will accommodate a herd of 60 cows. To the energy, enthusiasm and persistence of Mr. Canfield the Milk Commission is greatly indebted for its success, since each bottle of Certified Milk is nothing else than the tested product of a single dairy operated in the most approved and painstaking manner.

According to the rules of the Commission, the examinations by experts are to be made at least once a month in hot weather. Bacteriological examinations have been made with this frequency throughout the summer and fall, and have been the cause of great satisfaction to the Commission. Since the Commission was not certain what results could be attained under the conditions which existed in Cleveland, the maximum limit of 30,000 bacteria to the cubic centimeter was adopted as the bacterial standard of the Commission at the time of its organization. Milk coming within this limit would be a satisfactory product for certification. The first bacterial examination, before the routine at the farm was working smoothly, was but a little more than one-half the maximum permitted by the Commission, and the average of remaining counts, six in number, upon which this milk has been certified during the summer and fall, is 2656 bacteria to the cubic centimeter. The following low counts have been reported to the Commission:-June 15, 1085; August 8, 1000; September 16, 1450; November 29, 950. As a result of this experience the Commission has decided to reduce the maximum permitted for the certification of milk produced under its direction from 30,000 to 10,000 bacteria per cubic centimeter.

The inspections of the veterinarian and examinations by the chemist have not been made with the frequency of bacteriological examinations. Since the onset of cool weather these examinations on alternate months have been omitted. The veterinarian is charged both with the health of the herd, including the tuberculin test, and with all details connected with the management of the farm and the production and handling of the milk. The veterinarian has tested with tuberculin all cows of the original herd, and about forty added since May when Certified Milk was placed upon the market. Retests of the herd will be made annually and no cow giving the tuberculin reaction will be added to the herd or permitted to remain in it. The advice of the veterinarian as to the handling of the milk has been needed from time to time. The remarkably low bacterial count is an unquestionable evidence that these directions have been both wise and faithfully followed.

As to the chemical characteristics of this milk the Commission is satisfied that adulteration and the adding of preservatives would not be attempted as it would result in immediate withdrawal of certification. The reports of the chemist confirm the Commission in this belief. At the present time, however, the herd is somewhat deficient in cows producing milk rich in fat. As a result the milk has not always been up to the standard in fat content, namely four percent. This deficiency will be rectified by the addition to the herd of cows producing milk rich in fat, and, since new cows must be added with considerable frequency to meet the increasing demand for Certified Milk, the Commission does not anticipate that it will be long before the quality of the milk is in every way beyond exception.

The sales of Certified Milk have depended almost solely upon the rec

ommendation of physicians, and while at the present time they have not reached the total that they should have in a city the size and wealth of Cleveland, yet a steady and fairly rapid increase has been attained. The following shows the total shipments from the farm in round numbers, of bottled milk:-June, 2400 quarts; July, 5700 quarts; August, 5900 quarts; September, 7500 quarts; October, 7700 quarts; November, 8100 quarts. This milk is sold both in quart and pint bottles, and the relative sales for the last three months were as follows:-September, 5400 quarts, 4200 pints; October, 5600 quarts, 4300 pints; November, 6000 quarts, 4200 pints. The Commission is informed by those thoroughly conversant with the production of high grade milk that in no other city have the sales of Certified Milk increased as rapidly as this in amount. The favorable showing in patronage must be credited largely to the publicity given Certified Milk. This publicity was secured chiefly by means of circulars published and widely distributed by the Commission to the public and practicing physicians, and, to a somewhat less degree, by the willing co-operation of the daily papers of Cleveland, which recorded the organization and purpose of the Commission and the need of a supply of milk of exceptional cleanliness. The Commission particularly wishes to express its thanks to the Cleveland Plain Dealer for an illustrated article in an Sunday edition early in the summer and for the publication of a communication from the Commission at a more recent date.

The preliminary investigation of the methods of production of Certified Milk and the visit to the certified dairies in the East would have been impossible had it not been for the generous contributions of Mr. Samuel Mather of the Commission and Mr. W. S. Tyler and Mr. E. W. Oglebay. The thanks of the profession at large as well as those of the Commission are due to these gentlemen.

Before the report is closed, we wish to mention the attempt of a certain company which has taken to itself a firm-name in which the word "certified" appears, to trade upon the name of the Commission. Through their agents, who have been known to go to the homes in which Certified Milk has been prescribed by physicians, they claim that theirs is or is as good as Certified Milk. They have gone so far as to represent that their milk is Certified by this Commission. At one time a series of samples of milk sold by this firm was examined by the City Bacteriological Laboratory. The lowest count was 750,000 the highest, upwards of 7,000,000 bacteria to the cubic centimeter. The term Certified is copyrighted but the Commission has received legal advice that to proceed against the company on that ground would be not only expensive but also an exceedingly tedious process. The only steps, therefore, which have as yet been taken to counteract these false claims have been to warn the physicians and the public against them.

Certain difficulties have been met in the distribution of Certified Milk, but at the present time we feel that this matter is being attended to in a manner which is at least fairly satisfactory. At their request, the distribution of this milk was placed in the hands of the Belle-Vernon-Mapes Dairy Co., the Cloverdale Dairy Co. and the Walker-Gordon Laboratory. These firms with some exception cover practically the entire territory of the city, and from them when specifically ordered Certified Milk may be obtained.

Respectfully Submitted,

THE MILK COMMISSION OF THE CITY OF CLEVELAND.

The Cleveland

Medical Journal

CONTINUING THE CLEVELAND JOURNAL OF MEDICINE

Entered March 7, 1902, as Second-Class Matter, Post-office at Cleveland, Ohio, under Act of Congress of March 3, 1879.

EDITORIAL

The Typhoid Mortality of Cleveland in 1905

The typhoid mortality of Cleveland in 12 months, including the last six months of 1904 and the first six months of 1905, was 16.49 per 100,000 of the estimated population of the city.1 During the year 1905, of the deaths reported to the Health Department, 67 were assigned to typhoid fever as a cause. Estimating the population of Cleveland as 451,000 in round numbers, the mortality would be 14.86 per 100,000.

In an editorial which appeared in the March number of this Journal, forecasts of future mortalities from typhoid fever were given. These forecasts were based upon the mortality of the last six months of 1904 and upon the relation which has existed between the mortality of the first and last six months of the year, in Cleveland, for the years 1892 to 1902, and in the registration area of the United States, for the year 1900. The respective estimates were 18.76 and 15.92.

The result for 1905 is more favorable than either of these methods of estimation would warrant one in expecting, as well (1) Cleveland Medical Journal, October, 1905

as more favorable than the mortality of the 12 months ending June 30, 1905. Since both the actual and estimated mortalities, depend upon the last six months of 1904, it seems fair to conclude that the conditions resulting from the improved water-supply are better now than they were then. To avoid too sweeping conclusions from these facts, it is necessary to remember, first, that accidental varitations in typhoid mortalities are such that as favorable results as these need not invariably prevail under present conditions; second, that the improvement may be due to decrease of infection, not primarily but secondarily dependent upon the water-supply, and the water-supply of the city may have been as good in 1904 as at the present time.

The Municipal Journal and Engineer published two or three years ago, an article by George W. Fuller, in which he gave the typhoid fever death rate for 1898, 1899, 1900 and 1901, and the average for these four years, of all cities in the United States having over 30,000 population. The cities, 132 in number, were arranged in order according to average mortality. Cleveland with an average of 39, was 83d in the list from lowest to highest. Had its average been the same as the mortality of 1905, it would have been the third.

Scopolamin-Morphin Anesthesia

A great deal of interest has been manifested of late in the use of scopolamin with morphin as an anesthetic. As is usually the case, it was at first heralded as an ideal anesthetic but since fuller reports have been made from various sources, it seems that it is not so free from danger as was at first supposed. Scopolamin is closely related to hyocin and in fact is regarded by some as identical. A solution of 1-10 milligram of it with 25 milligrams of morphin is given hypodermically in divided doses, the result being a profound sleep, out of which, however, the patient can usually be awakened readily. The ordinary nerves of sensation are particularly affected and painful sensations are either abolished or so diminished that they fail to awaken the patient. In many cases the combination of these two drugs will produce such a deep and lasting sleep that many operations, even of a major character, may be performed, but in most abdominal operations it seems advisable to administer chloroform, in addition, in order to overcome the rigidity of the muscles. A very small amount of chloroform is usually sufficient for this purpose and after the incision has been made its further administration may

often be discontinued.

Scopolamin alone is apt to cause great restlessness, hence the advisability of combining morphin with it. It is said to produce a marked vaso- dilitation of peripheral vessels and chloroform rather than ether is recommended as there is less liability to pulmonary congestion and edema. It frequently interferes with respiration causing dyspnoea cyanosis and Cheyne Stokes respiration. Advantages claimed for it are that there is practically no nausea or vomiting after its use, and as the sleep is prolonged for some hours after the operation, there is in reality, less pain than after ordinary anesthetics. A number of deaths have been reported after its use in which the operation was trivial and the anesthetic itself undoubtedly to blame. With the rapidly increasing reports upon its use its final status will probably soon be determined.

Recent Experimental Work on Syphilis

With constant improvement in technic, and daily development of new methods of investigation, many of the problems which have been troubling us for many years have made distinct progress towards solution. Among the most important of these is the discovery of the agent of syphilis, with all that such a discovery means. The work of Schaudinn and his followers has already been referred to in these columns and gives good hope that the organism is definitely found.

Parallel with these researches other work dealing more particularly with the experimental inoculation in animals has been going on in Paris under the guidance of Metschnikoff and Roux of the Pasteur Institute of Paris. Through a generous gift they were enabled to procure a sufficient number of monkeys of different kinds for a most valuable series of experiments published in the November number of the Annales.

They have found that the varieties of apes are susceptible to syphilis in direct proportion to the nearness of their zoological relation to man, the lower apes being susceptible as far only as the primary lesion, no secondary lesions ever having been observed in them. The orang-outang shows occasional secondary lesions, while the chimpanzee, at once the most suitable and the hardest to keep alive, gives typical secondary lesions in over sixty per cent of the cases inoculated. In these animals the average time of incubation of the primary lesion is thirty days, that of the secondary lesion after the appearance of the primary is thirty three days. The secondary lesions are in general much less severe