SOME POSSIBLE SOURCES

OE

INFECTION

IN ENTERIC EEYEIl. By M. D.

O'CONNELL, LT.-COL., R.A.M.C.

m.d.

(Continued from })ar/e 376.)

has not, as far as I know, been suggested as a source of infection of And yet apparently in this enteric fever. fermented beverage, the bacilli of enteric having once rained an entrance would grow and Moreover, suspicion of multiply it arises when it is remembered that the Eurois the chief victim of enteiie, pean soldier, who as he does his consumes it daily ?'is regularly the while or sepoy ^vho so meat, ration of bread

///?Beer.?Beer

ever

"exceedingly.

seldom contracts enteric presumably never tastes beer at all. It may be said that as sepoys who never use fermented bread or beer sometimes contract enteric fever, these articles cannot be channels of infection. But it is not, of course, suggested that these are the sole channels of infection, only that they are possible sources of infection which are usually overlooked. As in the case of bread, it ma}' be well to examine first the making of beer or brewing, and then the articles used in such brewing. Brewing is said to be the process of extracting malted grain, anda saccharine solution from converting this solution into a fermented sound alcoholic beverage called beer. It consists of two processes: first malting, and second brewing. Malting is the promotion of germination in barley or other grain by which some of its starch is converted into sugar. The grain is steeped for 48 hours and then turned and re-turned till It lasts about root and stem begin to appear. seven or eight days. The grain is then killed by drying. The second part of the process or brewing proper then begins. The malt is crushed in a mill, then thoroughly mixed with hot water in a mashing machine, and then passed into a mash tun, a cylindrical vessel with false perforated bottom, through which a sweet liquor, the wort, drains, After three hours the wort is drawn off into a copper where the hops, or whatever substitute is used, are added, and the whole boiled for two hours to prevent When acetous or putrefactive fermentation. sufficiently boiled, the contents are run into the hop-back, a rectangular vessel with a perforated false bottom 8 or 9 inches from the true bottom. The hot wore passes through, leaving the spent hops, and thence into a cooler, where the wort is cooled to a temperature of about 100?.F. Then it is supposed to be passed to a refrigerator, where it is cooled to about 58? F. Next, it passes to the fermenting wooden tuns where the yeast is added. During fermentation portion of the saccharine matter is converted into alcohol, and the temperature tends to rise considerably. To keep it down various methods have been suggested such as inverted metal cones filled with ice, or coils of copper piping through which cold water runs. When fermentation has proceeded far enough the liquor is allowed to settle, the beer becomes clear and bright and is filled into casks or vats, and, if stored for some months, is called lager beer. This beer is said to be slowly fermented at a low temperature. Now, in the first part of the process of malting, the bacillus of enteric would find a capital environment for growth and multiplication, and also in the first part of the brewing process "

"

proper. But after adding the hops the whole is boiled for two hours. This, according to our present.

Nov.

1893.]

SOURCES OF INFECTION' IN ENTERIC FEVER: O'CONNELL.

409

table into a tin cylinder and filling in the interstices with water or appropriate fluid such as gravy for meat or syrup for fruit. The lid which contains a pin-hole perforation is then carefully soldered down. The cylinders are then set in a bath of solution of chlorate of calcium and boiled until all the air is expelled through the pin-hole which is then hermetically sealed. The tin is then exposed to heat until the enclosed food is perfectly cooked. When cool the can is painted over and then proved by being again exposed to the degree of temperature most favourable to decomposition. If the ends or sides of the tin have fallen in it is considered good; if they bulge out it is considered bad and rejected, because gases are then known to have formed inside the tin. Although this process may ensure that tinned food is free from putrefactive micro-organisms, it is by no means a guarantee that the bacillus grow luxuriantly. of enteric fever may not be contained in it. In bread, indeed, the danger is minimised b}7 the fact that the heating (baking) takes place after The temperature to which it is exposed may fermentation to stop it, and at the same time, if not be sufficient to destroy the bacillus, and efficiently done, kills any pathogenic organisms although it may be absolutely certain that all accidentally present. In brewing, the heating air is driven out of the tin, it does not follow (boiling) is done before fermentation, so that that the deprivation of air will kill the bacillus. For bacteriologists tell us that typhoid bacilli an}7 pathogenic organisms accident^ added are "facultatively lerobic," that is, although the}'' or after fermentation are not to during exposed a grow and multiply when exposed to the air, germicidal temperature at all. as the constituents of of they grow better without it. So that if enteric Now, beer, regards in food about to be tinned or course the water may be polluted or the grain bacilli be present there is no certainty that the process canned, or the hops or the }7east or other substances may of "canning" will destroy them. Tinned or be substituted for barley or hops. It is not canned food seems to be very popular with that will be substituted other for likely grain from the large quantity of it barle}7 in this country, as the latter is the cheap- soldiers judging institutions. in regimental Oysters, lobsters beer is made from sometimes Still est of grains. maize in America, and diseased maize is very and salmon, &c., are there sold in considerable quantities. Oysters are known to be frequent strongly suspected of causing disease in man. sources of infection in the fresh state, and as we for substituted have been substances Many have seen, the process of canning would tend seems to be the chief, of which hops picrotoxine rather to protect than to destroy the bacilli. intoxicatand beer because it makes the heady if there is anything in what I have Now, in and there are ing, many vegetable products written India which would have the same effect, and regarding the possibility of infection which could be procured at a much smaller cost through bread or beer or tinned food, it would than hops. As the note in Parkes' Hygiene be well whenever an outbreak of enteric fever declares, a very large quantity of cocculus cannot be traced to water or milk or butter, to indicus or its active principle picrotoxine was have the first-mentioned articles examined by a imported into England, and no other use was bacteriologist. If they are pronounced infected, known for it, if it was not used as a substitute biscuits might be substituted for bread for a few da}?s and the baking arrangements for hops in the manufacture of beer. improved. If the beer be in fault, another brand favourable a is there might be alwa}7s Again, in yeast, medium for the multiplication of enteric bacilli. substituted, or even a small quantity of rum, for a short time. And, as In beer as in bread then there is possibility regards tinned food, of infection. This is reduced to a minimum if if it were always boiled in water before being brewing is carefully carried out at suitable opened, it might be rendered safe. Perfect baking, perfect brewing, and the boilseasons of the year. But if the process is hurried, or carried out in the hot season, the dangers ing of tinned food before opening, would render such articles less likely to cause infection. of beer becoming infected with pathogenic are increased. Although only possible sources of infection vastly organisms were to be touched on in this paper, IV.?Tinned or Canned Food.?This process perhaps I a will offer be if I excused for the suggestion food which is called of preserving "canning" consists in packing the meat or fruit or vege- treatment of enteric fever. of temperatures at which spores die, the destruction of any enteric or spores which accidental^ find their way into the wort. Bat, as previously pointed out, it is not at all certain that such temperature kills spores, and next it may happen that such temperature may not always be reached as in the case of baking. Again, when the liquor is cooled before fermentation, it is quite possible it may again become infected, and especially during fermentation. In this country it must be very difficult to carry out what Pasteur calls low or sate fermentation, viz., at 39?F. to 41? in either making bread or beer. High fermentation, viz., at from oG?F. to 68? is perhaps more common, in which, as Pasteur sa}7s, there is much more danger of contamination with pathogenic organisms, and at which such pathogenic organisms

knowledge

should bacilli

ensure

410

THE INDIAN MEDICAL GAZETTE.

Myxcedema, a group of symptoms which follows the removal of the thyroid gland by the surgeon's knife or by disease, is found to be relieved in a marvellous manner by the internal administration of thyroid gland substance taken from animals such as the sheep. Theoretically it is said that the thyroid and other vascular or ductless glands produce an internal secretion" which is necessary for health and finds its way into the blood. When the gland is removed or destroyed, the secretion is not produced, and, as a result, certain morbid phenomena arise. The internal administration of similar gland substance from other animals is said to be a perfect remedy for such a condition. In enteric fever whatever be the cause, the result is invariably intumescence and destruction of Peyer's glands. These also, it is to be remembered, are vascular or ductless glands, and when thev are destroyed of course their internal secretion is lost. With the intention of supplying this important fluid. I would suggest the internal administration of Peyer's glands taken from the sheep, in cases of enteric fever. The method of preparation of such substances is, I understand, detailed in the new issue of the Pharmacopoeia. "

[Nov.

1898.

Some Possible Sources of Infection in Enteric Fever.

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