time it had to grow upon the incriminated food before consumption, and the temperature of growth. The symptoms vary with the dose, that is, with the number of bacteria ingested with the food. The susceptibility of the individual also plays an important role in this, as in other infections. The severity of the symptoms, therefore, may be due to a number of complicating causes, some of which are not understood. "Usually from six to twelve hours elapse between the ingestion of the food and the onset of symptoms, though occasionally the period of incubation is four or less, and it may be seventy-two hours or more. Not only does the incubation period vary in different outbreaks, but in the same outbreak widely different incubation periods have been noted. It is natural to accuse the food vomited as the food responsible for the trouble, but frequently several meals elapse between the ingestion of the infected food and the onset of symptoms. It is a common mistake to accuse the wrong food. "The case fatality rate varies greatly in different outbreaks. In the 112 British outbreaks studied by Savage, there were some 6,190 cases with ninety-four deaths, a case fatality rate of 1.5 per cent. "The age and sex distribution depends entirely on the accidental age and sex distribution of those who eat the infected food. "Most cases occur in the summer time, the disease corresponding in seasonal prevalence to typhoid fever, cholera, dysentery and other intestinal infections. The bacilli responsible for food infection grow in the food before it is eaten, and therefore temperature is a very important factor. The greater multiplication of these bacteria in hot weather also increases the opportunities for transmission of infection through flies and other means. Secondary infections rarely occur. There is the same potential possibility of contact infection as in typhoid fever, but the cases of food infection are for the most part acute and of short duration, so that there is little opportunity for secondary infection. Furthermore, human carriers are very infrequent. "The great majority of outbreaks of food infections are due to meat foods; hence, the frequent use of the term "meat poisoning" in this connection. Of the 112 British outbreaks, in twenty-one the vehicle was a non-flesh food; that is, milk, one; cream, one; ice cream, six; potatoes, two; pineapple jelly, one; peaches, one; rice cooked in fat, one. The remaining ninety were all due to flesh meat. The meat of the pig or ox accounts for 68 per cent. of the British and 61 per cent of the continental outbreaks. The almost complete absence of outbreaks due to the meat of the sheep is striking. The number of cases ascribed to fish is small. "Most outbreaks are due to some form of prepared meat foods, such as brawn, meat pies, sausage and chopped meat. When the nature of the infection is considered, it becomes obvious that the more the food is handled and the longer it lies around, the greater the opportunity for it to become contaminated and for the bacteria to grow and multiply. "It cannot be too strongly emphasized that in the vast majority of outbreaks of food infection the food affected is not noticeably altered in either appearance, taste or smell. The prevalent idea that poisonous food must be 'tainted' still persists, although long exploded. Bacilli belonging to the Gaertner bacillus group cannot be detected in food or water, any more than the typhoid bacillus, dysentery bacillus or cholera vibrio can be detected with the unaided senses. "In the Ghent outbreak, investigated by van Ermengem in 1895, a slaughterhouse inspector (a veterinary surgeon) was so certain that the suspected meat (saveloy), in the absence of any abnormal signs, could have no connection with the trouble that he ate two or three pieces of it to demonstrate its harmlessness. He was attacked with severe cholera-like symptoms and d`ed five days later, the Gaertner bacillus being recovered postmortem. "In a few outbreaks, however, minor peculiarities of the food have been noted, such as objectionable flavor, heavy odor, and moist or soft condition. These, however, are rare exceptions and not the rule. "It is not decomposed food, but infected food that is likely to cause trouble. "Diagnosis of food infection depends on: history of exposure to the suspected food; symptoms suggestive of food poisoning; isolation of the infecting organisms from the suspected food, and also from the blood, urine, feces or viscera of the patient (bacilli belonging to the Gaertner group disappear from the feces in from seven to ten days after the onset of symptoms); specific identification of the causative organism by agglutination tests; demonstration of agglutinins in the blood serum of patients. A positive reaction can be detected six or eight days after the onset of symptoms. Agglutination in comparatively low dilutions is usually accepted as diagnostic, owing to the fact that it is extremely rare to find a positive reaction for B. enteritidis or B. suipestifer in normal individuals. "It must be quite evident that the term "food poisoning" is not well chosen, so far as infections with Gaertner's bacillus are concerned. This bacillus produces an acute febrile infection, specific in nature. The attacks are usually mild and brief, with complete recovery. The disease, however, in all essential particulars clearly belongs to the group of intestinal infections, including typhoid fever, dysentery and cholera. No one would subscribe to the propriety of calling typhoid fever "food poisoning," even though the typhoid infection was contracted from bacilli contained in contaminated milk or infected water. GAERTNER'S BACILLUS AND SOURCES OF INFECTION "B. enteritidis is the type of a group of organisms lying midway between the colon bacillus, on the one hand, and the typhoid bacillus, on the other. It is therefore often spoken of as the 'intermediate group,' the 'hog cholera group,' the 'enteritidis group,' the 'paratyphoid group,' and the 'Salmonella group.' The classification of the members of this group is quite involved, and there is still a lack of agreement among bacteriologists concerning some of the details. "Gaertner, in 1888, brought forth the first definite evidence which incriminated bacteria as an etiologic factor in food poisoning. At Frankenhausen, fifty-seven individuals became ill after eating the flesh of a cow that had been slaughtered on account of enteritis; one case resulted fatally. Gaertner isolated the bacillus from the organs of the cow and also from the spleen of the man who died. "B. enteritidis and its congeners are pathogenic for some of our food animals as well as for man. Cattle suffering during life from puerperal fever, uterine inflammations, navel infection (in calves), septicemia, septic pyemia, diarrhea and local suppurations are likely to furnish meat containing the Gaertner bacillus or closely related bacilli. Such meat has frequently given rise to 'meat poisoning.' Hence, emergency slaughter (nothschlacht), unless intelligently supervised, furnishes meat that may be a menace. The meat of such animals presents no warning signs of its danger. This fact was well proved by the meat inspector at Ghent, already referred to. The story of this tragedy has become classic. "The meat may come from healthy animals, but become infected after slaughter. This may take place through the hands or instruments of the butcher who has just handled a diseased carcass. There are other possibilities, such as human carriers or fecal contaminations. "Bainbridge states that 'infection of meat by human carriers of B. suipestifer is unknown.' Human carriers of B. enteritidis are exceedingly rare. Human carriers of B. paratyphosus B are occasionally discovered, but these also are infrequent. In 4,154 specimens of human feces from healthy individuals examined in our laboratory in 1917-1918, not a single carrier of any of these nonlactose fermenters belonging to the enteritidis group was found. "The English observers believe that all cases of food poisoning traced to human carriers are in reality cases of paratyphoid fever; but the Germans, who do not differentiate between B. paratyphosus B and B. suipestifer, hold that the latter organism also occurs in normal, healthy human intestines, and may thus become a source of food infection. Such instances must be exceedingly rare in the United States, for in our studies of the subject we have found only the outbreak here recorded in four and one-half years. "The common gray rat and mouse may harbor B. suipestifer and possibly B. enteritidis as carriers. Zwick and Weichel examined 177 mice and found that twentyeight were acting as carriers of Gaertner group bacilli. Hence, food may become infected by contamination with rat or mice feces. There is abundant opportunity for such contact in the slaughterhouse, in butcher shops, in refrigerator plants, in transportation and in the home. "Contamination with fecal bacteria is highly improbable as a source of infection, for if it were true, food poisoning would be exceedingly common, so great is the ordinary fecal contamination of our food. During the years 1917-1918, more than 500 samples of food were examined in our laboratory without the discovery of a single pathogenic member of the colon-typhoid group." (A further discussion of the subject of food poisoning may be found in the chapter of "Food Poisoning" in Nelson's Loose Leaf System of Medicine, from which many of the facts cited above are taken; it is also discussed in Preventive Medicine and Hygiene (Ed. 4) by one of us (M. J. R.).) (Quoted from Rosenan and Weiss, J. A. M. A., December 17, 1921.) A CHAMPION OF THE HOUSE-FLY. "The fly is blamed for carrying all kinds of germs. This is one of the medical scape-goats; one of their explanations intended to cover a lot of ignorance. Did you ever watch a fly clean its feet and body? The fly keeps himself cleaner than many of those who talk about him." The above paragraph was copied from page 792 of "The Chiropractor's Adjuster," published in 1910, a volume from the pen of D. D. Palmer, the founder of chiropractic, by S. A. Matthiew, who, very kindly sent it to the Department of Health for the instruction (or amusement) of readers of the Bulletin. MORTALITY SUMMARY FOR THE WEEK ENDING JANUARY 7, 1922. The death rate during the past week was 13.28, as compared with 12.78 for the corresponding week of last year. The actual numbers of deaths reported during the weeks under consideration were 1,486 and 1,409 an actual increase of 73 deaths; but if allowance is made for the difference in the size of the population the increase of .50 in the rate is equivalent to an increase of 56 deaths. The most important increases in mortality were those of heart disease and nephritis from which two causes 77 more deaths were reported during the past week than during the first week of 1921. There was also an increase of 16 deaths reported from cancer. On the other hand there was a sharp decline in the deaths from lobar pneumonia and pulmonary tuberculosis. Bronchitis and broncho pneumonia showed a slight upward fluctuation in mortality. If we consider the mortality of the acute contagious diseases as a group there were 6 fewer deaths reported from this cause during the past week than during the corresponding week of 1921, to wit: 43 as compared with 49. Encephalitis lethargica and typhoid fever showed slight increases which were more than offset by decreases in the mortality of scarlet fever, diphtheria and whooping cough. If we now examine the age distribution of the decedents we find slightly increased mortality in the groups "under one year of age," "under five years of age" and over 65 years, which might be anticipated since the principal increases were amongst the diseases of later life and the diarrhoeal diseases. such as objectionable flavor, heavy odor, and moist or soft condition. These, however, are rare exceptions and not the rule. "It is not decomposed food, but infected food that is likely to cause trouble. "Diagnosis of food infection depends on: history of exposure to the suspected food; symptoms suggestive of food poisoning; isolation of the infecting organisms from the suspected food, and also from the blood, urine, feces or viscera of the patient (bacilli belonging to the Gaertner group disappear from the feces in from seven to ten days after the onset of symptoms); specific identification of the causative organism by agglutination tests; demonstration of agglutinins in the blood serum of patients. A positive reaction can be detected six or eight days after the onset of symptoms. Agglutination in comparatively low dilutions is usually accepted as diagnostic, owing to the fact that it is extremely rare to find a positive reaction for B. enteritidis or B. suipestifer in normal individuals. - Sa e true, fo f food v memb "It must be quite evident that the term "food poisoning" is not well chosen, so far as infections with Gaertner's bacillus are concerned. This bacillus produces an acute febrile infection, specific in nature. The attacks are usually mild and brief, with complete recovery. The disease, however, in all essential particulars clearly belongs to the group of intestinal infections, including typhoid fever, dysentery and cholera. No one would subscribe to the propriety of calling typhoid fever "food poisoning,"dis even though the typhoid infection was contracted from bacilli contained in contaminated milk or infected water. GAERTNER'S BACILLUS AND SOURCES OF INFECTION "B. enteritidis is the type of a group of organisms lying midway between the colon bacillus, on the one hand, and the typhoid bacillus, on the other. It is therefore often spoken of as the 'intermediate group,' the 'hog cholera group,' the 'enteritidis group,' the 'paratyphoid group,' and the 'Salmonella group.' The classification of the members of this group is quite involved, and there is still a lack of agreement among bacteriologists concerning some of the details. "Gaertner, in 1888, brought forth the first definite evidence which incriminated bacteria as an etiologic factor in food poisoning. At Frankenhausen, fifty-seven individuals became ill after eating the flesh of a cow that had been slaughtered on account of enteritis; one case resulted fatally. Gaertner isolated the bacillus from the organs of the cow and also from the spleen of the man who died. by blamed "B. enteritidis and its congeners are pathogenic for some of our food animals as well as for man. Cattle suffering during life from puerperal fever, uterine inflammations, navel infection (in calves), septicemia, septic pyemia, diarrhea and local suppurations are likely to furnish meat containing the Gaertner bacillus or closely related bacilli. Such meat has frequently given rise to 'meat poisoning.' Hence, emergency slaughter (nothschlacht), unless intelligently supervised, furnishes meat that may be a menace. The meat of such animals presents no warning signs of its danger. This fact was well proved by the meat inspector at Ghent, already referred to. The story of this tragedy has become classic. one of the ak about hu de paragrap "The meat may come from healthy animals, but become infected after slaughter. This may take place through the hands or instruments of the butcher who has just handled a diseased carcass. There are other possibilities, such as human carri fecal contaminations. "Bainbridge states that 'infection of meat by human carriers of unknown.' Human carriers of B. enteritidis are exceedingly rare B. paratyphosus B are occasionally discovered, but these also a specimens of human feces from healthy individuals exami 1917-1918, not a single carrier of any of these nonlactose enteritidis group was found. "The English observers believe that all cases of f carriers are in reality cases of paratyphoid fever SA. Matt ALITY SUM responding but if allo st impor hm which |