abdominal belt and rest in bed, accompanied by a fatten-
ing diet, which accomplishes two ends first, the formation
of fat within the abdomen, which holds the organs up in
place, and, second, the rest and forced feeding, which is
the best method of treating nervous weakness.

We may define visceroptosis, then, as a condition in which
there are anatomic displacements of the abdominal organs
combined with a tendency to nervous derangements, usu-
ally inherited, but sometimes acquired. A large propor-
tion of such patients are subject to functional or so-called
nervous indigestion.

It by no means follows that nervous indigestion is always
due to visceroptosis, however, but any causes tending to
lower the tone of the nervous system are capable of causing
nervous dyspepsia.

Nervous dyspepsia is then brought on by physical or
mental overwork, dissipation, strain of any kind, as from
family troubles (sickness and death), an unhappy love
affair, or business difficulties; certain debilitating dis-
eases predisposed to nervous indigestion, as tuberculosis
or anemia.

The chief difference between functional and organic
diseases of the stomach lies in the fact that the patient
suffers genuine pain in organic disease, whereas in func-
tional stomach trouble there may be great discomfort from
a feeling of fulness, distention, heart-burn, nausea, vomit-
ing, belching of gas, and bringing up of acid in the throat,
etc., but not real hard pain at any time. Then another
important distinction, which has already been made, is
that the presence of visceroptosis is itself presumptive of
functional rather than organic disease, since in subjects



280 THE PREVENTION OF DISEASE

of this habit one expects functional dyspepsia to occur.
On the other hand, of course, it does not follow that a
person with visceroptosis may not have organic disease
of the stomach, but the chances are that any digestive
disturbance is much more likely to be functional than
organic in the case of such individuals.

The prevention of nervous functional dyspepsia should
begin in infancy in children who have inherited the tend-
ency, as shown by the build which we have described
above. In general, the same care should be given them
as we have already recommended in another place for the
progeny of nervous parents (see page 247). A full nour-
ishing diet, with plenty of cream and butter and a healthy
outdoor life, with sufficient rest and sleep, are especially
desirable. The clothing should not hang from the outer
part of the shoulder, but from straps coming over the
shoulders close to the neck so as not to make the
shoulders droop. The child should be taught to stand
and sit erect, as in stooping the abdominal organs are
pushed downward out' of place. If the child cannot
be made to stand erect in any other way a brace
may have to be fitted by a doctor. To assume the
proper position the endeavor should be made to stand
as if one were attempting to be as tall as possible
without raising the heels from the ground. This brings
the head up and back. The common directions to
"throw the shoulders back" are not sufficient, and do not
cause the head to be held erect nor the stomach to be held
in, as is accomplished by the other position. The drinking
of large amounts of water between meals is detrimental to
persons with visceroptosis in favoring sagging of the
stomach. After any long, weakening illness, as typhoid
fever, the patient should not be permitted to get up until
his normal weight has been restored, because otherwise



DIGESTIVE DISEASES 281

the abdominal organs may prolapse from lack of the ab-
dominal fat-padding which naturally holds them up in
place.

Following childbirth it is always advisable for women to
wear a proper abdominal belt, as the so-called Storm
binder, in order that they may not suffer from sagging of
the stomach and other abdominal organs ^vhich is so com-
mon at this time. When the disease of visceroptosis is
present in an aggravated form with nervous symptoms,
emaciation, and digestive disturbances, such as we have
already enumerated, treatment of the patient while up and
about is so unsatisfactory that no physician should attempt
it. In the milder degrees of the trouble a good fitting belt
may be sufficient, with rest and drinking of a pint of cream
daily, but in the severe forms only a course of a month or
six weeks in bed with the rest treatment in a sanatorium,
followed by the use of a belt, will suffice. The question of
operation will arise in cases in which there is loss of appe-
tite, vomiting (sometimes of blood), emaciation, great
apathy, persistent constipation, flatulence, muscular and
joint pains, and in women, inflammation of the breasts.
Surgery is generally harmful to nervous persons and visce-
roptosis is often relieved by the means outlined above. One
of the chief reasons for resort to the surgeon is because the
patient and physician have tired of each other,, according
to one authority. There should be very good reasons for
operating, and it should be undertaken only after a consul-
tation with conservative men and after a thorough trial of
medical treatment. Operation for the cure of viscerop-
tosis is in disrepute with most of the leading surgeons,
unless there is sufficient displacement of the bowels to
produce actual obstruction in them.

The cases of nervous dyspepsia which are not part of a
visceroptosis are practically due to the same causes as



282 THE PREVENTION OF DISEASE

nervous prostration or neurasthenia. The prevention of
this class of cases is described under Neurasthenia. While
some of the causes may be removed, such as mental and
physical overwork, dissipation, sexual abuse or excess,
yet worry and strain consequent upon love affairs, family
or business troubles, or poverty are often beyond our
power to aid.



CHAPTER XV

FOOD POISONING
INTRODUCTORY NOTE

THERE are few fields of household hygiene, household sanitation,
or household medicine in which sound popular teaching is so im-
portant as in that which relates to the sanitation of food.

Right knowledge of this subject is not only clouded by lack of
information, but obstructed by definite misinformation freely dis-
pensed by pseudosanitarians, who make this subject their happy
hunting-ground. It is, therefore, a special pleasure to commend to
the public so clear and so well-balanced a statement as that which
follows.

Milk is very wisely placed in the forefront in discussing the
dangers from food, and the author's strong recommendation of
pasteurization must be heartily endorsed by all familiar with the
subject. Experience in public health teaches me more and more
clearly that no raw milk is a safe food and that pasteurization by
the heating system (140 F. for twenty minutes) should be every-
where insisted on. This process destroys all disease germs without
altering the food value of milk, except in one respect. The pecu-
liar bodies, known as vitamins, which milk contains, are destroyed
by heating, and infants fed on boiled and pasteurized milk alone
may suffer from scurvy as a result. The loss of vitamins has no
significance, however, for adults, and in the case of infants the
remedy is to give orange- juice (containing vitamins) along with
the pasteurized milk not to risk fatal intestinal or other disorders
by feeding raw milk.

In general, cookery is one of the most important of sanitary
arts and makes safe many of our foods which would otherwise be
dangerous. It must be remembered, however, that any food,
cooked or uncooked, may be infected by the "carrier in the kitchen."
The safeguards against this danger are the cultivation of habits of
personal cleanliness, the regular washing of the hands before handling
food, and the exclusion (so far as possible) of those persons who are

283



284 THE PREVENTION OF DISEASE

suffering from any symptoms of communicable disease from the
preparation and handling of food for others.

CHARLES-EDWARD AMORY WINSLOW.

Milk Poisoning, Ptomain Poisoning, Meat, Fish, Fruit, and Vege-
table Poisoning

MILK POISONING

Poisoning occurs more often from milk than from any
other food. It is a wonderfully good food for germs as
well as for man, and the germs not only live in it, but multi-
ply tremendously. There are always germs in milk, even
in boiled milk, unless it has been boiled several days in
succession. Raw milk contains to the teaspoonful from
5000 bacteria, in the very cleanest and most expensive
certified milk, to 5,000,000 or more bacteria in market
milk. In fact, the poorer samples of market milk contain
more germs than sewage. The germs are derived from the
surface of the cow, from the air and dust, from flies, from
the inside of the cow's udder, from the inside of the bowel
(in manure), and from milkers, dairy employees, milk uten-
sils, and water.

The chief source of infant mortality in the past has been
through the diarrheal diseases in summer, due almost
wholly to the contamination of milk with cow manure
which contains putrefactive germs from the cow's bowels.
It has been estimated that ten tons of manure have been
sold daily in the milk of our largest city in years gone by.
Conditions have enormously improved. The infant
mortality has been reduced one-half or more by the enforce-
ment of sanitary conditions and the improvement in the
milk supply. This was notably so in the case of Rochester,
N. Y., during Dr. Goler's regime. The other disease
most frequently taken from the cow is tuberculosis. This
chiefly affects children, as there is little danger to adults



MILK POISONING 285

in drinking milk, since they are comparatively immune to
such infection by the time they have reached maturity.
About 15 per cent, of the deaths from tuberculosis in infants
is due to cows' milk. Another frequent danger from milk
is infection with the diseases of man. Thus, there have
been recorded within the past few years outbreaks of
thousands of cases of scarlet fever, diphtheria, typhoid
fever, and tonsillitis from drinking milk.

Among 253 such epidemics (Trask) there were 179 cases
of typhoid fever, 51 of scarlet fever, and 23 of diphtheria.
Typhoid fever is contracted from milk more commonly
than from any other source hi New York City today.
Within five years in Boston there have been some 3000
cases of typhoid and scarlet fevers and diphtheria traced
to milk alone.

These diseases are conveyed to milk by the hands, by
the mouth in tasting milk, by bowel discharges of man
(sewage) in the water used to wash dairy utensils, and by
infection of milk in return bottles from homes in which
disease exists. The particular danger which it seems prac-
tically impossible to avert is from "carriers" apparently
healthy dairy employees who carry about disease germs in
their throats (diphtheria, tonsillitis), or are passing them
continually from their bowels years after recovery from
typhoid fever. We have alluded in another place (see
page 148) to the 1911 outbreak of tonsillitis or septic sore
throat in Boston, consisting of 1048 cases with 48 deaths,
due to infection of milk from an apparently healthy em-
ployee at a show farm. Then there was the typhoid epi-
demic of several hundred cases the same year in New York,
originating from a healthy farmer who had *been dis-
charging typhoid germs from his bowels for twenty-six
years since his sickness, thus contaminating his own milk
supply.



286 THE PREVENTION OF DISEASE

Now, in the cleanest milk it may be impossible to elimi-
nate some of these dangers. Manure may be usually kept
out of it sufficiently to prevent infantile diarrheas, but
accidents occur. Disease of the cow's udder may ap-
pear and pus escape in milk long before the most care-
ful supervision detects it. A leading sanitary milk
expert, Dr. North, figures that a ton of pus, blood,
and bacteria from diseased udders, together with other
dirt, might be separated from New York's weekly milk
supply. Inflammation of the udder (garget, mastitis)
is a common trouble in cows. An expert may find
one or more cases in every considerable herd. The
germs (streptococci) in milk from an inflamed udder may
also cause outbreaks of severe sore throat or tonsillitis
in man just as do the same germs from the human throat
which accidentally contaminate milk (see above). Cows
may be taken into herds which are tuberculous before
the test can show this condition. North estimates the
existence of 5 per cent, of tuberculous cows in tested
herds supplying certified milk 20 to 40 per cent, of
cows have been found tuberculous in famous certi-
fied herds (see page 120). Finally, employees infect milk
unknowingly and so produce thousands of cases of illness.
All these accidents being possible in the best dairies and
actually occurring, how can they be stopped? By only
one measure, and that is, cooking the milk.

This means pasteurizing milk, or heating it to 145 F. for
thirty minutes, followed by rapid cooling. By this degree
and duration of heating disease germs of all kinds are un-
questionably destroyed.

The proportion of germs, other than disease germs, which
are killed varies, and the more germ-laden the milk before
heating, the more so is it apt to be after pasteurization.

In other words, but a certain percentage of the miscel-



. MILK POISONING 287

laneous germs are killed. Thus, in a sample of milk con-
taining 400,000 germs per \ teaspoonful before pas-
teurization there were 23,000 after its completion; while
a sample of milk holding 40,000 germs to the | tea-
spoonful before pasteurization was found to contain
3000 afterward. But commercial pasteurization is un-
certain, and through carelessness and break-downs in the
machinery the product is often unsafe. Moreover, out-
breaks of disease have occurred from pasteurized milk
which was infected by handling it during the subsequent
bottling. The only safe commercially pasteurized milk
is that bottled at the farm or dairy and then pasteurized
in the bottle, as is done at the Deerfoot farm in South-
boro, Mass., and in a few other places.

But it is perfectly possible to secure a safe milk by buying
the best to be obtained and pasteurizing it at home. I
find by boiling water (as much as possible) in the outer
part of a 2-quart double boiler, and then removing it from
the stove and placing a quart of milk in the covered inner
part, that the milk may be brought to 140 or 145 F.
within ten minutes and retained at this point for thirty
minutes, with the exception of a loss of 2 degrees during
the last five minutes. The milk should be kept during
this time in a warm place or covered with a cloth.

By the use of a dairy thermometer, sold by druggists,
any intelligent person can secure this result, and by taking
the same quantity of milk and water each day, after the
proper conditions have been fulfilled, one may repeat the
process indefinitely without recourse to the thermometer.

The cleanest milk is that most suitable for pasteurization
since the heating only destroys a percentage of bacteria, and
the poisons which the germs produce in their growth are not
necessarily destroyed by heat, although usually they are.

So that one should buy certified milk if it is within one's



288 THE PREVENTION OF DISEASE

means, or the best milk obtainable, and then pasteurize it.
For pasteurizing milk for babies the Freeman pasteurizer
is most convenient, as the process is done by simply filling
the nursing bottles with milk for the twenty-four hours'
uje, and placing them in boiling water in his machine after
it has been removed from the stove. It is just as impor-
tant -that cream and milk for making butter and cheese be
pasteurized, as disease germs live in these articles for
months. This is not, however, generally done in this
country.

Ice-cream is a frequent cause of poisoning when it has
been stored for some time before using. The most enor-
mous number of germs ever found in (sweet) milk products
exist in ice-cream after it has been kept for some time, even
at zero temperatures. Over 100,000,000 bacteria to the
teaspoonful is not unusual, as the intense cold does not pre-
vent the multiplication of bacteria (in the course of time).
The safeguard is to make ice-cream from fresh pasteurized
cream at home, or to only buy it from dealers upon whose
word one may place dependence. The greatest danger
lurks in the street and small store vendor, who hawk un-
known and questionable products about among the poor
and serve them broadcast in the popular "cones." Ice-
cream, cream-puffs, and custards, made from germ-laden
milk or cream, are capable of producing the most in-
tense digestive disturbances, with vomiting, colic, diar-
rhea, and even death. Considering the opportunities
at every soda-water fountain, and the fact that fragile
children are the victims, it is a marvel that the sick-
ness and death resulting are not greater. The Chinese are
much more advanced than ourselves in some respects, de-
spite our boasted civilization, for they drink no uncooked
milk or water, and thus escape typhoid fever, which is com-
mon among the Europeans in China.



PTOMAIN POISONING 289

The poisoning from eating ice-cream, cheese, cream-puffs,
frozen puddings, and custards is more often due to milk
contaminated with the discharges of cows (manure, etc.),
and sometimes is derived from milk of diseased cows.

The germs inhabiting the bowels of the cow are those
chiefly responsible (colon and allied bacilli) . These organ-
isms produce poisons or toxins leading to vomiting, colic,
diarrhea, great prostration, and weakness of the heart.
If the milk were pasteurized in the beginning it is probable
that the poisons would not be formed. Poisoning from
ice-cream, cheese, and custard was formerly attributed by
its discoverer, Dr. Vaughan, to a special chemical sub-
stance (tyrotoxicon) , but it is now recognized that various
toxins formed by a variety of germs are responsible for the
poisoning, and usually not tyrotoxicon. The author con-
fesses that the milk question is a special personal hobby
upon which he is more or less of an authority, 1 but the
enormous hygienic importance of a clean milk supply has
become more and more evident with the passing of the
years and as a result of experience and study.

PTOMAIN POISONING

Ptomain poisoning is a fashionable term covering, in
popular usage, symptoms produced by almost any un-
known germ disease with abdominal symptoms. As a
matter of fact, it does not even mean food poisoning,
for food poisoning means damage done by a great variety
of poisons or toxins produced by a corresponding variety
of germs.

Ptomains are certain definite chemical bodies (basic
alkaloidal products) formed in the putrefaction of meat or

1 "The Production and Handling of Clean Milk," by Kenelm
Winslow, M. D., B. A. S., M. D. V., W. R. Jenkins Co., New York,
third edition.
19



290 THE PREVENTION OF DISEASE

vegetables. Only a few instances are known where food
poisoning has been due to ptomains, and no statement is
correct that such has occurred without an elaborate con-
firmative chemical analysis. Ordinarily the cultivation of
gernte from an offending food will explain the cause of
poisoning, so that the bacteriologic rather than the chem-
ical laboratory is the authority in such cases.

Ptomain poisoning is an unfortunate word, because,
while it may please the patient to be a victim of such a
patrician disorder, it permits the doctor to make a wrong
diagnosis without let or hindrance. In the writer's expe-
rience, ptomain poisoning has most often proved to be
appendicitis, gall-bladder trouble, or obstruction of the
bowels, and the unnecessary delay has frequently resulted
in the patient's death, which might have been prevented
by timely surgery. Ptomain poisoning is a cloak of ignor-
ance in the doctor's lexicon, and must be relegated to the
same category as "grip" and rheumatism, which include
a host of germ infections capable of being recognized. It
is somewhat difficult to be certain that illness is due to
food poisoning.

The occurrence of a number of cases of vomiting, colic,
and diarrhea at about the same time in a number of per-
sons who have eaten the same food (or of nervous symp-
toms, as in sausage poisoning, appearing some twenty-four
to forty-eight hours after eating the food, and consisting
in dryness of the mouth, disturbed vision, drooping eyelids,
loss of the voice, difficult swallowing, etc.) would be
strongly suggestive of food poisoning. The character of
the food and the attending circumstances, and, above all,
the bacteriologic examination of the suspected food will
positively determine the diagnosis.

Meat Poisoning. Four-fifths of all cases of meat poison-
ing are due to eating the flesh of animals suffering from one



PTOMAIN POISONING 291

of the germ diseases, more often cows killed because
of udder disease, blood-poisoning following calving, or
intestinal diseases; and calves with a form of blood-
poisoning common during the first few weeks of life.

Unfortunately, the meat is not altered in appearance in
such cases, nor is cooking by any means a sure preventive
against poisoning. Even poisoning by meat which has
decomposed from too long keeping is much more fre-
quent in the case of animals diseased before slaughter.
Expert veterinary inspection of the various organs of
slaughtered animals will detect disease and prevent the
killing of sick animals for food, which is most apt to occur
in small towns where meat for local use is not properly
inspected.

Poisoning from meat which has putrefied from long
keeping is more common in the warm months and in the
case of chopped meat or sausage.

Putrid meat is usually recognizable, if not chopped, by
softness and bad odor, especially about the bones and fat.
Boiling, roasting, or frying lessens the danger from putrefy-
ing meat, but does not absolutely prevent it. Proper refrig-
eration in the household, both before and after cooking
meat, is essential in order to preserve it, otherwise it should
be eaten fresh. It. is also advisable to clean refrigerators
frequently with a hot solution of washing soda. The
poisoning is due to toxins or poisons produced by germs
which originate in diseased animals, or contaminate the
meat after slaughter and grow luxuriantly when refriger-
ation is imperfect.

It is well known that persons eat game when it is
"high" with impunity in most cases, but such meat is
usually "hung" in cold weather.

Pork, veal, and beef are the source of meat poisoning,
while mutton and lamb are almost always safe, partly be-



292 THE PREVENTION OF DISEASE

cause these are free from the diseases of bovines. Pork
causes poisoning because it is imperfectly preserved by
salt or smoking, and is often eaten insufficiently cooked
in sausage and other forms. Cold storage of chickens,
turkey, and other fowl is undesirable because their vis-
cera are not removed. The enormous multiplication of
germs at zero which occurs after a considerable period is
exemplified in the case of ice-cream noted above. Num-
bers of instances of poisoning by cold-storage fowl are
reported. The government has issued a bulletin on the
matter, in which it is pointed out that if the internal
organs were removed before storage, and if the fowl were
sold frozen and immediately cooked and eaten, such food
would be very desirable. As a matter of fact, the dealer
often allows the bird to thaw out to improve its appearance
before sale. He may then replace the fowl in cold stor-
age and repeat the process several times if a sale is not
made.

Canned meat and canned vegetables prepared by reli-
able makers are usually wholesome because thoroughly
cooked, and poisoning has been more frequent in the case
of home-made products. Usually if the contents are bad
the ends of the can will bulge, or the can be "blown," and
putrid gas will escape when it is opened. Dishonest
dealers are known to have bought blown cans and to have
let out the gas and soldered them again. In this case there
will be two soldered holes in a can, and such should always
excite suspicion. Canned fish and pork and beans have
produced reported cases of poisoning. But it is not un-
usual for the poisoning to follow carelessness in keeping the
contents of the can too long after opening. Violent and
fatal poisoning has originated from canned string beans,
which had a rancid odor when opened. It is always wise
to cook all canned vegetables again, as the cases of poison-



PTOMAIN POISONING 293

ing have often been caused by eating the product in salad