Chapter III: Part 3

But sunshine not only controls in this wonderful manner the action of the living bacillus, but it also operates upon the products elaborated by disease organisms. Thus the microbe producing lock-jaw or tetanus may be grown in broth, and the latter may be subsequently passed through a porcelain or a Berkefeld filter, so that the resulting liquid is entirely deprived of all germ life. This tetanus-filtrate, as it is called, is endowed with very powerful toxic properties, and it will retain its lethal action even when kept for upwards of three hundred days, providing it is screened from all light; but place such filtrates in diffused light, and they lose their poisonous properties, requiring, however, upwards of ten weeks to become entirely harmless; if, on the other hand, they be exposed to sunshine, they are completely deprived of their toxic character in from fifteen to eighteen hours. Again, as little as five hours' sunshine is sufficient to greatly modify the toxic action of diphtheria cultures. It is of interest also to note that even the venom of the rattlesnake, that most potent of all poisons, cannot emerge unscathed from an exposure to sunshine maintained during a fortnight.

Interesting as all these isolated observations are, they indicate what an immense amount yet remains to be done before we can hope to have any connected conception of the mechanism, so to speak, of insolation. At present there is too large an allowance, which we are compelled to make, for the unknown to permit of our adequately manipulating this marvellous agency in relation to bacteriological problems. But who shall say what part has been, and is being still, played by sunshine in determining the individual character of microbes, operating as it has done from time immemorial upon countless generations of these minute germs of life?

The problem of insolation has been attacked from an entirely novel point of view by Dr. Masella, who has endeavoured to find out whether sunshine plays any part in the predisposition of animal life to infection.

Now sunshine has long been credited with possessing therapeutic powers, and, indeed, traditions of cures effected by the ancients by means of insolation have been treasured up and handed down to the present day. Even as late as the beginning of the present century we may read of a French physician seriously recording his claim to have cured a dropsical patient within two weeks by placing him daily for several hours in the sunshine, and many medical journals of recent years contain communications on the beneficial results derived from the use of sunshine in the treatment of various diseases. It seems curious, therefore, that whilst so much has been done to test the action of light on disease microbes in _artificial_ surroundings, such as are to be found in laboratory experiments, hardly any investigations have been made to try and define more precisely how sunshine may affect their pathogenic action within the animal system. Dr. Masella's researches, undertaken with the express object of, if possible, elucidating this question, are therefore of special interest and importance.

The first series of experiments was carried out to ascertain whether exposure to sunshine increases or reduces an animal's susceptibility to particular diseases, those selected for investigation being typhoid fever and cholera. For this purpose guinea-pigs were exposed to the full rays of the sun during a period of from nine to fifteen hours for two days, whilst other guinea-pigs, for the sake of comparison, were not permitted to have more light than that obtainable in a stable where only diffused light was admitted. Both these sets of animals were subsequently infected with virulent cultures of cholera and typhoid germs respectively, and were in neither case exposed to sunshine. The results which Dr. Masella obtained were remarkable, for he found that those animals which previous to infection had been placed in the sunshine died more rapidly than those which had been kept in the stable, and that the exposure to the sun's rays had so increased their susceptibility to these diseases that they succumbed to smaller doses, and doses, moreover, which did not prove fatal to the other guinea-pigs. Still more striking was the part played by insolation in the course of these diseases in animals exposed to sunshine _after_ inoculation, for instead of dying in from fifteen to twenty-four hours, they succumbed in from three to five hours.

Here, then, we find sunshine, in some mysterious manner not yet understood, far from benefiting the animal and assisting it in combating these diseases, actually contributing to the lethal action of these bacteria. It has been asserted on the authority of some medical men that in cases of small-pox recovery is rendered more easy and rapid when light is excluded from the patient's room; whether Dr. Masella's experiments will permit of any such interpretation being placed upon them remains to be seen; they are, at any rate, extremely suggestive.

That it is possible for temperature to have some determining influence upon the course of certain diseases has been shown by O. Voges, who, experimenting with a minute bacillus which he isolated from tumours characteristic of a cattle disease very prevalent in South America, found that although this bacillus was the undoubted _fons et origo_ of the disease, he could not produce fatal results in animals if he kept them in cold surroundings; only when the temperature was raised to from 35-45 degrees Centigrade did the infected animals succumb. The dependence of the activity and virulence of this micro-organism upon temperature is also borne out in actual experience, the disease being the more prevalent and the more fatal the hotter the climate of the country.

It may be mentioned in passing that this bacillus has the distinction of being the smallest yet discovered; the influenza bacillus hitherto held the palm in this respect, but it must yield its position to its more successful rival, for Voges states that when magnified about fifteen hundred times it is only just discernible in the microscopic field.

Even the smoke-laden atmosphere of our great cities, our leaden skies and dreary fogs and mists, may after all, then, if we can only learn to look at them from Dr. Masella's point of view, become a source of benefit and a subject for congratulation; yet our inherent love of light and sunshine would cause us willingly to hand over our murky climate had we but the chance of obtaining in exchange that of any of the sunny cities of the south. Moreover, in the case of tubercular disease experience is daily impressing upon us the wisdom, and indeed necessity, of absorbing as much sunshine as possible, and hence the pilgrimage which is now recommended to Davos and other resorts where invalids can get the maximum amount of bright sunshine. And not only is this the outcome of practical experience, but De Renzi has shown by actual experiment that sunshine acts beneficially in cases of tuberculosis in animals. Thus, guinea-pigs were infected with tuberculous material and exposed in glass boxes to the sun for five or six hours daily, others being similarly infected but protected from sunshine. The animals which had received the sunshine died in 24, 39, 52, and 89 days respectively, whilst those which had not been sunned succumbed in from 29, 25, 26, and 41 days; or, in other words, De Renzi found that insolation had very materially increased the infected animals' power of coping with tuberculosis.

The part which sunshine plays, or may be made to play, in disease is very obscure, but it would appear at least justifiable to assume that it is an agent which further investigation may show we cannot afford to disregard, contributing as it may to the production of a healthy tone in the system, and thereby materially assisting the body to defy the insidious attacks made upon it from without.

The so-called open-air treatment of consumption which has made such giant strides in the last few years is an example of how, by contributing to the general health of an individual, the powers for resisting a localised disease may be so increased that the latter can, in many cases, be thrown off altogether. In no country has more progress been made in the establishment of institutions for the cure of consumption on these lines than in Germany. At the end of the year 1899 there were forty-nine such institutions in Germany, with four thousand beds; in a little more than twelve months later there were no less than sixty such, with accommodation for altogether five thousand patients. It is of interest to note that amongst the earliest of these institutions to be founded was that erected and endowed by the famous Badischen Anilin and Soda Fabrik Company, for the exclusive benefit of those of their workpeople who were suffering from tuberculous disease.

We have learnt that sunshine is endowed with distinctly lethal action as regards particular bacteria, that it can modify the subtle properties of toxic solutions, and we are asked to believe that it may exercise an important influence on the animal system in determining the power of the latter to deal with the agents of disease; but, as we have seen, the mechanism of it all is shrouded in mystery, and we are at a loss to divine how it works. Might not some fresh light be thrown upon this problem if we could ascertain the effect of sunshine on some of these natural fluids of the body, which recent brilliant research has shown to be endowed with such wonderful protective or immunising properties? So far as I am aware, the action of sunshine on these anti-toxins or protective fluids has not yet been investigated. Can sunshine interfere with the therapeutic effect of diphtheria-serum, for example? If simple insolation can so profoundly modify the character of toxic fluids, it is not unreasonable to anticipate some action on these anti-toxins, and their study in this connection would appear to offer an important step in the direction of unravelling the mystery attending the action of light on life.

BACTERIOLOGY AND WATER

Whilst the Hamburg cholera disaster of 1892 will certainly rank in the annals of epidemiology as one of the great catastrophes of recent times, it will also be memorable as one of the most instructive which has ever taken place.

It is perhaps not unnatural that this should be the case, for since the last European epidemic of importance our study of the principles of sanitation has received a new impetus, and this impetus must be in great part ascribed to the science of bacteriology, which has sprung into existence within the past two decades. We have now no longer to confront mysterious and unknown morbific material, but have been brought face to face with some of the most dreaded foes of the human race. We are no longer groping, as it were, in the dark, but have a definite object, in the shape of well-recognised micro-organisms associated with specific zymotic diseases, for our common crusade.

But it is the light which has been thrown for the first time upon numerous intricate problems connected with the sanitary aspects of public water-supplies which constitutes not the least important of the many services rendered by bacteriology to the public. Perhaps one of the most striking of these may be considered the insight which it has afforded into the value of various processes of water-purification, furnishing us with the most subtle and searching tests, surpassing in delicacy those of the most refined chemical methods.

Thus for years the processes of sand-filtration, as practised at waterworks in dealing with river and other surface waters, were regarded by chemical experts as of but little or no value, because, on chemical analysis, but little or no difference was found to exist between the filtered and unfiltered samples respectively. Water engineers started this method of water treatment in London as far back as the year 1839, with no other object than the distribution of a water bright and clear on delivery, but, unknown to themselves, they were carrying out a system of water-purification the nature and extent of which has been left to the infant science of bacteriology to unravel and reveal.

It was in the year 1885 that Dr. Koch's new bacteriological water-tests were introduced, and systematically applied for the first time to the London water-supply by Professor Percy Frankland, and the entirely unexpected result obtained, that whereas the River Thames water at Hampton contained as many as 1,644 micro-organisms in about twenty drops, this water, after passing through the sand-filters, possessed as few as thirteen in the same number of drops. The remarkable purification effected in the treatment of the water was thus very clearly shown, and an entirely new aspect was given to the processes of sand-filtration.

The importance of these results was quickly appreciated by the official water-examiner, the late Sir Francis Bolton, and at the request of the Local Government Board regular monthly bacteriological examinations of the London water-supply were conducted.

It is amusing to recall that, at the time when these results were first published, the public, instead of being reassured by these facts, were greatly alarmed, and it is a matter of history that the mere demonstration of the presence of micro-organisms in drinking-water caused a fall in the price of several of the water companies' stocks!

These investigations, which have since been confirmed by others both in this country and on the Continent, have clearly shown, then, that sand-filtration, when carefully carried out, offers a most remarkable and obstinate barrier to the passage of microbes, and there was every justification in presuming that if disease organisms should at any time be present in the raw untreated water, they would also undergo a similar fate, as there was no reasonable ground for supposing that they would behave any differently from the ordinary harmless water bacteria.

But this was a hypothesis only, and, however satisfactory experiments in this direction made in the laboratory might prove, there was always the uncertainty attaching to a fact which had not passed through the ordeal of practical experience.

The answer to this searching and all-important question has been furnished in the most conclusive manner by the history of the cholera epidemic in Hamburg and Altona respectively in the year 1892.

These two cities are both dependent upon the River Elbe for their water-supply, but whereas in the case of Hamburg the intake is situated _above_ the city, the supply for Altona is abstracted below Hamburg _after it has received the sewage of a population of close upon 800,000 persons_. The Hamburg water was, therefore, to start with, relatively pure when compared with that destined for the use of Altona. But what was the fate of these two towns as regards cholera? Situated side by side, absolutely contiguous, in fact, with nothing in their surroundings or in the nature of their population to especially distinguish them, in the one cholera swept away thousands, whilst in the other the scourge was scarcely felt; in Hamburg the deaths from cholera amounted to 1,250 per 100,000, and in Altona to but 221 per 100,000 of the population. So clearly defined, moreover, was the path pursued by the cholera, that although it pushed from the Hamburg side right up to the boundary line between the two cities, it there stopped, this being so striking that in one street, which for some distance marks the division between these cities, _the Hamburg side was stricken down with cholera, whilst that belonging to Altona remained free_. The remarkable fact was brought to light that in those houses supplied with the Hamburg water cholera was rampant, whilst in those on the Altona side and furnished with the Altona water not one case occurred.

We have seen that the Hamburg water, to start with, was comparatively pure when compared with the foul liquid abstracted from the Elbe by Altona, but whereas in the one case the water was submitted to exhaustive and careful filtration through sand before delivery, in Hamburg the Elbe water was distributed in its raw condition as drawn from the river.

But further testimony was afforded later to the truth of these results, for during the winter, whilst the cases of cholera had almost completely died out in Hamburg, suddenly a most unexpected and unaccountable recrudescence of the epidemic occurred, and this time in Altona. This outbreak could not be traced to any direct infection from Hamburg, but must have arisen in Altona itself. In all about forty-seven cases were recorded between December 23rd, 1892, and February 12th, 1893. A searching inquiry was instituted, and it was ascertained that the number of bacteria found in the filtered water, usually about fifty, had during these months risen to as many as 1,000 and more in about twenty drops of water, clearly indicating that the filtration of the water was not being efficiently carried out. That this was actually the case was proved by the fact that one of the sand-filters which had been cleaned during the frost had become frozen over, and was not able to retain the bacteria. That the outbreak did not become more serious Koch ascribes to the fact that this, to all intents and purposes raw untreated water, was largely diluted with efficiently filtered water before delivery. Dr. Koch, who personally superintended this inquiry in Altona, traced another local outbreak of cholera in the city to the use of a well-water obviously open to pollution, which was used by about 270 persons. In one of the houses employing this water, and in the immediate vicinity of the well, a boy died of cholera on January 23rd, and during the week following a number of cases occurred amongst persons using this source. On discovering the cholera bacilli in this polluted water, its contamination was placed beyond doubt, and five days after the well was closed all cases ceased in the locality.

There cannot be any longer a doubt as to the value of sand-filtration as a means of water-purification, but the responsibility which we have seen attaches to this treatment of water cannot be exaggerated, for whilst when efficiently pursued it forms a most important barrier to the dissemination of disease germs, the slightest imperfection in its manipulation is a constant menace during any epidemic.

It is, as a rule, during the winter months that the largest number of bacteria are present in the filtered water, and it is therefore of especial importance that during this season, when the raw river water is generally richest in bacterial life, and when, therefore, the filters are most taxed and the consequences of frost are most to be apprehended, that those entrusted with this responsible task should be unremitting in their endeavours to obtain a good filtrate.

That waters submitted to exhaustive natural filtration, such as those derived from deep wells sunk into the chalk, and usually almost entirely devoid of bacterial life, may at times become the carriers of disease has been proved by the disastrous outbreak of typhoid fever which occurred some years ago at Worthing.

This town has long been supplied with water of the very finest quality for dietetic purposes, and nothing could have been more unexpected than this most fatal epidemic. It must, however, be borne in mind that such deep-well waters are not necessarily immaculate, for in the event of any fault in the water-bearing strata occurring, the filtration becomes inefficient, and the water may then, as in the case of Worthing, be the bearer and disseminator of zymotic disease.

The bacteriological methods for the examination of water, although when first introduced but a few years ago were lightly looked upon, and by many opposed, have now become of paramount importance in all questions of water-purification. The immense mass of evidence of a purely bacteriological character which was taken, and indeed required by the Royal Commissioners of 1893 on the London water-supply, indicates clearly enough the change which has taken place in the public estimation of the value of these methods; and it is highly significant that in their report the Commissioners lay stress upon the importance of extensive storage and efficient filtration, two factors the meaning and worth of which rest almost entirely on the results of bacteriological research.

Cholera is not, however, the only water-carried disease which has borne eloquent testimony to the services rendered by the efficient purification of public water-supplies. The experience of the State of Massachusetts in America, in regard to typhoid fever and drinking-water, is also exceedingly instructive.

Massachusetts has, by creating a Board of Health, and affording the same every facility for the prosecution of hygienic investigations of the greatest importance, laid the whole scientific world under a deep obligation. The reports issued have a very wide circulation, and embrace a variety of subjects, but second to none in interest and importance is the account of the experimental work carried out by the officials of the Board on the purification of water and sewage. These experiments have become classical, and have been conducted with a zeal and thoroughness which deserve the highest praise. It is in looking at the results achieved by the city of Lawrence in regard to its water-supply that some conception can be obtained of the immense importance to the community of the scientific experiments conducted in the State Laboratory. No expense has been spared, and for years past elaborate and costly experiments on a large scale have been carried out to determine the most efficient manner in which water may be rendered fit and safe for drinking.

Now the death-rate in a community from typhoid fever may be taken as an index of the general sanitary conditions prevailing in such a community, the character of the public water-supply, not without justification, being regarded as a prime factor in its determination. One of the most significant points in the sanitary history of the State of Massachusetts is the almost uniform decline in the mortality from typhoid fever in proportion as measures have been taken to introduce better water-supplies and to improve those which already exist. Thus in the twenty years, from 1856 to 1876, the death-rate from this disease was 8·6 per 10,000 of population, whilst in the period from 1876 to 1895 it had fallen to 4·1 per 10,000, the improvement in respect of typhoid-mortality being coincident with the improvement made during the last twenty years in providing public water-supplies. In the words of one of the State reports, "The death-rate from typhoid fever has generally fallen as the per cent. of the population supplied with public water has risen, for the reason that the majority of the deaths from this disease have occurred among communities and portions of communities _not supplied with public water_."

That this improvement is being maintained is seen from the fact that in the four-year period 1896-99 the deaths from typhoid fever in Massachusetts were further reduced to 2·6 per 10,000.

It is, however, in the city of Lawrence that the most striking insight is obtained as to the manner in which typhoid fever may be controlled by conditions surrounding the water-supply to the community. Thus, whereas the death-rate from typhoid fever reached a mean of 11·2 per 10,000 in 1886-90, it fell to 7·7 in 1891-95 and to 2·5 in 1896-99. It was in the autumn of the year 1893 that the raw river-water supplied to the city from the Merrimac River was first begun to be filtered, and since that time the sand-filters have been subjected to systematic and most elaborate bacterial supervision, and improvements have been constantly introduced so as to secure the most efficient purification possible of the water before distribution, and the results are reflected in the marked diminution in typhoid fever which has followed these strenuous efforts to obtain the best water-supply available.

The splendid example set by the State of Massachusetts, in promoting the welfare of the people by the encouragement of original researches in practical hygiene, has stimulated other American States to create Boards of Health and enact laws for the protection of their rivers and streams. In view of all that has been done to promote sanitary science in the United States, it is surprising to learn that Lake Michigan, which receives the untreated sewage of municipalities and small towns aggregating over two million people, still furnishes Chicago with its drinking water, and undergoes no preliminary purification before distribution. The city of Chicago, by constructing the Chicago Drainage and Ship Canal, opened in January, 1900, has diverted its own sewage from Lake Michigan, but this great sewer has only been made possible because of its advantages as a commercial waterway; and it has been stated, on high authority, that every project for the drainage of Chicago into the Illinois which has not recognised the waterway features has been predestined to failure. Dr. Egan, of the Illinois State Board of Health, however, points out that "with the present increase in population the Great Lakes, if they continue to be used as common sewers, will soon become totally unfit for use as drinking water, ... and one of two alternatives must be followed--either every source of water-supply must be filtered, or the sewage of the towns must be efficiently purified before it is allowed to flow into the lakes."

Doubtless this seeming inertia of the citizens of Chicago in the matter of filtering their water is attributable to the fact that already the authorities have expended eighty-five million dollars in their waterworks and sewerage systems, which represents an investment of something over fifty dollars per head of population, and that plans in connection with the great canal which has been described as "the greatest feat of sanitary engineering in the world," and to which reference has already been made, will, when carried out, involve an expenditure of thirty or forty million dollars more. In the face of such burdens even so prosperous a community as Chicago does not care to contemplate further capital charges, at any rate until the unsatisfactory conditions shadowed by Dr. Egan become more pressing in regard to the source of their water-supply.

The systematic investigations carried out in the great Institutes of Health on the Continent and elsewhere should surely make the sporadic work, as by comparison it must be designated, produced in this country an eloquent argument for the creation of a British Imperial Board of Health adequately endowed by the State, manned by the ablest investigators, and forming a centre for the prosecution of researches which in other countries, as in our own, have contributed so greatly to the health and welfare of mankind.

Why should England for ever have to knock at the door of foreign institutes for information and guidance in matters in which once she was the leader and enlightened example to every civilised country?

The question of how far polluted water-supplies, besides possessing the potentiality for spreading cholera and typhoid, may disseminate consumption, has been approached in a very instructive manner by Dr. Musehold, of the German Imperial Board of Health.

Some ten years ago the discovery of the tubercle bacillus in water for the first time was announced by a Spanish investigator, Fernandez. The water containing the bacillus tuberculosis was derived from an open ditch, and hence had been doubtless exposed to contamination of divers kinds.

In the course of the elaborate experiments on London sewage and its treatment, carried out by Professor Frank Clowes, Chief Chemist to the London County Council, an instance was recently met with in which a guinea-pig, inoculated with a portion of coke-deposit derived from a bacterial sewage bed, died from typical tuberculosis, and sections of its organs showed the presence of numerous tubercle bacilli. Dr. Musehold has now submitted the whole question of the vitality of virulent tubercle bacilli present in the expectorations of consumptive persons in sewage, in river water, and on cultivated land respectively, to an exhaustive examination, and the novelty as well as importance of these researches merit their being carefully considered.

In the first instance tuberculous sputum was introduced into river water in its natural condition, and as this water was abstracted from the River Spree, in Berlin, it was exposed at any rate to a certain degree of surface contamination. In this water, kept in ordinary daylight, the tubercle bacilli remained alive and in a virulent condition for over five months; in ordinary sewage for six and a half months. Some of the sewage-infected samples were left in the open air and exposed to ordinary meteorological conditions, but even the ordeal of getting frozen up in their surroundings did not in the slightest shorten the lease of virulence possessed by the tubercle bacilli. Some of this tubercle-infected sewage was poured over garden soil in which radishes were growing, and after the bacilli had spent eighty-eight days in these surroundings, during which time they had experienced frost, snow, rain, and sunshine, they still retained their virulence. Of special interest are the investigations Dr. Musehold made to ascertain if tubercle bacilli could be detected on the fields attached to a hospital for consumption and irrigated with the sewage from the same. Not only were tubercle bacilli found, but they were also, as was to be expected from the laboratory experiments cited above, discovered in a highly virulent condition.

That disease germs may be distributed with the vegetables grown on municipal sewage farms is not a mere whim or fancy of the faddist, but is a very real danger, and must be regarded as a menace to the health of all who consume such articles as lettuces, radishes, celery, and other vegetables which are not first cooked before being placed on the table.

This forcibly suggests the desirability of all expectorations from consumptive patients being thoroughly disinfected, or, in other words, deprived of their virulence before being admitted to sewage.

The importance of such precautions being taken is borne out by the examinations of the clear effluent derived from the treatment of the sewage of a consumptive hospital which revealed the presence of virulent tubercle bacilli, whilst they were also discovered in the bottom of a ditch conducting the effluent away.

Such facts as these deserve the earnest attention of all public authorities, and it is to be hoped that the overwhelming evidence which is now available regarding the distribution and Spartan character of the tubercle bacillus will lead to serious efforts being made to bestow upon it that measure of consideration which in the case of recognised zymotic diseases leads to the enactment of rules and regulations for the restriction at least of the fateful activities of these malignant foes of mankind.

Before leaving the subject of bacteria in relation to water, it will be interesting to glance at what is known regarding the attitude taken up by these minute forms of life towards that large and ever-increasing class of waters vaguely grouped together under the synonym of mineral waters. The fortunes made in manufacturing artificially aërated waters and the mine of wealth contained in a new mineral spring are sufficient evidence of the popularity enjoyed by this description of beverage. The beer and spirit statistics of the country and their contributions to the national revenue do not, however, permit us to indulge in the belief that this large consumption of harmless drinks is due to their displacing the use of intoxicants--the increasing sale of non-alcoholic beverages cannot in fact be taken as an index of the growing sobriety of a nation; far more must the greater demand be attributed to the improvements in manufacture which have cheapened production and placed what was formerly an article of luxury almost prohibitive in price, and hence reserved for the few, within comparatively easy reach of the many. Perhaps also an increased sale may be assisted by a prevailing impression that by substituting carbonated for ordinary potable water, the risk of contracting zymotic disease is, if not altogether removed, at any rate very materially diminished.

It will be therefore instructive to see how far this assumption is justified by actual facts.

The first fact to be recognised is that the number of bacteria present may and does fluctuate between such wide limits as is represented by as few as three, and as many as 100,000 being found in about twenty drops of artificially aërated waters. Seltzer water, manufactured from well water, was found by Sohnke to contain numbers varying from 200 to 6,000, whilst when only distilled water was used, _i.e._ water previously deprived of all bacterial life, only from ten to thirty microbes were present. But an important and far too little recognised factor in the manufacture of aërated waters is the contamination which so frequently takes place subsequent to the initial purification of the water by sterilisation. In some instances this contamination is due to the storing of water before use in reservoirs, where an excellent opportunity is offered for microbial multiplication.

Merkel found water which originally only boasted of from four to five bacteria per cubic centimetre, subsequently, when ready for distribution as seltzer water, contained considerably over 3,000. In this case storage had been resorted to. Again, insufficient importance is attached to the efficient cleansing of the syphons on their return to the factory. The experiments made by Slater in this country and Abba in Italy have conclusively shown that the gaseous aëration of water exerts an inhibitory action on the growth of at least some varieties of water bacteria, for both these investigators found that in proportion as the amount of gas present was diminished by being allowed to escape, so was the multiplication of the bacteria present promoted and their numbers increased. Unsavoury as may be the idea of swallowing down myriads of even harmless microbes, yet the real significance of the whole question from a hygienic point of view lies in the evidence as to the fate of disease germs in aërated waters.

On this important matter there fortunately exists some precise and conclusive information in regard to the bacteria associated with two essentially water-borne diseases, _i.e._ typhoid fever and cholera. The investigations made to test the vitality of the anthrax bacillus are of significance as again emphasising the superior degree of vitality possessed by the spore over the bacillar form of this micro-organism, but the chances of this disease being disseminated by water are usually regarded as too remote to excite much interest in the fate of the _b. anthracis_ in seltzer water. It may, however, be mentioned that whereas the bacilli succumbed after being in the seltzer water from fifteen minutes to an hour, the spores were still living after one hundred and fifty-four days. Investigations on the vitality of cholera bacilli in aërated waters have been made by Hochstetter in Germany, by Slater in England, and by Abba in Italy, and these various authorities all agree that the lease of life of these micro-organisms is a very short one in ordinary unsterilised carbonated waters, and that they are in fact destroyed in from half an hour to three hours. As regards typhoid bacilli the case is different, for the same investigators found that in ordinary unsterilised aërated water these bacteria can live as long as eleven days. In seltzer water their vitality is not so marked, but even then it greatly exceeds that of the accommodating cholera microbes, extending to five days.

Thus supposing typhoid bacilli to be present in the water employed for the manufacture of aërated waters--and we cannot afford to disregard such a possibility--we have no guarantee that such waters will be safe for drinking purposes unless a considerable period has been allowed to elapse between their production and consumption.

It was considerations of this kind which led M. Duclaux, the accomplished director of the Paris Pasteur Institute, to write now some years ago: "Contentons-nous de conclure que l'usage de l'eau de seltz, recommandé en temps d'épidémie peut en effet être recommandable, surtout si on laisse vieillir l'eau quelques jours. On a chance d'y voir diminuer ou même périr les germes nuisibles."

On the whole, therefore, the scientific report on bacteria and artificially aërated waters may be regarded as a reassuring one. It is to be regretted, however, that in England we do not follow the example set by Italy, where the aërated water manufacturers are closely looked after by the State, and no factory may be opened unless a satisfactory guarantee can be given of the chemical and bacteriological purity of the water which is intended to be used, whilst the authorities must also be assured that the methods employed are satisfactory from a hygienic point of view. The sale of all aërated waters prepared from insanitary water-supplies is strictly prohibited by the State.

It will now be of interest to ascertain what is the result of the endeavours which have been made to explore the bacterial flora of those highly prized and largely circulated natural mineral waters, which abound in so many parts of the world and are practically the making of so many health resorts.

Perhaps the most exhaustive examinations of mineral water which have been so far made are those published by Dr. Eugenio Fazio, who studied the bacterial condition of some of the celebrated springs situated near Naples at Castellamare, Telese, Acetosella, and Muraglione, care being taken to select examples of different types of water, samples being collected from chalybeate, carbonated sulphur, and alkaline springs respectively.

All these various mineral waters were characterised by a remarkable paucity of bacteria; in the chalybeate and alkaline springs sometimes as few as two microbes only in a cubic centimetre were found, and the largest number recorded only amounted to forty-five. The satisfactory significance of such figures will be appreciated when we realise that they rival very closely the numbers which characterise the purest spring and the deepest well water, and which are usually regarded as the aristocracy among drinking-waters. Of special interest is Dr. Fazio's discovery that the variety of bacteria present in these waters is extremely restricted, as a rule only three, or at most four, different kinds of bacteria being detected.

This is also characteristic of the pure water derived from deep wells sunk into the chalk, usually but very few different kinds of bacteria being found amongst the limited number of their Lilliputian inhabitants, whilst in samples collected from rivers or other surface sources, especially those which have been polluted with sewage or similar refuse matters, the bacterial population is frequently as diverse as it is unwieldy.

From the exacting point of view of the uncompromising bacteriologist the most satisfactory waters in existence for drinking purposes should be those derived from sulphur springs. Dr. Fazio and other investigators have frequently found absolutely no bacteria whatever in these waters, and often only four in a cubic centimetre. When we remember the high temperature of so-called thermal sulphur waters, which in many cases reaches more than fifty degrees Centigrade, it is perhaps surprising that even four individuals can be found in a cubic centimetre capable of withstanding the nauseous atmosphere of sulphuretted hydrogen in addition to such hot environment. Perhaps in the bacterial community these hot sulphur springs provide that place of punishment which figured so largely in the imagination of the early Christian fathers; certain it is that in this bacterial hell, in the picturing of which so many of the old masters seem to have revelled, but very few individuals are to be found, and those which are there are almost entirely derived from one family.

In giving weight to the highly satisfactory results of these bacterial examinations in forming an estimate of the microbial quality of natural mineral waters, it must be borne in mind that these investigations were all made of the said waters in a state of nature straight from the source, and before they had undergone the barbarous ordeal of commercial manipulation such as the process of bottling.

We are all of us sufficiently acquainted with the first principles of germ life to realise how deftly and how directly any inattention to hygienic details is reflected in the larder or the store-room; and it requires but little stretch of the imagination to picture the bacterial armaments which would at once invade these peaceful waters on the first suggestion of relaxed vigilance, or removal of that rigid surveillance so essential for their protection and preservation.

MILK DANGERS AND REMEDIES

It may with justice be said that in no department of applied bacteriology is more activity apparent than in that which has for its object the building up of a scientific basis for dairy practice. Although this is undoubtedly true, yet, unfortunately, unlike its continental neighbours, the British public, with whom practically rests the control of our dairy industries, has hitherto held itself strangely aloof, evincing little or no sympathy in researches which, even if they fail to interest, should surely impress with a sense of the great hygienic importance attaching to them. But this apathy is not only to be deprecated in the interests of health, but also on economic grounds.

We have only to turn to the reports issued by the Board of Agriculture to realise what this characteristic British apathy has brought about in the dairy industry of this country. Thus in the year 1898 we are officially informed that we imported 359,425,136 pounds of butter, the little country of Denmark alone sending over to us 163,883,360 pounds! Our cheese imports reached the enormous total of 262,018,624 pounds, whilst 817,274 cwts. of condensed milk and 10,691 of milk and cream were supplied to us from without.

If we glance at the energy and enthusiasm displayed by other countries, and notably Denmark, in the prosecution and scientific development of the dairy industry, we shall not wonder at the high standard of excellence achieved, or at the readiness displayed by Great Britain to absorb their produce. Thus, whilst in England it may be questioned whether in a single dairy the artificial souring of cream by pure cultures of bacteria is carried out, in Denmark the use of so-called special bacterial butter-starters is rapidly gaining ground. Thus, whereas in 1888 at the Odense Exhibition not a single sample of butter was exhibited in which pure bacterial cultures had been employed, in 1894, 46·7 per cent. of the samples shown were thus produced, in 1896, 89·2 per cent., in 1897, 94·4 per cent., 1898, 95·9 per cent, and in 1899, _every sample_, and since this year nearly every dairy of importance in the country employs special bacterial butter-starters.

The Danes are enlightened and shrewd enough to realise that in order to retain their existing markets and acquire fresh ones, it is necessary to take advantage of every improvement in methods of manufacture which scientific research has placed at their disposal, and their reward is justly reaped in the prosperity of their dairy industry and the high reputation enjoyed by their produce. If we contrast the adaptability and elasticity of the continental mind in regard to new discoveries with the crude conservatism of the British manufacturer, then, indeed, is the success of our rivals and corresponding decline of our own prosperity most perfectly intelligible.

Again, we are informed that the recent visit to London of a deputation representing Russian agricultural interests is already bearing fruit, and contracts have been signed for the regular importation of large quantities of Russian dairy produce. The English market is already well supplied with Russian eggs, but an opening has now been found here for the disposal of Russian butter and cheese.

Finland, again, the total population of which is less than half that of London, exports to this country no less than 12 million marks' worth of butter annually.

As a writer recently put it: "Foreigners and colonists have captured our butter markets; if the consumption of milk sterilised in bottles becomes the fashion, they will likewise capture our milk markets." And this is no fanciful suggestion, for whilst the production of Pasteurised milk does not involve any considerable outlay in apparatus, its transport may be effected with the greatest ease. Indeed, frozen milk has been introduced into England from Norway and Sweden. It is first Pasteurised, then frozen in large wooden boxes, and shipped in the congealed condition, in which state it remains unchanged for a long period of time.

But it is undoubtedly with the public that the responsibility really rests, for as long as it does not care to create the demand for Pasteurised dairy products all the efforts of enlightened agricultural authorities in this country must inevitably end in failure.

On the Continent and in America dairy-bacteriology, as already pointed out, has made enormous strides, and has practically revolutionised the conduct of dairy work; and if we could but rouse ourselves from our lethargy we likewise should be able not only to boast of progress, but also to better hold our own ground in this important branch of agriculture; and one result would be that dairy troubles, which for so long have been accepted as more or less necessary evils, would yield here, as they have done elsewhere, to a more rigid attention to details, the significance of which scientific research has so successfully shown.

Some of the most easily preventable, but at the same time most aggressively assertive, dairy troubles are undoubtedly directly dependent upon the conduct of milking operations.

In the first place, the cow itself is only too frequently in an uncleanly condition, and as its coat offers exceptional facilities for the harbouring of dust and dirt, the danger of foreign particles falling into the milk is always present unless precautions are taken to negative, or at least minimise, all such chances of contamination.

Professor H. L. Russell, of the Wisconsin Agricultural Experiment Station, cites in his little volume on _Dairy Bacteriology_ an instructive experiment which brings home very forcibly the importance of such precautions. A cow pastured in a meadow was selected for the experiment, and the milking was done out of doors, so as to eliminate as far as possible any intrusion of disturbing foreign factors into the experiment, such as the access of microbes from the air in the milking-shed. The cow was first partially milked without any precautions whatever being taken, and during the process a small glass dish containing a layer of sterile nutrient gelatine was exposed for one minute beneath the animal's body, in close proximity to the milk-pail. The milking was then interrupted, and before being resumed the udder, flank, and legs of the animal were thoroughly cleansed with water; a second gelatine surface was then exposed in the same place and for the same length of time. The results of these two experiments are very instructive. When the cow was milked without any special precautions being taken, 3,250 bacteria were deposited per minute on an area equal to the surface of a ten-inch milk-pail; after, however, the animal had been cleansed, only 115 bacteria were deposited per minute on the same area.

Thus a large number of organisms can, by very simple precautions and very little extra trouble, be effectually prevented from obtaining access to milk. Even in the event of the milk being subsequently Pasteurised, clean milking is of very great importance; but still more imperative is it when it is destined for consumption in its raw, uncooked condition. If we consider how cows become covered with dirt and slime, that obstinately adhere to them when they wade through stagnant ponds and mud, and realise the chance thus afforded for malevolent microbes to exchange their unsavoury surroundings for so satisfactory and nourishing a material as milk, then indeed precautions of cleanliness, however troublesome, will not appear superfluous.

That a very real relationship does exist between the bacterial and dirt contents of milk has been clearly shown by actual investigation. A German scientist has made a special study of the subject, and has determined in a large number of milk samples the amount of foreign impurities present per litre, and the accompanying bacterial population per cubic centimetre.

The following results may be taken as typical of those obtained: in milk containing 36·8 milligrammes of dirt per quart as many as 12,897,600 bacteria were present per cubic centimetre; in cleaner samples, with 20·7 milligrammes of dirt per quart, the number of bacteria fell to 7,079,820; whilst in a still more satisfactory sample, containing 5·2 milligrammes of dirt per quart, there were 3,338,775 bacteria per cubic centimetre.

Such results indicate how important a factor is scrupulous cleanliness in milking operations in determining the initial purity of milk, for there is no doubt that bacterial impurities in milk are in the first instance, to a very great extent, controlled by the solid impurities present.

I do not know of any determinations which have been made of the actual amount of such solid impurities present in our public milk-supplies, but such estimations have been made in many of those belonging to large cities in Germany. Thus, Professor Renk found in a litre of milk supplied to Halle about 75 milligrammes, whilst in another sample as much as 0·362 grammes per litre were detected. In Berlin 10 milligrammes, and in Munich 9 milligrammes per litre, were found. Dr. Backhaus has estimated that the city of Berlin alone consumes daily with its milk no less than 300 cwt. of cow-dung. If we associate these amounts of solid impurities with their consequent bacterial impurities, then we shall obtain some idea of what the microbial population of these milk-supplies may amount to.

These impurities are almost wholly preventable, but, unfortunately, but little importance is apparently attached to their presence in milk as a rule by dairymen.

In a letter published in the _Sussex Daily News_ a correspondent and well-known authority on dairy matters sounds a timely note of warning to our dairy managers:--

"I happen to know," he writes, "for a fact that Americans who
visited one of our Dairy Shows at Islington were so disgusted at
the method--or rather lack of cleanly method--exhibited there as
our ordinary way of milking cows, that these visitors stated that
nothing would induce them to drink milk while in England. I
mention this circumstance so as to bring home to the minds of
English dairy-farmers who may read this letter how very backward
we are in this country as compared with more studious and careful
foreign competitors. It is insisted upon by our foreign teachers
that our cow-stalls are too short and not roomy enough, and our
cow-houses badly constructed; that we do not (1) groom our cows or
(2) clean the teats, nor (3) sponge their udders, bellies, and
sides before milking with clean, tepid water; (4) that the milkers
do not tie up the cow's tail nor clean their own hands and
persons, nor (5) cover their clothes with a clean, well-aired
blouse during milking; that (6) they generally milk in a foul
atmosphere (bacterially), tainted with the odour of dung, brewer's
grains, or farmyard refuse. I am sorry to state that there is too
much solid fact about the contentions which, based upon
bacteriology, are given as causes of injury to quality....
Cleanliness is now a matter requiring the primary attention of
English dairy-farmers. The study of bacteria proves that such
inattention is greatly the cause of foreign butters beating ours."

It follows as a natural sequence that all the cans and vessels used for dairy purposes should be absolutely beyond suspicion of contamination. Professor Russell has shown by actual experiment that, even where the vessels are in good condition and fairly well cleaned, the milk has a very different bacterial population when collected in them and in vessels _sterilised by steam_.

Two covered cans were taken, one of which had been cleaned in the ordinary way, and the other sterilised by steam for half an hour. Previous to milking the animal was carefully cleaned, and special precautions were taken to avoid raising dust, whilst the first milk, always rife with bacteria, was rejected. Directly after milking bacterial gelatine-plates were respectively prepared from the milk in these two pails, with the following results: In one cubic centimetre of milk taken from the sterilised pail there were 165 bacteria; in that taken from the ordinary pail as many as 4,265 were found.

Another experiment illustrates perhaps even more strikingly the effect of cleanly operations in milking upon the initial bacterial contents of milk. The preliminary precautionary measures were carried out by an ordinary workman, and are in no sense so refined as to be beyond the reach of ordinary daily practice. "The milk was received in steamed pails, the udder of the animal, before milking, was thoroughly carded, and then moistened with water, so as to prevent dislodgment of dirt. Care was taken that the barn air was free from dust, and in milking the first few streams of milk were rejected. The milk from a cow treated in this way contained 330 bacteria per cubic centimetre, while that of the mixed herd, taken under the usual conditions, contained 15,500 in the same volume. The experiment was repeated under winter conditions, at which time the mixed milk showed 7,600 bacteria per cubic centimetre, while the carefully secured milk only had 210 in the same volume. In each of these instances the milk secured with greater care remained sweet over twenty-four hours longer than the ordinary milk."