pressure can condense these organic substances into much less volume than a cubic centimeter for a gram, so that the minimum ration will amount to approximately fourfifths of a pound or of a pint. 3. That milk or any other single food-. stuff can be considered a complete aliment for an adult in the sense of containing the three organic constituents-proteid, carbohydrate and fat-in proper proportions, even if we ignore the necessity of having a variety of proteids and inorganic materials. That health can be maintained or regained without the stimulus of a variety of foods. 4. That overeating furnishes a reserve of strength on the analogy of running up a bank account. Probably not more than 10 to 20 grams of proteid (about one-fifth to one-third of a day's rations), 200 to 300 grams of carbohydrate (one-half to one day's ration) can be thus accumulated. An excess of any kind of food is laid down as fat to a large degree, and as much as 500 grams (five to 10 days' ration) may be thus accumulated in a single day. 5. That fat is an efficient form of reserved energy. Theoretically, nearly 300 grams might be used in a day, but it is extremely doubtful whether so much can be oxidized and certain that in the oxidation of anything like this amount, a danderous degree of acid intoxication would be involved. During starvation there is also a considerable consumption of proteid tissues. The very slight danger, in civilized life, of any emergency necessitating lack of food, does not warrant the carrying of more than a moderate amount of adipose tissue. 6. That deposition of fat or increase of weight beyond the normal standard is a gauge of health or a favorable prognostic in tuberculosis or any other disease. 7. That a genuine and rapid diminution of weight can be secured by dieting in obesity. Many fat persons maintain their weight and perform considerable mental labor and exercise moderately on half or less of the standard diet. How they do it will not be considered here. For a few days the excess of elimination over the intake of water and the clearing out of the alimentary canal may cause a rapid loss of weight. After this, except by exercise which causes a breaking down of proteid tissues, it is doubtful whether a genuine reduction of weight can be carried beyond 250 grams (about half a pound) a day. A genuine gain of weight, at least in the sense of deposition of fat, may proceed for some time at double this rate. 8. That a carbohydrate free diet should be continued more than a few days even in diabetes. About 80 grams of carbohydrates a day must be given to prevent acid intoxi cation. 9. That obesity, diabetes, leanness, lithæmia, etc., can be treated simply by superfiIcial dietetic indications and contra-indications. 10. That anæmia is, unless exceptionally, an iron-starvation, that may be treated successfully simply by giving iron. Anæmia usually develops while there is plenty of iron in the food and, while the normal body can assimilate iron from inorganic salts or even from the metal, anæmia is not often benefited by administering an excess. II. For most purposes, the best form of iron is meat. Iron is also found in many fresh vegetable foods. Fancy proprietary imitations of hæmoglobin are not, as a rule, superior to officinal salts. 12. That candy or sugar is essentially injurious or even lacking in food value. Used in moderation, say 100-150 grams a day, sugar is one of the cheapest and best forms of nourishment for the production of energy. Even when not digested the products of decomposition in the alimentary canal, like those of catabolism, are less injurious than those derived from fats and proteids. 13. That the use of sugar tends to produce diabetes. 14. That fruits, nuts, desserts, etc., are unimportant ingredients of the diet. 1/5-2 of the ordinary civilized diet consists of "good things." A large piece of pie, serving of ice cream, nuts, etc., often yield 400 calories, about 1-6 of the day's ration. 15. That fish contains an excess ol phosphorus or "brain food." The phos phorescence of fish is due to beginning putrefaction and has nothing to do with phosphorus. Meats and various vegetable foodstuffs contain as much or more phosphorus than fish. 16. That vegetables consisting of leaves, stalks, etc., or fruits which are very watery and not sweet, can contain much nourish ment. 17. That ordinary vegetable foods contain appreciable quantities of fat. Excepting olives, almost the only vegetable foods rich in fat are nuts (though not necessarily so-called, as the cacao bean), a dense seed coat being necessary to the retention of fat. 18. That clam broth, bouillon, or any clear soup or solution of meat extract can contain enough nourishment to sustain life. The best of the last contain about 6% of proteid. 19. That proteid can be extracted from meat by boiling. Except for salts and waste matter closely resembling urine, beef tea is about equivalent to egg tea, that is, to the water in which an egg has been poached. 20. That one cereal, as oats or wheat, is materially more nourishing than another, as rice or corn. 21. That one meat, allowing for differences in fat and waste, for specific tendencies to infection, as for pork to trichinosis. for saprophytic decomposition, as in sea foods transported long distances, and similar extrinsic conditions, differs materially from another. 22. That vegetarianism or any similar hobby is conducive to robust health. 23. That, after securing reasonably fine comminution and insalivation of food, prolonged mastication should be made a cult 24. That an ordinary meal, for a healthy person, requires more than half an hour at the table. Dawdling over meals is nearly as bad as bolting the food. 25. That, after a meal, a healthy person is in a state of semi-invalidism, so that he requires a nap or cannot work. 26. That a bath or swim is any more harmful when there is food in the stomach than when it has passed into the intestine. 27. That the stomach empties itself all at once, or in a short period, at a definite time after this or that kind of meat or other food. 28. That meals should be given so frequently, either in health or in disease, that one meal overlaps another without giving the stomach a little time for rest. 29. That, on the other hand, a dilated or weak stomach can be rested by giving one adequate and necessarily large meal a day. 30. That spoonful doses of liquid foodis, whether repeated so often as to fatigue and confuse the stomach, or given at reasonable intervals, can ever support life. 31. That milk curds and meat extracts are mechanically or chemically superior to pultaceous cereals in typhoid and other. ulcerative diseases. 32. That pasty, sweetened and spiced foods are superior in the feeding of invaiids to carefully prepared and selected viands of ordinary nature. 33. That a raw egg is any more nourishing than a cooked egg. On the contrary, adventitious albuminuria is to be expected if 5 or 6 egg whites are given. 34. That a hard boiled egg is hard to digest. Try it with gastric juice in an incubator. 35. That eggs, inilk, oysters, etc., have any greater nutritive value than corresponds to their weights and composition. The day's ration in calories corresponds to about 25 eggs, or 3 quarts of milk. A kilogram of raw oysters (2.2 pounds) contains 50 grams of proteid, the minimum proteid ration, corresponding to about 1-12 of the total dav's ration in calories. 36. That when a man has eaten a fourth meal, at midnight, with coffee or alcoholic beverages, it is fair to ascribe the logical disturbance of digestion to a Welsh rabbit or any other single article. A Welsh rabbit is sterile, highly nutritious, and no harder to digest than a milk curd. Similarly, mince pie and various other articles against which there is a strong prejudice, are not necessarily difficult of digestion nor objectionable as articles of diet, although they may not be adapted to the nourishment of grave digestive disorders. Incidentally, it may be noted that the spelling and etymology "Welsh rarebit" is incorrect. 37. That human saliva is of great value in digestion. Starch digestion never advances far in a stomach of normal acidity and the pancreas is abundantly able to take care of all the starches. 38. That dry meals digest better than those at which a moderate quantity of water, say 500 c.c. in soups and beverages, is taken. 39. That one should always eat simply because it is meal time or, on the other hand, that he should always wait for an appetite. 354 Franklin St. A PLEA FOR THE USE OF RAW MILK AND PURE MILK.* BY E. MATHER SILL, M.D., New York. Visiting Physician to the Good Samaritan Dispensary Lecturer on the Diseases of Children at the Polyclinic Medical School and Hospital. IN view of the fact that so much has been written in the papers of late concerning the necessity of having all milk that comes to the city Pasteurized, I am prompted to say a few words in favor of raw milk. It has been my fortune for a number of years to oversee the feeding of many hundred babies and after numerous and careful experiments with feeding babies on Pasteurized milk I am forced to believe that it, in the vast majority of cases, produces rickets and scurvy or scurvy rickets and kindred diseases, if given continuously; these diseases being promptly cured by the use of raw milk, with no other treatment. This conclusion has been arrived at after thoroughly studying hundreds of cases. It A complete report will be found in a previous publication in the N. Y. Medical Journal for Feb. 8. 1908, under the title of "Is Sterilized Milk a Safe Food for Infants." would therefore seem a pity if mothers were forced to feed their babies on a milk that has been proven by careful observation to be harmful when given as a sole and constant diet. It has been found that the heating of the milk (Pasteurization) so changes its organic ingredients that it is no longer a perfect food fit for the proper nourishment of an infant. Certain vital characteristics of the milk are destroyed or altered by heat. "That commercially Pasteurized milk is more unsafe and less to be trusted than ordinary milk is abundantly proven by the investigations of Pennington and McClintock, of Philadelphia, and is probably true of other cities." P. G. Heinemann and T. F. Glenn have shown by their experiments on the germicidal action of cow's milk that the relative increase of bacteria in milk is more pronounced in milk heated to 75° C. or 100° C. than in raw milk or milk heated to 56° C., showing that the heating of milk destroys or greatly impairs its germicidal action. Heating the milk changes it from live, fresh food to a dead, preserved food. The ideal food for the infant (mother's milk) is a live, fresh food. Heated milk is not only a preserved food, but it has lost a large proportion of its nutritive quality, as has been shown by experiments both on the feeding of infants and young animals, thus giving an adequate and scientific reason for the rickets, scurvy, malnutrition and kindred diseases which it has been shown by many observers follow its use. Six years ago when there was so much talk of the virtues of Pasteurized milk for babies I examined and studied several hundred babies so fed and found that 97 per cent. of them showed signs of rickets or scurvy and their kindred diseases, and it was only after these careful observations that the fallacy of heated milk in infant feeding was made clear to me. An infant food must take the place of and simulate mother's milk to be an ideal food, and in order to do this it must be of anima! origin, it must not be heated above blood heat, as a temperature above that disorganizes the albuminoids and mineral constituents, on which the development and growth of the child depend. Uncontaminated milk is necessary, we admit, for successful infant feeding, but contaminated milk no matter how carefully Pasteurized will cause disordered digestion, improper assimilation, and is fraught with great danger in the young child. The question arises whether it is not better to give the raw milk even if it is not so pure and free from bacteria as we would wish (a certain number of bacteria are necessary for the proper digestion of the milk, it is claimed), rather than suffer thousands of babies to be forced to take a harmful food which inevitably will produce a serious disease. I would advocate that free milk depots be established by the city in various parts of the city, where pure milk could be obtained by the poor either free or at a moderate price; also depots where free ice can be obtained for those too poor to pay for it. Pasteurization is not getting at the root of the milk evil, and heating dirty milk that is full of bacteria will never make strong or healthy children. What we want is regulation to enforce a pure milk supply and this can only be obtained by having an adequate number of inspectors and skilled veterinary surgeons to visit and have under close observation the various sources of the milk supply. It is unnecessary to Pasteurize milk to destroy disease germs when a pure milk supply is provided for, and this can be practically done by having the herd frequently subjected to the tuberculin test to exclude tuberculous cows. The cows must be groomed, the teats and udders and the milkman's hands thoroughly washed and dried before milking. The milkman should wear clean washable clothes, and the milking should be done in a building away from the stables. The milk should be received into sterilized quart bottles or cans, which are then tightly sealed, labeled with the dairyman's name and the date, and cooled immediately to a temperature of 40° F. If the newly devised milking machines were used more extensively at the farms it would add greatly to the cleanliness of the milk. Experiments that have been made at the Yale University Agricultural Experiment Station show that when milk is cooled to 40° F. all bacterial growth is at once stopped and continues so as long as the milk is kept at that temperature. Milk has been kept sweet in this way for several months. 142 W. 78th St. A PLEA FOR THE EARTH CLOSET.* BY GEO. B. Lake, M.D., Special Lecturer in Rural Sanitation, Purdue University; Town Health Officer, Wolcottville, Ind. To those who enjoy the privilege of living in a city, the problem of the disposal of sewage means no more than an occasional visit from the plumber, unless they happen to be particularly interested in the subject, and, even then, their interest is, as a rule, largely academic. But to us who reside in small towns, where the adjuncts of civilization and the amenities of life have not yet penetrated, the problem is one which is not only intensely interesting, but which is vital to the preservation of our health and comfort. It is to such that this paper is particularly addressed, but I hope that it may not be wholly without interest to others. There are very few who have not upon the tablets of memory the picture of a vile and stinking hut, where they have been forced to go at some time for the sake of decent privacy while attending to the calls of nature. A nauseous shack, with disgusting heaps coming almost up to the top of the seat; ill lighted; il ventilated; infested with spiders, roaches and all manner of vermin; festooned with cobwebs, incrusted with dirt and swarming with flies. It is such disgraceful conditions as this which have caused the word "Privy" to be considered *Read before the 12th District (Ind.) Medical Society, at Fort Wayne, April 21, 1908. indecent and to bring to our minds recollections which give rise to nausea and unutterable loathing. Such conditions are absolutely unnecessary, and, in this day of enlightenment, inexcusable. The water works and municipal disposal arrangements give the city dweller a vast advantage in this respect, but even we of the smaller towns have an alternative which compares with the barbaric arrangements which are widely in vogue as day compares with night. In all towns where there are no water works or sewers the earth closet or dry method of disposal of excrement, can and should be practiced. The earth closet in its simplest form consists of a box (Fig 1), with a tight-fitting hinged lid, in which are cut as many holes as are needed. Under each hole is placed a non-corroding receptable (a galvanized iron coal hod does nicely) and over each is a tight-fitting hinged cover. A large box of dry garden earth is placed in a handy situation, and every time the closet is used a scoopful of earth is scattered over the excrement. The surface layers of the soil swarm with nitrifying bacteria, which, being thus brought into contact and intimately mixed with the excrement, immediately attack it and rapidly change it back to its inoffensive and harmless inorganic constituents. The excrement is, meanwhile, mechanically pro tected by the earth in such a manner that no nauseous odors can arise and, much more important, that no flies will be able to wander upon it and then come into our houses and promenade over our meat and potatoes. The danger from flies is, as all well know, not merely that of mechanical pollution of our food with fecal matter, but the more serious one of infection with the specific microorganisms of various infectious diseases, notably typhoid fever. The flies not only carry the germs of these diseases upon their bodies, but, eating infected material, they void the living bacteria in their feces for as long as twenty-three days after infection (Ficker, Archiv. f. Hygiene, Bd. xlvi S. 274). When the receptacles in the earth closet are two-thirds or three-quarters full they should be taken out and the contents buried in the garden (for in towns where there are no water-works there is almost always a little garden pertaining to each house). This emptying, if the earth has been used systematically, is not in the least a disgusting task, and the material so emptied greatly increases the fertility of the garden. No disinfectants should be mixed with the earth, as these would inhibit the activity of the nitrifying bacteria, to which the desirable results of this method of disposal are largely due, and which are, in themselves, the deadly foes of all pathogenic microorganisms. This box-closet may be set up in the woodshed, the basement or in a separate and special building, and no matter where it is placed, if properly attended to, it will give rise to no danger or nuisance. If it is desired to embody these ideas in a form that will require less frequent attention, the following arrangement (Fig. 2), taken from the Bulletin of the Montana State Board of Health, will be found useful. A tight-fitting door (A) is made in the side of the privy building so as to open the space under the seat, and through this door is introduced a drawer (B), made of heavy matched lumber. Two-by-fours are nailed to the bottom of this drawer edgewise to form runners (C), and other two-by-fours |