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of herniotomies to perform for strangulated hernia than in the past. Dr. BULL. — I think that all the patients to whom I have referred were allowed to get out of bed and move about and leave the hospital as soon as their wounds were closed. So far as the wearing of a truss was concerned, I cannot without reference to notes tell the exact number that wore trusses; but I instituted an inquiry with reference to this question, and could not find any figures that seemed to demonstrate one thing or the other. The entire table of cases upon which these statistics are based will be published in the Transactions of the State Medical Association of the present year.

THE RELATION OF THE CHOLERA BACTERIA TO MILK.

BY DR. KITASATO, OF TOKIO.

(From the Hygienic Institute of the University of Berlin.)

Translated from the Zeitschrift f. Hygiene, 1888, by J. M. Van Cott, Jr., M.D.

Prof. Robert Koch has already announced in the first cholera conference' that cholera bacteria can multiply in milk, and this has been since proven by numerous cholera infections by means of milk.

Simpson, of Calcutta, cites a particularly interesting example, occurring on the ship Ardenclutha from Hamburg. From February 26th to the day of the arrival of the vessel in Calcutta, or until March 8th, there was no sickness on board. From March 8th to March 11th ten men, or forty-one per cent. of the entire ship's company sickened, and of these five had chlorea and five a diarrhœa.

Investigations in all directions led to the fact that nine of the sickened men had been drinking milk which came from Calcutta. One other man who had partaken of the same milk was spared, which would lead to the conclusion that he must have taken but a small amount.

All of the others used preserved milk" brought from Hamburg. Of these only one took sick and was the last to be attacked. Furthermore it was discovered that there were cases of cholera in the neighborhood of the milkman who sold the milk to the ship, and that moreover a water-tank near by had been contaminated with the excreta from these patients, and the milk was watered by the milkman with the water contained in this tank.

1 Conferenz zur Erörterung der Cholerafrage. Berliner klin. Wochenschrift, 1884, H. 31.

2 Gesundheitsverhältnisse in Calcutta während des Jahres, 1887. Veröffentl. des Kaiserl. Gesundheitsamtes, 1888. H. 33, S. 494.

On the ground of such facts I have thought it necessary to investigate the relation in which the cholera bacteria stand to milk. My experiments I carried on in the following manner.

On every occasion I saw the milk taken from the cow direct, so that I knew just how long the milk had stood before being experimented with. This is of importance, because in time the milk becomes sour, and the cholera germs are very susceptible to the action of acid (which prevents their growth). Fresh milk reacts always amphoteric.

I. UNSTERILIZED MILK.-I was able at the latest, fifteen minutes after the milking, to begin my experiments, which were so conducted that sterilized test tubes were filled with 10 to 15 c. cm. of the milk, and each tube thus filled inoculated with a platinum loop of an agar culture of cholera bacteria. A second series of tubes was next inoculated and served for control. The tubes were next brought into various degrees of temperature, namely, 8 to 12°, 15 to 18°, 22 to 25° and 36° C., and from hour to hour examined, and a platinum loop from each removed, and Esmarch's roll-piates of alkaline gelatine. inoculated with the milk thus removed.

In the cultures which had stood at 36° C., the cholera germs multiplied very rapidly in the first three to four hours, and overgrew the remaining ordinary milk organisms, but afterwards lessened from hour to hour with the souring of the milk, and finally ceased growing, while the milk bacteria multiplied correspondingly.

The cultures which stood at 22 to 25° C. became much later sour, and the cholera germs remained longer alive, namely, they lived for one to one and a half days. Here also the cholera bacteria multiplied rapidly in the first ten to fifteen hours, and then were completely overgrown by the other bacteria forms.

At 15 to 18° and 8 to 12° C., the cultures first soured after one to two days, and the cholera germs died first in two to three days No increase of germs occurred at these temperatures. It resulted also that the milk became sour faster as the temperature was raised, at which it was kept. When, therefore, it is considered that in ordinary life several hours usually elapse after the milking before the milk is taken, the result follows, assuming an accidental contamination of the milk with cholera germs, that with low medium temperatures the intermixed germs, with high temperatures on the other hand multiplication of them, in germinative condition get into the digestive organs of the consumer of the milk. Besides this I added to 10 c. cm. milk 1 c. cm. of a 10 per cent. sodium hydrate solution, and inoculated the mixture with a platinum loop of an agar culture of cholera bacteria, keeping parts at 36° C. and other parts at 23 to 25° C. The

culture at 36° became pretty sour after 48 hours, but the cholera bacteria showed themselves to be still living, and cholera only ceased to appear after 55 hours in a strongly acid milk; while on the other hand in those cultures which had been kept at 22 to 25° C., there was a considerable number of cholera germs yet living at the end of 78 hours.

And so we see that the length of life of the cholera germs in milk depends upon its reaction, the germs always dying faster in proportion as the milk sours faster, and moreover that the cholera germs remain alive until the milk gets strongly acid.

I must yet remark in connection with my methods of experimenting, that I poured all the gelatine in those Esmarch's tubes in which no cholera germs could be found into fresh alkaline peptone-bouillon, and placed this for some days in the culture oven, and then renewed the plate experiments with it. These efforts gave always negative results; in other words, no cholera germs grew.

II. STERILIZED MILK.-I placed 10 to 15 c. cm. of fresh milk in a test tube in the steam sterilizer for four or five hours, and then inoculated it with a platinum loop in each tube of cholera culture, and stood the tubes, some at 36° and some 22 to 25° C. From their contents I then from day to day inoculated fresh nourishing-gelatine. The reaction of the milk was in the beginning amphoteric; at 36° an acid reaction set in little by little, and in two weeks the cholera germs died, so that the culture was entirely germ free.

I also made from these cultures anærobic culture experiments, but with negative results, and was also unable to find any germs with the microscope.

On the other hand, in the cultures at 22 to 25° C. the cholera germs were living after three weeks. These experiments I give more in detail. The control experiments remained naturally always germ free.

For the practical purposes of life, on these experiments hangs a weighty question. How shall one treat milk before drinking it? A simple experiment leads at once to its solution. I took fresh pure milk, which was also sterilized, and inoculated it with cholera bacteria, then cooked it for five minutes in boiling water, or water from 96 to 100° C., and finally inoculated fresh alkaline nourishing-gelatine with platinum loops of this milk, and made it into Esmarch's tubes. But I obtained no cholera growth.

Since I repeated this experiment again and again with the same result, I can claim that through cooking the milk, one can most simply and certainly free it from cholera germs.

3 The table of experiments is omitted as being quite unessential to the understanding of the paper. It is to be found in "Zeitschrift f. Hygiene," Fünfter Band, 1888, v. c.

BY GEORGE G. HOPKINS, A. M., M.D.

Surgeon to St. John's Hospital and Consulting Surgeon to L. I. C. Hospital.

Read before the Medical Society of the County of Kings, October 15, 1889.

This instrument is one that I designed for a patient who was suffering from papilloma of the bladder, and was constructed for me by Messrs. G. Tiemann & Co.

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It consists of two parts: a curette with a flexible handle, the curve of which is controlled by a screw movement at the proximal end.

The whole length of the staff is seventeen inches. Of this length three and a half inches of the distal portion are flexible. Ten and a half inches from the distal end the staff is enlarged and graduated into quarter inches for a distance of three inches. Nearer the proximal end is a metal loop, g, which indicates the position of the curette and serves as a handle to steady the instrument. At the proximal end. is a screw fitted with a nut, f. One complete revolution of this nut will curve the curette a quarter of a circle. A drop of metal, i, on this nut indicates the curve of the curette, and is so arranged that when in line with the loop handle, g, the flexible end of the instrument is straight. The other portion of the instrument is fashioned somewhat after a Bigelow straight. tube, a, No. 30 F, modified only at the proximal end.

About an inch from this end a perpendicular outlet is made at e, by means of which a fountain syringe may be attached when desired. It also serves the purpose of a handle, and indicates the position of the tube while introduced through the urethra to the neck of the bladder, as required while operating. The open end of the tube is fitted with a perforated screw cap, which sets down upon a washer, when it is desired, to hold fluid in the bladder to facilitate the manipulation of the curette.

The tube, having been introduced, the curette is passed through it. When the first graduation on the staff is flush with the screw cap, the curette has just emerged from the eye of the tube at the trigone of the bladder.

With care and gentle manipulation the whole surface of the bladder may be gone over, growths cleared away and detached. These can be washed away from time to time by removing the curette and closing the proximal end with the finger, while injecting fluid through the lateral tube.

I curetted the patient for whom I devised this instrument, with perfect success, removing about two tablespoonsful of papillomatous material and relieving the urgency of his symptoms very promptly. He was up and about the house the day following the operation.

There were present at the operation Drs. Bartley, Bird, Henry and Fairbairn.

PUBLIC LECTURES ON SANITARY SCIENCE.

Under the auspices of the Local Committee of the American Public Health Association, in connection with the Free Sanitary Exhibition, the following lectures were given during the month of November at the Brooklyn Institute. By A. N. Bell, M. D., editor of The Sanitarian, "The Public Health Exhibition," or Object Lessons in Sanitation. By Mrs. Lucy M. Hall, M. D., of Brooklyn, "Sanitary Clothing." By Miss Juliet Corson, "Foods and Economy in Cooking." By W. G. Anderson, M.D., "Physical Education. By Mr. A. L. Webster, C.E., "Sanitary Construction of Dwelling Houses;" Illustrated. By Professor Robert Spice, "Sanitary Lighting and Warming;" Illustrated. By James S. Coleman, Esq., Street Commissioner of New York City, "Civic Cleanliness."

THE CARTWRIGHT LECTURES.

These lectures were delivered by J. S. Billings, M. D., LL. D., at the College of Physicians and Surgeons, New York, on November 14, 20 and 22. The subject was Vital and Medical Statistics.

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