Twentieth Century History of Findlay and Hancock County, Ohio, and Representative Citizens, Part 85

Author: Jacob Anthony Kimmell
Publication date: 1910
Publisher:
Number of Pages: 1189

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am at the end of my lecture. I have not considered it my ct to dwell upon those symptoms of acidosis which are idered more or less absolute facts. This was unnecessary i an audience so well informed on the subject as an au- ce of American physicians. I have undertaken the more

valuable task to show, which problems are awaiting yet their answer and what objections may be raised to the doctrine of acidosis. To many of our profession the theme of acidosis seems to furnish no problems for future research. I hope to have demonstrated in which direction further research may be successful in order to advance both the theory of acidosis as well as its treatment.

SOME OBSERVATIONS ON THE BACTERIOLOGY OF THE BALTIMORE CITY WATER .*

By WILLIAM W. FORD, M. D., Associate Professor of Hygiene and Bacteriology, Johns Hopkins University.

he importance of a thorough knowledge of the water used he city of Baltimore cannot be overestimated, especially le present time when heavy expenditures are to be under- n for the enlargement and permanent improvement of the ly. It is essential that the character of the water collected le various water sheds which feed the city reservoirs should rell understood, particularly its content in bacteria, and extent to which it is polluted by microorganisms derived i the intestinal tract. The results of such a study belong tially to the medical public of the city, and if these results cate a pollution of the supply which is at all likely to be a ace to the public health, it is the duty of every one con- int with the bacteriology of the city water to make his vledge common knowledge. The number and character of microorganisms found in the water delivered to the con- er will determine in a great measure the necessity of ing it through sand filters, unless a careful examination e various tributaries of the main streams utilized by the :hould reveal that the pollution which may be found has urce in a few small streams which can be eliminated from ystem.

ring the past six years I have been making regular iological examinations of the water drawn from the tap : Bacteriological Laboratory, and in the organization of a in Practical Hygiene have had the opportunity of paying ent visits to the valley of the Gunpowder River and of ng several of its most important branches in Baltimore y, particularly the Beaver Dam Run, the Western Run, e Oregon Branch. For a number of miles in the vicinity se streams the general conditions prevalent along their have been carefully scrutinized, especially any local jons which might favor a sewage contamination. The from our tap has its source primarily in the Gun- River, and it has thus been possible to compare the blogical findings of the water as delivered with those of samples collected from the river itself and from the Mentioned tributaries. Recently it has seemed wise to the work of this fairly long period of time and the found during the different years agree so completely

{ before the Baltimore City Medical Society, May, 1910.

as to make deductions from the evidence presented of con- siderable value. The main conclusions obtained do not differ to any appreciable extent from those reached by Dr. W. R. Stokes and his co-workers in the Bacteriological Laboratory of the City Board of Health, but in a question so vital to the well-being of a community as its water supply, it is of para- mount importance that the work done in different laboratories should be carefully compared. Only in this way can obser- vations of permanent utility be made.

TAP WATER.

The water supplied to the Bacteriological Laboratory is derived from Guilford Lake and thus from the Gunpowder River at Lock Raven. This water has been examined at frequent intervals by the simplest methods in vogue for the study of water bacteria. The colonies have been counted on agar and gelatin plates, with 1 cc., 1/10 cc. and 1/100 cc. quantities. The average of these three counts has been taken to represent the bacterial content of the samples. Fermentation tubes of 1 per cent dextrose broth have been planted with 1 cc. and 1/10 cc. quantities and rarely with 1/100 cc. When these tubes showed positive fermentation by the production of acid and the evolution of gas, plates have been poured from the open bulb, the various colonies fished and planted on agar, and subcultures made in agar, gelatin, potato, Dunham's solution, litmus milk and various sugars. These reactions together with the morphology and motility of the organisms have served to establish the identification of the various species.

The number of organisms per cubic centimeter in our tap water is not large. It is uniformly below the standard of purity, 1000 to the cubic centimeter, and is usually between 500 and 600. It may be as low as 300 to the cubic centimeter. On rare occasions it may be increased to 1500 or even 2000. A high bacterial count is not common and is usually associated with heavy rains in the vicinity of Baltimore and is accom- panied by a great increase in turbidity. From the bacterial count alone there is little or no evidence of pollution. Fer- mentation tubes, however, show almost invariably a positive presumptive test for Bacillus coli. This is practically always

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given in 1 cc. quantities and it has proved a rare event, during six years of routine examinations, for this test to fail. Occasionally when a single Smith tube is planted with such a quantity, there is no active fermentation of the sugar as a result, but if half a dozen tubes be planted at the same time the majority always shows a positive presumptive test. Not infrequently the tubes planted with 1/10 cc. also give positive results and on very rare occasions I have seen acid and gas develop in the tubes planted with 1/100 cc. When plates are poured from the fermentation tubes and the various bacteria isolated which give rise to the splitting up of the sugar, considerable diversity is evident in the characteristics of the microorganisms encountered. The principal isolations, never- theless, have certain cultural features which indicate that their source of origin lies in the intestinal contents. The species may be grouped about six main types.

GROUP I. BACILLUS COLI TYPE.

In the majority of instances the microorganisms found in the fermentation tube conform to the classical type of Bacillus coli. They are small, sluggishly motile bacilli which produce a rather thick, moist, non-pigmented growth on agar, fail to liquefy gelatin, acidify and coagulate litmus milk without digestion of the casein, and ferment dextrose with acid pro- duction and the evolution of a gas composed of a mixture of hydrogen and carbon dioxide, with the formula 品=3=4.

Many of the strains isolated produce indol abundantly, the reaction being brought out by the addition of nitrites to the mixture of sulphuric acid and a Dunham's solution culture, and in many instances the usual dirty brown growth on potato is also seen. Neither indol production nor abundant growth on potato have been considered essential in the identification of the organism, the previously mentioned reactions being regarded as diagnostic.

GROUP II. BACILLUS PROTEUS VULGARIS TYPE.

Organisms of the "proteus vulgaris " type have been iso- lated on a number of occasions. In morphology they are not unlike Bacillus coli, but are somewhat longer and thinner. They have a rapid darting motility characteristic of this group. Their colonies on agar and gelatin have spreading, leaf-like edges and the lattter medium is rapidly liquefied. On the surface of slant agar the growth is spreading and in stab gelatin cultures liquefaction progresses rapidly in a trans- verse direction along the surface of the solid medium. The organisms ferment dextrose with a gas formula of CO2 1

3-4 the hydrogen being in excess of the carbon dioxide. Milk is not firmly coagulated but shows a soft clot, the reaction remaining alkaline, and the litmus being completely reduced. The elot is slowly dissolved and the litmus milk is eventually converted into a glairy, dirty brown fluid in which no trace of curd is visible. If fresh litmus be added, the reaction is seen to be alkaline. Indol is seldom produced by these micro- organisms. They belong clearly to the "proteus vulgaris" gror.

GROUP III. BACILLUS CLOACAE TYPE.

Bacteria of the " cloaca " type have been encountered fra time to time in the tap water. They have a morphology ani motility like that of Bacillus coli and on the surface of sar they look not unlike this microorganism. They acidify att coagulate milk, and produce non-spreading colonies in az and gelatin. The latter medium is liquefied and the preit- tated casein in the milk tubes slowly digested. The organiz, ferment dextrose actively, the gas produced showing e

inverted formula, H CO2 3-4 1 , the carbon dioxide being ? excess of the hydrogen. They may or may not produce into and in some instances their liquefaction of gelatin is e tremely slow.

GROUP IV. PARATYPHOID OR PARACOLON TYPE.

In a few samples we have isolated species which must '} called " paratyphoid " or " paracolon " bacilli. They resense Bacillus coli or Bacillus typhosus in morphology and motility fail to liquefy gelatin, and ferment dextrose with the us Bacillus coli gas formula, CO2 H = 3-4 In milk they prodes a slight but transient acidity which gives place to an alkaline: reaction after the lapse of four or five days. Their cultur characters place them clearly in the intermediate group.

GROUP V. LIQUEFYING ORGANISMS LIKE BACILLUS C'Hll

Under this heading we have placed a number of culture which represent a distinct type. The organisms have > greatest superficial resemblance to Bacillus coli in morphokes, motility and growth on agar. In the dextrose fermentatie tube they produce an acidity and evolve a gas which has the

regular formula ČO2

la 0, = 3-4. On potato they grow in a dim

brown layer. They may or may not produce indol. While thus having many of the characters of Bacillus coli they an distinguished from it by their rapid liquefaction of gelatin The liquefaction is funnel-shaped, proceeding out from the line of growth of the bacteria and not from above downward as in the " proteus " and " cloacae " cultures. The colonis have no tendency to spread and are thus distinguished friz Bacillus proteus vulgaris, while by their gas formula ther a* differentiated from Bacillus cloacae. The species is a distinc: one, and I have found it on a number of occasions in the city water.

GROUP VI. BACILLUS FAECALIS ALKALIGENES TYPE.

Many of the fermentation tubes which show the presence af the various organisms above mentioned give in addition (el- onies which develop into a non-fermenting organism of great importance. This is Petruschky's Bacillus faecalis alkaligen !. It has a motility and growth on agar like that of Bacilina typhosus, fails to liquefy gelatin, produces an alkaline reaction in milk, and in the fermentation tube grows only in the open bulb with the production of alkali. This organism okCars frequently in the city water and may be isolated both from the fermentation tubes and from agar plates.

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SIGNIFICANCE.

While the microorganisms belonging to the above-men- ioned types are accompanied, in our city water, by the usual water bacteria, spore-bearers, pigmented forms, etc., The latter are in the minority. The species usually encoun- ered are the non-pigmented, non-spore-bearing, sugar-split- ing bacteria, and it is important to consider what significance must be attached to their isolation. It seems to me that but ne opinion can be expressed as to these findings. They ndicate a permanent and serious pollution of the supply. The presence of Bacillus coli regularly in one cubic centimeter uantities is recognized by all sanitarians as evidence of sewage ontamination and its occasional isolation from smaller quan- ities, 1/10 cc., is evidence that this contamination is ex- ensive in character. The presence of these other strains ; also, I believe, not without considerable signficance. In ome instances, as with Bacillus cloacae, we are dealing with organism which is characteristically found in sewage from hich source it was first isolated by its discoverer, Jordan (1). other cases we have organisms of the "proteus " type, hich may and probably do exist in nature, but many years o I (2) pointed out that this species is, next to Bacillus coli, e most commonly found species in the intestinal tract of an, and it is not impossible that its presence in the city ter is due to fæcal pollution. Other organisms which have en isolated, those of the "paratyphoid " and " alkaligenes " e, are essentially intestinal in character. This is especially c of Petruschky's bacillus which is present in the ali- ntary canal in nearly every individual. Finally the organ- s mentioned above as "liquefying organisms," like Bacillus ; have long been viewed with suspicion by bacteriologists. ey are probably identical with the organisms described in literature as "liquefying coli " a misnomer which Durham especially has deplored. I have isolated them frequently in Baltimore from sewage, from some of the tributaries he city water, as well as from the tap water itself, and polluted deep water wells. They are identical in cultural acters with a liquefying bacillus which I described from intestines several years ago and the late Major James oll, of Washington, stated that these organisms were very non in various samples of water examined by him in ington and believed to be contaminated. While their ficance as an index of pollution is by no means certain, 'escott and Winslow (4) point out in regard to intestinal ria which are not Bacillus coli yet their constant isola- from the city water, which is definitely polluted by lus coli, is not without considerable interest.

SOURCE OF POLLUTION.

thus see that the water drawn from the tap shows the ce of serious pollution and since these results have obtained now for a period of six years this pollution tly has a permanent character. If we now ask its source ifficult, if not impossible, to point to any one particular which is responsible for the contamination. My own ations relate only to the district in the immediate vicin-

ity of the small town of Cockeysville and are concerned with three especial tributaries which empty into the Gunpowder River in this locality. These small streams are Beaver Dam Run which passes through Cockeysville, the Oregon Branch, and the Western Run. The water of these three runs is grossly polluted. This can be made out simply by an inspec- tion of their banks where the sewage of numerous farm houses and of one or two small settlements can be seen making its way directly into the streams. As these small runs join the Gunpowder not very far above the dam at Warren the origin of the contamination of the Gunpowder water is not far to seek. The evidences of pollution which may be gained by naked eye inspection are amply substantiated by the bacterio- logical examination of the water collected from the various runs and of samples drawn from the Gunpowder itself. The number of organisms in the river and in the tributaries is fairly high, varying from 2,000 to 25,000 per cubic centi- meter, and the fermentation tube reveals a very serious pollu- tion. The presumptive test is frequently positive in great dilution, 1/100 or even 1/1000. The species cultivated from the agar plates and from the Smith tubes conform to the types isolated from the tap water. Bacillus coli is most frequent, but Bacillus cloacae, the liquefying organism like Bacillus coli, and Bacillus faecalis alkaligines are also found with' some constancy. Some of these small streams indeed seem to carry nothing but a diluted sewage. The sedimentation in Lock Raven and in the various city reservoirs has served only to diminish the number of microorganisms. It has not altered the essential character of the bacteria, the species which survive and appear at the tap being practically identical in character with those found in the Gunpowder water above the Warren Dam before any considerable sedimentation has taken place.

REMEDY.

If our ideas as to the pollution of the Gunpowder River shall be substantiated by the work of other investigators, or if other sources of fæcal contamination shall be found, as for instance in Lake Roland and its tributaries, with the study of which Dr. W. R. Stokes has been engaged for some time, then the question naturally arises as to the means which must be adopted to remedy this evil and protect the citizens of Baltimore from the risk of water-borne infections. In my opinion the pollution of the Gunpowder River is too great and the sources of contamination too manifold to permit the adop- tion of hygienic measures which would be stringent enough to alter the character of the water permanently and make it safe for drinking purposes. Since the Gunpowder River offers the city the most convenient and most valuable source of supply, or at least may be used as the chief portion of our system, this water must in some way be made suitable for domestic use. There is evidently but one method of bringing this about. The water must be filtered, preferably through sand filters. Fortunately, this measure has already been adopted by the city, and it is a matter of supererogation at the present time to call attention to its necessity. Our bacteriological examina-

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tions serve then more to testify to the wisdom of these patriotic officials, who for some time now have insisted upon the installa- tion of some system of sand filtration for the purification of our water supply, than to call attention to some measure which it is impossible to carry out.

Even if it be claimed that filtration will not necessarily diminish our mortality from typhoid fever, the chief water- borne disease, we must remember that there is abundant evi- dence to show that the adoption of filtration plants has been followed by a diminution of the mortality from enteric fever in many cities. That this is not always the case seems to be true from the experience of the city of Washington. It may be pointed out, that this latter city forms an exception to the general rule, and that the typhoid fever was evidently not associated with a polluted water supply, but was due appar- ently to bad hygienic conditions in regard to the milk and food furnished the city. We believe, however, that our water supply is contaminated, and that it should be purified on general principles of good sanitation. If it diminishes the typhoid mortality, then we shall indeed be fortunate. But we do not know the source of all of our typhoid fever. Some may be water-borne and personally I am inclined to believe that much of it is associated with our polluted supply. But some may be milk-borne and some may be the result of a direct transmission of the typhoid bacillus from one individual ;. to another. Any one who has examined, over any length of

time, the milk sold in the little shops in the poorer sectie: of the city, where the bacterial count may reach 3 to ; million to the cubic centimeter, must realize that the co- ditions which allow this great bacterial pollution wil als : allow a pollution of the milk by Bacillus typhosue :: And any one who has read that valuable little contribution Baetjer (5) on an epidemic of tyhoid fever in Baltime County, where 17 cases of typhoid occurred in two home. must feel that part of this disease in our midst is due to dire. infection or to chronic bacillus carriers. Let us first provide- Baltimore City with pure wholesome water and eliminate or polluted supply as a possible source of typhoid fever. W: shall then be in a position to devote all of our energies to : further study of this malady, ascertain more accurately t: origin of the disease and adopt those preventive measures which modern hygiene is teaching us are effective in co- trolling the spread of this most serious infection.

BIBLIOGRAPHY.

1. Jordan: Special Report of the State Board of Health of Massy- chusetts on the Purification of Sewage and Water, 1890, II,SE

2. Ford: Studies from the Royal Victoria Hospital, Vol. I, No. i May, 1903.

3. Durham: J. Exp. Med., Vol. V, p. 353.

4. Prescott and Winslow: Elements of Water Bacteriology, 1908.

5. Baetjer: Johns Hopkins Hosp. Bull., Vol. XX, No. 218, Mar. 1909, p. 152.

A CASE OF CONGENITAL DEFORMITIES (PATENT DUCTUS BOTALLI: ABSENCE OF LEFT KIDNEY AND CHRONIC PERIPHERAL ŒDEMA).

By CHARLES R. KINGSLEY, M. D., Medical House Officer, Johns Hopkins Hospital. (From the Medical Clinic of the Johns Hopkins Hospital and University.)

Jennie L., a white child, five months old, of Russian parent- age, was admitted to the medical side of the Johns Hopkins Hospital, August 31, 1909. According to the mother, both parents had been well, with no history of tuberculosis or alcoholism on either side. The patient was the last of a family of eight children, all normal and healthy. There had been ne miscarriages. The patient was born after a nine- months' pregnancy, during which the mother did her usual housework, but suffered no trauma. The presentation was breach, but the labor was easy. Soon after birth the mother noticed that the child's hands and feet were swollen and the tongue was too large for the mouth. No attention was paid to this since the child nursed well and grew, but the con- tinuation of the deformities decided the mother to take the child to the hospital.

On admission to the ward the patient was found to be of average size for her age, 56 cm. long, and fairly well nour- ished, weighing 5675 gm. She appeared normally bright and intelligent, noticing people, surrounding objects, and moving

about actively. The skin was soft and smooth, with no erup- tion anywhere. The head was held up fairly well and seemed normally formed, with a small anterior, and an almost entirely closed posterior, fontanelle. There was no brachycephaly with shortening of the anterio-posterior diameter and flattening of the occiput, the measurements being about normal for i child five months of age. A growth of fine black hair covered the head; the eyebrows and lashes were long. There was s peculiar bluish pallor of the face, but no cyanosis of the lips and finger tips. The neck presented an odd appearance due to two folds of redundant skin which ran from behind the ears to the shoulders, extending about 8 cm. in breadth when stretched. A slight prominence of the eyes was noticeable: ocular movements were normal with no strabismus or nystag- mus. There was no epicanthus and the face was not that described as typical of a mongol. The pupils were equal. reacting normally; scleræ clear and conjunctiva of good color. Large, thin, flabby ears protruded at right angles to the head. Hearing was absent on the left side, and a purulent

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ti ial

FACE: NOTE LARGE TONGUE AND EARS.

CUTANEOUS FOLDS-FROM BEHIND.

HANDS SHOWING PECULIAR FINGERS AND OEDEMA.

CUTANEOUS FOLD-SIDE VIEW.

FEET: NOTE PUFFY OEDEMA.

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wcharge was found in the left external meatus. Breathing was unobstructed and the nose normal looking. A huge tongue protruded through the lips to a level with the sur- rounding skin. There was no furrowing or enlargement of the papilla, but the tongue was coated and indented by the upper and lower alveolar ridges. The saliva was swallowed. There was a highly vaulted palate and a large uvula but no abnormality of the tonsils and pharynx. The lips were not especially thick or protruding and there were no rhagades. No glandular enlargement was found. The thyroid could not be felt and there was no substernal dulness to suggest a thymus gland. The thorax was well formed, free from rickety rosary and Harrison's grooves. In the notch of the epigas- trium the cardiac impulse was most forcible and on percussion the heart's dulness was normal in location and size. On auscultation there was an embryocardia and a sawing systolic murmur, following the first sound, well heard over the left chest. At the base the systolic murmur was especially loud and vibrating with a point of maximum intensity over the upper third of the sternum; both second sounds were clear. The pulse was regular, of good quality, and well felt in the extremities. The abdomen looked natural, without marked prominence or hernia. A soft liver edge could be felt about 2 cm. below the costal margin. The spleen was not palpable. The genitalia were normal in all respects.

The extremities were bulbous, showing considerable swelling of the lower parts of the legs and forearms. The skin looked waxy and bluish over the dorsa of the hands and feet, pitting readily on pressure, but not thickened or indurated. The extremities were cold. The fingers and toes were long, showing a fusiform enlargement of the two proximal phalanges which were in slight flexion, the distal phalanx being in slight ex- tension. A transverse line of constriction formed a groove at the terminal phalangeal joints, most marked in the fingers, but present in the toes to a lesser degree. Both finger and toe nails were growing almost at right angles to the digits, ap- parently pushed up by an overgrowth of the terminal phalan- geal tissue. The muscular power and sensations seemed normal.

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Twentieth Century History of Findlay and Hancock County, Ohio, and Representative Citizens, Part 85

Author: Jacob Anthony Kimmell Publication date: 1910 Publisher: Number of Pages: 1189

Author: Jacob Anthony Kimmell
Publication date: 1910
Publisher:
Number of Pages: 1189