BUTTERMILK IN THE FEEDING OF INFANTS.

977 towards the close of this attack when tenderness was con- capacity of one quart. It is then placed on ice and is fit for fined to the lower third of each tendo Achillis and pain administration during the next 24 hours. At this hospital it occurred when the tendons were put in motion. Absolute is given in the form of a food, which is prepared as follows. rest and painting with tincture of iodine were ordered and A quart of buttermilk is added gradually at first with recovery took place in three days. That tonsillitis is liable constant stirring to one teaspoonful of wheaten flour and four to be attended with serious complications is not sufficiently tablespoonfuls of granulated sugar. The food is then heated ’appreciated. People, as these cases show, often fall into just to the boiling point in a double saucepan with constant the error of regarding it as a trivial affection which they are stirring, care being taken not to curdle it by excessive

competent to treat.

boiling.

-

DIRECT INFECTION IN ENTERIC FEVER.

THE

ORIGIN AND FEVER IN THE

SOME attention has recently been directed to the possibility of direct infection in enteric fever, of the same nature as occurs in measles or scarlet fever, as opposed to the wellrecognised mode of conveyance by drinking water and milk. An outbreak which occurred at the State Hospital, Trenton, New Jersey, affords a good illustration of the possibility of direct conveyance from patient to patient under favourable conditions, though it does not throw much light on the possibility of contagion when ordinary measures of cleanliness are carried out. In this instance a case was admitted to the west wing of the asylum, and ultimately 80 cases occurred in the main building, of which this was a part, whereas none occurred in the annex which was dependent upon the same supplies of water and milk. Clearly direct conveyance was at work, and this was easily explicable by the dirty habits of the inmates, owing to which contamination of bathrooms, door-knobs, and furniture was unavoidable, while spoons and forks were washed by the patients without boiling water and could scarcely escape infection. Cases from time to time occur in our hospitals in which a patient occupying the next bed to a sufferer from enteric fever contracts the disease. These are usually ascribable to some defect in the precautions taken by the nursing staff. The question which it is of importance to settle is whether without any direct conveyance of germs on eating utensils or other such vehicles an air-borne infection exists. This is

rapidly

and

kept

in bottles

ready

___

PREVALENCE OF ENTERIC DISTRICT OF COLUMBIA.

THE ’enteric fever problem in any one city or country is radically different from that in many other communities. Enteric fever forms a world-wide problem. The disease is endemic in almost every civilised community. The prevalence of the disease in Washington has long been a matter of concern to the inhabitants of the District of Columbia. The visitor to Washington observing the broad boulevards and the stately buildings and the general air of beauty and cleanliness of the city is surprised to learn that the death-rate is comparatively high, especially from enteric fever. As the water of the Potomac, the source of the watersupply, was considered impure a large expense was incurred in constructing sand filters, under the supervision of the Engineering Corps, United States Army. The filtered water has been supplied to the city since November, 1905, and yet the disease assumed an epidemic form in July, 1906. Arrangements were then made for almost the whole force of the hygienic laboratory, under Surgeon-General Walter Wyman, to cooperate with Dr. William C. Woodward, the health officer of the district, in order to solve the problem. The results of several months’ work have recently been published.I The investigations include a sanitary survey of the Potomac watershed; an epidemiological study of 866 cases of the disease ; daily chemical and bacteriological examinations of the watersupply ; an examination of pumps, wells, springs, ice and ice factories, bottled waters, shellfish, salads, fruits, and other foods ; and an inspection of dairies and laboratory examinations of the milk-supply. Special attention has been paid to the communicability of the disease from person to person by direct or indirect contact. The relation of privies and sewers to wells has been studied and the question of flies and other insects as carriers of infection has received attention. The bathing beaches and public markets have been inspected. Finally, many specimens of fseces have been subjected to examination in order to determine the possible The report relation of animal parasites to the disease. contains numerous maps, charts, diagrams, and curves and forms a most comprehensive monograph on the subject. It affords valuable information to medical officers of health in any part of the world because the situation in Washington has been studied, not only with regard to local requirements and conditions, but also in relation to studies made of the disease in other countries.

.

not

but it must at any rate be in view of the infrequency of regarded such cases in general hospitals to which cases of enteric fever are admitted in company with sufferers from other diseases. not

It is cooled

for use.

yet satisfactorily decided, as a rare occurrence

____

BUTTERMILK IN THE FEEDING OF INFANTS. Dr. H. C. Carpenter of Philadelphia has recently advocated the feeding of infants with buttermilk in cases of gastrointestinal disorders and infantile atrophy and in view of a recent correspondence in our columns we think Buttermilk contains on his observations of interest.l an average from 0’5 5 to 1’5 5 per cent. of fat, though From sometimes there is as little as 0’25 per cent. 2 to 3 per cent. of proteid is found in average samples of buttermilk. The calcium casein of ordinary milk undergoes: a change to casein lactate during the preparation of buttermilk. It is noteworthy also that buttermilk contains a higher proportion of albumin than does ordinary milk. InfantsI take it readily and it causes no unpleasant effects. A few vomit slightly during the first one or two days. Dr. Carpenter considers that the advantage of buttermilk is due not so much to the low proportion of fat as to the greater: ease with which the proteids are digested. Several infants who were unable to digest milk containing 0-75 per cent. of calcium casein were able to digest the: 2 to 3 per cent. of casein lactate in buttermilk. At the Philadelphia Hospital the following method is employed in preparing it. A pint of fresh milk is allowed to stand forr 24 hours in a jug covered with a cloth at a temperature ofE Tom 65° to 700 F. The cream is then skimmed off and the’ sour milk is churned for 15 minutes in a glass churn of the ,

,

.

___

r

.

l ,

: i

TiiE next International Congress on Tuberculosis, held under the auspices of the National Association for the Study and Prevention of Tuberculosis, will meet in Washington on Sept. 21st to Oct. 12th, 1908. Dr. Theodore Williams, who has been elected a Vice-President of the Association in the room of the late Sir William Broadbent, has accepted an invitation from the committee to deliver one of the special addresses at Washington. -

THE Department of Public Health of Queensland, in a bulletin dated August 24th, states that no case of plague has occurred in Brisbane since July 26th. As regards the 1

1

THE

LANCET, Sept. 7th (p. 733)

and 14th

(p. 794), 1907.

Bulletin No. 35, Hygienic Laboratory, United States Public Health Hospital Service, p. 361, 1907.

and Marine