REVIEW — TEOPICAL MEDICINE, ETC. 83 



scrubbed, there must always be a certain amount of organic material in a more or less advanced stage of Food 



decomposition in the cracks. In the serving rooms, kitchens, etc., and wherever food is exposed for any length of Poisoning' 



time to contagion by flies, the food should be covered up as soon as it is put down. The ordinary wire gauze dish cnutinved 



covers are cheap, and admirably suited to this purpose. 



Cooking utensils, plates, dishes, forks, spoons, etc., should be sterilised shortly before use. This would not 

 involve any very coasiderable extra labour, and convenient apparatus would not lie very costly. No pressure of 

 steam would be necessary, only tlie utensils should be brought to the temper.ature of steam. Cleaning with a jet 

 of live .steam, such as is done on ships, would be very effective. 



Copper cooking utensils have the disadvantage that they require re-tinning at intervals. There is no means 

 of getting this done in a first-class manner in the islands. The tinning is often irregular, and it is impracticable 

 to get such a surface really clean and free from small collections of organic material. Something other than 

 copper would, therefore, be an advantage. 



Soup must be made fresh every day, and the stock-pot abolished. 



With regard to rechauffes, even if protection from flies is guaranteed between the first and second cooking, it 

 would be well if the material were always brought to boiling-point and kept so for some minutes. 



Cold cooked provisions must be kept free from flies. 



There should be b>it little difficulty in keeping the kitchen, and even the whole house, comparatively fi'cc 

 from Hies by means of wire gauze frames to tlie windows and doulile doors; the outside door to consist of a frame 

 with wire gauze stretched upon it. Such a plan would allow plenty of air to come into the rooms, and would 

 exclude the majority of the flies. This is done very extensively in America, and even by some people in England. 



No suggestion is intended that the kitchens of the hotels are not clean in the ordinary acceptance of the word. 

 For instance, the kitchens of those I visited would compare very favourably with any kitchen I have seen in Europe. 



What the observations really imply is that precautions which are sufficient in England to prevent a degree of 

 infection by bacteria enough to produce symptoms, are wholly inadequate under the conditions of temperature, 

 etc., in the lower and hotter parts of the islands. 



It is quite possible that there may be one or more specific bacteria which are specially responsilile for the 

 aeuteness of the symptoms. Even if this be the case, however, there seems but little doubt that the flies are to 

 a large extent responsible for the original infection of the food. The rapid multiplication of the bacteria aud the 

 consequent production of toxins depends upon the local conditions. It would seem that the suggested precautious 

 are necessary whether there be a specific micro-organism or not. It is probable that food is more frequently 

 infected, even in the best conducted private kitchens in the towns in the islands, than is the case in Europe, and 

 that consequently the residents may have acquired a limited degree of immunity. I met several residents, 

 however, who told me that they had suffered from attacks after dining at hotels, but not at any other time. 



An important paper, dealing with the bacteriological aspects of an epidemic of food 

 poisoning due to brawn containing the Bac!U}i!< enfprifidix of Gsertner, is that by Buchan.' 

 It is likely to be useful to any bacteriologist having to carry out an investigation of an 

 outbreak of this type. 



Titze- sums up our present knowledge regarding meat poisoning as follows : — 



1. By far the majority of cases of meat poisoning hitherto investigated have been shown to Ije due to bacteria 

 belonging to Gfertner's group or to the paratyphoid B. group. 



2. These bacteria usually obtain entrance to the tissues of animals intended for slaughter as a result of septic 

 disease. The.y may not be the primary cause of septic processes, but possibly constitute an accompaniment of the 

 general disease condition produced by ordinary sepsis-producing organisms. 



.3. The paratyphoid bacillus may also be conveyed to the flesh of perfectly healthy animals through various 

 accidental circumstances (poisoning by sausage meat). 



4. We know nothing regarding the occurrence and spread of meat poisoning bacilli in and by healthy men 

 and animals, or their mode of existence outside the animal body ; we are equally ignorant regarding the reasons 

 for the variation in their powers of producing toxin, and in regard to the essential factors in toxin production. 



■5. No sufficient investigations have been conducted regarding the injurious qualities of meat which has 

 undergone albuminous decomposition in consequence of the action of saprophytes (ptomaines and sepsins). 



6. Botulismus is produced by an anaerobic saprophyte, the BacUlus botulinus. 



Guinea Worm (Dracontiasis). The most important recent work on this subject is 

 that by Leiper.'* He first of all classifies the hypotheses of infection that have been 

 advocated, as follows : — 



i. Those in which the development of the embryo is supposed to occur without the intervention of any 

 intermediate host, human infection being caused by — 



(a) The embryo, as discharged from the parent worm ; or 



(h) The mature larva, evolved from the embryo in water or marshy soil ; or 



(c) The young adult, the product of the continued grovrth of the larva in water. 



' Buchan, P. (December 7th, 1907), " kn Outbreak of Food Poisoning due to Eating Brawn." Lancet, 

 p. 1604, Vol. II. 



- Titze, C. (March, 1908),"Zeits ftir Fleisch und Milchhyg." Quoted in Jounial of Cmnparalive Patliology 

 inul Therapeutics, March, 1908, p. 87. 



" Leiper, R. T. (.lanuary 19th, 1907), "Etiology and Prophylaxis of Dracontiasis." Biiiish Medical Journal, 

 p. 129, Vol. I. 



