli did not do so well, having died out in nine substances. These results show that nearly all of the substances tested are good media for the growth of the bacilli of typhoid fever and cholera. DO ANIMALS HAVE TYPHOID FEVER? Dr. Roberts has published an interesting account of what he believes to have been an epizoötic of typhoid fever among the dogs of a town in India. In a large number of post-mortem examinations of dogs, victims of the disease, he found a combination of the following lesions: spleen increased in size, mesenteric glands inflamed and enlarged, large oval ulcers in the ileum, enlargement of Peyer's patches, points of submucous hæmorrhage, etc. These dogs had suffered a continued fever, diarrhoea, and other characteristic symptoms of typhoid fever. Dr. Roberts believes that if future observations *Zeitschrift für Hygiene, VIII., 143. 1890. †Zeitschrift für Hygiene, V., 527. 1889. La Salute Pubblica II, 280. 1889. From Indian Medieal Gazette. confirm the truth of his conclusions, that dogs may have typhoid fever, this fact may help to explain the continued prevalence of the disease in some places. Dr. Serres had already noted the existence of typhoid fever among monkeys, dogs and cats, and subsequently had an opportunity to observe an outbreak of typhoid fever among the monkeys of the Museum of Natural Sciences in Paris.* Dr. Rackford of the Medical College of Ohio experimented upon rabbits by pouring cultures of the typhoid bacillus into the stomach after an intra-peritoneal injection of morphia had been given, and a dose of bicarbonate of soda by the stomach. Though the production of this disease was not the object of the investigation, the experimenter believes that one animal died of typhoid fever. This animal remained well for a few days, and then had increased temperature and diarrhoea. Death followed on the thirteenth day after the inoculation. "Peyer's glands throughout the ileum projected normally above the surface of the mucous membrane, and were much injected; one patch, about six inches from the caecum, was slightly broken down in its center, apparently a beginning ulceration. Some twelve or fifteen ulcers were found in the small intestine. They were chiefly located in the ileum. These ulcers were clearly defined, circular, deeply injected, about one-sixth or one-eighth of an inch in diameter, and situated opposite the mesenteric attachment." The typhoid bacillus was recovered from the spleen by means of plate and potato cultures and sections of the kidney and spleen contained bacilli corresponding in size and shape to the typhoid bacilli. Two of the other animals also had ulcers in the ileum. The primary object of the experiment was to determine the physiological effects of typhoid ptomaines formed in various food stuffs. Cultures were made with peptonized milk, peptonized beef, peptonized brain and bouillon, and beef peptonoids. The conclusions of the doctor are: 1st. The bacillus typhosus of Koch and Eberth is the cause of typhoid fever. 2nd. The physiological and poisonous properties of the ptomaines formed by this bacillus will depend in great part upon the character of the food material on which it is growing. 3. Milk is the best diet in typhoid fever, since the ptomaines produced in it do not cause either fever or nervous symptoms. *La Salute Pubblica II, 280. 1889. †Medical News, LV., 453. 1889. THE INFECTION OF SCARLET FEVER. The following extracts give information in regard to the characteristics of the infection of scarlet fever, of a kind which is of practical value in connection with the adoption of measures for the prevention and restriction of this disease. Dr. Jacobi,* Professor of Diseases of Children in the College of Physicians and Surgeons, New York, writes as follows: There is no reason to believe in a primary origin of scarlatina. The efficacy of the virus is so persistent, and it clings so long to clothing, bedding and furniture, that it can be carried and transmitted to long distances by persons, towels, toys, letters, and even domestic animals and articles of food. It is transferable through the whole duration of the disease, from the incubation to the disappearance of the very last symptoms. The incubation of scarlatina may last but a few hours, like that of diphtheria or erysipelas, or as long as nine days; in this it differs greatly from measles, variola, and varicella. The last symptoms may not disappear until long atter the fortieth day, which, it is true, is the average termination. The fine desquamation of the second week may have terminated entirely, but the gross peeling, particularly of the hands and feet, extends frequently to the end of the seventh or eighth week. It carries contagion as well as the desquamation of the former weeks, or as the breath of the patient, or his expectoration in the earlier periods. So slow is sometimes the process of elimination that Spottiswoode Cameron claims that the end of the disease is seldom reached before the eighth week, and not always in the thirteenth. Whether the urine or the alvine dejections of the patient can spread the disease is not quite certain; but as long as there is an uncertainty they ought to be treated as dangerous elements, and disinfected and removed. The London Lancet Committee regards the period of contagiousness as running from the first appearance of the rash to the date when all roughness of the heels and ankles has disappeared. This time was found to be as follows for the four years from 1878 to 1882: In one year the average number of days was fifty-four; in two years seventy; and in one year seventy-four.† Dr. Rotch has recently related to the medical class the following histories to impress the truth that the most infectious period of scarlet fever is that of desquamation, while in measles it is readily communicated at the very earliest stage of the disease even before any trace of the eruption is seen. He, however, is careful to remind * Archives of Pediatrics, VI., 9. 1889. *An. Univ. Med. Sciences, Vol. I., I-2. 1889. Arch. of Pediatrics, VII., 131. 1890. his hearers that infection with both diseases may occur at any time during their course. A boy, six years old, and his sister, four years old, slept in the same room with their beds close to each other. The boy was taken sick May 1, but reinained in the same room with his sister during the day and night of May 2. He was seen by me early on May 3, and was then found to have a well-marked scarlet fever. The sister was taken to the country, and the boy left in charge of a trained nurse. There was then absolutely no communication between town and country house by either people, clothes or letter until June 1, when I was called out to see the sister and found her with well-marked scarlet fever. There were no other cases of scarlet fever in the vicinity of the country-house. The boy at this time was desquamating freely, and the sister was found to have received from the boy, on May 26, what she called a letter, directed from the boy's scarlet fever room by the nurse. The sister had kept this letter by her in bed and under her pillow. The boy, so far as the closest study of the case could disclose, had, during the period of his desquamation, infected his sister at a distance of twenty miles, by enclosing the scarlet fever contagium in an envelope, and this sister had, in the beginning of the boy's sickness, been in the same room with him for thirty-six hours without contracting the disease. In the following year, March 20, I was again called to see the same boy. He was well in the morning, but in the afternoon was found to have a high pulse and temperature, with cough, coryza, and lachrymation, so that it was deemed best to send the sister, who had only been in the nursery with her brother a few hours after he had been taken sick, to her aunt's house, where she was absolutely isolated from the boy. The boy showed a measles efflorescence on March 24, and the sister was taken sick with measles March 30. The sister was then infected at the very beginning of the boy's attack of measles, and after only a few hours' exposure. THE MOST SUSCEPTIBLE PERIOD OF LIFE. Dr. Arthur Whitelegge, Medical Officer of Health, Nottingham, England, read, a year ago, a paper of unusual excellence on scarlet fever from which we make a few extracts of practical value. He quotes the Registrar-General's Annual Report for 1886 to show that the liability of the unprotected to infection is small in the first year of life, increases to a maximum in the fifth year, or soon after, and then becomes rapidly smaller and smaller with the advance of years." In shielding a child against the infection during the first few years of his life there is a double gain; every year of escape from scarlet *Trans. Epidemiological Society of London, VII., 153. 1889. |