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THE BUTTERMILK GERMS.
Dr. Harold B. Wood, Providence, Rhode Island, While buttermilk has been used as a food for says that because the germs of sour milk are centuries, and in all kinds of forms, only within useful therapeutically, buttermilk can scarcely recent years has it been suggested as a medicine. be claimed, a priori, to be a valuable food for Such use of the lactic-acid bacilli really dates normal constitutions. In certain intestinal infecfrom Metchnikoff's adaptation of Massol's dis- tions or fermentations it may be used to change covery of the Bulgarian germ, which differs from the existing flora. The palatableness of butterother similar organisms (1) in its power to pro- milk, as with castor oil, is relative. Dr. Wood duce a very large quantity of the lactic acid, doubts if all people can be made to enjoy it. The and (2) in its extreme viability when in con- Bulgarian buttermilk may or may not be as tact with other germs, which, in the main, it bas objectionable as other makes. He has never used the power of “overriding'' when in contact there- the Bulgarian bacillus, his work having been with with:. Metehnikoff popularized this micro-organ- diphtheria cases and carriers, in which a conism with astounding rapidity—thanks to his sug- centrated spray of the bacillus lactici acidi, isogestion that it had the power of producing long lated from ordinary sour milk, was used. In life. The Bulgars were aserted to be peculiarly preparing the spray a two to four day culture prone to remain a long time on this troublesome of the organism is washed off by agitation withi spliere, and the fact that they used Bulgarian sterile normal salt solution; this is diluted to (Massol-germ produced) buttermilk as a bever- an opaque, heavy suspension, and used in a sterage was asserted to be the cause.
ile atomizer. Spraying of the throat may be While the claims at first made for the lactic done several times daily. Since lactic-acid germs acid germs were undoubtedly extravagant, in later in themselves are nonpathogenic it seems safe years we have been learning that they are ca- to apply them to mucous surfaces. Dr. Wood pable of doing good in a variety of diseases. In has learned of no contraindications; however, he addition to their direct action upon various mor- would hesitate to use them in gastric hyperacidity bid conditions of the alimentary canal-diarrheas, not bacterial in origin, and also in inflammation colitis, and the like—we are finding them of value of the ureters. in diseases only remotely referable to disturbance Dr. Wood says that in its influence upon inin this portion of the body. For instance, Bev- testinal conditions he would classify the lacticeredge and Boston are reporting excellent re- acid bacillus not as an antiseptic but as an oversults following the use of Bulgarian bacilli in rider which, by its excessive growth and prodiabetes, and recently a southern physician, duction of acidity checks and prevents the dethrough the columns of the Journal of the Amer- velopment of other bacilli. Its usefulness is, ican Medical Association, declares he has ob- therefore, limited to those cases in which it tained good results with them in treating pelle comes in direct contact with the infecting pathoagra.
gens. He has had no experience with these Of special interest is Dr. Wood's report (given organisms in the treatment of typhoid fever, but below) of the use of sour milk and ordinary sour- he would be willing to prescribe sour milk in milk germs in the local treatment of diphtheria early cases of this disease. In the diarrheas he and diphtheria carriers. We recommend that thinks lactic-acid bacilli will have more usefulthis be given very careful consideration.
ness in acute than in chronic or mucous colitic The subject is a very interesting one, and we conditions. sincerely hope a perusal of the papers that fol- In diphtheria.cases, Dr. Wood says that he has lows may elicit further discussion.
used sprays of the ordinary brew of lactic-acid
-vw, we use of douches of ordi- until th...
only t73. F. Biehn. Chi advantages posee
bacilli when membranes were present in the The doctor uses the bacillus Bulgaricus either throat; also in convalescents and in diphtheria in the form of fresh tablets, or in bouillon. Orcarriers. In each case there was rapid and dinarily he administers five to 10 Cc. of bouillon marked improvement with almost immediate dis- one-half hour after the breakfast, which is the appearance of all diphtheria bacilli and of sub- principal starchy meal of the day. When tabsequent infectiousness. As a result of this he lets are used, six to ten tablets are administered recommended (in the Journal of the American three times a day. This dose is maintained Medical Association) the use of douches of ordi- until there is marked evidence of improvement nary sour milk. Excellent results with this meth- and the indican has disappeared from the urine, od were soon reported by Michael and later by this usually requiring from a week to ten daysNicholson, Wessinger, and others. The sour milk rarely two weeks. The treatment is then disis not a substitute for antitoxin but should be continued for a week, after which it is again inused as an adjuvant and for clearing up the stituted for a week or ten days. parts infected with diphtheria bacilli. In diph- For local application, Doctor Biehn uses the theria with asthma, where anaphylaxis is almost bouillon in full strength, and also the tablets, certain to result from using antitoxin, the sour crushed, as a powder, without any diluent whatmilk and lactic-acid bacillus should constitute the ever. only treatment.
Up to the present he has not found any conDr. J. F. Biehn, Chicago, writes that, in his traindications to the use of bacillus Bulgaricus, opinion, the principal advantages possessed by nor has he seen any mentioned in the literature. buttermilk over ordinary sweet milk are: first, Doctor Biehn has found the bacillus Bulgariin buttermilk the casein has been precipitated cus to be an efficient intestinal antiseptic, at least and the curd being very fine, a much greater in so far as it prevents putrefaction, making conamount of surface is presented to the gastric ditions unfavorable for the growth of anaerobic juices. Digestion is, therefore, necessarily much putrefactive bacteria. Whether this action is more rapid, as a result of which the large curdy due to the lactic acid which this organism promasses are not formed, which are either so irri- duces (it produces on an average of four per tating to the stomach as to cause vomiting, or are cent of lactic acid), or whether it is due to some so large that they pass through the entire gas- other cause, he is not able to state. trointestinal canal without being completely di- . He has not used the bacillus Bulgaricus in the gested. Further, buttermilk does not usually treatment of typhoid fever, except for the avowed contain the many varieties of bacteria, some of purpose of preventing putrefaction in cases which them harmful, that are found in ordinary milk, showed a marked fetor of the stools. He emwhile the bacteria which sour milk rapidly drive ploys bacterins in the treatment of typhoid fever, out the other bacteria, as a result of the produce and has practically no failures with this method, tion of lactic acid.
combining it with the ordinary remedial measDoctor Biehn states that he experiences no ures. difficulty whatsoever in preparing bacillus Bul- The doctor states that all cases of infantile garicus buttermilk. He proceeds as follows; One gastroenteritis and bacillary diarrhea are amenquart of milk is boiled, and then allowed to cool able to bacillus Bulgaricus treatment. In chilto a temperature of 115° F. It is then inocu- dren he administers calomel or castor oil as an lated, either with bacillus Bulgaricus tablets, or initial purge, after which he gives either the a bouillon culture, and set aside, either in the bouillon, with milk sugar or in the regular food, incubator or in a fireless cooker, for eighteen or the tablets. In these cases the bacillus Bulhours. If at the end of twelve hours, the tem garicus, either in bouillon or tablet form, is given perature in the fireless cooker has fallen below every two to four hours. Practically the only 98° F., the milk is again heated to a tempera- cases in which a cure is not noted are those deture of 115° F. At times it may require as long veloping an intractable condition of malnutrias twenty-four hours for sufficient coagulation tion. Formerly the milk diet was not maintained, to take place. The milk is then thoroughly but now the regular diet of the child, provided stirred, to make it homogeneous (although there the child has been gaining weight on it before should be little or not separation of whey) and the illness, is continued during treatment with set on ice. Occasionally the bacillus Bulgaricus the bacillus Bulgaricus. will produce ropy milk. This is one of the def- Doctor Biehn has also employed the bacillus inite characteristics of the organism, and aside Bulgaricus and found it efficient in several cases from its appearance, there is no objection to the of mucous colitis, in combination with boldine, ropy form. A temperature of 110° to 115° is although most of these cases require from three absolutely essential.
to six months' active treatment. He has found
chcultures of the bachilles sprays. L. Benedict, Buffalo
the bacillus Bulgaricus especially effective, how- decreasing the water. He has never had a case ever, in derangements of the small intestine, its of gastro-enteritis in a breast-fed baby. He has effect upon the colon being not nearly so marked. never tried the Bulgarian bacillus in mucous
He uses the bacillus Bulgaricus in nasal and colitis or other chronic affections of the alimentonsillar conditions, and has had excellent re- tary canal. Neither has he had any experience sults in many cases. Nearly one hundred cases with the use of the bacillus in injections, douches, of diphtheria carriers have, in his hands, been sprays, etc. cleared up by spraying cultures of the bacillus Dr. A. L. Benedict, Buffalo, N. Y., thinks that Bulgaricus into the nose and throat every four as a food in the strict sense of the word, butterhours. Diphtheria bacilli rarely persist for more milk has no advantage over sweet milk, having, than seventy-two hours under this treatment, indeed, less nutritional value. He uses both the the majority of cases clearing up in forty-eight ordinary buttermilk, sour milk, and that prehours.
i pared from cultures or already bottled; he has Leucorrhea and gonorrheal vaginitis have also had no special trouble preparing buttermilk from reacted favorably and quickly to bacillus Bul- cultures in accordance with printed instructions. garicus treatment. Doctor Biehn now employs, The doctor asserts that the Bulgarian bacillus is as a matter of routine, a wet dressing of bacillus frequently contraindicated; in a great many cases Bulgaricus bouillon as a prophylactic and cura- in which it is prescribed there is already an tive measure in all open wounds, whether infected excess of lactic acid fermentation. Its indiscrimor not.
inate use as a food, he thinks, accounts for the Dr. Frank B. Kirby, Chicago, thinks that the disappointment experienced with it and its wholeflocculent casein of buttermilk is more easily sale condemnation. digested than the solid curd frequently observed Dr. Benedict does not consider the Bulgarian after drinking sweet milk. Convalescents who bacillus as an antiseptic at all, except that when like buttermilk appreciate the possibility of a there is an excess of true putrefaction its adchange in taste, too, when compelled to depend ministration, or that of any strain of lactic acid largely on milk. He has used the Bulgarian ba- ferment, antagonizes the putrefactive organisms. cillius as galactenzyme for making buttermilk, He has not used the Bulgaricus in typhoid fever; but does not find that it makes a pleasing butter and states that he very rarely encounters a case milk flavor under ordinary house conditions. Here of diarrhea in which lactic acid fermentation, the doctor depends on the ordinary lactic acid or some similar process, does not already exist. bacillus, expecting only increased nutritional He has employed it in cases of mucous colitis, value, not therapeutic effects.
where much indol is formed-corresponding apDr. Kirby has used the Bulgarian bacillus proximately to indicanuria-but does not think therapeutically, only in the shape of galactenzyme that the bacillus has any direct action on the tablets, giving 2 tablets three or four times a
lesion. day, either to be chewed or swallowed whole, Dr. J. H. Kellogg, Battle Creek, Michigan, says with a little sweetened water. He has never that buttermilk has the advantage that it is more found any contraindications to the use of the readily digested than ordinary milk. It conBulgarian bacillus. He states that when this tains an acid which is to some degree antiseptic, treatment follows an initial intestinal clean-out, opposing putrefactive processes and is also an there is a big reduction in the quantity and va- aid to digestion in cases in which the stomach riety of intestinal bacteria. Changing the diet secretes a deficiency of HCl. Buttermilk also inweakens the remaining organisms, which then suc- troduces into the intestine a harmless flora which cumb to the viable Bulgarian bacillus. In other opposes the development of putrefactive organwords, there is a change in the intestinal flora. isms.
The only case of typhoid fever in which the A buttermilk of excellent flavor can be made doctor einployed lactic-acid bacilli was in a from the bacillus Bulgaricus by the following patient who had an aversion to buttermilk. In method: First, use well skimmed milk. This is this instance he did not use galactenzyme, but important because the bacillus Bulgaricus decomwould do so if called on again in a similar poses fat and produces substances having an uncase. In infantile diarrheas he always insists on pleasant flavor. The desired amount of cream omitting the milk diet, giving whey or albumen may be added to the buttermilk when eaten. water and as much fresh water as possible. Aft- Second: Boil the skim milk for fifteen miner a calomel purge and rectal enema, galacten- utes then allow it to cool to a temperature of zyme will give good results in an aqueous sus- about 104 degrees and add to each pint of milk pension. The doctor then cautiously returns to a couple of specially prepared tablets dissolved cow's milk diet, slowly increasing the milk and in water, or better a tablespoonful of buttermilk
previously prepared. When the lactic germ is sweet milk contains about all the essentials prepared in tablets it is necessary to make sev- needed by the body; buttermilk merely lacks eral cultures, using a portion of the first prep- fat or cream and is comparable to sweet milk, aration for the second, some of the second for skimmed. The best buttermilk is made from the third and so on. About the third or fourth freshly separated milk. He has had no expericulture will develop a good flavor.
ence with buttermilk prepared with the Bulgarian Dr. Kellogg uses the Bulgarian bacilli as an bacillus. He is, however, very fond of the Bulgarelement of an antitoxic diet. It is necessary ian bacillus tablets as a therapeutic agent. These that meats of all sorts should be excluded from can be dissolved or suspended in water and in the dietary and in some cases as shown by Tissier this form there is no trouble in administering of the Pasteur Institute, it is necessary also to them, even to an infant. The dose depends enexclude eggs and milk. The bacillus Bulgaricus tirely on the effect required, and he repeats the does not become domiciled in the human intes- tablets, from one to four several times daily, untine so it is necessary that its use should be con- til he gets the effect required. There are absotinuous or practically so in order to insure per lutely no untoward results—at least in his exmanently beneficial effects. There are no con- perience. traindications excepting in cases of gastric ulcer For clearing the intestinal canal, or as an and in chronic gastritis, when the patient is ex- “intestinal antiseptic,'' Dr. Justice has found the tremely sensitive to acids.
Bulgarian bacillus tablets very efficient, though The Bulgarian bacillus is not an antiseptic. It he does not attempt to explain their action. He is beneficial only when used in connection with has not yet tried the remedy in typhoid fever, an antitoxic diet and increased intestinal activity but for three summers has absolutely relied upon secured by a laxative diet, and is necessary by the cultures of this organism in the treatment of use of paraffin oil and agar-agar or their equiva- the summer diarrheas of infancy and childhood lents. Dr. Kellogg has had no experience in the and he has never been disappointed where large use of the bacillus Bulgaricus in typhoid fever enough doses have been employed. He first cleans and thinks that on the whole milk products are
out the canal thoroughly, then begins the adminbetter avoided in cases of this sort. A culture of
istration of the tablets, pushing them to effect. the bacillus Bulgaricus made without milk or made
He has also found the tablets of great value in with whey will, he thinks, prove beneficial in these
grown-ups where the milk is the diet of choice,
but disagrees because the coagulated casein incases. Dr. Kellogg has found the bacillus Bulgaricus
duces constipation and toxin absorption. One highly satisfactory in treating diarrheas when used
or two of the Bulgarian bacilli following a glass
of sweet milk are all sufficient. He has also in connection with the bacillus bifidus of Tissier. The culture must be made without milk and the
tried the same remedy in mucous colitis and had use of milk should be avoided. The bacillus Bul
good success, if the canal is first carefully cleared
of debris. garicus combined with the bacillus bifidus is a
In a private letter Dr. Justice says that he very valuable remedy, indeed, in the treatment of
cannot explain why it is that the lactic-acid bacolitis. It should not only be taken by mouth,
cilli form and distribute lactic acid-and this he but should be injected into the colon. Astonish
leaves to us to explain. He adds: “If we obingly good results raay often be obtained in a very
serve the adult who imbibes freely of sweet milk –22ņģtiņģģbūti2ti2ti2m2/2\/2\\2\\2\/tiffimēòņģēņģēò–
at meals, who by reason thereof constantly emits vantage,” says Dr. Kellogg, "to combine the glu
a dead-house breath, is constipated and wears cobacter with the bacillus Bulgaricus and the bacil
that proverbially stinking coated tongue which no ius bifidus, and I add a small amount of malt su
amount of elimination, under the best directed gar and starch io the culture, especially when
regime, has the least effect upon, we should put used for injection into the colon. It should be
him on one or two tablets of Bulgarian bacilli freely used. About half a pint of the culture
(I prefer Abbott's galactenzyme) immediately should be taken daily in three portions by mouth
following a meal. There will be no more sewage and half a pint to a pint should be introduced escape. the oral cavity will be cleaned up and into the colon. I have employed this method quite the improvement will be maintained provided extensively and with very satisfactory results. I the treatment is kept up-in stubborn cases for have used the mixed culture above referred to in some weeks.'' the treatment of indolent ulcers and suppurating surfaces with good results."
For Facial Neuralgia.-Ether, essence of lavDr. J. D. Justice, Hunter, Oklahoma, in dis- ender, of each 50 grams; menthol, 5 grams. Apcussing the food value of buttermilk says that ply with friction.—Formulaire Astier.
THE MONTH IN BRIEF.
HINTS FROM THE THINKERS AND DOERS IN MEDICINE.
Constitutional Treatment of Epilepsy.-Becker When there is loss of vaso-motor tone as indi(Merck's Archives) declares that arsenic is of cated by a low blood-pressure on the spygmofirst value in the treatment of epilepsy. He manometer ergot is of very great service. It is esteems it mainly on account of its blood- administered in pill form of one to three grains building and alterative properties. There is of the aquaeous extract. Ergot may be conoften a profound secondary anemia from the sidered almost in the light of a specific adjuvant prolonged use of the bromides; to overcome this in epilepsy. Care must be taken, however, not it is best administered hypodermatically in the to prescribe too large a dose as it is apt to form of the sodium cacodylate, two or three cause dizziness and light headedness from the grains every second or third day; as an altera- cerebral anemia produced. Women tolerate tive and in conjunction with iodine and mercury larger doses than male patients. it is helpful in hindering the sclerotic process Strychnine, of course, is contraindicated in in the brain cortex. In epilepsy there is a dif- epileptics using bromides because of its therafuse neuroglia, sclerosis, progressive in nature, peutic incompatibility with the same; likewise which affects the cerebral cortex. Whether this when administering calomel it is well to bear in process is primary or secondary there is reason mind the possibility of its forming a poisonous to believe that these dugs have a prohibiting in- salt when bromide is being employed. fluence on this change. The iodine may be ad
ve et een ministered in the form of potassium iodide, but Furunculosis in Infant.—Le Grand Kerr (Long Becker prefers the syrup of hydriodic acid in Island Medical Journal) reports the occurrence of one or two teaspoonful doses diluted and taken a crop of boils in a nineteen months' old infant. twenty to thirty minutes before meals to obviate This infant was breast fed for one year and had a chemical incompatibility with starchy foods. experienced a perfectly normal development until The mercury 'may be administered in combina- the time of the present trouble. In October of tion with arsenic in the shape of Donovan's so- 1912, there developed one superficial furuncle lution in doses of from one to ten minims three which was followed in a few days by three more times daily; likewise protoiodide or biniodide that seemed to have their origin deep in the skin. can be given in tablet form.
These deep seated boils then continued to appear Next in importance to arsenic as a tonic and at rather regular intervals until December 30th. hematinic ranks iron. For overcoming anemia The infant was under the care of a surgeon (or it may be given in five grain doses of fresh to be more accurate, a gynecologist) who had apBlaud's mass or in the shape of the soluble scale plied a strictly surgical treatment of the local consalts, in solution.
dition without any attempted attention to the more Phosphorus is useful and may be combined general details. The treatment was invariably inwith Blaud's mass in the shape of zinc phos- cision and drainage. Fifteen boils had been treated phide, one-thirtieth grain per dose. The gly- in this manner and as they did not develop about cerophosphates may be given in the form of an any particular area, the little girl was considerably elixir and the hypophosphites in a syrup form. scarred. Quinine is too stimulating for use in epileptic At this time, the father, alarmed at the increascases except when there is a history of malaria. ing scarring and the persistence of the developIf there is a doubtful history of syphilis a Was- ment of the furuncles, called in a physician and sermann test should be performed before giving Dr. Kerr was consulted to see the infant. At his large specific doses of mercury and potassium first examination there were two boils in early iodide. In gouty and lithemic patients a stricter stage of development. These were treated locally diet is to be enforced, a modified vegetarianism by thorough cleansing of their surfaces and the and alkaline salts and mineral waters prescribed. surrounding skin and the injection of tincture of
f developmentre of their surfae tincture of