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Full text of "Proceedings of the second Pan American scientific congress, Washington, U. S. A., Monday, December 27, 1915 to Saturday, January 8, 1916"

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XibrariS 



of the 



T[lnivcr0iti? of Mieconein 




1 



Proceedings of 

The Second Pah American 

Scientific Congress 



WASHINGTON, U. S. A. 

Mouiaj, December 27, 1915 
to Satunlay, Janaary 8, 1916 



CMi»a«d Hid «dltad aadw tlw dhwtlM 1 
aitm Lntm Swiggatt, AaAttat Sacnterr G«Mcal 



SECTION vin 

(IN TWO PARTS) 

PART 2 

PUBUC EIEALTH AND MEDICINE 

WIUJAM C. GOBGA8, SURGBON GENERAL U. 8. A, CHAIRMAN 




VOL. X 



WASBONGTON 

GOTBBNMENT PRINTINO OffVICB 

ltl7 



DEC 13 1917 



^ ^ CONTENTS. 

10 



SECOND PABT. 

Letten ol traoflinittal *•• vn 

Register of writers of papen xm 

Foreword xv 

MamJDg ae— ion of Jeaoarj 3, 1016 8 

A r^sum^ of some of the recent studies of the United States Public Health 
Service relating to the causation and to a method of preventing pellagra, by 

Joseph Goldbeiger 3 

The known and the unknown with regard to the etiology and prevention of 

beriberi, by Edward B. Vedder 22 

Beriberi, estudio epidemiol6gico y experimental, by Mario G. Lebredo 29 

Concerning the chemical nature of the vitamines, by Rob^ R. Williams 30 

Infantile scurvy, by Alfred P. Hess 48 

La nutrlci6n en la altiplanicie de Bogotd, by Calixto Torres Umafia 62 

Influenda de la chicha sobre el metabolismo azoado, by Oalixto Torres Umafia. 105 

Afternoon session (»f Jaaoary 8, 1016 112 

Changes in the food supply and their relation to nutrition, by Lafayette B. 

Mendel 112 

A safe and sane milk supply, by John Weinzirl 127 

Proyecto de ordenanca reglamentaria del comercio de leche de consume de 

Buenos Aires, Argentina, by Ricardo Sarmiento Laspiur 130 

Vulgarizaci6n cientffica — Higiene bucal, by Julio L. Catoni 167 

Joint session of Subsection D of Section VIU and Subsection 4 of 

Section V 173 

Available methods for the sanitary disposal of refuse, by Creorge A. Soper 173 

Disposal of refuse, by William T. Sedgwick 187 

Collection and disposal of municipal refuse, by J. T. Fetherston 100 

Afternoon session of January 4, 1016 205 

The purification of water supplies, by Edwin O. Jordan 205 

The applicability of microscopic methods to the study of water-supply prob- 
lems, by E. M. Chamot 213 

The significance of chemistry in water purification, by Edward Bartow 220 

The control of Asiatic cholera on international trade routes, by Allan J. Mc- 
Laughlin 228 

Fresh air and ventilation in the light of modem research, by C-E. A. Winslow. . 232 

CUmatologia dos campos do JordAo-S. Paulo, by Victor Godinho 247 

Nouveau proc6d^ pour la transfusion du sang, by Louis Agote 248 

Morning session of Subsection B of Section Vm, January 6, 1016. . . 251 
Unifonnaci6n de las estadfsticas demogr^cas y de la fecha de levantamiento 
de los censes de poblaci6n de los paises panamericanos, by Alvaro Covarru- 

bias Arlegui 2G1 

Informs sobre el deearrollo de la estadfstica demogrifica en la Repdblica de 

El Salvador, by Pedro S. Fonseca 261 

Morning session of Section Vm of January 6, 1016 263 

AnaphyUxis, by Richard WeU 263 

Teoria bioldg^ de la inmunidad, by Julio M^ndes 267 

m 



IV CONTBNTB. 

Pag©. 
Specific parenteral digestion and its relation to the phenomena of immunity 

and anaphylaxis, by J. Bronfenbrenner 278 

The mechanism and clinical significance of anaphylactic and pseudo-anaphylac 

tic skin reactions, by John A. Kolmer 287 

The relation of hay fever to anaphylaxis, together with a theory regarding the 

nature of anaphylactic phenomena, by G. H. A. Clowes 904 

Anaphylatoxin and the mechanism of anaphylaxis, by Richard Weil 308 

Hay fever and certain other local ani^ylactic phenomena referable to the respi- 
ratory mucous membranes, by A. Parker Hitchens and Claude P. Brown 315 

Seroterapia antipestosa intensiva (M^todo de Penna), by Jos^ Moreno 329 

£1 asma: sus causas, defectos e inconvenientes de un sdo m^todo exdusivo 
para curarla, como el m^todo de Efraim. Necesidad de varios tratamientos 

con relad^n a las varias causas asmatdgenas, by Jo86 A. Rampini 836 

Night session of January 6, 1016 839 

Los alienados delincuentee y los delincuentes alienados— Oeaci6n de mani- 

comios cziminales, by Genaro Giacobini 839 

Greacidn de tribunales para nifios, by Genaro Giacobini 841 

Bducaci6n fisica, moral e intelectual del nifio, seg^ la ciencia psiccddgica 

contempor^ea, by Grenaro Giacobini 842 

La heredo am<n^dad infttntil y su influencia social pedagogics. Higiene all- 

menticia del nifio, by Genaro Giacobini , 848 

La delincuencia y d crimen, su represidn cientlfica, by Genaro Giacobini 844 

Defensa profilictica del nifio contra las enfermedades infecdosas. Cread6n de 
un Institute Inter-americano de profilaxia infantil de las enfermedades infec- 
dosas, by Grenaro Giacobini 846 

General i^oblems and tendendes in cancer research, by Leo Loeb 847 

Experimental studies in heredity, by Maud Slye 364 

Factors in immunity to cancer, by James B. Murphy and John J. Morton 3d0 

Immunity to transplantable neoplasms, by William H . Woglom 382 

Tumor immunity, by E. E. Tyzzer 365 

Ghemotherapeutic experiments on rat tumors, by Richard Weil 382 

The application of chemical methods to the study of cancer, by CWmir Funk. 388 
Linf ocitosis sangufnea en loe sifiliticos (signo diagn68tico y pr(m<Setico) by 

C&ndido Patifio Mayer and Augusto Celestino Gourdy 394 

Granuloma ven^eo— Contribuci6n provisoria a su estudio hi8tol<3gico, by 

Federico Susviela Guarch 400 

Morning session of January 6, 1916 407 

Morning session of Subsection C of Seotion Vm, Jsnoary 6, 1016 407 

Contribuci6n al estudio de la etiologia y profilaxis de la tuberculosis deede d 

punto de vista socioldgico, by NicoUs A. Solano 407 

La tuberculosis en Bolivia; su etiologia y profilaxia, by N^tor Morales Villaz6n . 437 

Profilaxia de la tuberculods, by Constancio Castells 447 

La tuberculosis en d Uruguay, by Joaquin de Sdterain 461 

A tooth is more valuable than a diamond, by Felipe Gallegos 466 

Joint session of Subsection E of Section Vm and tlie Amezioan Associa- 
tion for Oanoer Beseardi 472 

Further evidence that crown gall of plants is cancer, by Erwin F. Smith 472 

Cancer problems in special biological groups — ^fish tumors— further observations 

on so-called carcinoma of the thyroid, by Harvey R. Gaylwrd 490 

Tissue cultures in cancer, by Robert A. Lambert 493 

The tissue culture in cancer, by Montrose T. Burrows 494 

A mechanistic theory of cancer, by G. H. A. Clowes 496 

Radium in experimental cancer, by Francis Carter Wood 600 

Radium in the treatment of cancer, by William Duane 603 



CONTENTS. V 

Page. 
Pathological aapecta of some problems of experimental cancer research, by 

James Ewing 512 

Serodiagnostic methods in cancer reactions of Freund and of v. Dnngem, by 

A. F. (3oca 620 

Teratoma de la r^6n del tuber cinereum, by Guillermo A. Bosco 522 

IComing session of January 7y 1016 529 

General biology of the protozoan life cycle, by Gary N. Calkins 529 

The claasification of the parasitic amebie of man, by Charles F. Craig 536 

The biological and medical significance of the intestinal flagellates, by Charles 

A twood Kof oid 546 

Discovery and identification of the stages in the asexual cycle of the causative 

organism of Peruvian verruga, by Charles IT. T. Townsend 565 

Un nnevo flagelado de las plantas (leptomonas elmassianii) by Luis £ . Migone. . 572 

Paraaitologfa de ciertos animales del Paraguay, by Luis E. Migone 578 

M^todo de Ascanio para la coloraci6n de los parisitos del paludismo, by Rafael 

Gonz^ez-Rincones 576 

Adrenalin in amebic dysentery, by Theodore Bayma 578 

Afternoon session of January 7, 1016 586 

The mortality from cancer in the Western Hemisphere, by Frederick L. Hoff- 
man 686 

The relation of modes of infection to the control of bacterial diseases In Pkm 

America, by M. J. Rosenau 605 

On the inhibited properties of magnesium sulphate and their therapeutic appli- 
cation in tetanus, by S. J. Meltzer 607 

Observacionee sobre par^tos tropicales, by Rafael Gonzdlez-Rincones 615 

A method of approach in teaching sex ethics to girls and young women, by Wil- 
liam R. Manning 618 

Antirabic vaccination in Habana with statistics compared with those of other 

nations, by Juan Santos Feraindez 635 

Ensayo sobre profilaxia de la sffilis y la blenorragia, by Joaqufn Travieso 637 

Horbosidad y mortalidad infecto-contagiosa en el Uruguay, by Alfredo Vidal y 

Fuentes 641 

A historical r6siun^ of the investigations of yellow fever leading up to the findings 

of the Reed Board, by Geoige M. Sternberg 646 

Adjournment sine die of Section VIII 652 



Letters of TransmittaL 



Washinoton, D. O.y May SI, 1917, 

Sib: Punuant to the recommendation of the executive committee of the Second 
Fui American Scientific GongresB, which was held in Washington December 27, 1915- 
January 8, 1916, and by the cooperation of the United States Congress (oigent defi- 
ciency bill, Sept. 8, 1916), the papers and discussions of that great international 
scientific gathering have been compiled and edited for publication under the able 
direction of the Assistant Secretary General, Dr. Glen Levin Swiggett. In this 
volume is contained the report of Section YIII, of which Gen. W. 0. Gorgas, of 
the executive committee, was chairman. 

In my formal report, which has already been submitted, I enlarged upon the 
importance of tiie Second Pan American Scientific Congress, its laige attendance, and 
the high quality of its papers and discussions. I will, therefore, in this letter, which, 
in slightly varied f(»m, introduces each volume, make only a few general references. 

All of the 21 Republics of the Western Hemisphere were represented by official 
delegates at tiie Congress. Unofficial delegates, moreover, from the leading scientific 
associations and educational institutions of these Republics pre s en ted papers and 
took part in its deliberations. The papers and discussions may be considered, there- 
fore, as an expression iA comprehensive Pan American scientific effort and poss ow , 
in consequence, inestimable value. 

The Congress was divided into nine main sections, which, with their chainnen, 
were as follows: 

I. Anthbopoloot. W. H. Holmes. 

II. AsTBONOMT, Mbtboboloot, AND Sbumoloot. Robert S. Woodward. 

III. Consbbvation of Natubal Rbsoubobs, Agriculture, Irrigation, and Forestry. 
George M. Rommel. 

lY. Education. P. P. Claxton. 
v. Enoinbbbino. W. H. Bixby. 

VI. lNTBBNATIONALLAW,PnBU0LAW,ANDJUBISPBUDBN0B. JameS BrOWU ScOtt. 

VII. MiNiNo, Mbtallubot, Eoonomio Gboloot, and Appubd Chbmibtbt. Hen- 

nen Jennings. 
YIII. PuBuo Hbamth and Mbdigal Scibnob. William C. Gorgas. 

IX. Tbanspobtation, Commbbob, Finanob, and Taxation. L. S. Rowe. 

These sections, in turn, were further subdivided into 45 subsections. 

Over 200 delegates were in attendance from the Latin American Republics, while 
over a thousand from the United States participated in its meetiogs. The discussions 
and proceedings of the Congress attracted world-wide attention, and it was undoubt* 
edly the greatest international scientific meeting that has assembled anywhere in the 
history of the Western Hemisphere and possibly of the world. It was, therefore, a 
fitting successor to the first Pan American Scientific Congress, which assembled in 
Santiago, the capital of Chile, in 1908, and to its predecessors, confined to lAtin 
American representation, which in former years met, respectively, in Rio de Janeiro, 
Montevideo, and Buenos Aires. Its success was a logical result of these preceding 
gatherings in Latin America and of the hearty cooperation of the Latin American 
Governments and scientists. 

To thoee who may have their attention brought only to the individual volumes 
covering the papers and discussions and who wish to know more of the proceedings of 
the Congress and the results accomplished by it» it is recommended that they should 

▼n 



Vin LETTEBS OF TBAK8MITTAL. 

also read *'The Final Act — ^An Interpretative Commentary Thereon/* prepared under 
the direction of Dr. Jamee Brown Scott, reporter general of the Congrefls, and the report 
of the secretary general, prepared by the latter and the assistant secretary general, 
Dr. Glen Levin Swiggett. In these will be found not only the final act and the 
illuminating comment thereon but lists of delegates, participating Governments, 
societies, educational institutions, and other organizations, together with a careful 
story and history of the Congress. They can be obtained by addressing the Director 
General of the Pan American Union, Washington, D. C. 

In conclusion, I want to briefly repeat, as secretary general of the Congress, my 
appreciation, already expressed in my formal report, of the hearty cooperation in 
making the Congress a success given by everyone concerned from the President of 
the United States, yourself as Secretary of State, and the delegates of Latin America 
and the United States, down to the office employees. The great interest manifested 
by the permanent executive committee, headed by Mr. William Phillips, then Third 
Assistant Secretary of State, the Carnegie Endowment for International Peace through 
its secretary, Dr. James Brown Scott, and the executive aid of Dr. Glen Levin Swig- 
gett, as assistant secretary general, were vitally instrumental in making the gathering 
memorable. The Pan American Union, the official international organization of all 
the American Republics, and whose governing board is made up of the Latin American 
diplomats in Washington and the Secretary of State of the United States, lent the 
favorable influence of that powerful organization to the success of the Congress and 
authorized me as the director general of the Union to also take up the duties of secretary 
general of the Congress. 

Yours, very truly, 

(Signed) John Barrett, 



The Honorable The Sbcrbtary of State, 

Washington, D. C. 



Secretary General. 



Washinqton, D, C, si de maio de 1917, 

EzMO. Snb.: Em cimiprimento de imia recommenda^fto emanada da Commissfto 
Executiva do Segundo Congresso Scientifico Pan Americano, que teve lugar em 
Washington, de 27 de dezembro de 1916 a 8 de Janeiro de 1916, e, devido ao auxilio do 
Congresso dos Estados Unidos (Lei para Or^amentos extraordinarios de 8 de setembro, 
1916) as memorias e as discussSes dessa assemble scientifica intemacional, foram 
coUigidas e preparadas para publicay^ sob a proficiente direct do Secretario Geral 
Adjuncto, Dr. Glen Levin Swiggett. Este volimie comprdiende o relatorio da sec^fto 
VIII que foi presidida x>elo General W. C. Gorgas, da Commiss&o Executiva. 

No men relatorio official, que j& tive a honra de apresentar, me detive sobre a impor- 
tancia do Segundo Congresso Scientifico Pan Americano, da sua grande concorrencia 
e da alta importanda das theses e das discussGes. Na presente nota, portanto, de uma 
maneira muito ligeira, destinada a apresentar cada um dos volumes, eu farei apenas 
algumas referencias muito geraes. 

Todas as RepubUcas do Hemispherio Occidental, vinte e uma em numero, se 
achavam representadas por del^ados officiaes ao Congresso. Delegados sem nomea- 
^ dos Gtovemoe, mas representando as mais notaveis sociedades scientificas e 
instituigOes de ensino dessas republicas apresentaram theses e tomaram parte nas 
delibera^des. As memorias e discus85es devem ser consideradas portanto, como a 
ezpressfto de um justificavel trabalho scientifico Pan Americano e possue, por esse 
motive, um valor sem egual. 

O Congresso foi dividido em novo secgdes principaes, que a seguir enum^, com 
OS nomes doe sens presidentes: 

I. Anthropolooia. W. H. Holmes. 
II. Astbonomia, Mstbreologia e Sismolooia. Robert S. Woodward. 



LBTTEB8 OF TBAKSMITTAL.. IX 

III. CON8BBYA9IO DA RlQUBZA. NaCIONAL, AoRICULTURA, iBRIOAgXO E SlLVI- 

cuiTUBA. George M. Rommel. 
IV. IN8TRUG9I0. P. P. Claxton. 
V. Enoenhabia. W. H. Bixby. 
VI. DmEiTO Internacional, Dibbito Pubuco b Jurispbudencia. James 

Brown Scott. 
VII. M1NA8, Mbtalluboia, Gbolooia Pbactica e Chimica Industrial. Hennen 
Jennings. 
VIII. Saude Pubuca b Sciencias Medicas. William 0. €N>rga8. 

IX. VIA8 DE COMMTTNICAplO, COMMERGIO, FiNANpAS B ImPOSTOS. L. S. RoWO. 

Estas secedes, por sea lado, eram subdivididas em 45 subsec^des. 

Mais de 200 delegados das Republicas da America Latina frequentaram as sessdes 
emquanto oe Estadoe Unidos se achavam representados por mais de mil pessoas. As 
discnasOee e 00 relatorioe do Congresso attrahiram a attengfto de todo o mundo e ioi 
Bern duvida a maior assemblea scientifica que se realizoa no Hemispherio Occidental 
e talvez em todo o mundo. Foi sem duvida um idoneo continuador do Primeiro Con- 
gresso Scientifico Pan-Americano, que se celebrou em Santiago, capital da Republica 
Chilena em 1908 e das anteriores assembleas que previamente se tinham realizado, 
apenas com delegados da America Latina e que se reuniram em annos anteriores no 
Rio de Janeiro, Montevideu e Buenos Aires. O seu succeeso foi um resultado logico 
das reunides previas na America Latina e do cordial concurao doe Govemos da America 
latina e dos sens homens de scienda. 

A aqueUes que nfto quiserem limitar-se a consultar os volumes que cont^ as 
memcHias e as discussOes e que desejarem conhecer alguma cousa mais dos trabalhos 
do Congresso e dos resultados por elle alcan9ado se Ihes recommenda a leitura da 
Acta Final— a exposi^fio geral concemente i mesma— publlcada sob a direct do 
Sr. Dr. James Brown Scott, Relator Geral do Congresso, e o relatorio do Secretario 
Geral, preparado i>elo abaixo assignado e x>elo Secretario Geral Adjuncto Sr. Dr. 
Glen Levin Swiggett. Nestes trabalhos encontrar-ee-hfio nfto stoente a acta final 
mas tambem um magnlfico commentario, a lista dos delegados doe Govemos que 
adherinun, sociedades, instituigC^ de ensino e outras corpora^Ges, seguidas de uma 
cuidadosa historia do Congresso. Estes volumes continuam i dispoei^io dos que os 
pedirem ao Director Geral da Unifto Pan-Americana, Washington, D. C. 

Em conclusfto, eu desejo repetir, em duas palavras, como Secretario Greral do Con« 
gresBo, o men apre^o e reconhecimento, que }i tive occasiSo de ezprimir no men 
relatorio official, pela cordial coopera^fto que por todos me foi prestada para levar 
a bom exito este congresso, desde o IVesidente doe Estados Unidos, V. Exa., como 
Secretario d'Estado, os Senhores Delegados da America Latina e doe Estados Unidos 
at^ OS diversos funccionarios do Congresso. O grande interesse manifestado pela 
CommlssSo Permanente Executiva presidida pelo Sr. William Phillips, ao tempo 
terceiro Sub-secretario d'Estado, pelo Instituta de Carnegie para a Paz Intemacional 
na pessoa do Sr. Dr. James Brown Scott, assim como a collabora^fto prestada pela Sr. Dr, 
Glen Levin Swiggett, como Secretario Geral Adjuncto, constituiram obras baailares 
para o successo desta reuni&o. 

A Unifio Pan-Americana, institui^So intemacional sustentada por todas as Repu* 

blicas Americanas e cujo Conselho de Administra^fto 6 constitoido pelos represent 

tantes diplomaticos em Washington e pelo Secretario d'Estado dos Estados UnidoSi 

contribuiu com a sua poderosa influenda para o bom exito do Congresso e me aucto- 

rizou a servir de Secretario Geral do Congresso. 

Com a maicnr considera^fto, subscrevo-me 

De V. Exa., 

Vor. Mto. Atto., 

John Barrbtt, 

SeemarioChnh 
Exmo. Snr. Sbcrbtabio db EsTADOy 

WoikingUm, D. C. 



X LBXTEB8 OF XBA14I3MIIXAL. 

WASHiNOTONy D. G.y SI d€ mopo de 1917. 
SbAob: 

En cumplimiento de una recomendaci6n emanada de la Ck>mi8i6n Ejecutiva del 
8^;undo Gongreso Cientffico Panamericano que ae reuni6 en Washington deede el 
27 de didembre de 1915 hasta el 8 de enero de 1916 y gracias a la cooperaci6n al efecto 
prestada por el Gongreso de lofl Estados Unidos mediante bu ley sobre lectificaci^n del 
presupuesto dictada el 8 de eetiembre de 1916, h^se recopilado y preparado para 
BU publicaddn, bajo la hdbil dlrecci^n del Sr. Dr. Glen Levin Swiggett, Subeecretario 
General, las memoriaB presentadas a dicho Gongreso y los debates a que dieron lugar. 
El presente volumen contiene el informe relative a la Secci<Sn VlII, de la cual Iu6 
preddente el General W. G. Goigas, miembro de la Gomisi6n Ejecutiva. 

En el informe general que ya tuve el honor de preeentarle, me fu^ dable considerar 
detenidamemte la importancia del Segundo Gongreso Gientffico Panamericano, la 
numerosa concurrencia que al mismo asistid y el elevado m^to de las memorias 
presentadas y de los debates que en aqucl se suscitaron. Por consiguiente, he de 
limitarme en la presente, destinada a servirle de mera introducci6n a cada uno de los 
voldmenes, a algunas consideraciones de caricter general. 

En el Gongreso estuvieron representadas por medio de delegaciones ofidales las 
veinte y una repdblicas del Hemisferio Occidental. Tambi^n asistieron al mismo, 
tomando participaci6n en sus debates y presentando trabajos peisonales, delegados 
particulares de los principales cuerpos cientificos y de los institutos docentes de esas 
mismas repdblicas. En toX virtud, las memorias y los debates mencionados deben ser 
considerados como la expresi6n de un amplio eshierzo cientifico panamericano, 
encerrando, por lo tanto, un valor inestimable. 

El Gongreso estuvo dividido en nueve secciones principales que en seguida paso a 
enumerar junto con el nombre de bus presidentes. Fueron las siguientes: 

I. ANTBoroLOGiA. W. H. Holmes. 

II. AsTRONOidA, MbtbobolooIa y SiBMOORAFiA. Robert S. Woodward. 

III. GONBBBVAadN DB LAB FUBNTEB NaTURALBS DB RiQUBZA, AoBICULTURA, 

iBBioAciiN T Sblvigultura. Gooige M. Rommel. 

IV. In8truogi6n. p. p. Glaxton. 

V. InobnibbIa. W. H. Bixby. 

VI. Dbbbcho Intbbnacional, Derbcho Pi^blico y Jubispbudbncia. James 
Brown Scott. 

VII. MiNBBiA, Metalubqia, GeologIa Econ6mica y QufMiCA Apucada. Hen- 
nen Jennings. 

VIII. Salubbidad Pi^buca y Giencia MimoA. William G. Goigas. 

IX. Tbaspobtb, GoMBBao, FiNANZAB B Impuestos. L. S. Rowe. 

Estas secciones estuvieron dividas, a su vez, en cuarenta y cinco subsecciones. 

De las repdblicas latino-americanas asistieron m^ de doscientos delegados; en 
tanto que las sesiones del Gongreso concurrieron m^ de mil personas de los Estados 
Unidos. Los trabajos y debates del cuerpo despertaron universal interns, pues indu- 
dablemente fu6 aquel la asamblea cientffica mds grande que registra la historia del 
Hemisferio Occidental y probablemente la del mundo. 1^1 fu6, en consecuencia, digno 
continuador del Primw Gongreso Gientifico Panamericano que en 1910 se reuni6 en 
la capital de Ghile y de los que previamente y con una asistencia exclusivamente 
latino-americana se habfan congr^ado en Rio de Janeiro, Montevideo y Buenos 
Aires. Su 6xito fu6 consecuencia l^ca de las asambleas que anteriormente se habfan 
reunido en la AmMca latina y del cordial concurso que recibid de los gobiemos y 
de los hombres de ciencia de eea misma parte de America. 

A cuantos no quisieren limitarse a consultar los voldmenes que contienen als 
memorias y los debates y desearen conocer algo mils de las labores del Gongreso y de 
los resultados por 41 alcanzados, se les recomienda la lectura del Acta F^inal y de la 
Exposici6n General concemiente a la misma que escribid el Dr. James Brown Scott, 
Informante General del Gongreso, asf como el Informe del Secretarlo General, prepa- 



LBITEBS OW IBAHSMUIAU XI 

rado por el suscrito y per el Dr. Glen Levin Swiggett, Subsecretario General del 
mismo. £n esrtofl documentoR podr^ hallar no 86I0 el Acta Final y luminoflas consi- 
deraciones acerca de la muuna, sino tambi^n la n6mina de los delegadofl y de loe 
gobiernoe, sociedades e insdtutoe docentes que tuvieron repre8entaci6n en la Asamblea, 
j untainente con una relaci6n puntualizada de las labores de la miama. LO0 que deseen 
obtenw estoe voldmenes pueden aolicitarloe del Director General de la Uni6n Pan- 
americana en W&ahington, D. 0. 

Oomo Secretarlo General del Gongreso deseo hacer conatar una ves m^, antes de 
concluir, el agradeoimiento que en mi informe general expresd por el cordial concurso 
que de todoe redbf para asegurar el 6xito del Congreso, desde el Presidente de los 
Efltados Unidoe y usted mismo como Secretario de Estado y desde los delegados de 
la America Latina y de los Estados Unidos hasta los dlversos funcionarios del Congreso. 
£1 gran inter^ desplegado por la Comiai6n Permanente Ejocutiva, que pre8idJ6 el 
Sr. William Phillips, a la saziSn Tercer Subsecretario de Estado; por la Fundaci6n 
Oamegie para la Paz Intemacional, por el 6rgano de su Secretario, Dr. James Brown 
Scott; asf como la colaboraci6n del Dr. Glen Levin Swiggett, Subsecretario General, 
contribuyeron poderosamente a hacer memorable la aaamblea. La Uni6n Pan- 
americana, institucidn intemacional sostenida por todas las repliblicas de America y 
cuyo Consejo Directive estd formado por los representantes diplom&ticos latino- 
ameiicanos residentes en Wdahington y por el Secretario de Estado de los Estados 
Unidos, tontribuy6 con su poderosa influencia al ^xito del Congreso y me autorixd 
para que desempefiara las funciones de Secretario General de aqu61. 

Con sentimientos de la m^ alta consideraci^n me subscribe 

De usted muy atmito sorvidor, 

John Barbbtt, 

Secretario General. 
Al Honorable Secretario de Estado, 

Wdshingtan, D. C. 



Washinoton, D. C, jL< 51 mat J 917, 

Monsieur: Conform^ment k la recommandation du Comity Ex^utif du Second 
Ccmgrte Sdentifique Panam^ricain qui a eu lieu k Washington du 27 d^embre 1915 
an 8 Janvier 1916, et par la cooperation du Congrte des Etats-Unis Ooi du budget 
extraordinaire, 8 septembre 1916), les m^moires et discussions de cette grande reunion 
•oientifique Internationale ont 6t6 recueillis et 6ditds pour 6tre public sous Thabile 
direction du docteur Glen Levin S wiggett sous-secretaire general . Ce volume contient 
le rapport de la section VIII, dont M. le General W. C. Gorgas du Comity Exdcutif 
etait president. 

Dans men rapport officlel qui a 6t6 d^j^i soumis, je me suis etendu sur Timportance 
du Second Congr^ Scientifique Panam^ricain, sur le grand nombre de personnes qui 
y etaient pr^sentes et sur Texcellence de ses m^moires et de ses discussions. C'est 
pourquoi, dans cette lettre qui, aprte avoir subi quelques changements sans impor- 
tance, sert d'introduction k chaque volume, je n'en parlerai que d'une manito 
gen^rale. 

Toutes les r^publiques de rH^misph^re Occidental au nombre de vingt-et-une 
etaient representees au Congres. De plus, des deiegues k titre offideux envoyes 
par les associations scientifiques et les institutions educatives les plus en vue de ces 
republiques ont soumis des memoires et ont pris part aux deliberations. On peut 
done considerer les memoires et les discussions comme I'expression d'un grand effort 
scientifique panamericain, possedant en consequence une valeur inestimable. 

Le Congr^ etait divise en neuf sections principales que nous enumerons ci-dessous, 
en donnant le nom de leurs presidents. 

I. ANTROPOLoaTB. W. H. Holmes. 

II. AsTRONOMiE, MirAoROLOOiB ET SisMOLOoiB. Robert S. Woodward. 



XII LETTEB8 OF TBAKSMITTAL. 

III. Conservation des Rebsources Naturellss, Aoricui/fure, Irrioatioh 
BT FoR^TS. George M. Rommel. 

IV. Instruction Publiqub. P. P. GUxtcm. 

V. GAnib Civil. W. H. Bixby. 

VI. Droit iNTBRNATioNAii, Droit Public bt Jurisprudrnck. James Brown 
Scott. 

VII. Minks, M^alluroib, Gioi/>oiB pratique, ct Chimib AppuquAb. 
Hennen Jennings. 

VIII. SantA Publiqub bt ^ibncb MAiuoalb. William C. Gorgas. 

IX. Transport, Comufrcb, Finance it iMpdr. L. S. Rowe. 

A leur tour ces sections ^taient !*ubdivis^ en quarante-cinq sous-sections. 

On y cH>mptait plus de deux cent«« d^l^i6s des rdpubliqnes latino-am^ricainee, et 
plus de mille d^I^u4s des Etutd-Unl** ont assist^ aux reunions. Jjq» discussions et 
les proc^s-verbaux du Congr^ ont attir^ Tattention dii monde entier, et il a M sans 
le moindre doute la plus ^nrande a»?emb16e sciontifique intemadimale de I'hl^toire 
de rH^misph6re Occidental, et peut-6tre mfimedu mor.de pnder, quise soit r^unie jus- 
qu'ici. Venant apr^s le Premier Congr^ Scientifiqie Panam^ricaic qui p'cst r^uoi k 
Santiago, capitaledu Chili, en 1908, et apr .sceux qui ont eu lieu pr^c6demment, respec- 
tivement ^ Rio de Janoiro, k Montevideo et k Buenos- Ayree, cos demiers n'ayant que 
des repr^Swntants de T Am^rique Latine, il s'est montr^ leur digne successeur. 8a r^us- 
site a 6t6 un lo^que r^iiultat do ce« pr6c^ents concours dans VAm^rique Latine et de 
la sincere et cordiale ci operation des gouvemements et des hommes de science de 
I'Am^riqne Latine. 

Pour ccux qui n'ont port^ leur attention que sur lea volumes renfermant les m^moired 
et les dipcussious, et qui d^reraient connnttre d'une msni^re plus approfondio les 
act?s et proc^-verbaux du Conp*^, ainsi que les result >ts qui e*on Ront sui\is, je leur 
conseillerai de lire "L'actf- Fiiul, Oommontsire explicatif,'* r^dijr6 sous la direction 
dTi docteur James Brown Scott, rapporteur general du Congr^, ot le rapport du Secre- 
taire G6n4ra] r6dig6 par ce dernier et le doc teur Glen Levin Rwiggett. En les lisnnt 
en n'y trouver? pad soulemont TActo Final et le commentaire cxplicatil, mais encore 
les listcs dw3 a^l6&ru^, des gouvemements qui ont particip^ au Congr^s, des soci'^tA^, 
des institutions Mucatives et aiitres, en mdme t mps qu'iic compte lendu s<»gn4 
ainsi que Vhistoire du Ccngr^. On pent se les procurer en lai^nt une demande par 
toit au Direclenr G^n^ral de TUniop Pai.am^ric ine ^ Wapbin^ton, D. C. 

En terminant, je vais en quality de Secretaire G^n^ral du Congr^s exprimer de 
nouveau en peu de mots mes remerctments, ce que j'ai d^j^ fait dans mon rapport 
officiel pour la part que chacun a eue dans la r^usaite du Congr^s depuis le President 
des £tats-Unis, vous comme Secretaire d'etat, les dei^gu^s de I'Am^rique Latine et 
ceux des £tats-Unis jusqu'aux employes de bureau. Le haut int^r^t manifeste par 
ie Comite Ex^cutif permanent preside par M. William Phillips, qui etait alors troisidme 
Sous-Secretaire d'£tat, par la Fondation Carnegie pour la Paix Internationale, par 
I'entremise de son secretaire le docteur James Brown Scott, et Taide prdte dans I'exe- 
cution par le docteur Glen Levin Swiggett, comme sous-secretaire general, ont puisaam- 
ment contribue k foire de ce Congr^ un evenement memorable. L'Union Panameri- 
caine, administration officielle intemationale de toutes les republiques americaines, 
et dont le Comite d 'Administration est compose des diplomates latino-americains k 
Washington et du Secretaire d'etat des £tats-Unis, ausede sa favorable influence pour 
assurer le succ^ du Congr^ et m'a autorise, en qualite de Directeur General de 
I'Union, k prendre en mains les responsabiiites de Secretaire General du Congr^. 

Veuillez agreer, M. le Secretaire d'etat, en mdme temps que mes reepectueux 

hommages I'assurance de mon entier devoOment, 

John Barrbtt, 

Secretaire GhUral. 

Monsieur le Sbcr^tairb d'£tat, 

Washingtont D, C. 



REGISTER OF WRITERS OF PAPERS. 



SBCX>ND PABT. 

Page. 

Agote, Louis 248 

Bartow, Edward 220 

Bayma, Theodoro 678 

Boaco, Guillenno A 522 

Bronfenbrenner, J 278 

Brown, Claude P 315 

BmrowB, Montrose T 494 

Calkins, Gary N 529 

Oastells, Oonstancio 447 

Oatoni, Julio L 167 

Chamot,E. M 213 

Clowes, Q.H. A .' 304,496 

Coca, A. P 520 

Covairubias Arlegui, Alvaro 251 

Oraig, Charles P 536 

Duane, William 603 

Ewing, James 512 

Pem&ndes, Juan Santos , 635 

Fethenton, J. T 190 

Ponseca, Pedro S 261 

Funk, C^mir 388 

GaUegoe, Felipe 465 

Gaylor, Harvey R 490 

Giacobini, Genaro 339, 341, 342, 343, 344, 346 

Godinho, Victor 247 

Ck>ldbeiger, Joseph 3 

GonzAles-Rinconee, Rafael 576» 615 

Gourdy, Augusto Celestino 394 

Heoi, Alfred F 48 

Hitchens, A. Parker 315 

Hoffman, Frederick L 586 

Jordan, Edwin O 205 

Kofoid, Charles Atwood 546 

Kolmer, JohnA 287 

Lambert, Robert A 493 

Lebredo, Mario Q 29 

Loeb, Leo 347 

Manning, William R 618 

McLau^ilin, Allan J 228 

Meltaer, S.J 607 

Mendel, Lafayette B 112 

M^nde«.JuUo 267 

Migone.LuisE 572,673 



XIV BBGISTBR OP WRITERS OF PAPERS. 

Page. 

Morales Villazdn, NMor 437 

Moreno, Jo«6 329, 335 

Morton, John J 360 

Murphy, James B 360 

Patifio Mayer, Cdndido 394 

Rampini, Jo86 A 325 

Rosenau, M.J 605 

Salterain, Joaqufn de 451 

Sarmiento Laspiur, Ricardo 130 

Sedgwick, William T 187 

Slye, Maud 354 

Smith, Erwin P 472 

Solano, NicoUs A 407 

Soper, George A 173 

Sternberg, George M 645 

Susviela Guarch, Federico 400 

Torres Umafta, Galixto 52, 105 

Townaend, Charles H. T 565 

Tra vieso, Joaquin 637 

Tyzzer, E. E 365 

Vedder, Edward B 22 

Vidal y Fuentos, Alfredo 641 

Weil, Richard 263,308,382 

Weinzirl, John 127 

Williams, Robert R 39 

Winslow, C.-E. A 232 

Woglom, William H 362 

Wood, Francis Garter 500 



FOREWORD. 



The work of the hygienic section has been most valuable. It has 
already produced excellent results in causing the Rockefeller Foun- 
dation to undertake the work of exterminating yellow fever. All 
the South American countries affected by this disease have agreed 
to cooperate, and if it had not been for the European war the work 
would have now been well under way. 

(Signed) W. C. Gorgas, 

Chairman, 

XV 



GENERAL SESSION OF SUBSECTION Vm. 

New Ebbitt Hotel, 
Moviday morning, Jannunry 5, 1916. 

ChairmaQy Surg. Gen. Rupebt Blue. 

The session was called to order at 9.30 o'clock by the chairman. 

The Chairman. The session will please come to order. Dr. 
Qoldberger is to present the first paper. 

A RfiSUMfi OF SOME OF THE RECENT STUDIES OF THE UNITED STATES 
PUBLIC HEALT H SER VICE RELATING TO THE CAUSATION AND TO A 
METHOD OF PREVENTING PELLAGRA. 

By JOSEPH QOLDBERGER, 
Swrgeon, United 8tate$ PiMie Health Smnce. 

Introduction, — One of the outstanding featuiee of the epidemiology of pellagra is 
the striking relation of the disease to poverty. In reflecting on this and in consider- 
ing the elements that differentiate poverty from affluence, diet, in view of the con- 
spicuous place it has always had in discussions of the disease, naturally arrested 
attention. Approaching the problem of the possible relation of diet to pellagra in 
this way, it seemed permissible to assume, on the one hand, that the diet of the poor^ 
that is, of those who as a class are the principle sufferers from the disease — ^is few some 
reason pellagra-producing and, on the other, that the diet of the well-to-do, who, as 
a class, are practically exempt is. Ion some reason, pellagra-preventing. The thou^t 
was near, therefore, that it mig^t be possible to prevent the disease by providing 
those subject to pellagra with a diet such as that enjoyed by well-to-do people. Early 
in 1914 it was proposed to put this idea to a practical test. Befoie this test was 
actually begun, studies of the prevalence of pellagra at institutions, such as prisons, 
asylums, and orphanages were made, the results of which, in the li|g}it of the recent 
advances in our knowledge of beriberi, very strongly suggested the idea that the dia> 
ease was dependent upon a diet that was for some reason faulty, and that this fault was 
in some way either prevented (w corrected by including in the diet suitable propor- 
tions of the fresh animal protein foods and legumes.* 



> Prof. VoagtUn UUi mt thtt si ftbont the mom or tren proviout to this time, ho had indopoodcntlj 
fonnod aonioirlMt fimnar viowi which ho protontod in o pttpor rood Juno 26^ 1914, ol tho rnooUnc of tho 
Amoricon Hodical AModotion, sod imblithod in tho Joarnol of tho Amorlora 

S8, 1914. Tho bllowtnc qoototiooo from thlo popor wOl givo tho itiidont of thofobiloct tho OMiHob of 
VoogtUn't oonooptSon: 

" From o forroy of tho eUnlooI and potholofio atpocU of poUofra, I hoTO trrivod ot tho oonehMloii that 
wo aro doaliof with a chronio intoxioatlon. Whilo tho aicanto at work in this intoxication aro ao yot on 
known, I am InoUnod to hoUo?o that toxlo ■qbo>ancoi ozlst in oortain Ttcotablo foodi, not nocoMorlly 
■poilod, which If oonoomod b7 man ovir a long poriod of timo may prodnoo an li^|iirloiit offoct on otrtaln 
orgaiMofthohody. This hypothosb dooo not nilo out tho pooribtllty that a diotary doOcioncy, • • • 
(Titamino) * * *. may play a rMo In tho production and troatuMot of pollacra. BxtoulTO fooding 

68486— 17— VOL x ^2 B 



4 PBOCfiEDINGS SECOND PAN AMEBICAN SCIENTIFIG C0NGBE88. 

Theee findings not only confirmed the original conception, but helped in defining 
this more clearly, and, moreover, made it possible to formulate more definite plans, 
which were temporarily broadened to include a test of diet in the treatment as well as 
in the prevention of the disease. 

TRBATMBNT. 

At the suggestion of the writer, Dr. W. F. Lorenz, who was at that time studying 
the ps}'chiatric manifestations of pellagra at the Georgia State Sanitarium, treated a 
series of 27 cases in the insane at that asylum exclusively by diet. Considering the 
character of the cases with which he was dealing his results, as well as those of Dr. D. G. 
Willets, who for a time continued the work begun by Lorenz, were notably favorable. 

When the various recent methods of treatment, each warmly advocated by ita 
author, are critically reviewed in the light of the test made by Lorenz and by Willets, 
one can hardly foil to be impressed by the fact that the one thing they all appear 
to have in common is the so-called '^ nutritious diet,'' and it is difficult to escape the 
conclusion that it is to this single common factor that the marked success that is 
usually claimed for the ''treatment" should properly be assigned. 

It is of much interest to note that fully 50 years ago Roussel (Roussel, 1866, pp. 
529-^530), on the basis of long experience and from a critical review of the literature of 
his day, came to precisely the same conclusion. This is so much to the point that 
it is quoted herewith: 

Without dietetic measures all remedie$ fail.* « « « When drugs and good food 
are simultaneously employed, it is to the latter that the ciuative action belongs; the 
former exercises simply an adjuvant action and is without approved efficacy except 
against secondary changes or accidental complications. 

Hereafter the clinician who would attribute therapeutic value to any drug or other 
remedy in the treatment of pellagra should be prepared to show, what has not hereto- 
fore been done, that the curative effect claimed can not be attributed to the diet. It 
is true that the claim is not infrequently made that the beneficial effects of the remedy 
advocated were obtained without any change in diet. When the claim is critically 
considered, however, it amounts usually simply to this, that the observer gave no 
instructions as to a change in the patient's diet or assiunes that such change as was 
made was too slight to merit consideration. It should not be overlooked that the 
symptoms of the disease (sore mouth, diarrhea) are very frequently such that the 
patient, entirely on his own initiative, may or does add or increase the proportion 

exp«rtmeDt8 vUdi I havt carrtod on during the hut year with anhnahi, each as mice, rata, and a few mon- 
keys, on an exclusive vegetable diet, have shown that these lower animals develop certain gastro-intestlnal 
symptoms, and sometimes die if pat on an exdosive diet of com, carrots, sweet potatoes, oats, etc. Symp- 
toms arise often within three or four days, which point to the presence of an intoxication in these animals. 
Death resulted in some cases in a remarkably short time (three or four days). At necropsy constant leslona 
were found, such as hyperemia and hemofriiage in the gastro-intestinal canal. Sometfanes the kidneys, 
lanp, and other organs show a oongestion and sli^tly hemorrhagie condition. * * * 

" It is probably more than a mere coincidence that the population of that part of the world in which pel- 
lagra is endemic Uves on a mainly vegetable diet. 

"The recent advances in the field of nutrition suggest new avenues of approach to the solution of this 
difficult problem. One will have to consider very seriously: 

" 1. A deficiency or absence of certain vitamins In the diet. 

"2. The toxic effect of some substances, as aluminum, which occur in certain vegetable food. (The 
possible relation between aluminum and pellagra was also discussed in a recent monogn^ by Alessan- 
drini and Scala, Gontributo nuova alia etiologia e pathogenesi della Pellagra, Roma, 1914, which the author 
received at the time of proof reading. These invietigators claim that colloidal silica contained in drinking 
water is one of the most important etiologio Cactors. inasmuch as they succeeded in producing lesions 
resembling pellagra in animate fed on water containing colloidal silica. Colloidal almninam hydroxid 
or a mixture of colloidal silica and alumina produced the same results. In view of the liMst, first discovered 
by us, that aluminum occurs in certain vegetable food in relatively large amounts, the work of the Italian 
authors ftimishes additional evidence that aluminum occupies a prominent position in the etiology of 
pellagra.) 

**3, A defidency of the diet in certain amino-adds." 

1 Italics are Roussel's. 



PUBLIO HEALTH AKD MEDICnnB. 5 

of the liquids (milk, eggs, broth) in his diet. And this may be done even before the 
l^ymdan is consulted. 

Again, in order to substantiate the claims made for some particular remedy it is 
sometimes asserted that the patient's diet had all along included an abundance of 
the animal proteins and legumes. Careful inquiry in a number of such instances 
has almost invariably shown that what is meant in such cases is that either the family 
table was known or was assumed to be well supplied with these foods of which the 
patient was perhaps quite naturally assumed to have partaken abundantly. The 
important possibility that the patient by reason of a personal idiosyncracy or otherwise 
did not actually eat these foods is almost invariably overlooked. That these foods 
may in some degree enter into the pellagrogenous dietary calls, however, for no denial . 
Hie question always to be borne in mind is: Was it enough? The possibiUty, if not 
the probability, of a "twilight" sone within which a very slight chaoge in any of the 
dietary components may cause an important shift of balance is not to be overiooked. 
In the present state of our knowledge, therefore, the question of a sufficient proportion 
can not in all instances be answered on the simple statement of the case. That as a 
matter of hct the proportion of the foods in question in these, which may be called 
borderland cases, was not enough is very strongly suggested by the faivorable result of 
the simple expedient of having the patient continue the diet on which he is supposed 
to have subsisted, seeing to it, however, that there is actually consumed an abundance 
of the animal foods and legumes. This and the unsatis&ctory progress of those patients 
who for one reason or another fail or refuse to cooperate in taking the diet is decidedly 
illuminating. 

Such observations as the writer has been able to make strongly suggest that real 
recovery from an uncom]^cated attack may not take place untU after a minimum 
of about three or four months of full feeding of fresh animal proteins and legumes. 
But this should not be taken to mean that thereafter recurrences are impossible. 
A "recurrence, " so-called, may conceivably take place after the lapse of any interval 
if theie is a return for a sufficiently long period to a pellagrogenous— that is, "ftmlty " — 
diet. In pellagra, as in other conditions, the renewed operation of the essential 
causative factor may be expected to bring about a renewed manifestation of its effects. 

PBBVBNTION. 

In planning the test ci the preventive value of diet it was decided to take advan- 
tage id the universally recognised fact that "normally" pellagra tends to recur in 
the individual from year to year. 

In order to obtain as significant and decisive results as possible it was necessary 
to submit a large number ci pellagrins to the test under known conditions. Fortu- 
oatdy, two orphanages were found in liay, 1914, each having a high incidence <d 
pellagra among its inmates. Later this preventive test was extended to include two 
groups of insane at the Georgia State Sanitarium. 

In the study at the orphanages there was associated with the writer Asst. Surg. 
O.H. Waring, and in that at the Qeofgia State Sanitarium, Assistant Epidemiologist 
D. 6. Willeta. 

Orpkanage ttudy, ^-Tbe two orphanages at which the value of diet in the prevention 
d pellagra has been tested are located in Jackson, Miss. At both, cases of pellagra 
have been recognized for several years. During ibe spring and summer of 1914, up 
to September 15, a total of 209 cases of pellagra was observed in the children of 
t h o s e <Hrphanages. Althou^ a number of these at both institutions were known 
to be admission cases, others appeared to have developed first after considerable 
periods of residence, while a large proportion were in long-time residents. The 
factor or factors causing pellagra and favoring its recurrence seemed, therefore, to 
be operative at both institutions. 



6 PBOCBEDINGS SBOOKD PAN AMEBIOAK 80IBKIIFI0 C0K0BE8S. 

At both, places hygienic and sanitary conditions left much to be desired. Both 
were overcrowded. Each drew and has continued to draw its drinking water from 
the public supply. One has a water-carriage sewerage system connected with that 
of the city; the other is provided only with unscreened privies. At the latter a 
great deal of soil pollution was noted. 

Before beginning the test it was requested that no change be made in hygienic 
and sanitary conditions; this request, it is believed, has been fully complied with. 

Since about the middle of September, 1914, the diet at both orphanages has in 
certain respects been supplemented by the Public Health Service. At both insti- 
tutions a very decided increase was made in the proportion of the fresh animal and 
of the leguminous protein foods. The milk supply was greatly increased. The 
children between 6 and 12 years of age were provided with a cup of about 7 ounces 
of milk at least twice a day. Those under 6 had it three times a day. Until the 
spring of 1915 the milk used was all fresh sweet milk. In April of that year buttermilk 
was added to the diet; this was served at first only on alternate days to those over 
12 years of age; later it was served to all at the midday meal. Eggs, which had not 
previously entered into the regular diet of these children, were served those under 
12 years of age at the morning meal. It had been the custom to serve fresh meat but 
once a week; this was increased to three or four times a week. 

Beans and peas, which had been conspicuous in the diet only during the summer 
and fall, were made an important part of nearly every midday meal at all seasons. 
No canned foods other than tomatoes were allowed. This was done in order to elimi- 
nate the possibly injurious action on the foods of the high temperatures to which 
they are necessarily subjected in the process. 

The carbohydrate component of the institution diets was modified with the object 
of reducing the proportion of this element. In this connection it may be noted that 
though the com component was much reduced it was not wholly excluded. Com 
bread was allowed all children once a week and to those over 12 years of age grits 
once or twice a week in addition. 

Of the 209 cases of pellagra observed at the two orphanages during the spring and 
summer of 1914, up to September, 1915, not less than 172 completed at least the anni- 
versary date of their attacks under observation. In only 1 of these 172 pellagrins, 
following the change of diet, was there recognized during the year 1915 evidence 
justifying a diagnosis of a recurrence, although, on the basis of Rice's * experience 
at an orphanage in Columbia, S. C, there mi^t reasonably have been expected 
some 58 to 76 per cent, or 99 to 130 of them, to recur. Furthermore there was observed 
no new case in any of the nonpellagrin residents, 168 of whom were continuously 
under observation for at least one year. Recent admissions aside, there has, during 
1915, been no pellagra at one and but a single case at the other of these insitutions. 

Asylum study, — ^Through the courtesy and with the very helpful cooperation id 
the officers and staff of the Georgia State Sanitarium, two wards of pellagrins, one in 
the colored and the other in the white female service, were made available for the 
test. 

Large numbers of cases of pellagra are observed annually at this institution, the 
largest in the South. A large proportion of these are admission cases, but cases d 
intramural origin are of frequent occurrence. This asylum must, therefore, be re- 
garded as an endemic focus of the disease. 

The wards were organized for this test late in the fall of 1914. In selecting the 
patients only one condition was observed, namely, that the patient should be d 
such a type as would give reasonable degree of probability of remaining under obser- 
vation for at least a year. In consequence a considerable proportion were of a much 
deteriorated, untidy class. 

lOoldberger, Wiring, and WJlleU 1915 b^ P319e 



FUBUO HEALTH AKD MEDICINB. 7 

The diet furniahed the inmatee of theee two wards was, as at the orphanages, sup- 
plemented by the Public Health Service and modified so as to increase decidedly 
the proportion of the animal and leguminous protein elements. A cup of about 
7 ounces of sweet milk is furnished each patient for breakfast and one of buttermilk 
at both dinner and supper. Fully half a pound of fresh beef and 2 to 2) ounces of 
dried field peas or dried beans enter the daily ration. In order to favor the consump- 
tion of milk, oatmeal has almost entirely replaced grits as the breakfast cereal. With 
a view of reducing the carbohydrate component, sirup has been entirely excluded. 
Com products, althou^ greatly reduced, have not been entirely eliminated. The 
menu that follows will sorve to give a more detailed idea of the character of the diet 

M * % %. 

WBBKLT MBNU. 

Mcnday, — Breakfast: Grits, sweet milk, sugar, broiled steak, hot rolls, biscuits, 
cofifee. Dinner: Boast beef, gravy, peas, potatoes, rice, biscuits, buttermilk. Sup- 
per: Stewed apples, light bread, coffee, buttermilk, sugar. 

Tuuday. — Break^urt: Oatmeal, sweet milk, sugar, hamburg steak, biscuits, hot 
rolls, coffee. Dinner: Beef stew, potatoes, rice, bread, buttennilk. Supper: Baked 
beans, light bread, coffee, sugar, buttennilk. 

YFedneadlciy.— Breakfast: Oatmeal, sweet milk, sugar, beef hash, hot rolls, biscuits, 
coffee. Dinner: Pea soup, com bread, gravy, potatoes, rice, bread, buttermilk. 
Supper: Stewed prunes, light bread, coffee, sugar, buttermilk. 

Tkundojf, — ^Breakfast: Oatmeal, sweet milk, sugar, fried steak, hot rolls, biscuits, 
coffee. Dinner: Beef stew, peas, potatoes, rice, bread, buttermilk. Supper: Baked 
beans, bread, coffee, sugar, buttermilk. 

Friday, — Breakfast: Oatmeal, sweet milk, sugar, broiled beefsteak, hot rolls, bis- 
cuits, coffee. Dinner: Pea soup (pur^), roast beef, potatoes, rice, bread, butter- 
milk. Supper: Lig^t bread, coffee, sugar, buttermilk, apples, baked beans. 

Saturday, — ^Breaktot: Oatmeal, sweet milk, sugar, hamburg steak, hot rolls, bis- 
cuits, coffee. Dinner: Beef stew, potatoes, rice, bread, buttermilk. Supper: Bread, 
baked beans, buttennilk, coffee, sugar. 

^ttfulrqf. —-Breakfast: Oatmeal, sweet milk, sugar, mackerel, bread, coffee. Dinner: 
Loaf beef and gravy, peas, potatoes, rice, bread, buttermilk, pudding. Supper: Beef 
bash, bread, sugar, coffee, buttennilk. 

NoTS.— Qreen vegetables in season at irregular intervals. Milk and eggs, as a 
■pedal diet, are furnished those patients who may require them. 

Aside from the modification in the diet and the increased watchfulness over the 
individual feeding, enjoined on the nurses and attendants, no change in the habitual 
routine of the corresponding services was made. 

Of the pdlagrins admitted to these wards at the time of their organization, or shortly 
thereafter— ^hat is, up to Deoembor 31, 1914—72 (36 colored and 36 white) remained 
continuously under observation up to October 1, 1915, or, at least, until after the 
annivefsary date of their attack of 1914. Of the colored patients, 8 have histories of 
at least 2 annual attacks; of the white patients 10 have histories of at least 2 attacks. 
Nevertheless not a single one of this group of 72 patients has presented recognizable 
evidence of a recurrence of pellagra, although of a group of 32 control pellagrins (17 
colored and 15 idiite) not receiving the modified diet, 15 (9 colored, 6 white), or 47 per 
cent, have had rec u rrences during the corresponding period. 

iSi^t/lcance.— Considering the foregoing results as a whole, bearing in mind that 
three different institutions are involved, each institution an endemic focus of the 
disease, and bearing in mind also that the number of individuals is fairly large it 
would seem that the conclusion is justified that the pellagra recurrence may be pre- 
Tented and, in view of the conditions of the experiment, that it may be prevented 
without the intervention of any other factor than diet. In this connection the quea- 



8 PB0CEEDINQ8 BEOOKD PAK AMTCRTOAIT SOIBiriinO 00KQBB8S. 

Hon arises whether it is permissible to extend this condusion to the primary attack, 
apart from its recurrence. The charactw of the answer to this question will depend on 
the view held as to the nature of the pellagra recurrence. 

Among the epidemiological features of pellagra none is more striking than the 
tendency for the disease not only to develop in spring or early summer, but to recur 
year after year at about the same season. Various explanations of this singular phe- 
nomenon have been advanced. According to Sambon (1910, p. 49), ''this peculiar 
periodicity of symptoms can be explained only by the agency of a parasitic organism 
presenting definite alternating periods of latency and activity. ' ' A somewhat similar 
conception appears to be held by the Thompson-MacFadden Commission (SUer, 
Garrison, and MacNeal, 1914c), who distinguish between conditions favorable for the 
development of the disease, in the first place, and those that permit its subsequent 
recurrence. Why these and many other observers should consider this periodicity of 
symptoms as explicable only by the agency of a parasitic organism or of a virus or a 
toxin presenting definite alternating periods of latency and activity is rather hard 
to understand when it is recalled that in endemic scurvy (Lind, 1772, pp. 33, 34, 130, 
306), and particularly in endemic beriberi (Scheube, 1903), diseases of well-known 
dietary origin, a strikingly similar periodicity is present. It would seem, therefore, 
entirely permissible to invoke as an explanation of the periodic recurrence in pellagra 
what undoubtedly is the explanation of the same phenomenon in these other dis- 
eases, namely, a modification or change in diet brought about by or incidental to the 
recurring seasons. Viewed in this light, the recurrence in pellagra may be consid' 
ered as in beriberi, etiologically at least, as essentially identical with the initial attack, 
and, therefore, it would seem permissible to conclude that the means found effective 
in the prevention of recurrences will be found effective in the prevention of the initial 
attack. 

NATURE OF DI8B1BB. 

In the course of the preliminary studies relating to the prevalence of pellagra at 
such institutions as prisons, asylums, and orphanages, to which reference was made 
early in this paper, the association was found of a very high incidence of pellagra, 
restricted to certain groups, with a diet which differed from the diet of the exempt 
groups so far as could be determined only in that it included minimal quantities of 
the animal foods. It was inferred at that time that this association had etiological 
significance. Advantage has been taken of an opportunity to put this inference to 
the test of experiment. 

The experiment was carried out in association with Asst. Surg. G. A. Wheeler at the 
farm of the Mississippi State Penitentiary, about 8 miles east of Jackson, Miss. 

At about the center of this farm of some 3,200 acres, well isolated from the sur- 
rounding community, is the convict camp. There is no history of the previous 
occurrence or presence of pellagra on this farm. During the period of the experiment 
there were quartered at the camp an average of between 70 and 80 white male convicts, 
of whom some 30 were present throughout this time. Throu^ the kind offices of 
Dr. E. H. Galloway, secretary of the Mississippi State Board of Health, the interest 
of Gov. Earl Brewer was enlisted, who, on the offer of a pardon, obtained 12 vdunteen 
for the test. 

ExperimenL — White adult males were selected because, judged by the inddence 
of the disease in the population at large, this age, sex, and race- group would seem to 
be the least susceptible to the disease. 

The "pellagra squad, " as it came to be called, was organized between February 1 
and February 4, 1915, with 12 volunteers. On July 1, 1915, one of the squad was 
released because of the development of a physical infirmity. This left 11 men in 
the squad, 24 to 60 years of age, who remaii^ in the test to its termination, October 
SI, 1915. These men were quartered in a small, practically new, screened cottage, 



FUBLIO HEALTH AKD MEDIdKB. 9 

about 500 feet from the "cage " in which the other convicts were domiciled. Part of 
thie cottage had previoualy heen need, and continued to be used, throughout the 
period of the experiment as quarters for one of the officers of the camp. From the 
time of its oiganisation the squad was segregated and under special guard. 

From February 4 to April 19, 1915, a period of 2} months, these men were kept 
under observation without any change in the regular prison fare. Having detected 
no evidence of pellagra during this preliminary observation period, the diet of the 
squad was changed at noon April 19, 1915. The ingredients of this diet were wheat 
flour (patent), com meal, (com) grits, cornstarch, white polished rice, standard 
granulated sugar, cane sirup, sweet potatoes, pork fat (fried out of salt pork), cabbage, 
collards, turnip greens, and coffee. In the preparation of the biscuits and of the 
com bread Royal baking powder was used. 

The quantities of the different articles of cooked food actiially consumed is illus- 
trated by the following for the week ended August 8, 1915: 

Biscuits, 41.81 pounds; rice, 24.25 pounds; com bread, 24.56 pounds; grits, 27.06 
pounds; fried mush, 33.87 pounds; brown gravy, 37.81 pounds; sweet potatoes, 23.62 
pounds; cabbage, 4.25 pounds; collards, 23.75 pounds; cane simp, 5.94 pounds; sugar, 
8.75 pounds, making a total of 255.67 pounds of food consumed during the week, or 
3.32 pounds per man per day, having a value of 2,952 calories. 

In this connection it may be i)ertinent to note that the com meal and grits were ol 
the best quality obtainable at the local market and the same as that used at one of the 
orphanages at which the test, already discussed, of the value of diet in prevention 
was made and at which no pellagra occurred this year. Except for one meal in 
which 4 ounces of meat were included the animal proteins and legumes were almost 
entirely excluded. 

The character of the labor periormed by these men during the week for which the 
statement of the quantity of food consumed has been given was as follows: White- 
washing fences and buildings, 2^ days; sawing lumber (ram sawmill), 2 days; rest, 
2i days. 

The volunteers kept about the same hours and did about the same kind of work as 
the other convicts. The amount oi labor periormed by the volunteers was, however, 
distinctly less than that by the other convicts. 

The general sanitary environment was the same tor volunteers and controls. With 
respect to personal cleanliness, cleanliness of quarters, freedom from insects, par- 
ticulariy bedbugs, flies, amd mosquitoes, the volunteers were decidedly better ofif. 

RemlU.'-Ot the 11 volunteers not less than 6 developed symptoms, including a 
''typical " dermatitis, justifying a diagnosis of pellagra. Loss of weight and strength 
and mild nervous symptoms appeared early. The gastrointestinal symptoms were 
flli^t. Definite cutaneous numifestations were not noted until September^ 12, or 
about five months after the beginning of the restricted diet. In all 6 cases the skin 
lesions were first noted on the scrotum. Later the eruption also api)eared on the 
hands in 2 of the cases, and on the back of the neck in 1. The scrotal lesion conformed 
to the type described and figured by Merk (1909, p. 24, fig. 6), and also by Stannus 
(1913). 

Although the entire population of the camp was kept under observation, no one, 
not of the volunteer squad, presented evidence justifying even a suspicion of pellagra. 

The diagnosis of pellagra was concurred in by Dr. E. H. Galloway, secretary Missis- 
sippi State Board of Health, and Dr. Nolan Stewart, formerly superintendent Missis- 
sippi Asylum for Insane, at Jackson. In excluding the other known dermatoses the 
expert Imowledge and skill of Prof. Marcus Haase of the Medical College of the Univer- 
sity of Tennessee, Memphis, Tenn., and of Prof. Martin F. Engman of the Washington 
University Medical School, St. Louis, Mo., was utilized in consultation. 

Condu»ion8.— The conclusion drawn from this experiment is that pellagra hfia been 
brought about in at least 6 of the 11 volunteers as the result of the one-sided diet on 



10 PBOGEEDINGS SECOND PAH AMEBIOAK SdBNTIFIO CONGBESS. 

which they subsiflted. Taken in conjunction with the striking results of the test of 
the preventive value of diet, the further conclusion seems justified that pellagra is 
essentially of dietary origin. 

In order to avoid misunderstanding it may be weU to point out that it does not neces- 
sarily follow that all one-sided, unbalanced or, as the writer prefers for the present to 
speak of them, faulty diets are capable of bringing about pellagra any more than they 
are of bringing about scurvy or beriberi. 

A definite conclusion as to the intimate mechanism involved in bringing about or in 
preventing the disease by diet can, of course, not be drawn from the available data. 
It would be premature to conclude that pellagra is necessarily due to a lack or defi- 
ciency of fresh animal or leguminous protein foods. Clearly, however, the dietary 
'*f9MlV* upon which the production of pellagra essentially depends is capable of being 
corrected or prevented by including in the diet a suitable proportion of these foods. 
It would be equally premature, moreover, to assume that the pellagra-causing dietary 
"&ult" is capable of correction in this way only. The possibility that there may be 
other foods capable of serving the same purpose is by no means to be overlooked. It 
may be, too, if Funk's suggestion that pellagra is a vitamine deficiency, brought about 
by the consumption of overmilled com, is proven to be correct, that the use of under- 
milled com will of itself correct the **fault" in a diet in which this cereal is the staple. 
There is to be considered also Voegtlin's explanation of the beneficial effect of a liberal 
diet on the course of the disease. Voegtlin suggests that by substituting for part of the 
vegetable food animal foodstuffs, the absolute amoimt of vegetable products con- 
sumed will be reduced considerably and thus probably also reduce the possibility of 
an injurious action of the v^;etable food on the body, particularly the irritant action 
on the gastrointestinal canal. On the whole, however, the trend of available evi- 
dence strongly suggests that pellagra will prove to be a ''deficiency" disease very 
closely related to beriberi. 

For the practical purposes of preventive medicine, the point of chief of fundamental 
importance would seem to be the recognition of the fact that the pellagra-producing 
dietary fault, whatever its intimate nature, or however brought about, is capable of 
correction or prevention, as the results of the studies above summarized clearly indi- 
cate, by including in the diet suitable proportions of the fresh animal and leguminous 
protein foods. 

SUMMARY. 

1. Diet is the common factor in the various methods of treatment recently advocated . 
The marked success claimed for each of these methods must logically be attributed to 
the ^tor (diet) which they have in common. 

2. The value of diet in the prevention of pellagra has been tested at two orphanages 
and at an asylum for insane, endemic foci of the disease. Marked increases in the 
fresh animal and leguminous protein elements of the institution diets were made. 

Of 209 cases of pellagra observed at the two orphanages during the spring and sum- 
mer of 1914, not less than 172 completed at least the anniversary date of their attack 
under observation. In only one of these 172 pellagrins, following the change in diet, 
was there recognized evidence of a recurrence, although on the basis of experience else- 
where some 99 to 130 might reasonably have been expected. Nor was any new case 
observed among the nonpellagrin residents, 168 of whom completed not less than one 
year imder observation. 

Of the group of pellagrins on the modified diet at the insane asylum, 72 remained 
continuously imder observation up to October 1, 1915, or at least until after the anni- 
versary date of their attack of 1914. Not one of this group has presented recognizable 
evidence of a recurrence, although of a group of S2 controls 15 have had recurrences. 
Pellagra may, therefore, be prevented by an appropriate diet without any alteration 
in the environment, hygienic or sanitary, including the water supply. 



PUBLIO HEALTH AND MEDIdNB. 11 

3. At uk iflolatod convict camp, previously free from pellagra, with an average 
population of 70 to 80 white males, 11 volunteers were segregated and, after a prelimi- 
nary observation period of 2^ months, placed on an abimdant but one^ded, chiefly 
carbohydrate (wheat, com, rice) diet, from which fresh animal proteins and legumes 
were excluded. At least 6 of these volunteers developed pellagra. This result would 
appear to have been brought about by the diet on which they subsisted. 

4. A definite conclusion as to the intimate mechanism involved in bringing about 
or in preventing the disease by diet can not be drawn from the available data. 

5. For the practical purposes of preventive medicine it would seem to be of funda- 
mental importance to recognize that the pellagra-producing dietary &ult, whatever 
its intimate nature or however brought about, is capable of correction or prevention 
by including in the diet suitable proportions of the fresh animal and leguminous 
protein foods. 

BBFBBBN0B8. 

1914a. Funk. (Casimir); Die Vitamine. Wiesbaden, 1914. 

19146. Idem. Prophylaxie und Therapie der Pellagra ins Lichte der Vitaminl^ire. 
Munch. Med. Wchnschr., 1914, pp. 698-699. 

1914a. Goldbeiger (Joseph). The Etiology of Pellagra; the significance of certain 
epidemological observations with respect thereto. Public Heedth Reports, Wash- 
ington, June 26, 1914, pp. 1683-1686. 

19146. Idem. The Cause and Prevention of Pellagra. 
Idem . September 1 1 , 1914 . 

1914e. Idem. Beans for Prevention of Pellagra. Joum. Am. Med. Assn., vol. 63, 
October 10, 1914, p. 1314. 

1914a. Goldbeiger (Joseph), Waring (C. H.), and Willets (David G.). The Treat- 
ment and Prevention of Pellagra. Public Health Reports, Washington, October 
23, 1914. 

19146. Idem. Idem. Reprint No. 228 from Public Health Reports, Washington, 
October 23, 1914. 

1915a. Idem. Idem. Reprint No. 228 from Public Health Reports, Washington, 
October 23, 1914. Revised Edition, January 15, 1915. 

19156. Idem. The Prevention of Pellagra; a test of diet among institutional inmates. 
Public Health Reports, Washington, October 22, 1915, pp. 3117-3131. 

1915. Goldberger (Joseph) and Wheeler (G. A.). Experimental Pellagra in the Hu- 
man Subject brought about by Restricted Diet. Public Health Reports, Wash- 
ington, November 12, 1915, pp. 3336-3339. 

1772. Lind (James). A Treatise on the Scurvy. 3d Ed., London, 1772. 

1916. Littie (Y. A.). The Dietetic Treatment of Pellagra. With report of eleven 
cases. Southern Med. Joum., vol. 8, August, 1915, pp. 659-662. 

1914. Lorenz (W. F.). The Treatment of Pellagra. Public Health Reports, Wash- 
ington, September 11, 1914. 

1909. Merk (Ludwig). Die Hauterscheinungen der Pellagra. Innsbruck, 1909. 

1914. Meyers (C. N.) and VoegtUn (Carl). Soluble Aluminum Compounds; Their 
Occurrence in certain Vegetable Ftoducts. Public Health Reports, Washington, 
June 19, 1914, vol. 29, pp. 1625-1629. 

1866. Roussel (Theophile). Traits de la Pellagra et des Pseudo-Pellagres. Paris, 
1866. 

1910. Sambon (Louis W.). Projpress Report on the Investisation of Pellagra. (Re- 
print from the Joum. Trop. Med. and Hyg.) London, 1910. 

1903. Scheube (B). The Diseases of Warm Countries. London, 1903. 

1914a. Siler, J. F., Garrison, P. E., and MacNeal, W. J. Further studies of the 

Thompson-McFadden Pellagra Commission. Joum. Am. Med. Assn., Sept. 26, 

1914, p. 1090. 
19146. Siler. J. F., Garrison, P. E., and MacNeal, W. J.^ A statistical study of the 

relation of pellagra to use of certain foods and to location of domicile, etc. Arch. 

Int. Med., October, 1914. 
1914c. Siler, J. F., Garrison, P. E., and MacNeal, W. J. The relation of Methods of 

disposal of sewage to the spread of pellagra. Arch. Int. Med., Sept., 1914. 



12 PB00EEDINQ8 SECOND PAN AMEBICAN 801ENTIFIC C0NQBB88. 

1913. Stannus (Hugh S.). Pellam in Nyasaland, Trans. Soc. Trop. Med. and Hyg., 
November, 1913, vol. 7, pp. 32-^. 

1913. Vedder (Edward B.). Beriberi. New York, 1913. 

1914. Voefftlin (Carl). The Treatment of Pellagra. Joum. Am. Med. Asm. Sep- 
tember 26, 1914, vol. 63, pp. 1094-1096. 

1915. WiUets (David 6.). The Treatment of Pellagra by Diet. Southern Med. 
Joum., December, 1915, vol. 8, pp. 1044-1047. 

The Chaibman. Dr. Goldberger's paper is open for discussion. 

Dr. AoBAMONTB. The question of pellagra in South and Central 
America is still, I believe, to be investigated. So far as I know, 
pellagra has not been observed in Cuba. That may be accounted 
for to a certain extent — discounting the possibility of unrecognized 
cases, which, of course, must be considered — by the fact that the 
diet in our country is quite abundant in leguminous food, particu- 
larly beans, which form a usual part of tibe menu almost every- 
where, and as for the orphanages and asylums either com or beans 
form a daily part of the diet. The fact that is pointed out by Dr. 
Ooldberger and well known to those who have studied this question, 
viz., that the disease imtreated tends to recur, would serve to do 
away with the idea of the disease passing unrecognized amongst us. 
If we did not think of it the first time, I think o\ir attention would 
have been called to it the next time or at a subsequent time, so I feel 
safe in stating that we have no cases of pellagra, at least in our public 
institutions. 

About three years ago I had occasion to see a few cases of pellagra 
in London, shown to me by Dr. Sambon at the time when he claimed 
that the simulium was the cause of the disease, and he explained 
the reason of these recurrences by calling attention to the fact that 
the recurrence took place during the warmer part of the year, when 
the parasitic nature of the disease seemed more in condition to 
develop. Of course that has all been explained by Dr. Ooldberger, 
and the argument alone would not be sufficient to do away with all 
other arguments. 

The Chairman. Is there anybody else? I see that Capt. Siler, of 
the Robert M. Thompson Pellagra Commission, is here. 

Capt. J. F. SiLEB, M. C, United States Army. I think we should 
all congratulate Dr. Ooldberger on the very thorough way in which 
he has demonstrated that we can cure and prevent pellagra by 
dietary changes. I think those of us who have treated pellagra 
have been very much struck by the fact that a very large percentage 
of the victims have been living on a restricted diet, and also that 
recovery would occur in a very large majority of cases by putting 
them on the proper diet. I suppose that in the three years I was 
working with pellagra I have probably answered two to three himdred 
letters from patients who had it, and my advice was always to treat 
the disease as if it were tuberculosis ; that is to say, to build up the 



FUBUO HBALIH AVD M^IGINB. 13 

nutrition by the use of eggs and milk particularly; and though such 
a diet did not give results in all individual cases, in a large majority 
of cases the results were good. 

One point to which I wish to refer is the disappearance of pellagra in 
institutions and in communities. We made epidemiological studies 
in Spartanbu]^ County, S. C, as well as other places in this country 
and abroad, and we found it to be not unusual to have a large amount 
of pellagra in a community one year and very little or none the fol- 
lowing year. We had a number of instances of that kind. There 
is a mill village near Spartanbui^, S. C, in which in 1910 or 1911 
you could go out any day and find 50 or 60 cases of active pellagra. 
In 1914 there were only two or three cases in that village. So far 
as we could determine, no particular dietary changes had been made 
in that time. There was a very distinct tendency to better condi- 
tions in the way of improved hygiene and sanitation, but we could 
not lay our finger on any particular change or changes to which we 
could attribute the marked decrease in incidence. 

In 1913 I made a trip with Dr. Sambon, of London, to the British 
West Indies, including Jamaica and Barbados. In Jamaica, curiously 
enough, the disease appeared to be confined to two or three institu- 
tions. We examined several thousand people in villages and insti- 
tutions in all parts of Jamaica, and found pellagra prevailing in but 
two institutions — the asylum and a home for children. The diet in 
the children's home was very poor, but even so it was better and 
more varied than the inmates were getting before they went into the 
home. In 1913, when we made this trip, between 10 and 15 per 
cent of the children in this home were affected. I have heard recently 
from authoritative sources that during the past two years they have 
made no changes in the dietary, only giving tonics, and the disease 
has disappeared. We have noted repeatedly in our epidemiological 
studies that the incidence rate has a tendency to go up one year and 
down the next. 

I also noticed in investigating conditions in the West Indies that 
individuals who were living on an improper and poorly balanced diet, 
presented all the evidences of undernourishment, and one of the 
strikmg evidences presented by them was interference with the nutri- 
tion of the skin. Dr. Sambon wished to class these as pellagra, 
though the skin symptoms were somewhat atypical. I did not agree 
with him for the reason that I could in no instances get a history of, 
nor did I personally observe any individuals with the gastro-intestinal 
symptoms so common in pellagra. In Barbados, when going through 
the poorer sections of Bridgetown, by house-to-house canvass, and in 
Jamaica, we saw many cases which seemed to me to fit the ones that 
Dr. Goldberger has described to-day as occurring in the convicts. 
I particularly wish to ask him just what the gastro-intestinal symp- 



14 PBOGEEDINOS SECOND PAN AMEBICAN 80IENTIFI0 OONQRESS. 

toms were that he refers to. It seems to me that in a crucial test 
of this kind, where people have been on a so-called pellagra-producing 
diet for the length of time these convicts were, he ought to have gotten 
two or three cases with at least moderate but typical intestinal symp- 
toms so frequently observed with pellagra. The cases that I saw 
in Barbados and Jamaica that presented somewhat atypical skin 
lesions resembling pellagra, gave no definite gastro-intestinal symp- 
toms, and in not a single case did I see the picture so frequently found 
in pellagra of a severe stomatitis. 

There are many observations that lead me to feel that it is quite 
possible that some etiological factor in addition to dietary faults 
enters into the production of pellagra. Dr..Goldberger has demon- 
strated very clearly that the way to cure pellagra and to prevent 
pellagra in practically all cases is to give the proper food. In con- 
sidering all the factors entering into the causation of pellagra, there 
are some things that seem to me to be difficult of explanation on a 
dietary hypothesis alone. One of these is the recent appearance of 
pellagra in this country. There is no question that pellagra has 
been in this country for the last 15, 20, 30, or even 40 years; but I 
think there is also no question that about 1906 or 1907 it began to 
increase very rapidly in the United States. We are told that the 
explanation of this is that we began to recognize it then. I do not 
believe that. I have no doubt that many cases were missed in the 
early days, but I believe that there is no doubt that the disease has 
increased tremendously in very recent years. 

One of the arguments advanced against calling pellagra an infection 
is that doctors and nurses are presumed never to have been affected 
by it, though thrown with it constantly. Personally, I know of 
about five cases among nurses, certainly of that number among 
nurses employed in institutions. I know, also of about twelve or 
fifteen doctors in the South who have, or have had pellagra. Pellagra 
and tuberculosis are, in my opinion, comparable in many respects; 
and we might with just as much logic argue that tuberculosis is not 
an infection because doctors and nurses working with tuberculosis so 
seldom acquire it. In the very excellent paper presented by Dr. 
Ravenel, before this congress last week, he laid particular stress on 
the fact that statistics show very conclusively that tuberculosis is 
but seldom acquired by nurses and doctors working in sanitariums 
for tuberculosis or by nose and throat specialists who are constantly 
being thrown in contact with cases of laryngeal tuberculosis. I have 
had occasion to observe the incidence of tuberculosis in doctors and 
nurses working with such cases, and these observations are con- 
firmatory of those cited by Dr. Ravenel. 

One thing that has struck me is this: I have seen a number of cases 
of the very severest type of pellagra that, during the acute attack, 



PTJBLIO HEALTH AKD MEDICIKB. 15 

adhered to a proper diet — ^that is to say, an increase in protein, more 
particularly milk and eggs — and recovered from the acute attack 
with no recurrence in after years, notwithstanding the fact that they 
have gone back on the same diet on which they lived before they had 
pellagra. £ have gone into the diet of a number of people who have 
given such a history, and it is somewhat hard for me to understand 
how a person who has had a disease of a dietary nature can avoid a 
recurrence on a return to the original diet causing the disease. In 
beriberi, we know that if one returns to the beriberi-producing diet, 
he is very likely to acquire the disease again. I have seen a number 
of pellagrins after severe attacks return to what is theoretically a 
pellagra-producing diet for two or three years or more without the 
slightest evidence of recurrence of the disease, and it is very difficult 
for me to explain this subsequent immunity on ths dietary hypothesis. 

I have also seen this happen: Two cases would go into a hospital 
side by side — one a very n^d case of pellagra in which we wanted to 
build up the resistance by the use of eggs and milk; the other a case 
of such great severity that food could not be swallowed for several 
days. We would put them on the same diet and at the end of a 
month or six weeks the mild case would be dead and the other prac^ 
tically well. You see a thing Uke that not infrequently. 

I have also seen some cases where, though it could not be cUumed 
that the diet was perfect from the viewpoint of the dietary enthusiast, 
it seemed to me to be very well balanced indeed. 

In our epidemiological studies we have noticed the factor of dis- 
tribution according to race. In the particular section in which we 
were working we found that the relation existing between the colored 
race and white race was about one to four, certainly one to three — 
that is, three white persons had pellagra to every colored person. 
The diet, in my opinion (and I have lived in the South; I may say spent 
my whole life there until manhood), of the colored tenant farmers in 
the section in which we were working more nearly approximated the 
diet given the convicts in this test than that of the white people of 
the same section, notwithstanding that the proportion of pellagra in 
that region was about one to three. If you will investigate condi- 
tions in Charleston, S. C, you will find the racial distribution reversed; 
there are three cases of pellagra among the colored population to every 
case among the whites. We investigated this point in Alabama, and 
found that in Montgomery the disease is evenly distributed between 
the negroes and the whites. In formulating any hypothesis as to 
the etiology of pellagra these factors require consideration. 

In discussing diet as a factor in the causation of pellagra, and par- 
ticularly the matter of proteins, I recall that several years ago in the 
State of Illinois a commission was appointed by the governor to 
investigate pellagra in the institutions of the State. I think a good 



16 PB0GEEDINQ8 8E00ND PAK AMEBICAN S OAJ t H T U f iO COKQBBINI. 

many people have overlooked the fact that this commission reported 
that among the institutions of the State the one in which the protein 
content of the diet was lowest never had had a case of pellagra. 

There are some other points to which I desire to refer. In my 
work on pellagra I have had in mind beriberi and scurvy — our two 
well-known deficiency diseases — and have constantly attempted to 
connect the epidemiology of beriberi and scurvy with the epidemi- 
ology of pellagra. For instance, it is said and we know that nursing 
children are very subject to beiiberi. In pellagra I have never seen 
a case in a child nursing its mother, although the mother might have 
a very severe case of pellagra. This is another respect in which pel- 
lagra differs very markedly from beriberi. 

The age and sex distribution are also of great interest to me. Dr. 
Goldberger has spoken of the remarkable fact that women are very 
much more subject to pellagra than men. In 1913 we had collected 
a series of 740 cases, of which in a group of 414 between the ages of 
20 and 44 there were 357 women as against 57 men. This is most 
remarkable, in my opinion, in comparing the disease with beriberi. 
So far as I can determine from mortality statistics, beriberi is more 
evenly distributed. It might be argued that the men in the home 
are getting the best diet, but I have investigated the homes of the 
people most subject to pellagra and they do not have meat every 
day, so the men could not get it. If they have not the proper food 
on their tables, how can they get it, and how do the tremendous 
number of men escape the disease ? 

This is a very haphazard discussion, but I should like to ask Dr. 
Goldberger if he has ever gotten any negative results that seemed to 
him to indicate the possibility of its not being a food deficiency alone. 
For example, has he ever made any observations on people who have 
had pellagra who have gone through two or three attacks and, not- 
withstanding the fact that they have been kept on a presumable 
pellagra-producing diet have not had the disease? In children we 
have foimd that it does not recur in 50 per cent, possibly more, of 
the cases. They have an attack one year, and that is the end of it. 

I was very glad to hear Dr. Goldberger's discussion about this 
disease, and I should like very much to hear the experiences of 
doctors from the Central and South American coimtries. I might 
say that as far as Jamaica and Barbadoes are concerned, and also 
Bermuda, I have some knowledge. In Jamaica the disease was 
confined practically to a few institutions, hardly a dozen cases, I 
believe, outside of institutions. In Barbadoes it was scattered 
generaUy over the island. There had been 200 deaths from pellagra 
in the two years prior to 1913. The only particular difference in 
the diet of the natives of Jamaica and Barbadoes was that in Jamaica 



PUBLIC HBALTH AND MEDIOIKE. 17 

the peasants had bananas and in Barbados they did not. This 
dietary difference is of interest in connection with Maj. Ashford's 
observations on sprue. He noted that sprue occurred in the cities 
and towns of Porto Rico, where the carbohydrate element of the diet 
was made up of bread, and it did not originate in the country dis- 
tricts where the peasant secured his carbohydrates by eating bananas. 
In Barbados sprue is very common and wheat bread is the staple 
carbohydrate food. In Jamaica sprue is very rare, and the peasants 
subsist very largely on bananas. 

With regard to the use of legumes, we found that they were con- 
sumed with great frequency by the people of the Southern States. 
In Jamaica and in Barbados, as Dr. Agramonte has said, they use 
leguminous foods very largely. In Barbados, where there is much 
pellagra, the people have 15 to 20 varieties of beans and peas, which 
are eaten throughout the year. We know also, if we can beheve 
what we hear about the diet of the people, that in Elgypt the fellaheen 
use l^umes as one of the staple articles of diet. We also know that 
the fellaheen are extremely susceptible to pellagra. 

Capt. Siler's remarks were interpreted in Spanish by Dr. 
Agramonte. 

Dr. Goldberger's paper was discussed fiulher in Spanish by Dr. 
Gonzalez-Rincones, of Venezuela; Dr. Teodoro Muhm, of Chile; 
Dr. CaUxto Torres Umafia, of Colombia; and Dr. Luis Migone, of 
Paraguay. The remarks of these gentlemen were interpreted as 
follows by Dr. Agramonte: 

Dr. Rincones has practically determined the absence of pellagra 
in his country. He refers to several cases which he has had occa- 
sion to see, but which turned out to be cases of uncinaria; and recog- 
nizing the importance of Dr. Qoldberger's findings with regard to the 
treatment of the disease by the change of diet, he is inclined to attri- 
bute the absence of this disease to the fact that legumes are used 
largely. He says the observations have an indirect bearing on cases 
of infectious disease in relation to improving the general condition 
of the individual and thereby allowing him to overcome the disease, 
and that he has decided to employ the treatment as soon as he has 
an opportunity to do so. 

Dr. Muhm, of Chile, recalls no case of pellagra in his country. 

Dr. Torres Umafta, of Colombia, recalls that he has seen no classi- 
cal case of pellagra, although he has found cases similar to pellagra, 
produced by the use of a drink which is called '^ chicha," obtained by 
the fermentation of com to such a degree that it contains actual 
putrefactive element. The individuals who use this drink present 
disturbances of nerves, skin, and gastro-intestinal tract, very much 
like pellagra. He considers they are exactly hke the classic pellagra. 



18 PBOCEEDIKGS SECOND PAN AMEBICAN 80IEKTIFI0 CONQBESS. 

Dr. Migone^ of Paraguay, remarks that no cases of pellagra are, to 
his knowledge, found in his country. Once a year the doctors from 
the interior meet in the form of a congress and discuss unusual cases 
that have come to their notice, and that in so far as he knows pel- 
lagra has never been reported. He states that maize, com, and many 
vegetables are consumed in most tropical and semitropical countries 
in great quantity by every one. 

Dr. Eebleb. I was rather interested in what Dr. Goldberger has 
said relative to the effect, if any, of drugs in the treatment of pel 
lagra. According to the view taken by Dr. Goldberger, drugs have no 
influence. Dr. Siler, however, seemed to give the impression, whether 
he means it or not, that tonics might be of value in the treatment 
of this disease, when he stated that in a certain institution there was 
virtually no change in diet, but that tonics had been added and 
that improvement took place. We have made an investigation of 
quite a niunber of these so-called cures for pellagra on the market, 
and as in the case of nephritis, tuberculosis, and other diseases, it is 
quite a problem in these cases.to decide just what to do. 

Dr. SiLEB. May I explain myself, Mr. Chairman ? I did not say 
that drugs were of any value. I did say that they were using 
tonics in this institution in Jamaica. The drug they were using 
there was salvarsan. I would like to have it distinctly imderstood 
that I agree with Dr. Goldberger that drugs really do no good in 
pellagra. Diet is the most important thing and I place no reliance 
at all on drugs. There are two drugs that are indicated in these 
cases. There is no doubt that most cases of pellagra have a distinct 
decrease in hydrochloric acid and a decrease in peptic activity, and 
I think as a kind of placebo mdicated in those cases where you have 
such factors in the stomach it is wise to give those drugs to increase 
the digestive action. That is about all that is really necessary — 
pepsin and hydrochloric acid. 

The Chaibman. Dr. Goldberger will close the discussion. 

Dr. Goldbeboeb. I have been very much interested in what the 
del^ates from the other coimtries have had to say about pellagra in 
their respective Republics. I might say, as the result of some cor- 
respondence with colleagues in Mexico City, that I have found condi- 
tions there as regards prevalence about the same as in these other 
countries. There is apparently no pellagra in Mexico. I learned of 
one case in Mexico City, that occurred a few years ago in a native and 
resident of the plateau region of Mexico. There have been no cases 
(up to 1914) in the ''Manicomio,'' the National Insane Asylum at 
Mexico City, although com, and spoiled com, have formed at times 
a very large and important part of the diet. My correspondent who 
was in a position to speak authoritatively, stated that if pellagra 
was the result of spoiled com there should have been no nonpella- 
grins in that institution. 



PUBLIC HEALTH AND IfBDICINB. 19 

While I believe these reports to be substaQtiaUy correct, I must 
nevertheless confess to a certain degree of skepticism as to the abso- 
lute absence of the disease, an idea that one might get from these 
reports. I say that because I have very keenly in mind the pellagra 
history in our own country. Unquestionably it has occurred and 
has prevailed in this coimtry for many years. It has, however, only 
been definitely recognized in the last eight years, and even now after 
all the publicity that this subject has had in the medical and the lay 
press cases are constantly occurrmg and are being seen and passed 
o^er by physicians without recognition. I know of instances of that 
sort in the hands of very competent and able men in other respects. 

That brings me to the point raised by Dr. Siler in connection with 
the experimental cases at Jackson, at the State farm. Now, in the 
diagnosis of a disease like pellagra, concerning which we have no 
laboratory methods of diagnosis, there is left a great deal to the per- 
sonal point of view, to the conception or mental picture that the 
observer has, to which the case must conform to be classed with 
this disease. We have the same sort of thing in other diseases, 
notably in connection with yellow fever. You will recall that in 
cities where the first case was reported or was about to be reported, 
or where there was danger of its being reported, unless the patient 
had all the classical symptoms of black vomit, profound jaundice, 
suppression of urine, etc., it was not yellow fever. Now the same 
thing undoubtedly appUes to a greater or less degree to pellagra. 
Unless the individual has a marked eruption, unless he has a severe 
stomatitis with nausea, vomiting and continuous diarrhea with 
marked mental manifestations in the opinion of some men it is not 
A case of pellagra. 

Now I think we ought to know a Uttle more in this day and gener- 
ation about any disease. As with other diseases, pellagra varies and 
does not in most instances manifest the so-called classical picture in 
cross section. 

The following subjective manifestations were presented by our 
cases at the farm: There was observed marked loss of weight and 
strength, slight bumii^ of the mouth, some redness of the tongue, 
eructations and dyspeptic symptoms and irregular, brief periods of 
looseness of the bowels. Not any of the cases, as I stated in my 
paper, showed the classical, complete gastro-intestinal symptoms — 
that is, severe saUvation or sore mouth, with severe diarrhea. They 
were cases that had not gone that far. We were obliged to termi- 
nate the test by a certain fixed date. Fortunately, both we and a 
nimiber of experienced consultants were able to satisfy ourselves 
that it was pellagra that our subjects had. The skin manifestations 
had the classical anatomical characters. They conformed, as I 
stated, to some of the pictures given by Merk in his ''Handbuch''; 

68486— 17— VOL x 8 



20 PBOOEEDINGS 8E00KD PAN AMEKTOAN SODSKTIFIC OONGBESfik 

thej conformed very beautifully to some of the observations made 
by Stannus on pellagra in Nyassaland. 

The illustrations of the eruption on the male genitalia in Merk 
and in Stannus give an excellent idea of what we observed in our 
experimental cases and are sufficient to indicate that what we saw 
in our experimental cases had been seen by others in other places 
under natural conditions. Nor should it be forgotten that we had 
a large niunber of controls, both convicts and free men and women, 
none of whom showed the least suspicion of the disease. 

A number of points were raised by Dr. Siler that are very fre- 
quently raised in the discussion of pellagra, and it may be perhaps 
well to take up these things as fully as my time will allow. One of 
these points that is very frequently raised is the question of the 
explanation of the marked increase in the prevalence of the disease 
in this coimtry in the last seven or eight years. As I mentioned, 
pellagra undoubtedly has prevailed in this coimtry for a generation 
or more. Dr. Babcock, of Columbia, S. C, reports that he has been 
able to find records of the disease as far back as 1828, quite far 
enough back to establish that it has existed among us for a long 
time. The question to be answered then is, why is it so much more 
prevalent than it used to be ? This probably may be explained in two 
or three ways, or rather two or three factors enter into the explana- 
tion. One of these is that when we know a disease we are better able 
to diagnose it. Those of you who are familiar with the classical 
manifestations of the disease, know it has many relations, side chains, 
if you will; the dermal manifestation is allied closely to other non- 
pellagrous dermal manifestations, and one without a complete picture 
of pellagra in his mind will be inclined to consider it simply a skin 
disease, to call it dermatitis, eczema, or erythema solare, and let it go 
at that, without paying due regard to the other symptoms, just as 
some of the earUest students of the disease did. 

Again, the intestinal symptoms are sometimes very prominent 
and dominate the picture, and to the inexperienced observer, who 
is not famiUar with the complete sjoidrome, that feature will con- 
centrate attention, and the case will be called dysentery or "con- 
sumption of the bowels,'' a very favorite diagnosis in this country. 
It is the same way with the mouth symptoms. It is reported in the 
early American Uterature on the subject that a very distinguished 
clinician of this coimtry who saw a case in consultation after a very 
careful investigation decided that it was a case of "glossitis." It is 
said to have been a typical case of pellagra. I mention these things 
to show how important a clear conception of a disease is in making a 
diagnosis. Improved diagnosis makes for an increase in known or 
reported cases; an increase that may be more apparent than real. 
Incidentally this also brings about a reduced fatality rate and then 
we hear that the disease has become milder. 



PUBLIC HEALTH AND MEDICINE. 21 

I might cite evidence also to show the importance of knowing of 
the existence of a disease to help one recognize it, and thereby 
further increase the apparent frequency of its prevalence. One factor, 
ihen, in explanation of the increase in prevalence is the better 
diagnosis of cases, an increased ability to recognize the disease as 
the result of increased experience and because of a knowledge of its 
existence. This same factor applies also to the laity. The laity have 
learned to recognize pellagra, and frequently the patient comes to 
his physician for a confirmation of the diagnosis which the patient 
or friends have already made. This was not the case seven or eight 
years ago. 

Furthermore there are good reasons for believing that the diet 
of the people most affected has changed in the last seven or eight 
years. The factors involved in bringing this about are the eco- 
nomic ones which in the last 15 or 20 years have caused a gradual 
and progressive increase in the cost of food. This increase has been 
particularly notable in the last seven or eight years as compared 
to the previous seven or eight years. Again dietary and budgetary 
investigations have repeatedly shown that there is a very decided 
difference in the character of the diet ot the northern as compared 
with the southern section of this country. The diet of the South 
is more largely carbohydrate than that of the North, and with the 
change in economic conditions, as regards the increased cost of 
certain foods without a corresponding increase in income, there has 
naturally and inevitably been a modification ot the character of the 
prevailing diet tending toward a further increase in the carbohydrate 
component and a reduction in the more costly animal protein ele- 
ments. The effect of such influences will naturally be most appar- 
ent in that locality where the prevailing type of diet already has 
the narrowest margin of safety. Such are some of the more impor- 
tant factors which must be considered in explaining the alleged 
increased prevalence of recent years. 

Another point mentioned by Dr. Siler was that he had observed 
that in spite of the fact that a good diet was given pellagra patients, 
even apparently mild cases, some nevertheless died in a month or 
six weeks. I quite agree that this may happen, although rarely; 
but I can not quite see how that affects the question before us. We 
have the same thing in beriberi and scurvy. 

Then the point was raised that in spite of the fact that individu- 
als go back to their old diet they do not always develop pellagra 
again. The fact that people go back to what apparently was their 
diet before their attack does not constitute conclusive evidence that 
the diet is in fact exactly as it was before their attack. Such state- 
ments take cognizance of superficial appearances only. They do 
not and can not recognize apparently slight differences which may 



22 PBOGEEDINGS SECOND PAN AMEBICAN SCIENTIFIC CONGRESS. 

in reality make all the difference between an inadequate and an 
adequate diet. It is a type of ai^ument that I am sorry to say is 
altogether too frequent. It deals simply with surface indications. 

With regard to the marked difference in sex incidence in individu- 
als with the same diet available, it is well to recall that a difference 
in sex incidence under like circmnstances is recorded tor both scurvy 
and beriberi, only that in these the preponderance oi cases is in the 
male, not in the female. It would seem therefore that we are dealing 
here with a difference in physiological requirement in the two sexes, 
an interpretation that is by no means without experimental evi- 
dence for its support. Other factors probably also contribute to the 
bringing about of this difference in sex incidence. 

The CHAiBifAN. We will now have to pass to the next paper, en- 
titled "The known and the unknown with r^ard to the etiology 
and prevention of beriberi," by Capt. Vedder. 



THE KNOWN AND THE UNKNOWN WITH REGARD TO THE ETIOLOGY 

AND PREVENTION OF BERIBERL 

By EDWARD B. VEDDER, 
Captain, Medical CorpSf United State$ Army. 

There are certainly few diseaseB concerning which we are in a position to state that 
everything with regard to them is known. While in general, sanitary measures 
adopted to prevent a given disease must be based upon accurate knowledge of the 
cause and methods of transmission of that disease if they are to be effective, yet very 
effective sanitary work in the past has been based upon information which while 
accurate is still incomplete. The sanitarian has controlled smallpox by vacci- 
nation in spite of the fact that no satisfactory demonstration has yet been made witib 
regard to the exact biological relationship between vaccinia and smallpox. Yellow 
fever has been eradicated in several localities by a warfare against the transmitting 
agent, the stegomyia mosquito, although the etiologic agent of the disease is still 
unknown. 

It may be worth while to take stock of our knowledge concerning beriberi. Do 
we know sufficient concerning its etiology to prevent the disease, and what gai>8 in 
our knowledge remain to be filled? 

Opinions as to the etiology of beriberi have varied widely in the past, but for the 
most part fall into three categories. Some have believed that it was an infectious 
disease, some that it was an intoxication, and some that it was caused by a certain 
deficiency in the dietary of those affected. The result of this confusion has been 
that with few exceptions the sanitary measures taken to prevent this disease have 
been futile. It is worthy of note that in the case of these exceptions the measures 
that succeeded in preventing the disease consisted in certain radical changes in 
the dietary. 

At the present day there is a very general consensus of opinion to the effect that 
beriberi is caused by a dietary deficiency. It would far exceed the limits imposed 
upon a paper of this character to go into all the details of the work that has led to 
this conclusion. Moreover, the writer has elsewhere ^ attempted to sift all this evi- 

>B«rIberi. Wm. Wood & Co. New York, 1018. 



FUBLIO HEALTH AND MEDIOIKE. 23 

dence. As a result of this study, I stated in 1913 that ''we are now in a position 
to prevent beriberi in any community that can and will follow our advice, just as 
surely as we can prevent smallpox and yellow fever." In a general way this opinion 
was based on the following facts: 

1. The c(Hnplete failure of the adherents of the infection and intoxication theories 
to prove their case. 

2. The very carefully planned and controlled human feeding experiment of Fraser 
and Stanton/ in which they demonstrated beyond all cavil that beriberi can be 
experimentally produced in men by too exclusive feeding on overmilled or highly 
polished rice. This experiment was later repeated by Strong and Growell ^ in the 
Philippines with a similar result. 

3 . The long series of animal experiments which have been repeated with substantially 
the same results in all parts of the world and by which it has been equally demon- 
strated that various animals, but particularly birds, when fed on diets that will 
produce beriberi in man, suffer with a disease which in some instances is identical in 
symptomatology and pathology with human beriberi and in other instances is so 
similar that we must believe that it is essentially the same disease. 

4. The instances referred to above in which beriberi has been eradicated from various 
institutions or groups of men by certain simple but radical changes in the dietary. 
Every sanitarian should be familiar with the practical results of this character re- 
ported by Van Leent,* Vorderman,^ Takaki,* Fletcher," Highet,^ Heiser,^ Theee,' 
Chamberlain,'® and others. 

However, beriberi has still continued to prevail in many localities, chiefly because 
sanitary officers have not been convinced of the truth of the statement that beriberi 
is a deficiency disease and have been unwilling to adopt the necessary dietary changes. 
Since 1913, when the writer published the results of his investigation," there has 
been a considerable amount of experimental work that has confirmed the belief that 
beriberi is caused by a dietary deficiency, and not one iota of evidence to the con- 
trary that will stand careful analysis. Many statements casting doubt on the dietary 
origin of beriberi have appeared during this time in the literature. These instances 
will not bear careful investigation. Most of them consist of occasions in which beri- 
beri is reported to have occurred in spite of the fact that the dietary is stated to have 
been "satisfactory as to quantity and quality." In all of these cases either no details 
at all or entirely insufficient data as to the diet actually eaten are given. Often these 
epidemics are reported by the very man responsible for the diet used, and who would 
naturally believe that it was satisfactory, although he might actually have very small 
reason for this belief. After having analyzed a munber of such instances the writer 
stated, in 1914," that *4t will not be sufficient in the future, in attempting to disprove 
the dietary origin of beriberi, to make statements that the diet was liberal and varied. 

1 StndJas rrom the Institute for Medical Resesrcb, Federated Malay States, 1909, No. 10. 

• The Etiology of Beriberi. PhUippine Joam. Science, 1912, VII, 271 . 

• Aiefa de Ked. Nav. 1867, Oct., p. 241. Communication sur le Borlberf, Cong. Internet, d. 8c. Med. 
Amst. 1880, VI, 170, etc. 

« Ondersoek naar het verband tnsBchen den aard der rystroeding in de gevangenissen op Java en Madoera 
en het voorkomen van beriberi onder de geintemeeden. Batavia, 1897. 

» Three Lectures on the Preservation of Health Amongst the Personnel of the Japanese Navy and Army. 
Lancet, 1906, 1, 1369, 1451, 1520, etc. 

•Rice and BeriberL Joom. Trop. Med. and Hyg. 1909, Xn, i27. Lancet 1907, 1, 1776, etc. 

' Beriberi in Siam. Philippine Joum. Science 1910, V, 73. 

• Practical Experiences with Beriberi and Unpolished Rice. Philippine Jour. Science 1911, Vi, 1237. 
Abo Joum. Am. Med. Ass. 1911, LVI, 1238. 

•Note sur le Beriberi a Poulo-Ccodore. Ann. d'Hygitee de Med. Col. 1910, xm, 16. 

>• The Eradication of Beriberi from the Philippine Scouts by means of a Simple Change in their Dietary. 
Philippine Joum. Science, 1911, VI, 133. 

M Beriberi, Wm. Wood & Co., New York, 1913. 

BSome Further Remarks on Beriberi Am. Joum. Tropical Diseases and Preventive Med. 1914, I, 
826. 



24 PROCEEDINGS SECOND PAN AMERICAN SCIBNTIFIO CONGRESS. 

Any such communicatioii to be worthy of attention should contain a detailed state- 
ment of the food actually consumed by the affected persons, for the 90 days prior to 
the development of the disease, showing components, quantities, and a statement as 
to whether the articles used were fresh, cann^, or otherwise preserved.*' 

Therefore, while we do not even suggest that our knowledge concerning beriberi is 
complete, it is believed that the points that remain for investigation are of scientific 
rather than of practical interest. They concern the chemist, the physiologist, and 
the clinician and need give no concern to the practical sanitarian, who can eradicate 
beriberi by compelling the use of a proper diet, even though the exact physiological 
vction of the vitamines has not yet been determined. I would even go further and 
say that the sanitarian who is faced by a widespread occurrence of beriberi and refuses 
to recommend the changes in the diet that experience has proved will prevent beri- 
beri is in the same class with the man who to-day would disinfect the mails to prevent 
yellow fever. 

There are however many misconceptions concerning beriberi and deficiency dis- 
eases in general which should be dissipated. Many suppose that beriberi only occun 
on a diet of rice. Beriberi is a disease resulting from foulty metabolism and is directly 
caused by the deficiency of certain chemical substances in the food. These chemical 
substances have been called vitamines. Certain foodstuffs have been shown to be 
either relatively or absolutely deficient in these beriberi-preventing vitamines, idiile 
other foodstuffs contain a rich supply . If a group of men live almost exclusively upon 
those foods that are deficient in beriberi-preventing vitamines, beriberi will almost 
surely develop. The danger of contracting beriberi is therefore greatly increased by 
the consumption of a poorly-balanced or one-sided dietary. Beriberi may occiur, 
however, on a mixed diet furnishing a suflicient number of calories and containing 
the proper ratio of fats, proteids, carbohydrates, and salts, if all of the articles of this 
ration are deficient in the vitamines that prevent beriberi. Such occasions are 
infrequent, but they occur often enough to cast doubt upon the fact that beriberi is 
a deficiency disease in the minds of those who are not fully acquainted with the 
e\idence that incriminates certain foods. 

Obviously the sanitarian should know which foods have been proved to be beriberi 
producers and which foods will correct this deficiency. The rdle played by polished 
or overmilled rice, or rice that has been denuded of its aleurone layer, in the pro- 
duction of beriberi is too well known to deserve more than a passing comment. The 
fact that the great endemic centers of beriberi are almost always confined to peoples 
that use rice as the staple article of diet is a sufficient commentary on the part played 
by rice in the production of beriberi. 

It does not appear to be so generally known that various carbohydrate foods, such 
as tapioca, sago, and the various starches and sugars are quite as deficient in vitamines 
as rice and will produce beriberi in man or animals with great certainty when used 
too exclusively as articles of diet. It is even more important to note that ordinary 
white wheat flour is also very deficient in vitamines. Little ^ was perhaps the first 
to report the occurrence of beriberi among men living almost exclusively on fine wheat 
flour, but the literature is fuU of outbreaks of what was evidently beriberi in jails, 
as^'lums, and other institutions where bread has been used as the main staple of diet. 
One of the latest instances of this kind was reported from a jail at Elizabeth, N. J., 
by Parker.' It has also been shown ' * that fowls fed upon a combination of rice and 
bread, or upon bread alone, develop polyneuritis quite as promptly as when fed 
exclusively upon rice. All food products made of white-wheat flour must be regarded 

I Beriberi caused by Fine White I lour. Joum Am. Med. Ass. 1912, LVni, 2 2Q29. 

9 A Report on Beriberi in the County Jail at Elizabeth, N. J. Pub. Health Reports, 1914, XXIX, 339. 
See aim V'edder, Some Further Remarks oo Beriberi. (Reference 12.) 

* Vedder and Clark. Polyneuritis Gallinanim, a Fifth Contributicn to the Etiology of Beriberi. Phil- 
ippine Joum. Science, 1912, vn. 



PXJBLIO HBALTH AND MEDIOINB. 25 

as deficient in beriberi vitamines and as beriberi producers. Macaroni falls into 
this category. It produces polyneuritis in fowls,^ and on at least one occasion > a 
sanitary officer endeavored to prevent the occurrence of beriberi by substituting 
macaroni for the rice previously used. Quite as much beriberi occurred after this 
change as before, and in this particular case, instead of concluding that both foods 
were deficient, the erroneous deduction was made that the disease was not of dietary 
origin. 

It should also be noted that all canned foods must be regarded as possible beriberi 
producers. It has been shown by numerous investigators, including the writer,* 
that heating to 120^ 0. destroys the beriberi preventing vitamines in certain foods. 
All protein foods that are canned must be subjected to about this amount of heat in 
order to kill all the putrefactive organisms, and such canned foods are undoubtedly 
beriberi producers when used in excess. I have seen at least one case of undoubted 
beriberi in a white man, a ship's officer, who had eaten a most varied and satisfactory 
diet except that for the previous four months everything he had eaten had been 
canned. 

Com meal and potatoes are intermediate foods. The evidence from experimental 
animals seems to indicate that beriberi has been occasionally produced by feeding 
these foods. No extensive occurrence of human beriberi to be attributed to these 
foods is known to exist. It is certain however that they are relatively deficient in 
protective vitamines because their curative or prophylactic value in animals or men 
fed <m rice is practically nil. They can not therefore be used to balance an otherwise 
deficient ration. 

On the other hand a number of foodstuffs have been found to be relatively very rich 
in beriberi preventing vitamines. This is particularly true of rice polisldngs or the 
powdered aleurone layer removed from the rice in the process of milling. Rice which 
has been undermilled and which theref(»e retains the major p(»tion of the aleurone 
layer, has been definitely proven to prevent the occurrence of beriberi. However, 
in the introduction of such rice as a prophylactic, three difficulties have been encoun- 
tered. One that it is difficult to keep ^e rice up to specifications. This can be 
guarded against by examining a sample of every lot of rice delivered. If a few grains 
are stained by Gram's iodine solution, the percentage of the aleurone and pericarp 
remaining can be determined in an instant. Secondly, this rice is difficult to keep as 
weevils and other insects are very apt to infest it if it is kept long. The authmities 
of Java,^ have investigated sevend preservatives, and have found that the preserva- 
tion of undermilled rice may be secured by placing here and there among the rice, 
bottles or tins containing chloroform or carbon tetrachloride GGI4. They state that 
the use of these chemicals is without a single disadvantage, and that they do not 
influence the taste or smell of the rice or affect its prophylactic value. Tlie third 
objection to the use of undermilled rice is that natives that have been accustcmied to 
the use of pdished rice will frequently refuse to eat undermilled rice . For this reason, 
although the use of undermilled rice has been made compulscHry among the native 
troops of the Army (Philippine Scouts) and in all civil institutions in the Philippines, 
there is no means at present of compelling the native population to \ise it. For this 
reason, a tax on overmiUed or polished rice has been advocated,^ of such an amount 
as to practically render such rice prdiibitive in price for the poor people who are the 

1 WeUman and Bass. Polynearitis Qallinarum Caused by Different Foodstuffs, etc. Am. Joum. Trop. 
Dia, and Preventire Hed. 1913, 1, 1». 

sLoivelaoe. Peripheral Neuritis in the Amasoii Valley. Am. Joum. Trpp. Dis. and Prev. Hed. 1918, 
1, 140. See also Joum. A. M. A. 1912, LIX, 2134. 

t A Fourth Contribution to the Btiology of Beriberi Phnipplne Joum. Science, 1912, VU, 419. 

* Ottow. Testing, Storage, and Preparation of Uiqwliahed Rice. Natunrkundig Tyjdsdirift voor Ned. 
India. 1916, LXXIV, 148. 

• Haistf. Beriberi: GoTemmentia aid in its Eradication. Medical Record, 1912, LXXXI, 616. Ved- 
d«. The Prevention of Beriberi. TransactlonB 16 Intemat. Cong, on Hyg. and Demography. See also 
BecftMri, Wm. Wood A Co., 1913. 



26 PBOOEEDINGS SEGOKD PAK AMSBIOAN 8CIBNTIFI0 OONQBESS. 

main sufferera from beriberi. ThiB would compel these people to use iindermilled 
lice which can be sold at a cheaper rate than polished rice and which in addition 
would prevent beriberi. 

It has also been ascertained that various species of legumes, such as ordinary white 
beans, and several varieties of peas when added to a ration of polished rice, will 
prevent the occurrence of beriberi.' It has also been shown experimentally,* 
that peanuts will prevent avian polyneuritis. It is probable that all leguminous 
vegetables are rich in beriberi preventing vitamines. 

The Japanese have found that barley is an efficient prophylactic against beriberi. ' 
Barley also prevents the development of polyneuritis in birds fed on polished rice. 

There are undoubtedly other foods than the ones mentioned which ^en used too 
exclusively may produce beriberi. There are also undoubtedly other foods that 
possess a prophylactic value. It would be of some practical value if all foodstuffs 
were tested esperimentally to determine their content in beriberi preventing vita- 
mines, and the writer hopes some day to carry on this work. In the meantime, how- 
ever, as already stated, the sanitarian may at any time eradicate beriberi by substi- 
tuting for some of the beriberi producing foods enumerated above, either undermilled 
rice, beans, or bariey, or preferaUy a combination of these foods. The combination 
is preferable when possible, because through accident or design some of the i>eople 
whom we aim to benefit may fail to eat one of the above prophylactics, and this 
danger is reduced to a minimum if several such prophylactics are used. 

Passing to the unknown with regard to beriberi there are three problems that are 
of the utmost scientific interest. These may be stated as follows: 1. The relationdiip 
between dry and wet beriberi. Are these two types of the disease caused by the 
deficiency of the same vitamine or by different vitamines? 2. What is the physiolo- 
gical action of the vitamines? Do they act as indispensable building stones for 
certain tissues, or are they concerned in some other manner, as, for instance, in 
carbohydrate metabolism? 3. What is the chemistry of the vitamines? The sdu- 
tion of these problems is not only of great importance to a proper understanding of 
beriberi, but will probably throw much lig^t upon other deficiency diseases and upon 
our conceptions of physidogical problems. 

1. The niaiidnM'p between dry and wet 6m6ert.-— Althon^^ the paralytic symptoma 
in beriberi may be easily explained as a result of the degeneratians tlutt occur in the 
nervous system, no rational explanation of the occurrence of the anasarca and effusioDs 
that characterize wet beriberi has been afforded . If the pathological condition known 
as dry beriberi and that known as wet beriberi are both produced as the result of a 
deficiency of one vitamine, what is the explanation of the well-known feet that in one 
epidemic most of the cases will be of the dry type, while in another epidemic most 
of the cases will be of the wet type? 

I have thought,^ *, that a probable explanation of this strange phenomenon is afforded 
by the theory that dry beriberi is caused by the deficiency of one vitamine, while wet 
beriberi is caused by the deficiency of another vitamine. There is a certain amount of 
experimental evidence in favor of this theory, since it has been foimd that a simple 
alcoholic extract of rice polishings contains substances that will produce an immediate 
cure in cases of wet beriberi, while it is entirely ineffective in the treatment of dry 
beriberi. However if the rice polishings are treated in a different manner, the vita> 
mine that cures dry beriberi is obtained, and its administration results in a prompt 

1 Holahoff Pol. Ka^ang-idjo, irn noaveaa medicament oontre le Beriberi. Janus 1902, VTI, 534, 570 
See also BeibefteZmn Arch. f. SchMb u. Tropenhyg. 1910, XIV, 7. 

> Roramel and Vedder. Beriberi and Cottonseed Poisoning in Pigs. Jomn. of Agrieultnral Reeeardi 
Dept. of A ^culture, Wash., D. 0., 1915, V, Noii, 488. 

* Saneyoshi. On Kakke. Proceedings of the Xni Internat. Congress, Paris, 1900, XVII, 78. 
« Vedder. Beriberi, Wm. Wood A co. New York, 1913. 

• Vedder and Clark. Polyneoritis and QaUinamm, a fifth oontnbcitlon to the Etiology of Berfberi. 
Phittpptne Joum. Sdenoe, 1912, VII. 



PUBUO HEALTH AKD MBDIOIKE. 27 

cme of the paralytic Bymptoms of dry beriberi. These facte at least indicate the 
possibility that rice pc^isbings contain two distinct though probably chemically 
related Titamines. Unfortunately concliudye evidence as to the truth or falsity of 
tills theory has not yet been obtained because a suitable experimental animal has been 
lacking. Fowls and pigeons are ideal experimental animals for the production of dry 
beribm but appear to suffer rarely, if at all, from wet beriberi, and t3rpical wet beri- 
beri can not be produced with any degree of regularity in any of the common laboratory 
animals. Howerer, within the past year Rommel and Vedder,' have found that pigs 
fed on polished rice suffer from wet beriberi in a considerable percentage of cases. 
Further woric is now in progress, and it is to be hoped that, having found a suitable 
experimental animal, an explanation of the rdation between dry and wet beriberi 
may soon be afforded. 

2. Whai 18 the phytioloffieal action of (he vikxmines, — I have been strongly of the opinion 
that the vitamine of dry beriberi is a building stone which is essential for the meta- 
bolism of the nervous tissues. This oi^nion is based upon the following facts: 

1. If the supply of this vitamine is cut down by feeding exclusively <m polidied 
rice, changes in the structure of the nerve fibres of fowls may be demonstrated after- 
only 7 days on such a diet. The evidence of beginning degeneration at such an eariy 
date i^pears to indicate that a certain amount of this vitamine is constantiy necessary 
in Older to maintain the nervous system in a healthy condition. 

2. The nerve cells from the cord of fowls suffering from polyneuritis galHnarum 
I»esent changes very similar to those demonstrated in the nerve cdls of birds that 
suffer from fatigue as the result of long flints. 

d. Fowls suffering from polyneuritis may be completely cised within a few homa^ 
by the administration of the vitamine obtidned from rice poMshings. 

This evidence at least strongly suggests that this vitamine is a constituent tiiat is 
essmtial to the normal metabolinn of nervous tissue. It is difficult to understand how 
it can act in any other manner than as a building stone of that tissue. 

More recently Funk,* and Bradd<m and Cooper,' found that when fowls were allowed' 
a fixed amount of vitamine, the greater the proportion of carbohydrate in the food, 
the quicker was the onset of polyneuritis. From thn evidence these investigatoTB- 
coBcMe that the vitamines play an active rdle in the assimilation and metabolism of 
carbohydrates, and that it is in this way rather than as a building stone for nervous^ 
tissues tiiat vitamines are essential to the Hfe of the organism. 

It appears to me that this ccmclueion is premature to say tiie least. It has always 
been supposed that carlx^ydrate foods were chiefly of value in the animal economy a» 
fnd, or as a source of heat and energy, ratiier than as tissue builders. It seems highly^ 
im|»obable that carbohydrates are of such importance in tiie metabdism of tiie nervous 
tissue, that a hult in cnbc^ydrate metabolinn would result in tiie profound degenera- 
tion of the nervous system seen in beriberi. But aside from such a priori reasoning,^ 
there is experimental evidence which it is difficult to reconcile with such a theory. 
Schanmaon,^ produced paralysis with evidence of degeneration in the nerves, in both* 
rats and dogs by feeding them exclusively on. meat that had been sterilised in an auto- 
clave at 120^ 0. If beriberi and nerve degenen^ons may be produced as the result 
of the destruction of the vitamines in animals that eat no carbohydrate food, this 
would appear to show that the vitamines are essential to the body in some other way 
than as factor in carbohydrate metabolism. 

> Bwlbcri and C«tteMeed PoiaoDiiis io Pics. Jour, of Agrteattiiral Rwearah, Waih., D. C, 1916, V, 
NoiL488. 

• Fonk. Die RoDe der Vitamine iMim Kohtahydnt-StQffwwfaMl. Boppa-Seylflfs Zdtachrift for 
PhjrsiolosiiolM Chemto 1014, LXXXIX 37& 

• Braddoo and CoofMr. The Inituflnoe of MataboMc Faotora in Baribcri. Jonm. of Hygl»6 lOU, ZIV, 
aSL SeealM>Brtt.liad.Joitf]Liai4,I,1348. 

4 flohaomann. Die Aetiotogle der Beriberi unter Berooksiofatigtnig dea Oeaasten Pho^hontoffweohaela. 
Befaefte. ram Ardi. f. Soliilb a. Tropcnhyg. 1910, XIV, 825. 



28 PROCEEDINGS 8E00ND PAN AMEBIC AN SCIENTIFIC C0NQBB88. 

Funk ' performed one experiment in an endeavor to show that beriberi is not 
an intoxication, difficult to reconcile with the theory that the vitamine is concerned 
in carbohydrate metabolism. Four healthy doves and four doves in the last stages 
of polyneuritis were killed, plucked, and finely minced and extracted with three 
times their volume of absolute alcohol in a shaking machine. The extracts were 
filtered and evaporated in vacuo. The residues were taken up with water and fed 
by mouth to birds suffering from polyneuritis. In all eight cases a cure was effected, 
with the extract from birds suffering .from polyneuritis, as well as with the extract 
from normal birds. This contradicts the intoxication theory, since no trace of intoxi- 
cation resulted from the administration of extracts of birds suffering from polyneuritis, 
but on the contrary a cure. The extract from healthy birds contained more vitamine. 
Funk says: "This exi)eriment shows that all the vitamines of an organism can not be 
mobilized to take part in metabolism. It appears also that the organs most essential 
to life are the ones first robbed and the animal dies before the whole supply of vita- 
mine is exhausted from the body.'' It appears to me that Funk here admits what he 
elsewhere denies, namely, that the vitamines exist in the body as constituents of the 
tissues and particularly of nervous tissue. 

Further experiments are greatly needed to determine the exact r61e of the vitamines 
in the metabolism of the body. But at present I see no reason to doubt that one of 
them is concerned in some way with the metabolism of nervous tissue, probably as a 
building stone, and that this is the most plausible explanation of the degeneration 
of the nervous system in beriberi, which occurs when this vitamine is withdrawn. 

WTuU x$ the ehemUtry of (he vitaminetf — ^The study of the chemistry of the vitamines 
has been a source of confusion. Funk ' claimed to have obtained the viatmine from 
rice polishings in a pure state and gave its empirical formula. Edie ' and his co- 
workers obtained a different formula. Suzuki and Shimamura and Odake ^ by a differ- 
ent method obtained a vitamine of still different chemical composition. Vedder and 
Williams * obtained substances that would promptly cure fowls suffering from poly- 
neuritis, but were not able to obtain sufficient vitamine in a pure state to submit it 
to chemical analysis. Finally, Drununond and Funk ^ now admit that they can not 
isolate the pure vitamine and say that it is apparenly decomposed during the frac- 
tionation, and all trace of it is lost. The chemist who reads these various papers mig^t 
come to the conclusion that the very existence of such a thing as vitamine was doubtful. 
However the fact that a vitamine exists is as well proven as any natural fact can be. 

All of the above investigators have succeeded in obtaining from rice polishings 
a chemical substance, which in doses of a few milligrams was capable of curing birds 
suffering with polyneuritis induced by a diet of overmiUed rice. The explanation 
of the uniform failure to obtain a sufficient amount of this substance in the pure state 
for a B&dsiactoTy chemical analysis is very simple. In various foodstuffs it is a very 
minor quantitative constituent and it is very difficult to extract. It is rapidly de- 
stroyed by most of the chemical reagents that are used to fractionate these complex 
foodstuffs and is a most unstable body even when minute quantities are obtained. 

Mr. Williams who worked on the chendstry of the rice polishings in Manila has been 
able to continue this work and is now able to make some definite suggestions with regard 

1 E3q)erlmeiiteUe Boweise gegea die toxlsche Tbeorto der Beriberi. Hoppe-Seylers Zeitachrift (. Phyai- 
ologische Cbemie. 1914, LXXXIX, 378. 

• On the Chemical nature of the Sahstanoe which onreB PoiyneoritiB in Birds. Joom. Ph jalology, 1011, 
XLUI, » also 1912, XLV, 75. 

• Edie, Evans, Moore, Simpoon, and Webster. The Anti-Nearitie bases of Vegetable origin with a 
Method of Isolating Tomlin. Bio^:iienL Joom. Liverpool, 1911-1913, Vn, 334. 

« Ueber Oryxanin, etc Biochemische Zeitscfarlft, 1918, XLm, 89. 

» Concerning the Beriberi Preventing Substances or Vitamines contained in Rice PoUshlngs. Phil- 
ippine Joom. 8c 1918, Vm, 175. 

• The Chemical Investigation of the Phospho-Tongatate Precipitate from Rice PoUshings. Bioobemioal 
Journal, 1914, vm. No. S, 598. 



PUBLIC HEALTH AND MEDICINE. 29 

to the chemical constitution of the beriberi vitamine and the reason for its unstable 
nature. 

We thus find that while there are still important problems connected with beriberi 
they are all being studied and there is a fair prospect that they will be solved. 

In closing I can not refrain horn commenting on the attitude of several physiolo- 
gists toward the new conception of the vitaminee and toward the term itself. Thus 
one physiologist who has several times objected to the use of the term vitamine says 
inarecentpai)er: 

I am conscious, in the midst of our enthusiasm, of a warning given by Rubner in a 
protest against the creation of a new scientific vocabulary and the danger of trans- 
forming ue natural sciences into a play of words. The science of nutrition must 
never tolerate the substitution of unhealthy speculation for what is admittedly a 
laborious undertaking, namely, experimentation. 

The conception of the vitamine rests securely upon experimental evidence. I 
suppose there was a time when Harvey's discovery of the circulation of the blood 
was termed a "play of words" and "unhealthy speculation" by some of the scientific 
"standpatters" of that day. The chemical constitution of the vitamines has been 
very uncertain although there is good reason to believe that the beriberi vitamines are 
members of the pyrimidine group. But if the chemistry of these bodies should never 
be thoroughly understood, it is equally true that the chemistry of our common foods, 
of our secretions, and even of the blood itself is still very obscure. 

With regard to the term itself it may be possible later to find a better one. But 
in the meantime we are obliged to name this substance before we can discuss it. 
"No ideas can materialize except throu^ their expression," and for the present 
the term vitamine is quite as useful and plays the same rdle in our scientific vocabulary 
as the terms enz3ane, hormone, and antibody. The existence of these substances 
has been demonstrated by experimentation, and we can not ignore them because we 
are as yet ignorant concerning their chemistry. 

The Chairman. There are two other papers on this subject. If 
there is no objection, we will defer the discussion until after the com- 
pletion of these papers. We wiU now have the paper of Dr. Lebredo, 
of Cuba. 



BERIBERI, ESTUDIO EPIDEMIOLOGICO Y EXPERIMENTAL 

Por MARIO G. LEBREDO, 

Je/e de la Seccion y del LaboraUmo de Investigacionei, etc,, Direccum de Sanidad, Habana^ 

Cuba. 

De ninguna manera negaremos que el anez pulimentado, cuando se administra en 
grandes cantidades, como alimento principal o exclusivo, a diversos animlaes en los 
estudios ezperimentales, provoca verdaderos trastomoe de origen polineurftico. 

Igualmente estd plenamente demostrado, que esas polineuritis experimentales, se 
deben, en d^nitiva, a la pobreza que en principios fosforadoe tiene el arroz puli- 
mentado, principios nutritives importantes que quedan en el desecho del arroz en 
las operadones de pulimentaci6n. 

Por lo tanto, es evidente que, en los palises donde el arroz es alimento principal o 
ezdusivo, han de encontrane, naturalmente casos de esas formas polineurfticas, 
aniUogas a las expmmentalmente provocadas en animales y dasificadas como beriberi. 

Pero, punto concreto que hemos de abordar: ^Debe de quedar aceptada de manera 
definitiva, como tinica, esa explicaddn etioldgica? ^Deberi quedar convenido que 



30 PBOGEEDINQS SECOND PAN AMEBIOAK 80IENTIFI0 C0NQBES8. 

68 86I0 una enfermedad producida por falta de piindpioe nutritivoe, determinadoo, 
en el airoz y que, por lo tanto, sea asunto resuelto que ocupe el beriberi en loe hituros 
congresoe el lugar principal que ocupa en ^ste entre las enfermedades producidas por 
una alimentad^n deficiente (starvation). 

Nosotros creemos que hay algo mds que hacer; creemos que, tambi^n, debe de 
haber algo active que produzca el beriberi. 

Y lo creemos porque, no siempre, reviste la foima cr6nica, la depaup^ante, per— 
fectamente explicable por prolongada carencia de determinado principio nutritivo; 
porque no todoe loe que utilizan el arroz como alimento exclusivo se hacen berib^ricos, 
como debiera suceder, indefectiblemente, de ser la carencia del elemento nutritivo 
indispensable, el causante de esa enfermedad. Por el contrario, unas vecee formaa 
agudas sorprenden a individuos que hasta entonces gozaion de perfecta salud y que 
comian el arroz agregado a una variada alimentaci6n; y otras voces, formas verdadera- 
mente fulminantee, se preeentan, tambi^n, en individuos que, durante afios, ban 
estado sometidos — sin preeentar la menor manifestaci6n patol(3gica — a la ezclusiva 
alimentaci6n del arroz, ataques fulminantes que estallan de repente, como si algtkn 
elemento pat<5geno hubiera venido a provocarioe. 

Nos parece que serfa 16gico aceptar— y conveniente diferenciar con nombres ade- 
cuados, dos mecanismos etiol6gicos: uno, el puramente alimenticio, provocando 
polineuritis a tipo cnSnico y la predispoeici6n; otro, el t6zico, tambi^n orizeo, provo- 
cador de fen6menos de intoxicacidn aguda y subaguda y, quizes, cr6nica del genuino 
beriberi. 

I. En el trabajo que vamos a someter a la con8ideraci6n de ustedes, exponemos 
algunos hechos interesantes de epidemiologfa del beriberi en Cuba, en reladdn con 
un estudio especial de virulencia de los anocee consumidoe en y fuera de los lugares 
donde se presentd la enfermedad. 

Nada hay m^ provechoso para el investigador, que el estudio de las epidemias, en 
regiones indemnes, de aquellas enfermedades que ezisten, constituyendo focos end^ 
micos, en determinados paises. Y mayor provecho hay si ha side necesario llevarlo 
a cabo desde el importante punto de vista sanitario. 

En loe focos end6micos, por lo general, el inters sanitario es de d*tBminuci6n y, por 
lo tanto, no llegan a discemirse bien los matices de los cases benignoe que en epide- 
miologfa son tan graves. Experienda de ello, y grande, tuvimos con la fiebre amarilla, 
enfermedad que vino a moetrar bien sus formas atenuadas, benignas, cuando la acci6n 
sanitaria, en^igica, hizo descender la secular endemia amarilla, a reduddos Ifmites 
epid^micos. 

Con el beriberi pa86 lo mismo. 

En Cuba se tuvo al beriberi como enfermedad corriente, abundante, casi end^mica, 
en las plantadones de azticar, en la ^poca de la eedavitnd, ^poca en que la inmigra- 
ci6n de esclavoa africanos y hasta de semi-esdavos chinos, parecia traer, con el c<m- 
tingente propenso a contraer la enfermedad por el duro trabajo y la mala alimentaci6n 
a que se les sometfa, la causa desconocida de la enfermedad, naturalmente considerada 
exdtica. 

En un trabajo que publicamoe ' en 1913 expusimos, que, en esa ^poca ylassiguientes 
hasta la de nueetra independenda, no fueron diagnosdcados berib^ricos todos los que 
debieron serlo, pues se pasaban por alto loe casos f ugaces, ni fueron poeitivos todos los 
diagnosticadoe, engrosando las estadlsticas como berib^ricos, an^micos palddicos o a 
parasitologfa intestinal, hidroh^micos por miseria, etc. 

Sin embargo, encontramoe en la literatura m^dica de ese perfodo, casos aislados y 
verdaderas epidemias, innegables, de genuino berib^. 

De marzo de 1911 data nuestra primera observad6n de un interesante brote epi- 
d^mico bien caracterizado de beriberi. 

1 Beri-Beri. M. 0. Lebredo. Boletfn OflofaU de la 8«cretarla de Senidad y Beneflcencia de Caba, mayo 
y Jtinio de 1013, tomo IX, No. 5 y 6 (en espafiol). En inglet en el tomo X. 



PUBUO HEALTH AND MEDIOINB. 81 

Se presentd en los presos de la c&tcel de Santa Clara (Provinda de Santa Clara). 

Las manlfeBtadones patokSgicas fueron muy evidentee y tuvimos oportunidad de 
hacer la autopsia de on case, muerto per lonna agada, cuya agonia, dolorosa y cruel, 
presendamos. 

Deseando hacer an estudio completo del arroz que consumlan los atacados, recogimoe 
algona cantidad, estudio ampUo que nos llev6 a condusiones que hideron arraigar 
en nosotros la idea, de que el beriberi puede ser produddo por un t6xico, desarrollado 
en el arroz a expensas de la substanda amilicea atacada por un germen amUoaimo, 
t6xico que actda sobre los elementos nerviosos, est6n o no predispuestos. 

Las condusiones provisicmales del estudio, fueron presentadas al Congreso de la 
American Public Health Association, reunido en la Habana el 2 de didembre de 1911. 

La epidemia fu6 grave: de siete atacados murieron cuatro con len6menos agudiisimos 
cardio-pulmonares. 

Cofrespondiendo con esa gravedad epidemiol6gica, el estudio especial del arros 
que se consumia allf , mostr6 una notable vinilenda para el curiel. 

£1 arroE contenia un germen andlodmo, a esporos resistentes a la temperatura de 
lOO^'C. por mis de 20 minutes. Este germen al vivir a expensas de la substanda 
amiUcea dd arroz preparado hervido, fabricaba substandas t6xicas (no identificadas), 
mortales para d curiel, por la via intra-peritoneal, en dosis de 16 c. c. y aun menos; 
por la via cerebral, en dosis pequefias, gotas; y en un case, por la via gistrica, depu^ 
de haberse provocado la irritaci6n del aparato digestive. Las substandas t^caa 
paredan tensr una exdusiva acd6n, directa, sobre los elementos nerviosos, imtados 
o no, ya que fueron inofensivas por las vfas subcutAnea y drculatoria. 

Los fendmenos presentados por el curid intoxicado mostraron una interesante 
analogia con los dd beriberi agudo, cardio-pulmonar, humane; y en las autopsias 
encontramos: poca cuagulabilidad de la sangre, dilataddn dd coraz6n derecho, exu- 
dado end pericardio, en las pleuras, aunend peritoneoy m&B o menos limitadagastro- 
ileo-yeyunitis, que recnerda la duodenitis que, segtin Hamilton Wright, acompafia 
a todo beribdrico agudo, o existi6 en aquellos casos que encontramos ya en 6poca de 
polineuritis reddual berlbdrica. 

II. En junio de 1912, y en febrero y abril de 1913, surge de nuevo la sospecha de 
estar atacados de beriberi varios penados, en la misma dlrcel de Santa Clara donde se 
present6 la grave epidemia anteriormente dtada. 

Los casos de junio de 1912 y los de febrero de 1913, no pudieron ser retrospectiva- 
mente confirmados. Las histcnias clfnicas de los presentados en abril, sefialaron algo 
m^ concrete. Fufmos a verlos y no pudimos llegar a condudones precisas: ninguno 
(eran 6), presentaba aspecto clinico que correspondlese a ninguno de los cuadros 
tfpicos de las formas intensas dd beriberi, ni forma htimeda ni athSfica y menos la 
terrible forma aguda cardio-pulmonar. En todo case, d fueron de berib^ genuino, 
lo fueron de la forma ligera, fugaz. 

Creemos que existen esas formas ligerisimas en d verdadero beriberi, tan diflciles 
de difltingnir de algunas manifestadones polineuriticas de una condderable tenuidad, 
que pueden manifestarse en los individuos que viven recluldos en los asilos, donde 
causae de orden moral y, prindpalmente, d hadnamiento, la vida sedentaria, la 
podci6n habitual de pie, la monotonia de la existencia y de la misma alimentad6n, 
son sufidentes para produdrlas. 

Ninguna de las muestras de arroz, recogidas en las diversas ^i>ocas sefialadas^ se 
mostr6 virulenta para d curiel. 

No deja de ser sugestivo el poisamiento de que puedan existlr esas formas tenues, 
no bien acentuadas, fugaces, por acci6n trandtoria dd t6xico, cuando d material 
infectado (arroz) no es muy abundante, coinddiendo la desparad6n de las invaakmes, 
d poeo retieve mostiado por la epidemia y la curaci6n r&pida de los iavadidos, con d 
agotamjento dd elemento etiol6gice por censumo del arroz tdxico, resuhando entonces 
taidfo d empefio en encontnur muestras infectadas. 



82 PROCEEDINGS SECOND PAN AMEBIOAN SCIENTIFIC C0NQBE8S. 

III. Airoces de div^safl dases y procedencias (caniUa viejo [old hard], Valencia 
corriente, semilla Siam, Valencia Bombay, semiUa corriente, canilla nuevo Santiago 
de Cuba, semilla americano, semilla S. Q.*)» estudiados en distintas ^pocas (14 muestras 
en 1914), no mostraron ningdn efecto txSxico sobre los curlelee, ni por la via mds activa, 
la peritoneal, ni en dosis considerable hasta de 20 c. c. 

Es cierto que a ocasiones encontramos en estos arroces inofensivos, g^rmenes banales 
a esporos resistentes a lOO^'C. amilozimos en corto grade, no virulentoe; pero estos 
g^rmenes no llegan — o si Uegan lo hacen mal — a adoptar la especial forma de tabaco, 
a reaccion amilodea excepto en el extreme esporulado que en el perfodo de esporulaci6n 
toma el germen virulento estudiado por nosotros en nuestros arroces t6xicos y el 
encontrado y aislado por Le Dantec de excrementos de berib^ricos. 

rV. En didembre de 1914 se desarroll6 en Banes (Provinda de Santiago de Cuba), 
una epidemia de beriberi, denundada por el Dr. Ruiz Ariza, m^ico muy competente, 
superintendente de la Divisi6n Banes de la United Fruit Company, quien, solamente 
en el Hospital de la compafila a su cargo, ob8erv6 siete atacados. 

Ya unos dfas antes tuvimos notidas de un case por una historia cUnica remitida por 
el jefe de sanidad de aquella poblad6n. 

En el afio 1908, es dedr, pr6ximamente 6 aflds antes de la ^poca de la aparld6n de 
este brote, hubieron varies individuos atacados de beriberi, no s61o en Banes, sine en 
un embarcadero situado a pocos kilometros de esta poblad6n, siendo dos de los cases 
fatales. 

Trasladados a Banes pudimos observar varies casos de genuino beribm; pero todos, 
aunque bi^n pronunciados, ya en periodo de desaparid6n sintomitica, fin de epidemia. 
Estudiando retrospectivamente las historias de dos individuos f alleddos al prindpio 
de este brote, resulta, que puede considerarse murieran de beriberi agudo, adem^s 
de otro case tfpico (Antonio Gonz&lez) falleddo al dia siguiente de haber salido del 
hospital, con trastomos del coraz6n, taquicardia, etc., fen6menos graviaimos que, 
muy amenudo no son sospechados por el mismo enfermo hasta que estallan en crisis 
mortal. 

Segdn nuestras observaciones, el proceso pat6geno desarrollado en Banes, examinado 
en conjunto hi6 uno polineuritico, con trastomos m^ o menos marcados de la motilidad 
por tension de los gemelos, con edema tibial, con disminucidn o aboliddn total de los 
reflejos rotuUanos, con molestia epig^trica, con pulse frecuente, con angustia precor- 
dial, con taquicardia, Uegando los trastomos cardio-pulmonares a produdr la muerte 
en los casos enumerados. 

Sin entrar en profundas consideradones con respecto a la sintomatologfa del beriberi, 
no podemos menos de seflalar que, para nosotros, en todo genuino berib^rico — ^ya se 
estudie en su primera invasidn, o en un brote siguiente — deben de mostrarse, m^ 
o menos acentuados, fendmenos cardiacos acompafiando a los fendmenos polineuriticos 
de las extremidades inferiores. A este respecto dice Lacerda con raz6n: '4o mds 
especial del beriberi es la aparid6n temprana de los trastomos cardiacos y de los 
trastomos respiratorios ligados a alteradones del neumog&strico y del fr^nico. '' 

En Banes recogimos 16 muestras de arroz, en 6poca en que aun estaban presentes 
manilestaciones berib^ricas en algunos de los casos; de ellas, 7 fueron virulentas para 
el curiel. 

Correspondid a la prueba de virulencia, la presenda de un germen amilozimo 
semejante al encontrado en el arroz pat6geno de Santa Clara, aunque no tan activo 
en su desarrollo ni en la producd6n de substancias t6xicas. 

V. Ultimamente, en mayo de 1916, lleg6 a Cienfuegos, procedente de la India, el 
vapor ingl^ Deioa despu^ de estar en cuarentena por venir de puerto sucio de bub6nica 
(7) atrac6 al muelle. 

Al dfa siguiente de atracar, ya en operadones de descaiga, muri6, repentinamente, 
el indio Latifall6e, de 25 afios de edad. Segdn breve historia recogida, resulta que 
tavo al levantarse ''un pequefLo dolor en la regidn precordial, a pesar del cual con- 
tinue trabajando durante el d(a; por la tarde se acentu6 el dolor acompafiado de disnea, 



PUBUO HEALTH AKD MSDICIKB. 33 

intensa, colapeo y muerte." Segdn el cwtificado de autopsia, fu6 diagnoBticado de 
pericarditiB. 

Tree dfas despu^s, el m6dico de puerto visita el vapor, y encuentara nueve tripulantee 
con el siguiente cuadro: '*aspecto deprimido, flacoe, eon edema de las extremidades 
inferiores, cara angustioea, pupilas contraidas, trastomos de la locomoci<5n en distintofl 
gradoe hasta notable paraplegia, el reflejo rotuliano en unoe notablemente disminufdo 
y en otros abolido, apir^ticoe, pulso frecuente, ruidoe del corazdn dismindidoe, dolor, 
en todoB, m^ o menoe intense en la regi6n epig&Btrica que se irradia a la regi6n pre- 
cordial." No se pudieron tomar mayores antecedentes epidemiol(5gicoe por dificul- 
tades de idioma. 

Sin embargo, ante el caso de muerte y el cuadro deecrito, era 16gico pensar que hubo 
un verdadero brote epid^mico de genuine beriberi dentro del vapor Dewa, 

La alimentaci6n casi exclusiva de la tripulacidn era el arroz. Interesadoe por el 
resultado del estudio de los arroces virulentos y no virulentos, antes mencionadoe, y 
por la correlaci6n ballada entre esos resultados y la intensidad de los brotes berib^ricoe, 
tenia x)ara nosotros un gran valor el estudio del arroz Dewa^ que habfa servido de casi 
exclusive alimento a esos individuos de su dotaci6n, atacados de beriberi, en epidemia 
reciente, con muerte, y en recinto bien limitado. 

El arroz recogido result6 particularmente virulento, el mds virulento de los estudi- 
ados x>or nosotros, por lo que vamos a dar algunos detalles del trabajo experimental, 
aprovechando la ocasi6n para sefialar particularee interesantes. 

OERHBN. 

Contenia un germen amilozimo, a esporo resistente a la temperatura de ebullici6n 
por m&a de 20 minutes, que despu^ del tercer dfa de germinaci6n adoptaba formas de 
tabaco, con reacci6n amiloidea de todo el elemento, excepto en el extreme esporulado. 

Este germen result6, como veremos comprobado despu^, productor de considerable 
cantidad de substancias t6xicas (beriberlgenas?) para el curiel. 

En el arroz preparado, hervido, y dejado con bastante cantidad de agua, 1 : 4, el 
germen evolucion6. Como es natural, esa evoluci6n influye poderosamente sobre el 
medio, en el cual se acumulan los productos que se desarrollan al atacar el germen- 
fermento al almid6n del arroz, U^ando por concentraci6n de esos productos, despu^ 
de algunos dfas, a bacerse impropio para el natural desenvolvimiento biol6gico del 
germen. Cuando esto sucede, ocurre polimorfismo por involuci6n. 

El germen no se desarrolld bien cuando utilizamoe como medio de cultivo otros 
medios amil&ceos, ni cuando esterilizamos el arroz en agua, bajo presi6n. Su mejor 
medio de cultivo es el propio arroz que debe esterilizarse seco, en el autoclave y luego, 
seco y est^il cocido con agua est^il. 

Se comprende que cuando el grano de arroz contiene el germen, porque viene 
naturalmente infectado, y estos son los cases habituales de nuestras pruebas, basta con 
hervir el azroz, tal como viene, en agua, durante 20 minutes y pasarlo a frasco est^ril. 

El germen, cultivado en agar, pas6 a la forma de resistencia, esporulando, sin dar 
la evoluci6n morfol6gica que en el propio cultivo orizeo. 

En resumen, el germen del arroz del Dewa, en su morfologfa, biologfa y reacciones, 
fu6 semejante, si no fu6 el mismo, a los encontrados en los arroces virulentos de las 
epidemias de Santa Clara y de Banes. 

Seguramente que el germen debe de existir, de manera natural, dentro del grano de 
arroz, infect&ndose, quizis, en los envasaderos despu6s de pulimentado, y es probable 
que la corteza (c^ara) y principalmente la pellcula peric^ica, sean contra ello 
excelentes protectores. 

VIRULENCIA. 

Este arroz se ha mostrado sumamente virulento. 

Via intraperitoneal . — ^Por Via intraperitoneal ha side muy mortifero, pues no s61o la 
cantidad clisica de 16 c. c. del agua del arroz preparado produjo la muerte de los curi* 



M 



PBOOEEDINQS 8SC0ND PAN AMEBICAN SOIBNTIFIO OONQBESS. 



eles inyectadog, sino que canUdades de 10 y hasta de 5 c. c, con b61o 23 6 24 horas de 
preparado el arroz, mataron a los curieles, en 1^, 6, 6 y 9 horas. 
Dosis de 1 c. c. nada produjeron. 

InyecciSn intraperitoneal. 



Caiiel. 



No.l 

Ho. 1,2 8.. 
No. 2, 2 8.. 
No. 8, 2 8.. 
No. 4,2 8.. 
No. 10,2 8. 
No. 11, 2 8. 



Feoha. 



Kayo 36 
JuziiolS 

...do 

...do 

...do 

Julio 20 
...do 



Cantldad. 



C.C. 



16 

16 

10 

10 

5 

1 

1 



Tiompo 

preparado 

elaiTos. 



23 
24 
24 
24 
24 
«6 
16 



Tiampo 

muerte 

desptite 

inyeoddo. 



HOTOt, 

1 all 
a 7 
a9 
5 

24 
No. 
No. 



6 

8 



Fendmenos 
yaotopcia* 



TIploos. 
Do. 
Do 
Do 
Do. 

No. 

No. 



■Dlaa. 

Lo6 fen6menoB t6xicos fueron loe mismoe que los provocados por los arroces t6xico8 
de Santa Clara y Banes. A voces hay, inmediatamente deepu^ de hecha la inyecci6n, 
ligeros fen6meno6 de shock, manifeetados por alguna inquietud y sobresaltos, p^o son 
fen6menoe que duran muy poco tiempo. 

Los propios sfntomas t6zico6 no aparecen, nunca, antes de la media hora de haber 
side inyectados, y so suceden de la siguiente manera: ligero malestar que se acentda 
T&pidamente, lenta progresiva angustia, respiraci6n con contragolpe diafragmdtico, 
que poco a poco se hace miuB dificultosa, erizamiento del pelo del cuello y cara, posicidn 
recogida en bola, y a voces con aspecto leonino, ojos hundidos, sufrimiento, martilleo 
de la cabeza con movimientos is6cronos con los golpes diafragm&ticos, caida de lado, 
agonf a lenta, y muerte, conjunto sintomdtico que corresponde segtin parece deducirse 
de la autopsia, a trastomos cardio-pulmonares. No ha habido reten8i6n de orina, ni 
par&lisis intestinal. 

En la autopsia encontramos: exudado en las pleuras, en cantidades de 0.1, 0.2, 0.25, 
•0.4 hasta 1.5 c. c; exudado en el pericardio, en cantidades de 0.1, 0.2, 0.3 c. c. 

Exudado. 



CurleL 



No. 1, 1 a 8 
No. 1, 2 a 8 
No.2,2a8 
No. 3, 2 a 8 
No. 4, 2 a 8 



Cavidades pleurales. 


Derecha. 


Isquierda. 


Ce. 


C.c. 


ai 


1.5 


1.5 


.25 


.0 


.0 


.4 


.1 


.2 


.1 



Pericardio. 



C.c. 



0.1 
.2 
.2 
.2 
.8 



No transcribimos el resultado de la medici6n del Ifquido encontrado en el peri- 
toneo, porque como la inyecci6n ha side hecha por esta via, no ha habido tiempo, 
por muerte r&plda, a la total absorci6n del Uquido inyectado. £sa medici6n es impor- 
tante en los exi)erimentados por la via subdural y gistrica. 

Los demds caracteres de autopsia fueron los habituales hallados en las experiencias 
con loe arroces de Santa Clara y Banes: dilataci6n del coraz6n derecho, siempre en 
m^ o menos amplitud, y algunas voces de la auricula izquierda muy Inguigitada; 
venas cavas y sus gniesos afluentes, principalmente los de la superior, sumamente 
inguigitadas, encontr&ndoee un verdadero molde de esos vasos, en gran parte de su 
trayecto, hasta el corasdn, formado por la sangre coagulada, cuando la autopsia es 



FUBLIO HEALTH AND MEDIOIKE. 



85 



tardia; cuando es muy reciente la muerte hay que ser muy cuidadosos para eea 

obaervaci6n de plenitud vascular veiioea, pues ee considerable la disminuci^ii de la 

coagiilabilldad eanguinea; color del corazdn, paido obscuro, con gran congesti6n de 

8UB paredes, y ocasional equimosis pequefio; diafragma la mayor parte de las voces 

muy abovedado, reduciendo considerablemente el espaclo de la cavidad tor&xica; 

pulmones, a voces muy blancos, p&lidos, con focos bien determinados de infartos 

hemorr^icos, y, al corte, como enfisematosos, otras voces, mds congestionados; 

intestino delgado, principalmente yeyuno, e fleon, color rojo, hasta rojo vinoso, y el 

estdmago con algimas zonas congestivas que ll^an en algunos casos el grade de 
equimosis. 

Via intracranecma. — ^Ha side menos mortffera que la intraperitoneal. Los curieles 

murieron en 4), 8 y 9 boras despu^ de la inyecci6n, desde gotas hasta 0.1 c. c. del 

agua de arroz virulento, de 43 horas a 8 dias de preparado. 

Tnyecci&n intracroTieana. 



No. 2,1 
No. 2, 1 
No. 4, 1 

No. 4, 1 
No. 6,1 
No. 6, 1 
No. «, 3 
No. 6, 2 
No. 7 2 



a 8. 
a 8. 
aS. 
a 8. 
a 8. 
aS. 
as. 
as. 
aS. 



Curiel. 



Cantidad. 



Vleotas.... 

...do 

0.1O.O 

.10.0 

.20.0 

.20.0 

.20.0 

.10.0 

.20.0 



Tiompo 

preparado el 

arros. 



43 boras. 

...do 

Gdlas... 
Sdfas... 
Sdlas... 
Sdias... 
Sdlas... 
6d1as... 
fidtes... 



Tiempo 
suiertedea- 

pote 
inyeockSn. 



9hofM.. 
...do.... 

No 

...do 

..do 

nhOTM. 

..doV.V; 
U boras. 






Feodmenos 
yautopsia. 



Tfpioos. 

Do. 
No. 

Do. 

Do. 
Tlpioos. 
No. 

Do. 

T4»iO08. 



En total: de 7 inyectados, murieron 4 solamente. 

La tunica de la inyecci6n es simple: punci6n dsea, punci6n delicada de las mem- 
branas cerebrales con una aguja de disecci6n fina, penetrando muy ligeramente en la 
Bubstancia cerebral, de manera que se provoque ima ligera irritaci6n de la viscera, 
sin grave traumatismo. La inyecci6n del agua de arroz virulento preparado, se hace 
muy cuidadosamente, sin hacer pre6i6n sobre la delicada estructura cerebral. Quizes 
algunos de los fracases experimentales por esta via, se deban a un exceso de precau« 
cidn de este particular de la t^cnica. 

Cuando, a pesur de todo cuidado, se ha producido un traumatifimo grave, se pre- 
sentan, inmediatamente despu^ de la inyeccl6n, contracturas fuertes hacia uno u 
otro lado, hasta convulsionee, en cuyo case desechamos al animal en experimentaci6n. 
81 solamente se presentan ligerisimos movimientos de inquietud, de torsion hacia 
uno u otro lado, rdpidamente fugaces, se deben al ''shock." 

Los fen6menos t6xicos, se presentaron a la media hora de la inyecci6n. 

Los sfntomas fueron: inquietud, marcha algo par^tica con ligeto titubeo de las 
extremidades posteriores; luego, inmovilizacl6n, sin par&lisb, con gran malestar 
mientras se establecen los trastomos reepiratorios con notables movimientos de con« 
tragolpe diafragm&tico; despu^ se echan de lado, erizamiento, etc.; los trastomos 
cardio-pulmonares se hacen m^ graves, y agonizan con relativa lentitud. 

Nunca, en nlnguno de los casos, (por ningima de las tres vfas efectivas para el 
t6xico), ha habido retenci6n de orina, ni par&lisis intestinal. Al contrario, la orina, 
abundante, se elimina con fuerza, siendo tambi^n muy notable el aumento del 
peristaltismo intestinal. La orina, examinada mucha voces, no ha mostrado sine 
ocasional traza de albtimina. 

En la autopsia encontramos: exudado pericMico 0.1, 0.2 y 0.25 c. c; y, hecho 
muy notable, exudado peritoneal en cantidad de 2, 3 y 5 c. c. Todos estos exudados 
perfectamente If mpidos, transparentes. 

6848e— 17— VOL X— 4 



36 



PBOOEEDINQS SECOND PAN AMEBICAN SCIENTIFIC C0NGBES8. 



Extulado. 



Curlel. 



No. 2, 1 a S 
No. 2, 1 a 8 
No. 6, 1 a S 
No. 7, 2 a 8 



Cayidades pleurales. 


Pericardio. 






Dereoha. 


Itquierda. 




C.e. 


C.e. 


C.e. 


0.0 


0.0 


0.25 


.4 


.0 


.2 


.0 


.0 


.1 


.1 


.1 


.2 



PflritoiMO. 



C.e. 



5.0 
2.6 
S.0 
5.0 



For lo dem&8, iguales manifestaciones viscerales que por las otras viae, aunqe 
mucho m^ ligera la congestidn del intestino delgado y de los meeenterioe corre- 
Bpondientes. 

Nada se encuentra en la cavidad craneal; si acaso, el sitio de la inoculaci6n sefialado 
por un punto casi imperceptible; pero, por lo dem^, no hay apreciable congestidn 
ni reblandecimiento de las superficies cerebrales. 

Via gdstrioa. — Este arroz del Dewa ha sido particiilarmente t6xico, administrado en 
muy diverse tiempo de su coccidn, por la via g^istrica, preparando previamente, por 
irritaci6n, el aparato digestive — en algunos cases hasta sin preparaci6n. 

Todos los curieles en los que experimentamos este arroz, por esta via, murieron. 

La irritaci6n g^istrica e intestinal ha side provocada de diversas maneras: adminis- 
trando pequefia cantidad, (una sola vez), de una soluci<5n clorhldrica d6bil, (3 a 5 por 
ciento, en agua, o en alcohol diluldo; o pimienta molida en bastante cantidad. 

Por lo general no se di6 el arroz hasta estar seguro de que el curiel estaba bien; 
horas, o uno o dos dlas, despu6s de administrar el irritante. 

El arroz hay que ponerlo, ya preparado, en la boca del curiel, pues raras voces lo 
comen espont&neamente, y el llquido, rico en los principios t6xicos solubles, se da 
por medio de un gotero. 

Administramoe el arroz, una sola vez, diariamente, por lo general por la maflana, 
en dosis variable, lo m&s corriente, 15 6 20 c. c. o m&s, del agua de arroz, y otro volumen 
igual del grano, en muy di versos dias de preparaci6n, 2, 3, 4, etc. , aunque por lo general, 
usamos el preparado, entre los 3 y los 8 dias, en que es mayor su virulencia. 

Lo m^ importante en todas estas experiencias, es que se mantienen, constante- 
mente, a los curieles, en la condiciones de vida acostumbrada. La alimentacidn 
habitual les fu6 dejada abundante. Nunca dejaron los curieles, si se ponfan en sub 
cajas, inmediatamente despu^ de administrado el arroz virulento, aun en dosis 
considerables, de comer con avidez la yerba o maloja que tanto les satisface. Sin 
embargo, por lo general, dejamos un periodo de 1, 2 6 3 horas antes de volverlos a su 
dieta acostumbrada. 

Los fen6menos presentados fueron los mismos que los ya descritos producidos por 
otras vlas de inyecci6n, pero, en todos los casos de esta via g&strica, durante las crisis, 
medianas, graves, o gravlsimas, se ha manifestado un sintoma muy importante, la 
poresia de las extremidades posteriores, pareeia que nunca encontramos, intensa, entre 
los slntomas producidos por la via intraperitoneal o intracraneana. La paresia se 
manifiesta por dificultad en sostenerse sobre las patas posteriores, cuando camina, 
tambaleindose el cuarto trasero durante la marcha; a voces les obliga a preferir la 
inmovilidad, pero, enti6ndase bien nimca Uega a haber par&lisis. 

Esta paresia, asi como cierto grade de inconciencia y los trastomos respiratorios, 
erizamiento, etc., dura horas, hasta 10 y 12, pero al fin pasa, para reproducirse, 
siempre con gran aspecto de gravedad, despu^ de unos dias; son verdaderas crisis 
que se repiten muy graves, 2, 3, o mds veces, sin que, ya lo dijimos, haya periodicidad 
fija en la ^poca en que viene cada crisis, producida tras la toma del arroz virulento, no 
Buspendido, sine ocasionalmente, en su diaria administraci6n; al fin, en una de eeas 
crisb, la gravedad se hace extrema, y la agonla aparente de tantas ocasiones se hace 
efectivamente mortal. 



PUBLIC HEALTH AND MEDICINE. 



37 



En la autopeia encontramos; exudado peric^dico, hasta 0.5 c. c; y, peritoneal, 
hasta 4 y 5 c. c. ; en cambio, en ningdn cafio bubo exudado pleural(?). 

? Cu&l ee la patogenf a de eaos f en6meno6 de intoxicaci6n por la via g^usrtrica, presenta- 
doe por ese grupo experimental; via g^btrica, tinica por donde ha de infectarse el 
hombre, de beriberi? 

Aunque creemoe que eeguramente esos fen6meno8 ban de obedecer a algfin mecan- 
iamo en el que juegue principal papel la preparaci6n del elemento nervioeo, no noa ha 
sido poeible comprobar la oportunidad en que aparece esa condici6n. 

En nueetras experienciaa por via gistrica, ante los efectivoe y numeroeos hechos de 
muerte (10 cases), provocadoe por el arroz, no hemos podido dilucidar, si para que 
exista la predi8posici6n al t6xico — me refiero exclusivamente en la producci6n de 
forma aguda — ^ha de haber, solamente, initacidn especial de la mucosa gastro intestinal 
para que el t6xico actde sobre los filetes nerviosos, o tambi^n, alguna especial sensibili- 
zaci6n de estos filetes nervioeos. 

Unas voces — ^pocas — las administraciones del arroz virulento mataron a los animales, 
al poco tiempo— uno o dos dfas — de hab^rseles administrado el irritante de la mucosa 
digeetiva, tal parece que por acci6n directa del t6xico sobre el elemento nervioso 
irritado. Recordemos que este mecanismo ha sido comprobado mtiltiples voces en la 
producci6n de diversas polineuritis. Babinsld > al tratar sobre las neuritis perif^cas, 
en un importantfsimo capltulo, dice, que a veces hay acci6n electiva de las substancia, 
t^xicas sobre los extremes perif^cos nervioeos, lo mismo que una infecci6n, o una 
intoxicaci6n, pueden obrar, localmente, sobre esos nervios; y, tambi^n Pitres y Vail- 
lard dicen: "contrariamente a la opini6n generalmente aceptada, los nervios sufrens 
muy f^ilmente, cuando se les pone en contacto con ciertos reactivos (qulmicos, 
t6xicos), las alteraciones nutritivas y degenerativas que se tiene costumbre de con- 
siderar como electee de la inflamaci6n." 

Pero, tambi6n es cierto, que otras veces — en la mayorfa de nuestros cases experi- 
mentales por la via g^trica — al empezar la administraci6n del arroz t6xico, los animales 
no revelaron ningtin sintoma, aun cuando previamente les dimes substancias irritantes 
g&Btricas, y a pesar de ingerir, diariamente, y durante muchos dias — 12, 14 y m&a — 
grandes cantidades del arroz virulento, hasta que, un dfa, tras la administraci6n del 
arroz, estallaron los sfntomas t6xicos, poni^ndose graves, pareciendo inminente la 
muerte. Desde este primer ataque, que siempre pas<5 — ^ya lo hemos dicho — se repi- 
tieron otros, mientras administramos el arroz t6xico, sin periodicidad en la 6poca de 
las apariciones sucesivas, hasta morir en uno de ellos. 

^Se ha producido en estos cases, en que tr^ la irritaci6n preparatoria, no se presen- 
taron fen6meno8 mortales con las primeras administraciones del arroz virulento, una 
S6nsibilizaci6n tardla, especial, del elemento nervioso, producida por esas primeras 
adminiBtraciones del arroz virulento ? 

Exitdaho. 



No. 4, 
No.6; 

No. 7, 
No.< 
No. 5^ 
No. 6 
No.8; 

No. 10, 
No. Il,2a8 



laS.... 
laS.... 

IftS.... 
aaS.... 
2a8.... 
aaS.... 
2a8.... 
aaS... 



Curiel. 



CftTidades pleurales. 



Derecha. 



C.e. 



ao 

.0 
.0 
.0 
.0 
.0 
.0 
.0 



.0 



Isquierds. 



C.e. 



0.0 
.0 
.0 
.0 
.0 
.0 
.0 
.0 



.0 



Peiicardio. 



C.e. 
0.5 
.25 
.1 
.5 
.2 
.0 
.1 
.1 



.1 



Peritoneo. 



C,e, 
1 
4 

5 

Qotas. 
.0 



Oo 



tas. 



Qotas. 



1 BtMtmki, Oapttulo en el Timit^ de mMeofne de Charcot, Bouchard Brissand— Neuritis perif^ricos. 



38 PBOCEEDINGS SBOOND PAN AMEBICAN 80IBNTIFI0 OONQBESS. 

For lo dem&B, conge6ti6n pasiva subcutinea, y muy notable de loe afluentes de la 
vena cava superior; coraz6n derecho dilatado; diafragma alto; pidmones, per lo 
general pdlidos, a veces m^ o menos intenBamente congestionados, con zonae hemorri- 
gicas. El corazdn muy rojo y vascularizado; e8t6mago y parte del intestino delgado 
contienen exudado gleroso con partfculas de arroz, y muchos hematies, que pueden 
ser tan to de origen congestivo como debido a lesiones post-mortem; alguna congeetidn 
del intestino delgado y del mesent^io correspondiente. A veces al corte, los pulmones 
parecen insuflados, crepitan, y recuerdan los pulmones de la anafilaxia su^ca. 

El proceso total, desde la primera doeis del arroz virulento, por la via g&strica, hasta 
la muerte del curiel, en estos casos prolongados, a crisis repetidas, ha durado prictica- 
mente do8 meses; hubo un case de 1} mes, y otro, prolongado, de 4 meses, sin que 
presentaran nimca atrofia ni parilisis, ni-Hudvo case excepcional — emaciacidn. 

Y terminamos, sefiores, sin pretender por un memento, que hayamos dado sobre el 
importante problema de la etiologfa del beriberi, valiosas conclusiones. 

S61o hemes querido exponer, modestamente, ante ustedes las pruebas y contra- 
pruebas que anteceden, y que son sugeetivas, porque en medio del complejo aspecto 
del asunto tratado, se destaca, sin embaigo, determinada unilormidad. 

A la inconstancia o a la poca intensidad de los casos humanos, ha correspondido el 
fracaso en encontrar muestras de arroz virulento en el sentido en que lo hemes venido 
eetudiando; y, en cambio, a la intensidad y mantenimiento del brote epiddmico ha 
correspondido la virulencia del arroz recogido. ^Es pura coincidencia, o se tratari 
de una verdadera relaci6n do causa a efecto? 

A la investigacidn respondieron las muestras virulentas del arroz, de manera igual, 
precisa: presencia de un germen-fermento a esporo resistente a la tempeiatura de 
ebullicidn — ^por lo tanto, arroz no esterilizable por la cocci6n; producci6n en ese airoi 
cocido de substandas que matan a loe animales experimentales, de manera brutal, 
con paresia de las extremidades posteriores, fendmenos caidio-pulmonares, lesiones 
agudas del corazdn, derrames serosos, principalmente pericirdico. 

^Escapar^ el hombre a semejante proceso? 

Indudablemente habrd causas que influyan en activar la produccidn del tdxico, o 
en poner la mucosa gastro-intestinal en condidones de mayor o menor sensibilidad 
del demento nervioso sobre el que parece actuar d t6xico, de manera que la acddn 
de dste se manifieste mils o menos r&pidamente grave, mortal. 

No debemoe olvidar, para explicamos posibles mecanismos, que tambidn en d 
aparato digestivo de los giandes consumidores de arroz hay gran cantidad de este grano 
sobre cuyos piindpios amilAceos deber^ actuar los fermentos que en giandes canti- 
dades hemes visto contiene cuando est4 infectado, resultando de este mode el oiganismo 
preparado, para que sobrevengan formas crdnicas o sub-agudas, o para que — d se 
producen algunas de las causas predlsponentes, aun no bien determinadas, a que 
aludimos en d pfoafo anterior — estalle la forma aguda. 

Le Dantec ^ encontrd gran cantidad de arroz, sin digerir, en excrementoe beribdricoe, 
y de ellos aid6 im germen amilozimo. Por otra parte Metchnikoff, con sus importantes 
estudios sobre la flora titil intestinal, da fundamentos para pensar que es podble la 
acUmataddn de un germen amilozimo, en un intestino caigado de material amiUceo, 
de la misma manera que se provoca la aclimataddn del badlo bulgirico para sus titUes 
actuadones sobre la leche. 

Reeulten no dertas estas condderadones apuntadas, no del todo hipotdticas, sine 
fundadas en razones Idgicas de analogfa, y en pruebas experimentales, la intend6n 
deflnitiva y concluyente de este trabajo, es exponer, que en d estudio de los gdrmenes 
amilozimos que se encuentran en d arroz, y en d analftico y exprimental de las 
substancias t6xicas que producen, hay que buscar m^, antes de dar por cerrados los 
capf tulos importantfsimos de la patogenia y etiologfa del beriberi. 

ff 1 Le Dantec: Pathologie exotlque. 



PX7BU0 HEALTH AND MEDICINE. 39 

The Chairman. The reading of the next paper, by Mr. R. R. Wil- 
liams, of the Bureau of Chemistry, on ''Chemical Nature of the 
Vitamines/' will conclude the symposium. I take great pleasure in 
relinquishing the chair to that distinguished investigator of Cuba, 
Dr. Lebredo. Dr. Lebredo will preside. 



CONCERNING THE CHEMICAL NATURE OF THE VFTAMINES. 

By ROBERT R. WILLIAMS, 
Bureau of Chemittry, Waskingtorif D. C. 

The difficultieB Involved in the isolation of vitamines from yeast or rice polishings 
have proven so serious that success seemed doubtful until a clearer idea should be 
gained of the chemical nature of these interesting and important substances. 
Accordingly attention has been directed to the preparation and testing of synthetic 
substances, which appeared likely to display some curative properties similar to 
the vitamine fraction of natural foodstuffs. ' 

Two facts were considered of primary importance in determining the direction 
of the work. The firist of these was that the curative substance is probably a P3nidine 
derivative, since the curative fraction of rice polishings contains nicotinic acid,' and 
has been found to develop a pyridine-like odor. 

The benzene or six-carbon atom ring is found in many tissues of all forms of plant 
and animal ^fe. It constitutes an integral part of most proteins, and in plants occurs 
widely in the form of tannins, or the extractives which give distinctive colors, odors, 
and flavors. Het«x>cylic nuclei containing nitrogen, notably pyrrol, indol, purine, 
and pyrimidine, are encountered very generally in animal tissue. On the other 
band the pyridine ring, consisting of one nitrogen and five carbon atoms, has a very 
limited distribution. 

Many natural vegetable bases are pyridine derivatives, including most of the 
powerinl alkaloids, such as nicotine, strychnine, and atropine. However, such sub- 
stances are of a strictly limited occurrence, and no one, so far as I am aware, has sug- 
gested that any pyridine derivative may have any general importance in normal 
physiological processes. 

A second hint was foond in the fact that the blue color reaction given by 
antineuritic foodstuffs when treated with phosphotungstic add and alkali seems to 
be rather closely associated with the potent constituents.' Since this reaction and 
the similar reaction with phosphomolybdic add ' are known to be produced by 
substances containing hydroxyl groups in the benzene ring, it was not surprising to 
find that hydroxyl derivatives of pyridine also give one or both reactions according 
to the number and position of the substituted hydroxyl groups. 

Accordingly a series of pyridine derivatives was prepared and the therapeutic 
action of each individual roughly tested on polyneuritic pigeons by the administra- 
tion of doses of from 1 to 10 milligrams by intramuscular injection. In some cases 
doses of 10 to 100 milligrams were administered by mouth as a supplementary test. 
The series included nicotinic, cinchomeric, quinolinic, 6 hydroxy nicotinic and 
dtrazinic adds, a hydroxy pyridine, glutazine, 2, 4, 6, trihydroxy pyridine and its 

> Simild, Shlmamiin,aDd Odake. Biochem. Zeitsch. (1912)43, S9. Drummond and Funk, Blochem. 
Jour. (1914), 8, fi08 and elsewhere. 

• Funk, loc. dt. FoUn and MoOallum, jr. Jour. BloL CheoL (1912) 11, 206; 13, 363. 

t FoUn and Denis. Jour. BioL Chem. (1912) 12, 239. Funk and McCaUum. Biochem. Jour. (1913) 
7,360. 



40 PBOGEEDINQS SECOND PAN AMEBICAN SOIENTIFIC CONGRESS. 

anhydride and finally 2, 3, 4 trihydroxy p3nidine and the so-called tetrahydroxy 
pyridine. 

Nicotinic, dnchomeric, and quinolinic acids were prepared by the oxidation of 
nicotine, quinine, and qiiinoline, respectively,^ and citrazinic acid from citric add.^ 
The methods of Pechmann and Stokes ' were followed for the preparation of ethyl 
amino /3 hydroxy glutamate, glutasdne, 2, 4, 6 trihydroxypyridine and its anhydride. 
Tetrahydroxy-pjrridine and 2, 3, 4 trihydroxy pyridine were produced by the 
method of Ost^ from the nitroso derivative. In the distillation of meconic add 
for this purpose the modification of Peratoner and Leone ^ was used. Better methods 
than those of Ost are offered by Peratoner and Castellana * for the production of 
hydroxycomenic add, from which by suitable modification of Ost*8 second method 
fair yields of 2, 3, 4 trihydroxypyridine may be obtained. These methods are bdng 
studied, as are those of Collie,^ Tickle and Collie,^ Lapworth and Collie,' and Baron, 
Remfry, and Tborpe.'*^ Coumalic add was used for making 6 hydroxynicotinic 
add," by the distillation of which a hydroxy pyridine is readily obtained." 

The test animals used were pigeons in which polyneuritis was developed by 
feeding ad libitum on white rice. Tn all cases the disease was allowed to run its course 
till the animals were unable to stand or make controlled movement of the legs or 
wings. In such cases death usually follows within 24 hours and may occur at any 
moment. A number of times birds died in the experimenter's hands before treat- 
ment could be administered. During and after treatment the birds were continued 
on a diet of white rice, and under such conditions a redevelopment of the symptoms , 
can be only a matter of a few days. Since forced feeding was not resorted to on 
account of the time necessary to care for a lai^ number of birds in this way, it was 
occasionally the case that the pigeons became very weak and emaciated before the 
symptoms developed to the deoLred point. Such cases are not of course strictly 
comparable with those of sudden development in which the animals retain a great 
deal of their original strength and vigor, though losing muscular control, and a meas- 
ure of uncertainty is thereby introduced in occasional cases. On treating polyneuritic 
pigeons with the substances above mentioned definite evidence of curative power 
was noted in the case of a hydroxy, 2, 4, 6 trihydroxy. and 2, 3, 4 trihydroxy P3rridine. 
The remainder of the series showed no effect. But as will be seen later such negative 
evidence in the case of any hydroxy pyridine derivative can not be regarded as 
conclusive. The first of the curative substances tested was a hydroxy pyridine. 
Three birds were treated with excellent results. Three others, however, showed 
little or no improvement. On proceeding with the series to the polyhydroxy com- 
pounds a rapid striking cure was obtained with a preparation of 2, 4, 6 trihydroxy 
pyridine, followed by several partial or complete failures. A second and third fresh 
preparation, however, produced two and three fairly rapid cures, respectively. A sin- 
gle fresh preparation of 2, 3, 4 trihydroxy pyridine was administered to three pigeons 
simultaneously, one pigeon receiving 2 milligrams, the second 1 milligram, and the 
third one-half milligram. The following morning the first bird was dead, while the 
second and third had completely recovered from all paralytic symptoms. 

1 Weidel. Annalen (1873), 165, 330. Weidel and Schmidt Berichte (1879), 12, 1140. Uoogewerfl and 
Dorp. Rec. Trav. Chlm. Pays Bas. (1882), 1, 107. 
s Behrmann and Hofmann. Berlchto (1884), 17, 2687. 
« Berichte (1885). 18, 2291, and (1886) 10, 9094. 
« Jour. f. Prakt. Chem. (1879) (2) 19, 203, and (1883) (2) 27, 257. 

* Qazz. Chim. Ital. (1894) 24, U, 75. 
« Iden> (1906) 36, 1, 21. 

7 Jour. Chem. See. London (1801) 50, 617. 
« Idem (1902) 81, 1004. 

• Idem (1807) 71, 838. 
10 Idem (1904) 85, 1726. 

i< Pechmann and Welsh Berichte (1884) 17, 2384. 
" Pechmann and Baltser Berichte (1801) 24, 8144. 



PUBLIC HEALTH AND MEDICINE. 41 

In each case all the cures obtained were of those pigeons which were first treated 
with a given preparation, while those treated with the same preparation a few days or 
weeks later invariably received no benefit. It was obvious that the substances had 
changed in some manner so as to lose the curative power. As there was no evidence 
of decomposition, it seemed probable that it was due to a tautomeric change; that is, 
a rearrangement of the grouping of the atoms without any actual disruption of the 
molecule into simpler substances. Such rearrangements are well known in many 
chemical substances, and have greatly interested oiganic chemists for the past dec- 
ade. No emphasis has been laid on the possibility of a biological significance of 
such transformations, though they appear to be just such reactions as might easily 
occur within the animal (organism. M^ny of them take place with the greatest of easo 
and without resort to the violent methods ordinarily employed in our laboratories. 

The existence of such a tautomerism in the hydroxy pyridines has long been recog- 
nized in a general way. It has been observed that these substances under certain cir- 
cumstances react as hydroxy or enol compounds, under others as ketones. However, 
no one has regarded it possible that the two forms could exist in a free isolated state as 
two distinct individuals. Each of the hydroxy pyridines is described in the literature 
as one substance of definite though dual properties. A critical examination of the 
literature, however, suggested that this was not the case. It was therefore decided to 
study the tautomerism of some one of the curative substances more thoroughly than 
had been done previously. For this purpose a hydroxy pyridine was chosen. This 
substance has been administered to about 80 pigeons under varying conditions and 
certain important facts have come to light. 

It is prepared by fusing 6 hydroxy nicotinic acid and distilling the residue after the 
evolution of carbon dioxide has ceased. The oily distillate presently solidifies to a 
mass largely made up of prism crystals but often containing a few needle forms. The 
residue condensing in the neck of the distilling flask after completion of the process 
always crystallizes in the form of needles. The crystalline mass of prisms on being 
melted and allowed to cool, again solidifies to a mass, now consisting largely of needles. 
If this remelted mass is dissolved in benzene and recrystallized therefrom by the addi- 
tion of ligroin, needles are found to predominate in the beautiful crystalline precipitate. 
With care the needles may be obtained absolutely free from prisms. From the mother 
liquor on concentration prisms separate and may be obtained in a pure form by 
filtering from the hot solvent, as the small residuum of needles dissolves freely in the 
hot mixture of ligroin and benzene. The needles after washing freely with petroleum 
ether and drying rapidly in a vacuum desiccator, melt sharply at 106° to 107°. The 
imsms melt at the same temperature but less sharply, and tiie melting point varies 
slightly with the speed with which the temperature of the melting point bath is raised. 
Evidently prisms are converted into needles very rapidly by dry heat. On allowing 
the solid needle form to stand for a few days in an open vessel or cork-stoppered bottle, 
it will be found that the crystal form has undergone a change. The needles which 
were originally clear and sharply defined are marked by transverse lines of cleavage. 
In the courw of 10 to 20 days they become roughly needle shaped aggregates of prisms. 
The rate of this change seems to depend greatly on the amount of moisture in the 
atmosphere surrounding the crystals. By exclusion of moisture the transition takes 
place much more slowly, if at all. A water solution of needles on slow evaporation 
deposits only prisms. 

If the two forms of crystals are titrated in the cold with alcoholic bromine according 
to the method of Kurt Meyer ^ neither absorbs appreciable amounts of bromine in- 
stantaneously. The prism form absorbs bromine gradually and the needle form still 
more slowly. Neither form can therefore be the hydroxy or enol form. However, on 
dissolving either form in an excess of alcoholic sodium hydroxide of known strength 

>Aiii»l«n (1011), 880, 312. 



42 PB00EEDIKQ8 SEGOND PAN AMEBIOAN 8CIEKTIFI0 00K0BE83. 

and titrating in the cold with bromine, instantaneotu absorption occutb in excess of 
that required by the caustic soda, a hydroxy pyridine in alcoholic sodium hydroxide 
solution is unquestionably laiigely in the enol form. Presumably all the metallic salts 
are likewise enols, a prestmiption which is in accord with the known facts in regard to 
other enol-keto tautomers . If the cold alcoholic solution of the sodium salt is just neu- 
tralized with cold alcoholic hydrochl(»ic acid, detectable amounts of the free enol form 
are momentarily present as determined by bromine titration. The existence of any 
considerable prop<^(ms of the enol form in the free state i^[>pears to be brief in all 
neutral solvents and no method has been found for its isolation. Since a hydroxy 
pjrridine is a base as well as an acid, it forms well-defined salts with strong acids. 
Whether these salts are partly salts of the enol form can not be determined by titri- 
metic methods since the presence of the acid makes the determination of an end 
point impossible. If these salts are not partly enols they are at least transformed 
into enols with the greatest rapidity during titration. 

It therefore appears that there exist not two but three tautcHneric forms of a hydroxy 
pyridine for which we may readily imagine structural formulae ^ expressing intra- 
molecular rearrangement. However, in the present state of our knowledge no useful 
purpose would be served by attempting to assign a definite pictorial representation to 
each of the three forms. 

By simple means we may cause any desired form to predominate and may pass 
through the cycle repeatedly. Each exists in equilibrium with the others in relative 
quantities depending on conditions. We shall understand their relationships fully 
only after finding a method for determining each of the three forms quantitively under 
varying conditions. At present we can measure only the amount of enol. 

To a degree it has been possible to determine the curative power of each of the three 
forms. Several preparations of freshly crystallized needles dissolved in water imme- 
diately before injection have been administered to 14 i)olyneuritic pigeons in doses 
of 1 to 2 milligrams. Improvement or cure resulted in every case, as evidenced 
by change in weight, paralytic symptoms, and appetite. In general, the action 
appears to be of the same character as that of unhydrolysed extract of rice polishings, 
though somewhat more rapid. Most of the birds reached an optimum from 1 to B 
days after treatment, and alter a single dose of 1 to 2 milligrams lived from 6 to 1 days. 
Three birds were partially cured a second and third time alter redevelopment of severe 
symptoms and lived 11, 13, and 15 days, respectively, after the first onset of the 
disease. However, six cures differed markedly from the others obtained with a 
hydroxy pyridine. The first evidences of improvement were noticed in from 40 
minutes to 2 hours alter injection, when the animals began to assume nearly normal 
attitudes. At intervals spasms of spastic movement occurred, which gradually 
became less frequent and less prolonged, and in the course of from 3 to 12 hoiirs ceased 
altogether. After this time the birds did not differ markedly in condition from those 
in which less rapid cures were obtained. The gain in weight and other evidences of 
improvement were of the same character. The rapid cures obtained with 2, 4, 6, 
trihydroxy pyridine above reported were attended by the same symptoms. Protec- 
tive experiments on healthy birds on a white-rice diet have not yet been made. 

The physiological effect of the enol form can only be guessed so long as it remains 
impossible to obtain it free from the other forms and in a more or less permanent state. 
Injections of 1 milligram in caustic-soda solution produced fairly rapid cures in two 
birds so treated. Administration by mouth of 10 milligrams in caustic soda followed 
by dilute acetic acid also effected more rapid cures than the needle form usually gives. 
Ths. silver salt was also administered to three pigeons in doses of 20 milligrams each, 
follo>red by salt solution as an antidote for the silver. Two had recovered from the 
paralysis the following day and lived 3 and 7 days, respectively. One died 5 hours 

1 Kaofmazm B«lchte (1903) 30, 1083. Deokar. J. Pr. Ch. (1900) 02, 266. 



PUBUO HEALTH AND MEDIdKB. 43 

alter treatment. No very satialactory conduaioii can be drawn from theee expert* 
ments on accoimt of the disturbing factor of the toxicity of caustic soda and silver. 
The former produced severe inflammation of the tissues with which it came in contact, 
and the latter evidenced a general toxic action as was to be expected. Nevertheless, 
there was indubitable relief of the typical paralytic symptoms, and this action on the 
whole appeared as rapid as that obtained by treatment with the needle form. I 
was led to suspect that the enol form is the rapidly curative one and that the needle 
form is beneficial by reason of its gradual transformation into the enol in the tissues. 
However, this is very uncertain. 

The prism form has been tested on some 30 birds under varying conditions. Doses 
ol from 0.5 to 100 milligrams have been tried by injection and by mouth. Injections 
in water have been made immediately after solution, after standing several days, after 
boiling, and after heating under steam pressure. Injections in mineral oil and in 
fatty acid have also been tried. In no case was there the slightest evidence of any 
benefit. When large doses were administered, the action seemed distinctly adverse 
in several cases, as the birds died sooner than was expected. Doses of 10 milligrams 
injected into healthy birds, however, produced no gross toxic symptoms. 

This absolute lack of curative properties is very striking and suggestive. It is ap- 
parent from the experimental evidence that the tautomeric forms exist in equilibrium 
and that there is fairly rapid transformation in any direction. One would therefore 
suppose that the prism form would, when injected into the body, rapidly convert 
itself into the curative form as the latter was removed from solution by absorption in 
the tissues or fluids requiring it. That such is not the case suggests very strongly that 
the pathological conditions of polyneuritis are not due to a deficiency of a substance 
per se, but to a lack of a certain type of potential energy which only that substance can 
supply. In other words, one is led to surmise that it is the potentiality of tautomeric 
change that produces the desired result. In this connection it is interesting to note 
that many purine and pyrimidine derivatives, some of which Funk has reported to 
be partially curative for polyneuritis,' are also theoretically capable of a similar tau- 
tomeriam. That these substances are to a greater or less degree enol-keto tautomers 
18 very strongly indicated by well-known reactions of uric add, for example. The 
existence of a third tautomer is not excluded by theoretical considerations, but lacks 
the support of any experimental evidence. 

It appeared not unlikely that other hydroxy pyridines might prove more easily 
controlled. Accordingly fi and y hydroxy pyridine and a a dimethyl y hydroxy 
pyridine or y lutidone have been prepared and are being tested. They show curative 
properties only under certain conditions. Each crystallizes in two different forms 
and forms metallic salts which absorb bromine rapidly in cold alcohol. In every way 
they appear to be strict anologues of a hydroxy pyridine 

Dr. Lebbedo. The discussion is now open on these papers. I will 
ask Dr. Guiteras to preside. 

Dr. M. X. Sullivan. For about six months I have been working 
on this question of the vitamines, and I think we have a few points 
that might be rather interesting to this gathering. One that stands 
out particularly in my memory is the fact that the mode of prepa- 
ration has a great deal to do with its being effective in keeping off 
these polyneuritic processes. In Boston Dr. Voegtlein and I reported 
a paper showing diat if you kept hens on com bread made out of 
com not highly milled and baking powder that the hen woxdd run 
at least 165 days; but, if in addition to the com meal a certain 



1 Jour. Physiol. (1913)16,480. 



44 PROCEEDINGS SECOND PAN AMERICAN 8CIBNTIPIC CONGRESS. 

amount of milk was added by doubling the amoxmt of baking soda, 
in 14 days it would bring about polyneuritis in the hen. That is 
rather striking, because we have added to the diet milk, which of 
itself is a protective agent; but we have doubled the bicarbonate 
of soda used, and this in the process of baking the bread destroys the 
protective kernel, so that in 14 to 20 days we were making these 
hens polyneuritic with com bread, showing that the method of 
preparation of the food makes a difference in its effectiveness in 
protecting the individual. We can not say that we have the pure 
vitamine, because we do not know what the pure vitamine is, but 
we have been working on a number of things that we got out of 
liver, peas, and beef that was prepared by Dr. Seidell, and one of the 
most active that we got came from wheat bran by hydrolysis with 
acids, not very strong hydrolysis and not very strong heating, but 
it was by hydrolysis. 

Dr. Clark. A significant point was raised by Dr. Sullivan in his 
remarks on the acid solutions. It is perfectly possible that by 
making the solution alkaline, as Dr. Sullivan did in his com bread, 
that the particular element was more easily destroyed than it would 
be in an acid solution. I am reminded of an observation that I 
made a year or two ago, which may have some significance on the 
treatment of infantile scurvy. It has commonly been recommended 
that the acidity of milk should be neutralized in feeding mUk to 
infants, and there has been a good deal of misconception as to what 
we meant by the acidity of milk. Determining the acidity of milk 
by the hydrogen ion concentration, we find it is to all intents and 
purposes practically a vital medium. Now Holt and some other 
people have recommended that in cases where limewater is not 
available milk of magnesium should be used; but I found that in 
some of the more diluted milks fed to normal infants the addition 
of limewater in the proportions suggested brought the hydrogen ion 
concentration far below the point needed by a great many bacteria 
and to a point where the state of the milk was changed to a very 
large extent and would go to pieces in some of its constituents on 
pasteurization. Such milks are probably more alkaline than any 
food which is taken in the ordinary course of events by any adult. 

Dr. Sullivan. May I say another word? It is said that there 
was some confusion on the question of the vitamines, because you 
could heat foods like orange juice and not destroy the vitamine 
and you could heat milk and destroy the vitamine. It is perfectly 
right that this should be so. When you heat milk, you lower the 
hydrogen ion to such an extent that it comes in the same category 
as com bread. 

Dr. Agramonte. I wish to say that I am in perfect accord 
with the opinion that this disease, beriberi, as well as pellagra, 



PUBLIC HEALTH AND MEDICINE. 45 

scurvy, and others, is induced directly by malnutrition or 
faulty nutrition. The interesting experiments reported by Dr. 
Lebredo in his paper, presenting an oi^anism, an extremely resist- 
ant bacterial oi^anism, as the producer of the beriberi toxin or the 
producer of an anaphylactic substance, is new to me, as, of course, 
to all of you who hear this for the first time, and I think should be 
reserved for future corroboration or confutation as the case may 
be. The germ theory of beriberi, I think, has been exploded a long 
time ago, and we need not, therefore, go over the old matter here. 

We ought always to take into consideration the personal equation 
in dealing with tiiese diseases of systemic disturbance and with 
all infectious diseases. We know that a nmnber of individuals in 
the worst epidemics remain unaffected, resistant to disease, and 
that has been really one stxunbling block in considering beriberi. 
For instance, we have eight or ten or fifteen individiials coming down 
with the same disease, but other individuals who are subjected to 
the same exposure do not come down with the infection, and there, 
I think, the personal equation should be considered. In this case I 
think it should be considered as much as when we consider epidemics 
of other disease, because if we continue to say it is due simply to 
the lack of this or that in the diet the question immediately arises. 
Why have the other men subjected to the same diet not been affected 
with the disease, since the hiunan race must be considered as an 
entity? So, I think, we must consider that the vitality of those 
individuals who are susceptible to disease is below par, while that of 
the others is a little above par. 

Dr. Tom Williams. It has been stated several times that beriberi 
is due to a deficiency in the diet and that all individuals living on this 
diet and subject to the deficiency should be affected with the disease. 
This is a fallacy which I do not think can be exposed too often or too 
urgently. There is no reason to suppose that a number of individuals 
will all be affected in like maimer by any condition. If we give 
strychnine to men, there are no two who will be affected exactly alike. 
They aU die, but there will be great difference in the rapidity of the 
action, etc. The same thing is true when we come to ii^ectious 
processes. If we vaccinate a hundred men, 95 per cent will be ^'takes" 
and 5 per cent will have to be revaccinated. In the matter of food, 
we all know that what is one man's meat is another man's poison. 
Some people can not eat eggs, some people can not drinkmilk, and there 
is no reason why we should suppose all people are going to react in 
the same way to food. Some one man may consume a tremendous 
amount of one substance and another man a very small amount. 
Our retention of uric acid in the system, our individual metabolism, 
all differs. I tlnnk there has been enough said on that point to show 
that just because a person is deprived of a certain chemical element 



46 PBOOEEDIKOa 8E00KD PAN AMEBIOAN 8CIEKTIFI0 OOKQBESS. 

in the food, all persons under the same conditions will not behave in the 
same way, any more than they will do anything else. Our practical 
experience indicates the same thing. 

I suppose in the present day and generation everybody will admit 
that scurvy is due to a deficiency, and you know that if you feed a 
man on hardtack and bacon long enough he will get scurvy; also that 
if we feed 500 men, as frequently occurs in sieges, etc., all on the same 
ration, all do not suffer in the same degree. 

With regard to Dr. Lebredo's work, I want to say that I think his 
experiments are absolutely accurate. I do not think there is any 
question about his facts, but I differ with him as to the interpretation 
of those facts. In the first place, if you extract rice or any other 
substance which has proteid materials in it — rice contains a very con- 
siderable amount of proteid — and subsequently inject those sub- 
stances iuto the body through the skin or through the peritoneal 
cavity, in any other way than through the mouth, you will iuvariably 
have a certain amount of toxic phenomena. You will have them 
particularly if you inject simple peptones. You can thus kill an 
animal very rapidly. The fact that the mjection was at first harm- 
less and that only after three or four repeated injections did the harm- 
f\il results obtain, the fact that the harmful effect appears with pa- 
ralysis of the hind legs, respiratory embarrassment, all suggest very 
strongly that Dr. Lebredo was dealing with anaphylaxis produced 
by foreign proteid, and I have not the slightest doubt in the world 
that he can kill animals in that way, but I do not beUeve that it 
proves that the rice taken by mouth is toxic. 

Then I wish to point out very briefly the focal nature of Mr. 
Williams's contribution. I think Mr. Williams is the only man who 
has had the conception of producing these vitamines synthetically 
in the laboratory. He has been working steadily at it for three years, 
and I think this is in its scientific nature as important as Ehrlich's 
synthetic preparation that will kill spirochetes. It is an absolutely 
new idea in medicine. We have been talking about vitamines, etc., 
but now we are going to get them. Of course, Mr. Williams does not 
dahn that we wiU get vitamines as we find them in food, because it 
is not known what they are; but we are on the road, and I think the 
reproach which has been thrown on the term ''vitamine'* should be 
removed, and that a great many physiologists who have beUeved 
that we were discussing things that we knew not whereof we were 
talking will now perhaps revise their opinions somewhat. 

Dr. Lbbbedo. I will answer briefly all remarks that have been 
made to me. I said to Dr. Agramonte, I have not claimed to find 
anything new; the only point has been that the experiment has 
been very striking. I presented it to the AmericaiT Public Health 
Association several years ago. I had in mind anaphylaxis in 



PUBLIO HEALTH AKD MEDICINE. 47 

these experiments and made the autopsy in one case of beriberi, 
wishing to see if it was not anaphylaxis, because I think in beriberi 
more than the etiological point is that of pathogenesis. That could 
be proven by taking the serum of the particular case and trying it 
with guinea pigs, also by using different kinds of rice and different 
ways of experiment. I could not find anything in that experiment, 
and following that I used the rice when I foimd that the rice was 
toxic and truly toxic, acting not because it was anaphylactic in the 
way that the anaphylaxis is with the serum anaphylaxis. I have 
studied many, many kinds of rice in different wajrs, leaving them for 
several days, 2, 3, 4, 5, 10, and, as I said in my paper, I put into the 
peritoneum 20 cc. and never killed one animal. When I foimd this 
special germ that resists the temperature for 100^, I began killing the 
animals right along in three or four hours by injecting into the peri- 
toneum. In my last experiments that was the most striking thing. 
When I give to animals rice by the mouth I do not always kill them, 
but when I cause some irritation in the intestinal tract, then I can 
kill the animals, occasionally in two or three hours after giving it, 
but not at other times. But it is not anaphylaxis, as I said in my 
paper. 

In a matter more important, that of prophylaxis, I think we are 
all in the same boat. 

Ebcperiments were made some time ago with chickens and guinea 
pigs, using rice, but I never have seen them give the heart troubles 
and the pulmonary troubles of the acute beriberi as I have seen in 
those of my experiments. 

I will conclude in saying that we should take great care with the diet 
itself. I am in accord with that theory. It is necessary to be very 
careful with the diet and to have it mixed, because we may have 
the more chronic form, but there also should be some care taken as 
to the rice used. There is also the packing of the rice, which is one 
of the chief things to be considered in future congresses, because I 
think in packing lies a great danger for many, many diseases, as in 
plague. We need to know how to have packing done to prevent 
the infection of the rice, which to me is one of the things that must 
be looked for. 

Mr. H. R. Williams. There is very little further comment that I 
woidd care to make, except that I do not want anyone to misunder- 
stand me as saying that I consider that any one of these substances 
actually exists in rice or yeast or any other food substance, or that 
it is necessarily a substance essentially of the same character. But 
there is some feature of these molecules which is common to them 
and to the vitamines, and will be so admitted when we shall event- 
ually find out what the vitamines are. 



48 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONGRESS. 

The Chairman. Having concluded the discussion of these papers^ 
we will continue with the reading of the last papers of the session. 
I will now call upon Dr. Hess. 



INFANTILE SCURVY. 

By ALFRED F. HESS. 

In a consideration of the 'deficiency diseases'' we can not omit infantile scurvy. 
This disorder would seem to have made its appearance in the course of modem 
civilization since artificial feeding has replaced mother's milk to so laige an extent- 
It is a subject of increasing importance, which concerns the health and welfare of the 
infant population. 

As is well known, infantile scurvy practically never develops among breast-fed 
babies, but is encountered among those who are fed on cow's milk, and more especially 
among those who receive, in addition, some of the proprietary foods which are so 
commonly resorted to in the preparation of the milk formulae. There has been a dif- 
ference of opinion as to whether the use of pasteurized milk alone can induce the 
scorbutic condition. The Commission on Milk Standards, composed of experts on 
this subject, in its report for 1912, stated that pasteurization does not destroy the 
chemical constituents of milk, which is not altered by exposure to heat under 145° F. 
As a favorable opportunity presented itself, and as the subject had a wide practical 
bearing, I determined to test the validity of this opinion. Accordingly, the infants 
in one ward of an infants' home, where all babies are fed upon grade A i>asteurlzed 
milk, which has been heated to 145*^ F. for 30 minutes, were separated into two groups. 
As regards the one group, no change was made in the diet; they received pasteurized 
milk, cereal, and orange juice; in the case of the others, the only change made was 
to discontinue giving orange juice. 

Without going into detail, the results may be summarized by the statement that 
almost all the infants who did not receive orange juice developed a more or less 
marked form of scurvy, whereas those who continued to receive the juice remained 
entirely free from this disorder. The opportunities for studying this question were 
unique, as most of the Infants had been in the institution almost since birth and 
remained there for a period of years, so that their condition both before and subse- 
quent to this test could be thoroughly observed. It should be added that in an 
investigation of a disease such as scurvy, metabolism studies are not well suited, on 
account of the slow course of the illness, but that clinical observations of the effect 
of diet or chemical analyses of the ultimate constituents of the body are far more 
reliable. These results were published in detail. However, in view of the fact that 
they were questioned by some, another test of the same character was carried out in 
the subsequent year. The results were the same; so that I feel safe in stating that a 
diet of pasteurized milk leads to the production of scurvy in infants unless some 
antiscorbutic food is also given. This scurvy is not as a rule the classical florid type 
such as is frequently met with in infants fed upon proprietary foods for months, but 
may be termed latent or rudimentary — there is a gradually increasing pallor, a failure 
to gain in weight, the development of some petechial hemorrhages, and, in the more 
marked instances, the classical superiosteal hemorrhages. It would seem probable 
that this insidious type of scurvy is far more common among infants than is generally 
recognized by physicians, and that there are many suffering from slight nutritional 
disturbances which may be ascribed to this cause. When the pasteurized milk was 
replaced by raw milk, the scorbutic condition improved, although it may be added 
that raw cow's milk was not comparable to orange juice as an antiscorbutic. 



PUBLIC HEALTH AKD MEDICINE. 49 

It is not to be inferred from theee conclusions that the use of pasteurized milk is 
fraught with danger, but merely that it is an incomplete diet for babies and must be 
given with antiscorbutic food. Its use is highly desirable and to be recommended 
for pasteurization does not seem to aSect the nutritional value of the milk and renders 
marked service in preventing the occurrence of various infectious diseases. There 
are secondary factors in the causation of scurvy. In the first place there is an indi- 
vidual variation which must be taken into account. This would seem to depend ux>on 
hereditary characteristics, upon the amount of antiscorbutic material which the infant 
brings with it when it comes into the world. Secondary food factors would also seem 
to play a part; in our experience those infants which received malt preparations 
seemed to be most predisposed to the development of scurvy, and it is quite possible 
that there is a relationship to carbohydrate diet, similar to that which Funk has drawn 
attention to in the case of beriberi. Whenever the connection of pasteurization and 
scurvy is brought forward, the statistics of various French writers who claim to have 
fed some thousands of babies on steralized milk without encountering scurvy, are cited 
in refutation of the harmful effects of heat. Without analyzing these results, it may 
be said that these infants were cared for in an ambulatory service and that their diet 
was therefore not under close observation and probably they were not observed for a 
sufficiently long period to detect the rudimentary form of scurvy which we have just 
outlined. 

Infantile scurvy differs clinically from the other '* deficiency diseases'' mainly in 
the fact that it is characterized by the production of hemorrhage in various parts of 
the body, hemorrhage into the gums, into the skin, beneath the periosteum, into the 
kidneys, etc. A study of the pathogenesis of these hemorrhages has shown that they 
were not the result of alterations of the blood itself, a delayed coagulability, or a 
decrease of blood platelets, but that they were due to the alteration of the blood vessels 
which allow the blood to traverse its walls. This alteration probably should be regarded 
merely as a part of the general tissue changes which occur in this disorder. 

Although hemorrhage is not encountered on beriberi, another typical '* deficiency 
disease/' a careful consideration will show some clinical relationships between these 
two diseases. As is well known, signs of involvement of the nervous system are the 
characteristic manifestations in beriberi. A study of the cases which came under our 
view showed that infantile scurvy is not entirely free from nervous signs. The knee 
jerks are increased, there seem to be slight involvement of the optic disks in some cases 
and perhaps sensitiveness of the cutaneous nerves. Again, dilation of the right heart, 
a remarkable pathological condition which has been frequently described in beriberi 
and noted by Andrews in infants who had suffered from this disease, was found to occur 
likewise in infantile scurvy, as demonstrated in numerous Roentgen ray examinations. 
Oedema, which is such a common symptom in beriberi, is not infrequently present in 
infantile scurvy. In fact, there is one form of this disorder, an exceptional tyx>e, 
where oedema is most marked. In this connection it should be remembered that 
degeneration of the nerves has been found by Ingier in some animals suffering from 
scurvy, that Hoist and Froelich have noted that guinea pigs fed on decorticated or 
highly milled rice, developed scurvy and not beriberi, and that Darling has reported 
that in some African negroes a diet that caused scurvy in one set of men, caused neu- 
ritis in others. There ia evidently, therefore a definite interweaving in the symptom- 
atology of these two deficiency diseases. As is well known, beriberi is produced 
by a diet of decorticated rice and may be cured by feeding the rice polishingB. In 
this regard, there seems also to be some connection between the two diseases, for we 
found that the giving of wheat middlings, which may be regarded as the pericarp of the 
wheat, in some instances resulted in a prompt amelioration of the symptoms, although 
it was unable to bring about a complete cure of the disorder. 

The sovereign cure for scurvy is orange juice . This juice is efficient even when it has 
been boiled for 10 minutes. In order to test a juice of a far less degree of acidity, a 



50 PBOGEEDIKQS SECOND PAN AMEBIOAN 80IENTIFI0 00N0BE8S. 

concoction of orange peel was prepared. This was found also to poeaefls antiscc^butic 
qualities and to be effective even after it was boiled. This is of interest in view of 
the fact that Hoist and Froelich showed that only antiscorbutic substances which 
were highly acid, were able to maintain their potency after boiling. Potato, one of 
the best known antiscorbutics, was found most effective in combatting the sc(»butic 
symptoms and might well be employed for this purpose in infant feeding where orange 
juice can not be obtained. For this purpose the milk should be diluted with potato 
water instead of plain water or the usual cereal decoctions. The commercial potato 
flour was found to possess no antiscorbutic properties. Ckni-liver oil was also found to be 
wanting in this particular, as not only was it unable to cure the scorbutic condition, 
but infants developed symptoms of scurvy in spite of receiving this oil from the very 
first day when orange juice was discontinued. 

In connection with this study, observations of the effect of infantile scurvy upon 
growth was recently carried out. These observations were continued for a period of a 
year or more. Three periods may be distinguished in this investigation; a prescor- 
butic or preliminary period of about three months, during which the infants were 
weighed daily and measured every two weeks; a test period embracing about four 
months, during which the infants received the diet of pasteurized milk and cereal, 
which differed from the previous diet only in the fact that orange juice was no longer 
given; and a postscorbutic period, lasting about six months, whidi dated from the time 
when orange juice or other antiscorbutic food was once more added. 

During this entire year or more the in&nts were weighed daily and measured every 
two weeks. As far as I am aware, no similar study has been carried out. Such an 
investigation is possible only under the conditions which obtain in an institution of 
this kind where the children enter at an early age and remain for long periods. Its 
object was to ascertain the connection between infantile scurvy and growth— growth 
in length as well as in weight. As is well known and has been shown by Freund, as 
well as by Variot, infiwts are particularly tenacious as regards growth in length and 
not readily affected by nutritional disorders, even such as reach a considerable degree 
of intensity. However, this must not be regarded merely as a study of growth. It 
must be considered rather a study of infantile scurvy and of the effect of this disorder 
on growth, as numerous other conditions may affect growth. That such is the case, 
has been shown admirably in animals in the recent investigations of Osborne and 
Mendel, of McCoUum and others. Where growth was retarded or stimtdated at will by 
means of diet, but which nevertheless can not be considered to have any connection 
with scurvy. Scurvy and growth stunting are by no means the same either in 
.animals or in in&nts. It would seem that these remarks are timely in view of a re- 
cently published study by McCoUum, in which he shows that the growth factor in 
milk is closely linked to its casein content, and prefaces his report by drawing an 
analogy to infantile scurvy, although none of the animals showed any signs of a scor- 
butic condition. That the factors which stimulate growth are not neceesarily anti- 
scorbutic, may be inferred from other experiments. For example, McCollum and 
Davis showed that butter fot, even after it had been heated to a high degree, was able 
to induce growth and Osborne and Mendel showed that this fat can be subjected even 
to steam and not lose its growth producing power. Notwithstanding these results there 
is no doubt that butter fot in pasteurized milk does not possess sufficient antiscorbutic 
properties to prevent the development of scurvy. 

Cod-liver oil has been foimd to possess growth promoting qualities of a hi^ degree 
of efficiency, but there is also no question that this substance, as I have stated above, 
is unable to prevent the development of or to cure scurvy. All of the infants under 
consideration obtained milk which, as a food, has been shown to contain all the con- 
stituents necessary for growth, and almost all of them obtained cereal in addition. 
Particular attention was given to the foct that they should obtain a sufficient quantity 
of food, so that the question of starvation might not enter into the experiment. To 



FUBUO HEALTH AKD MEDICINE. 51 

this end, when orange juice was discontinued — that is to say, in the second period of 
this test — more cereal was given or the strength of the milk mixture was increased so 
as to obviate this complicating factor. When the scorbutic symptoms insiduously 
b^an to manifest thenselves, among them, loss of appetite, particular attention was 
given to the feeding, so as to induce the infanta to take a sufficient quantity, and, 
although it is true that the total amount which they consumed was not in most cases 
as great as when they were entirely well, it nevertheless reached a total quite equal 
to that which infents frequently consume and on which they continue to grow. In 
. almost no case did it fall below 80 calories per kilo for any considerable period of time. 

First as to growth as measured by weight. It was found that, although the infants 
continued to gain in most cases for a few weeks following the discontinuance of the 
orange juice, they soon reached a stationary plane and for months were unable to rise 
above this level, but increased in weight promptly when the antiscorbutic food was 
again added to their diet. In only one instance was there no effect upon the gain in 
weight during this test period. There was, however, no permanent retardation of 
weight, the growth impulse remaining imaffected. In fact, when the orange juice was 
rebegim growth as manifested by gain in weight generally took place with an abnormal 
intensity. These infentp have been found, after the observation of about half a year, 
to have r^;ained the normal level of weight. In two cases, where the infants were 
under six months of age and had never received orange juice previously, the necessity 
for adding an antiscorbutic substance to the diet was manifested by a gradual lack of 
gain of weight at about the eighth month of life. It is very probable that many infants 
fail to continue to gain at this period, the third quarter of the first year of life, for the 
want of this essential addition to their food, and that for this reason they fail to 
progress until mixed feeding is b^un some months later. 

As has been stated during the test of the past year the infants were not only weighed 
but they were also measured. This group included about 20 infants, one-half of which 
continued to receive orange juice, whereas the others were deprived of this food. Our 
results in this connection may be summarized by the statement that scurvy not only 
has a direct effect on the weight, but also upon the growth in length, that the orange 
juice contains properties corrective in both regards. This fact is more striking than the 
Mlure to gain in weight, for, as has been mentioned, growth in length is a physiological 
impulse to which the body clings with great tenacity and which is rarely affected, 
even when other functions are held in abeyance. This is true likewise in animals, 
for example, Aron showed that in rats, which are underfed, there is a marked loss in fat 
and in muscle, but the skeleton continues to grow and the total ash content of the body 
to increase. The same holds true, as in the case of the growth in weight, when the 
essential substance, the orange juice, is once more given. There is an abnormally rapid 
increase; in other words, the stimulus has been merely temporarily held in a latent 
condition. It is likewise true here that boiled orange juice is effective, and the juice 
of the orange peel, although it seemed that the latter lost some of its potency as a 
result of being heated. 

The time does not seem ripe for a discussion as to the nature of the peculiar dietary 
substance or substances, which are clearly so essential for the nutrition of the body. 
It is evident that it is not one or more of the various amino acids which have been 
shown to play such an important rdle in the production of growth. For example, 
lysin and tryptophan, substances which possess most marked growth producing power, 
must have been present in large quantities in our diet, as it has been shown to exist 
in considerable amounts in the proteids of the milk. Whatever their nature, it would 
seem that these substances are intimately associated with the continuation of health 
and life and until we are able to define them more definitely, we can do no better than 
accept the term "vitamins'' suggested by Funk. 

The Chairman. The next papers are those of Dr. Calixto 
Torres UmafLa. 

68486— 17— VOL x 5 



52 PBOOEEDINGS SECOND PAN AMEBICAN SCIENTIFIC CONGRESS. 

LA NUTRICION en LA ALTIPLANICIE DE BOGOTA. 

For CALIXTO TORRES UMANA. 
Introducci6n. 

Todo el que haya eetudiado cienciaa naturalee sabe que hay para cada organismo 
una fisiologla normal o i)atoI6gica que le es peculiar y que esta fisiologla reviste mo- 
dalidades distintas que cambian con la raza, el clima, la alimentaci6n, etc. Como 
consecuencia de estas modalidades fisioldgicae vienen tambi^n variaciones en la^ 
higiene, en la patologla, en la terap^utica, etc., cuyo conjunto constituye toda una 
medicina nacional o regional. 

Hasta hace poco tiempo vivlamos noeotros de las investigaciones hechas en Europa 
y todavfa hacemoe muchoe de nueetros estudioe de medicina sobre la base de una 
fisiologla que no noe pertenece. No pocos estudiantes aventajadoe ban gastado nada 
m^ que en corroborar estudioe hechoe en el extranjero, eneiglas que hubieran podido 
ser empleadas en resolver o tratar de resolver imo de tantos problemas que tenemos 
por delante, cuya soluci6n b<S1o a noeotros pertenece. 

Porque hay que pensar que lo que constituye la medicina nacional no son sola- 
mente ciertas enfcrmedades propias de nuestra zona, sine todo el cuadro noeol6gico 
que cambia de fisonomfa desde que cambia de residencia. 

El presente estudio que representa un trabajo mds arduo de lo imaginable, es una 
modesta colaboraci6n a uno de nuestros mds trascendentales problemas. 

Su iniciaci6n tuvo origen en dos hechos de observaci6n diaria en Bogotd: el des- 
censo de la cifra de la urea en la orina y el descenso de la temperatura humana. 

Mis primeros experimentos hechos en BogotA, versaron sobre dos puntos: primero, 
temperatura humana; segundo, numeraci6n de gl6bulos rojoe y medida de hemo- 
globina, o sea sobre el vehfculo encaigado de llevar el oxfgeno a los tejidos para las 
combustiones; tercero, sobre el anilisis qufmico de los alimentos, es decir, el examen 
del combustible; y cuarto, sobre productos de de8a8imDaci6n azoada en las orinas. 

Durante el ejercicio de mi profesi6n en Tunja, poblaci6n situada a mayor altura 
que Bogotd, sobre todo como medico de algunas compafLlas de 8^:uros, tuve oca8i6n 
de observar un mayor descenso de la temperatura en casi todos los individuos exa- 
minados. 

Esto me Bugiri6 la idea de emprender en aquella localidad observaciones seme- 
jantes a las de Bogotd, practicando andlisis de orinas tan cuidadosos y completoe 
como creo que no se hayan hecho antes entre nosotros. 

Estudiando las causas del retardo de la nutrici6n en la altiplanicie, quise darle 
especial preferencia al asunto de la chicha, y al ef ecto aprovech6 la buena acogida que 
di6 a ima solicitud mfa el Sefior Ministro de Guerra General Lujdn y emprendi ex- 
perimentos a este respecto en scis soldados: experimentos que me dieron ensefianzas 
muy interesantes, como se verd en la tiltima parte de este estudio. 

DEFINICI6N DE LA NUTEICI6N. 

Toda c^lula viva funciona y se gasta. Para producir eneigla, para repararse, toma 
al medio ambiente materiales alimenticios, y despu^ de haberlos elaborado en su 
interior, arroja los residues de esta elaboraci6n. Este doble proceeo de asimilaci6n 
y desa8imilaci6n, representa las funcionee de nutrici6n celular y obedece a cambioe 
quimicoe que se conocen con el nombre de metabolismo, el cual puede ser dividido 
en dos partes: el catabolismo, o reducci6n de los compuestos quimicoe mds compli- 
cados a los mAs sencillos, y el anabolismo, o slntesis de cuerpos simples para formar 
miks complicadas combinaciones. 

Los actoe nutritives que se verifican en un organismo m&B complejo, como el del 
hombre, son id^nticos, en principio, a los que se observan en los oiganismos unicelularee. 
Los elementoe que se utilizan para la nutricidn son tomados a los tres reinos, vegetal, 



PUBLIC HEALTH AND MEDICINE. 53 

animal y mineral; elloe llevan al oiganismo loe elementoe necesarioe para la consti- 
tuci6n o para la reparaci6n de loe tejidos; las transformacionee que sufren eetos aliment06 
en la economia ponen en libertad energia que se manifiesta en forma de labor, de tra- 
bajo mecinico y en algunos animales en la de luz o electricidad. 

La miama con8tituci6n quimica de loe alimentoe noe da la explicaci6n de su papel 
energ^tico; caei todos elloe estdn fonnadoe de albtiminas, graeas, hidratoe de car- 
bono, que eon compuestoe endot^rmicoe, ee decir, fonnadoe con abeorcidn de calor; 
y encierran por consiguiente eneigla latente; la desint^graci6n de eetoe elementoe 
en el organiemo deja en libertad eeta eneigla. De eeta manera Uenan lae fiincionee 
de nutrici6n un triple objeto en el hombre normal: primero, mantener fija la compo- 
Bici6n de loe tejidoe vivoe; segundo, mantener constante la temperatura del cuerpo, 
tercero, reemplazar la energia gaetada por el trabajo del individuo. 

En el nifio, durante el periodo de crecimiento, y en la mujer durante el embarazo 
y la lactancia, tiene ademds por objeto ayudar al crecimiento de loe tejidoe. En loe 
convalecientee, el trabajo de reproducci6n de material gaetado ee naturalmente 
mucho m^ intense que en el eetado normal. 

Loe materialee alimenticioe siguen en el mundo un ciclo evolutivo, tendiente a 
una complicaci6n progresiva. Loe m&a simples no son otroe que el oxfgeno y el 
carbono del aire, que son fijadoe por la materia clorofiliana de las plantas verdes, 
bajo la influencia de la luz, y entran de eeta manera en la compoeici6n de loe tejidos 
v^;etalee. Luego loe vegetalee eon ingeridoe por loe animalee herbfvoroe y eetoe por 
loe camf voroe. Ee, puee, en definitiva, la eneigla eolar almacenada por lae plantas, la 
que transmite de un oiganismo a otro y representa el origen de la eneigla humana. 

£1 oiganismo sirve i)ara la transfonnaci6n de la energia, y ^1 no la retiene, como 
no la crea. En im cuerpo adulto, en equilibrio de peso, la eneigla Uevada por los 
alimentoe ee equivalente a la gaetada por el individuo; de ahl la concepci6n de Ber- 
thelot: "El mantenimiento de la vida no consume ningima eneigla que sea propia a 
la vida.'' El piincipio de la conservacidn de la energia se aplica, pues, al animal 
tan exactamente como a la mdquina de vapor. 

Lavoisier habla ya demoetrado que el principal gasto de la energia humana tiene 
por origen las combustiones veiificadas en el organismo. Berthelot, por el descubri- 
miento de la termoquimia, resolvid el problema demoetrando que la nutricidn se 
reduce a una transformacidn de la energia. 

Lavoisier demoetr6 que los animales viven y respiran oxigeno en la atmdefera y 
producen icido carb6nico; que se verifica en ellos una combusti6n an^oga a la com- 
busti6n de las materias oigdnicas y que, como ^ta, produce calor. De este descu- 
brimiento, hecho por uno de los mayores genios que haya tenido el g^nero humane, 
8ac6 Lavoisier su aforiamo, que el ilustre Richet reputa como ''el axioma fundamental 
de la biologla." "La vida es una funci6n quimica." 

Pero la hipdtesis primitiva de que las oxidacionea 86lo ee prodiician en el pulm6n, 
fu4 destmida. Suigi6 entonces la idea de que el dcido carb6nico y el agua nacian 
a favor de combustiones verificadas en la sangre misma. En 1837 Magnus descubri6 
que la sangre contiene oxigeno y dcido carb6nico, lo que parecia demostrar la nueva 
teoria. Ludwig lleg6 a creer que las oxidaciones del hidr6geno y el carbono se efec- 
tuaban en la sangre; pero despu^ de la publicaci6n de los estudios de Liebig, en 1842, 
qued6 establecido que no es hidrdgeno y carbono lo que se quema en los tejidos, sino 
albuminoideos, hidratos de carbono y grasas. 

Fu6 Liebig el descubridor de loe m^todoe modemos de an&lisis; vinieron con 61 
gran cantidad de conocimientos respecto a compuestos hidrocarbonados, entre los 
cuales se cuentan muchos prod uc toe de la economia animal. E^stos conocimientos 
suministraban nociones importantfsimas sobre la constitucidn de los alimentos, de 
la orina y de las materias fecales que no posey6 Lavoisier. 

Liebig aplio6 estas nuevas nociones de quimica a la resoluci6n de los problemas 
debiologia. I)e8cubri6 que los albuminoideos contienen dzoe, y en 1842 sugiri6 la 



54 PBOOEEDINGS SECOND PAN AMEBIOAN BCIENTIFIO G0NQEE8S. 

idea de que el izoe xxxlrla ser proporcional a la deBtTucci6n de loe albuminoideoe en 
el organismo. Bilder y Shmidt fueron los primeroB que hicieron experimentos sobre 
este asunto.^ 

La hlp6tesis de la producci6n del calor animal por las oxidacionee intraoig&nicas 
debia dar lugar a rectificaciones importantes. Berthelot fu6 el primero que observd 
que el oxfgeno absorbido por el animal no es proporcional al calor producido, y, por 
coneiguiente, no puede servir de medida aun teniendo en cuenta, por una parte, el 
dcido carb6nico produddo y por otra, el agua avaluada por diferenda pues hay en el 
organismo otras reacciones que consisten en hidrataciones y desdoblamiento que son 
tambi6n fuentes de calor; de modo que el agua y el dcido carb6nico no son loe tinicos 
productos de transformacidn de los materiales nutritivos, sino que hay muchos, como 
la urea y otros productos azoados, que resultan de la transformacidn de los albumi- 
noideos. 

Aun haciendo abstracci6n de las reacciones de hidrataci6n o de desdoblamiento 
que intervienen en todos estos cambios, una misma cantidad de oxfgeno como lo 
dicen Doyon y Morat,' "reacciona con producci6n de distintas cantidades de calor, 
segtin que obre sobre sustancias diferentes o cuando, dirigi^ndose a una misma sua- 
tancia, da por resultado grades diferentes de oxidaci6n.*' 

El dcido carb6nico producido puede corresponder tambi^n a cantidades diferentes 
de calor, por razones an^ogas. 

£n fin, el estado inicial y el estado final de la reacci6n que absorbe oxigeno y dee- 
prende dcido carb6nico, puede no ser determinado por el conocimiento de los ingeeta 
(que son los alimentos, haciendo figurar entre ellos el oxfgeno absorbido) y de loe ex- 
creta (o sean los productos de desasimilaci6n por que en el curso del experimento 
puede cambiar la reacci6n de los tejidos, fijar ciertas substancias que provengan de 
los alimentos y eliminar otras que provengan de los mismos tejidos. 

Ninguna de estas transformaciones se hace, de manera directa, ee decir, que no son 
ni el carbono ni el oxfgeno, ni mucho menos el dzoe los que van a producer el icido 
carb6nico, el agua y la lurea; son principios inmediatos que vienen, sea de los tejidos 
o de los alimentos, los que por una serie de transformaciones, van a dar nacimiento a 
aquellos cuerpos. Ni se crea que estas transformaciones consisten todas en reacciones 
exot^rmicas, sino que pasan tambi^n por reducdones o detddratadones, que dan lugar 
a absorci6n del calor. En virtud de estas transformadones, la glucosa pasa al estado 
de glic6geno, antes de convertirse en ^ido carb6nico. Pero el resultado final es si- 
empre la producd6n del calor puesto que siempre ima reacd6n endot^rmica est& 
compensada por varias exot^rmicas. 

Los testigos de la reacci6n son, pues, en definitiva, por una parte, los alimentos y el 
oxfgeno (ingesta) que van a producirla y por otra, la urea, el addo tirico, el &ddo car- 
b6nico y el agua (excreta) que constituyen el t^rmino final de las transformadones 
quf micas. 

La consideraci6n de la destrucci6n m^ o menos profunda que los organismos 
hacen sufrir a los materiales nutritives, conduce a aproximar, en esta relaci6n, la 
nutrid6n de los organismos superiores y la de los fermentos, en las cuales un enorme 
poder de de8Composici6n da aspectos tan espedales. La descomposid6n de que 
acabo de hablar, que los organismos superiores hacen sufrir a la albt!imina, a los hi- 
dratos de carbono y a las grasas y que terminan, como elementos prindpales, en agua, 
&ddo carb6nico, dcido drico y urea, es una descomposici6n muy profunda cuyo rendi- 
miento en energfa es considerable. Es, por ejemplo, de 1,677 calorfas para una mol^ula 
de glucosa (180 transformada en H3O y CO2). Considerando ahora la levadura de cerv- 
eza, vemos que este organismo vive a expensas del azticar; pero en lugar de conducir 
este alimento hasta la baja escala de las transformadones mencionadas, la levadura 
lo desdobla simplemente en alcohol y en &ddo carb6nico. Para una mol6cula de 
glucosa la cantidad de calor, es decir, de energfa disponible, no es sino de setenta y 

1 Graham Lusk, The Elements of the Sdenoe of Nntritloii. 
1 Doyon 7 Moral, Traits de physiologie. 



PUBLIC HEALTH AND MEDICnTB. 55 

una calorias. £1 reBdimiento de energia es, pues, mucho menos coneiderable, porque 
el alcohol ee lleva consigo cerca de nueve d^cimos de la energia de la glucosa. 

En loe oiganismos superiores hay relaci6n entre el peso del cuerpo y el peso de la 
sustancia transfonnada. Estas relaciones, son, por ejemplo, para el hombre, de 500 
a 600 gramoe de materia org&nica para 60 a 70 kilogramos de peso vivo. Al contrario, 
entre el peso de la levadura y el peso de la sustancia transfonnada hay una despro- 
porci6n enonne, lo cual se debe a que el fermento no hace sufrir a su alimento sino muy 
pocos gradoe en la eecala de destrucci6n de la materia, y que, como dice Lambing ^ 
compensa la mediocridad del rendimiento de energia de esta operaci6n, con la masa 
del alimento transformado. 

Pero eetafl destrucciones no traen nada de e6X)ecifico que haga una diferencia de 
naturaleza entre estos organismoe y los organismos superiores. Y aun las distinciones 
mencionadas desaparecerian si se considerara, no el peso del alimento transformado, 
eino la cantidad de energia suministrada al fermento por eBta transformacidn. 

"Lo mismo sucede,'* dice Lambling," * en lo que concieme a la cantidad de mate- 
liales alimenticios consumidos y destruidos por el organismo; depende, no del aporte 
alimenticio, sino de la magnitud de las necesidades del orgauismo. 

Pero se nota, en verdad, que inmediatamente despu^s dela ingestidn delos alimentoe 
hay un aumento de las descomposiciones qufmicas, lo que parece estar en contradicci6n 
con la ley enundada m^ arriba, puesto que serf a la entrada del combustible la que 
producirfa la combusti6n. Este evento se revela por la elevacidn sdbita de las can- 
tidades de oxfgeno consumidas, como tambi^n por un balance total de calorfas, mayor 
cuando se pasa del estado de ayuno al de alimentaci6n. Asf, en un experimento de 
Levy, un perro consumfa, en el estado de reposo y en a3ainas, 158 c. c. de oxfgeno por 
minuto. Se le dl6 entonces una comlda abundante compuesta de 500 gramos de arroz, 
200 gramoe de came y 25 gramoe de grasa. En las boras que siguieron, las cantidades 
de oxfgeno fueron, respectivamente: 188, 204.8, 203.8, 212.1, 115, 210.7, 207.8, 209.3, 
211.3, 206, 188.5, 176.8, "2.** De la misma manera Voit ha notado en el hombre un 
gasto de calorfas de 2,470 y de 2,320 (t^rmino medio 2,390) en 24 boras al estado de 
ayuno; mientras que con la ingesti6n de alimentos variados, el gasto oscLlaba entre 
2,350 y 2,940 (t^rmino medio 2,556), sea un aumento de 7 porciento, poco mia o menos. 

Observadones hechas posteriormente en el ayunador Cetti, en Berlin, confirman 
plenamente los resultadoe. "Pero este aumento,*' dice Lambling' ** depende tinica- 
mente del trabajo secretor y sobre todo, mecdnico, impuesto al tube digestive, y no 
del aumento de las combustiones llevado por la aUmentaddn.'* Sin embaigo, eegtin 
la autoridad no menos respetable de Lable ^ esto no parece exacto, pues el trabajo 
del tube digestive no exige sino un gasto muy pequeno de calorfas, y por otra parte, 
la concordanda bien notada por RQbner y Atwater, entre el valor calorfgeno de la 
rad6n aUmentida y la excrecidn cal6rica establece el hecho con precision: 

Mientras m£a coma un sujeto, mds calorfas virtuales ingiere, y m^ calorfas realee 
gasta. Se necesitarfan nuevoe experimentos, institufdos en este Bentido,jpara estable- 
cer que el gasto de calorfas varfa a voluntad con la raci6n alimenticia. De la misma 
manera que, en general, se ingiere una raci6n alimenticia excesiva, se excreta probable- 
mente una suma de calorfas demasiado grande. El equilibrio cal<5rico podrfa obtenerse 
con una rad6n alimenticia m^ d^bil, aportando nuevas calorfas. Lo que habrfa que 
determinar ee precisamente el limite de la inge8ti6n alimenticia susceptible de 
mantener la temperatura constante sin que el peso del sujeto baje y sin que eet^ 
oblig&do a quemar sue propioe tejidoe. 

Se sabe que la cantidad de oxfgeno consumida por el organismo es, en muy anchoe 
Ifmites, independiente de la cantidad de oxfgeno ofredda a los tejidos por la reepira- 
d6n, y que la cantidad de oxfgeno gastada varfa con la calidad de alimentos que se 
van a transformar; 100 gramoe de oxfgeno transforman 38 gramos de grasa en HjO y 

t Lftmblns, TraiU d« Pathologie O^n^nle de Boaohard. 

* LambUng, obn citada. 

* M. Labl6, Les regimes alimentaires, p. 30, 1010. 



56 



PBOOEEDINGS SECOND PAN AMEBICAN SCIBNTIFIO CONGRESS. 



CO2, con produccidn de 325 calorfas u 84.4 de hidratoe de carbono, en HjO y COj, 
con producci6n de 362 calorias. La cantldad de oxfgeno pues, ni descubre la 
cantidad de combustible destnifdo ni la energfa puesta en libertad. Cuando hay 
cierto minimum de aporte de materiales azoados, baeta Buministrar un exceeo de 
alimentoe terciarios para que la neceeidad de energia sea cubierta; eete exceeo puede 
ser proporcionado por las cantidades mis variables de grasa o de hidratos de carbono. 

Este es el cuadro esquemdtico de nuestras necesidades alimenticias, tal como se 
realiza en el cuadro eequemdtico de nuestroe experimentoe de laboratorio. Pero en 
la vida ordinaria, ^c6mo pasan las cosas y c6mo satisfacen loe hombres sus necesidades 
alimenticias, tinicamente guiados por su instinto? Es aqul donde la noci6n de los ali- 
mentoe isodin&micos de Rdbner esclarece en gran manera la fisiologfade la nutricidn. 
Antes de la adquisici^n de tal noci6n hubiera side imposible abordar este problema. 

Sean, por ejemplo, dos individuos de los cuales el uno vive con 120 gramos de 
albdmina y 269.7 de grasa, y el otro con la misma cantidad de albtimina, mis 611.7 
gramos de hidrocarbonados. Al no comparar sine los pesos se veria que la cantidad de 
albdmina representada en el primer case es de 30 por ciento, y en el segundo es 16 por 
ciento de la raci6n. ^C<5mo podrla pensarse, en presencia de estoe cases, que la albd- 
mina represente en ambos el mismo papel y tenga la misma importancia? 

Introdtizcase, entonces, la consideracl6n de los valores calorim^tricos, y se tendri: 

Primer case: Albdmina, 120 por 4.1—492 calorfas; grasa, 269.7 por 9.3—2,508 
calorias; total, 3,000 calorlas. 

Segundo case: Albdmina, 120 por 4.1 — 492 calorfas; hidrocarbonado, 611.7 por 
4.1-— 2,508 calorfas; total, 3,000 calorfas. 

La albdmina ha aportado en 61 un case y en el otro la misma cantidad, sea 16.4 por 
ciento, de la cantidad total de energfa gastada; el resto, sea 83.6 por ciento, es sumi- 
nistrada por cantidades isodinimicas de grasa de hidrocarbonados. 

Rabner ha calculado de esta manera el aporte de energfa de cada especie de ali- 
mentos observando en individuos que pertenecen a categorfas sodales menos y menos 
elevadas y que suministran un trabajo mis y mis penoeo. 

El cuadro siguiente resume los resultadoe obtenidoe: por 100 calorfas suministradaa 
por el organismo se encuentran: 



Inanicidn 

Clases ocomodadas 

Carpinteros, sol(lados,etc 

Obreros qii(< suministran un trabajo considerable 

Mineros, obreros de f4briea 

Lefiadores 



En albi)- 
mina. 


En grasa. 


12.1 


87.9 


19.2 


29.8 


10.7 


16.3 


18.8 


17.9 


13.4 


21.3 


8.3 


38.7 



En hidratos 
deoarbono. 



11.0 

.w.o 
r>6.9 

63.3 

fiS.S 
52.8 



En lo que concieme a las materias albuminoideas, se ve que la proporci6n relativa 
de calorfas suministradas por ella va disminuyendo a medida que se deeciende en el 
cuadro y esto depende de que en lasclases acomodadas se hace uso de preferencia de la 
alimentaci6n animal, es decir, que se consumen pesos absolutes de albdmina mucho 
mayor que en las menos afortunadas. Como por otra parte las clases ricas, en raz6n del 
menor trabajo m^anico, gastan menos calorias que las necesarias para un obrero, la 
proporci6n relativa de calorfas tomadas a la albdmina se encuentra por esta raz<5n 
aumentada en los ricos y disminufda en los pobres y en los obreros. 

Para las grasas se pueden hacer consideraciones anilogas. Midiendo el ndmero rela- 
tive suministrado por ellas se ve que va disminuyendo a medida que se desciende en 
la escala; pero de la clase V en adelante principia a aumentar y puede de nuevo 
Uegar hasta igualar a las clases acomodadas. Esta diminuci6n se explica porque el 
obrero toma a los hidrocarbonados (almid6n del pan f ^ula de la papa) cantidades ere- 
cientes a medida que el trabajo mec^co lo va exigiendo; pero luego, dice RQbner, 
llega un memento en que el volumen de los alimentos impondrfa un trabajo muy 



PUBLIC HEALTH AND MEDICINE. 57 

coDfliderable al tabo digestivo, el cual queda impotente para dominar una gran masa, 
e interviene entonces como complemento indispensable el alimento grasa, que tiene la 
misma ventaja y asegura un valor calorffico considmable. Agr^ueee a esto que las 
grasas soli ingeridas caai en naturaleza y que repreeentarlan, per lo tanto, en una masa 
igual un aporte de eneigfa mis considerable que los otros alimentoe. De esta manera 
el organismo encuentra: 

En 100 gnunoe de came flaca a 21 por ciento de albtunina, 86 calorfas; en 100 gramos 
de pan a 8 por ciento de albtimina, 86 caloilas, y en 5 por ciento de almiddn, 258 calo- 
rfas; en 100 gramos de mantequilla de 85 por ciento de grasa pura, 790 calorfas. 

Vienen, en fin, los Mdrocarbonados adndrablemente representados por los vege- 
tales, de los cuales, por ser m^ baratos, toma el obrero el total de su racidn alimenticia; 
pero por razones ya dichas disminuye el tamafio relativo de hidiocarbonados hasta 
22.8 para la tiltima categorfa. 

El calor de combustidn de los aKmentos, o sea el total de calcnlas suministradas por 
la unidad de peso, mostrado por el calorfmetro no es siempre igual al que se produce en 
el organismo. Si se trata de grasas o de Mdrocarbonados, tenemoe para un gramo de 
sustanda, tanto en el calorfmetro como en la combusti<ki oig^ca: Grasa 9.3 a 9.4 calo- 
rfas; hidrocarbonados, 4.1 a 4.2 calorfas, pero con los albuminoideos no sucede lo 
mismo, porque el izoe, que queda en libertad en el calorfmetro al estado elemental, se 
transforma en el organismo y se elimina bajo la forma de productos complejos, de 
los cuales las nueve d^cimas partes, poco m^ o menos, son urea y el resto deja el 
organismo bajo forma de productoe menos simplificados. Hay pues que restar el 
calor de combusti6n de eetos productos del de las materias albuminoldeas para lo 
cual la mayor parte de los autores, tienen en cuenta la urea y hacen abstracci6n de los 
otros productos azoados. Como 100 gnunos de materia albuminoidea, a 16 por ciento 
de &zoe, suministran aproximadamente 34 gramos de urea, o sea casi la tercera parte 
de su peso, hay que restar del resultado medio del calor de combustidn de la albtimina 
(5 a 6 calorfas) la tercera parte, poco m^ o menos del calor de combu8ti6n de la urea, 
o sea, 0.850, correccidn que da del 15 al 16 por ciento del calor de combusti6n total. 
Hay que anotar, adem^, que el izoe se eleva en algunos albuminoideos de 16 a 19 
por ciento, lo que aumentarfa la eifra de 0.85 a 1 calorfa. Hechas estas anotaciones y 
despreciando una d^ima parte del dzoe que no se txansforma en urea sine en otros 
compueetos, se puede tomar como cifra media del calor de combustion de los albumi- 
noideos, la de 4.7 a 4.8 calorfas por gramo. 

Cuando se quiere valorizar el podercalorimOtrico de un alimento pon la comparaci6n 
de la albdmina ingerida y el izoe excrementicial hay que hacer dos correcciones 
que corresponden: la una al alimento y la otra a la excreci6n azoada. La primera es 
debida, por una parte, al aumento, de algunas albdminas hasta 19 por ciento de ^oe 
y que el dosado de la albtimina se hace por el dosado del izoe, y en los vegetales hay 
sustancias azoadas qu^ no son albuminoideas. Por este motivo se baja el valor caloil- 
m^trico de la albtimina a 4.1 en vez de 4.8 cuando se trata de alimentos mixtos. La 
segunda causa de error se efectiia cuando no se hace el andlisis del &zoe eliminado por 
las deposiciones. RObner estima este residue en 8.11 por ciento del valor calorim^trico 
total de la reaccidn; algunos Uegan hasta el 10 por ciento para el regimen mixto. Es 
natural que con la alimentaci6n vegetal, que da una mayor cantidad de residues no 
absorbidos, esta dfra debe aumentar. .^ 

Con 861o dosar el dzoe total de la orina, puede medirse la cantidad de albtimina de la 
cual ha dispuesto el organismo, es neceeario entonces tomar la dfra 4.8 en vez de 4.1 
como valor calorim^trico. 

Sea, por ejemplo, un individuo que elimine 14 gramos de &zoe, total en las 24 horas. 
Sabiendo que a 100 gramos de albtimina corresponden 16 de dzoe, tendremos la si- 

guiente relad6n: 

1400 
16:100::14:X, de donde X»^ o a 14 por 6.25X87.50 (6.25 es el coefidente que 

resulta de dividir a 100 por 16) y 87.50 por 4.8=>420 calorfas. 



58 FBOOEEDIKGS SEOOND PAN AMBBIOAN 80IEKTEPI0 CONGBESS. 

Ouando b61o se desea la urea se hace el cdlculo aproxLinado de esta manera: peso 
de la urea multiplicado por 1.30 o 1.14, que es el peso del dzoe expresado en urea, y el 
producto multiplicado por 2.91 gramo de urea ccHresponde a 2.1 de albdmina). 

Se obtiene de eeta manera segtin Lambling, ^ con aproximaci6n muSdente, la cantidad 
de albdmina desaomilada. Una mayor precifli6n se obtendr& naturalmente con el 
primer procedimiento.* 

Al lado de esta teorfa isodindmica o teorfa de Rtlbner viene a oponerse la teorfa de 
Chauveau mds cientifica en mi concepto; y si he desarroUado m^ extensamente la 
primera es porque sobre ella est^ todavfa reposando muchos prindpios de fisiologfa 
modema y porque hasta cierto punto ^a viene a ser necesaria para el f undamento y 
desarroUo de la segunda. 

La teorfa de Chauveau que llamar^ tambi6n teorfa glicog^nica, dice que el pod^ 
nutritive de los alimentos se confunde con su poder term^eno o dinam6geno. La 
grasa no puede ser utilizada como elemento energ^tico, sine despu^ de su transforma- 
ci6n en glicdgeno; hay pues en este alimento tma ]>^rdidade eneigfa sobre la que sufre 
segtin la teorfa de Rtlbner. El glic<5geno serfa el estado a que tienen que U^^ar las 
sustandas alimenticias para produdr energfa. Es dedr que un alimento es tanto m^ 
productor de eneig:fa cuanto mayor sea su capaddad para transformaree en glic<3geno. 

^'El cuerpo que en el organismo llena la fund6n eneig^tica," dice Morat, ** es el 
carbono; la forma qufmica alrededor de la cual evoludona en esta funci6n, es el azticar 
y el cuerpo que en su conflicto con 61 manifiesta esta fund6n el oxfgeno. La evolu- 
d6n energ6tica se encuentra como condensada en estos tres t^rminos correspon- 
dientes a funciones que son: la alimentacidn, la glicogenesis y la termogenesis.'' 

Chauveau ha demostrado y confirmado por la experimentaci6n la teorfa, demostrando 
que un gramo de graaa y 1 .52 gramos de azticar de cafla son capaces de suministrar, 
la primera por oxidaci6n, la segunda por hidrataci6n, la misma cantidad de glicosa y 
por consiguiente de glic6geno; las cifras dadas por la experimentaci6n, son exacta- 
mente las que da la ecuaci6n hipot^tica de la transformaci6n de la grasa. 

Lo que se ha dicho de la grasa se aplica a todas las otras sustancias alimenticias, 
inclusive los albuminoideos; de aquf que haya dado a esta teorfa el nombre de teorfa 
glicog^nica. 

Pero segtin esta tiltima teorfa la grasa y el azticM" concurren a la nutrici6n en el 
mismo grado no en cuanto se lee administra en cantidadee t^rmicamente equivalentes 
(Rtibner), sino en cantidad es propias para producir la misma cantidad de glic6geno 
(Chauveau). En reeumen, la segunda teorfa le quita a la primera, el error prove- 
niente del gasto de energfa, de la p^rdida de valor energ^tico que una sustancia 
alimenticia necesita para trasformarse en glic6geno. 

Es una conexidn semejante aunque hecha en opuesto extreme, a la que se hace, 
segtin Rtibner a los albuminoideos cuando se compara su valor energ^tico real con su 
vaJor de combusti6n dado en el calorfmetro. Proviene esta cqnexidn, de que en el 
organismo no llegan los albuminoideos al mismo extreme de de8Compo8ici6n a que 
llegan en el calorfmetro, sino que se transforman en otros productos de compostci6n 
tan complicada como la urea. 

Por no caber en el plan de mi estudio, no me he detenido a hablar de las trans- 
formaciones de los albuminoideos en el tube digestive. En un capftulo posterior 
hablar^ de las distintas formas de eliminaci6n azoadas y de la proporci6n en que se 
verifican en Bogota y en otras poblaciones de la altiplanicie. 

INPLUBNCIA DEL CLIMA DE LA ALTIPLANICIE SOBRE LAS COMBU8TIONE8 HUMANA8. 

Voy a hacer algunas consideraciones sobre los climas de Bogotd y Timja, poblacio- 
nes donde he practicado mis investigaciones. 

1 La Taoi6n media de mantenimlento en los hombree se divide, segt^ la mayor parte de los fisUSlogos, de la 
maneiB sigiiiente: Albthnina, 185 par 4.1 equivale a 563; grasa, 140 por 9JS eqoivale a 1,302; hidratos de 
oarbono, 249 par 4.1 equiyale a 1,021; total, 2,876 oalorias. Restando de 68tas tm 8 par ciento que se pierden 
en las deposloionee, quedan 2,646 oalorias netas, o sean 86 por klldgramo. 



PUBLIO HEALTH AND MEDICINE. 69 

Tomo las de Bogotd de un trabajo presentado por el Dr. Julio Garavito a las sesiones 
cientificas de 1910 y las de Tunja, de mis observaciones personales y de datos tornados 
en los gabinetes y laboratorios del seminario conciliar de esta ciudad. 

Har6 luego algunas consideraciones sobre la influencia del clima en las combustio- 
nes humanas para lo cual servird de mucho la comparaci6n entre dos poblacionee de 
altura un poco diferente. ^ 

Bogotd estd situada cerca del ecuador entre las Uneas isotennas 25 y 28 grades, pero 
8U clima puede claslficarse entre los medios o los frfos. 

El minimum de temperatura se observa a las 5 y 45 a. m. y es de 8.74 grados, y el 
maximum a las 2 p. m. es de 16.95. Las mayores variaciones se encuentran durante 
el mes de enero. La temperatura media es de 12.97 grados, la amplitud media de las 
oscilaciones diumas es de 7.11. 

£1 estado higrom^trico es de 79.5 por ciento. La velocidad maxima del viento co- 
rresponde al mdximum de temperatura. En los meses de junio, julio y agosto se 
observan golpes de viento, de corta duracidn, que alcanzan hasta 15 metres por se- 
gundo. 

En general, se considera la presi^n atmosf^rica en Bogotd como de 560 mils, de 
mecurio. Segdn los dUculos de Garavito hay un mjjximun de 0.5609 y im minimum 
de 0.5579. La mayor altura del bar6metro se observa en los meses de junio, julio y 
agosto y la menor en octubre, noviembre y diciembre. 

Oxigeno. — Si se considera la proporci6n de oxlgeno en volumen, es casi igual en 
Bogota y a nivel del mar (21 por ciento), pero si se tiene en cuenta, no el volumen 
sine el peso, es natural que la cantidad disminuya en io versa proporcidn con la 
presi6n. Teniendo en cuenta que un litro de aire, a la preei6n de 0.76, contiene 
0.259 gramo de ox%eno, se ob tiene poco m^s o menos 0.192 gramo de oxlgeno por 
litro de aire en Bogotd. 

Tunja tiene una 8ituaci6n y un clima muy semejantes a los de Bogotd, 661o que el 
estado higrom^trico es m^ bajo en aquella y la velocidad del viento mayor. 

La temperatura media es de 11.99 grades. La mayor amplitud de las oscilaciones 
diumas es de 6 grades. El m^imum de temperatura se observa en el mes de enero 
y el minimum en julio. 

La altura sobre el nivel del mar es de 2,790 metres y la presidn media del banSmetro 
de 0.536 mils, de mercurio. 

Temperatura humana en la altiplanicie. — ^Todes los autores europeos que he consul- 
tado estdn de acuerdo en fijar para el hombre una temperatura axilar media de 37 
grades a 37.2 grades. En Begetd, segdn lo habrdn observado todos los medicos y 
eetudiantes, la temperatura media rara vez pasa de 36.5 grades; de tal manera que 
muchos consideran come febricitantes a los individuos cuya temperatura llega a 36.8 
grades. 

El Dr. Pabon en 135 observaciones que reunid para su tesis de dbctorade, obtuvo 
un promedio de 36.5 grades, es decir, de 0.5 grade, inferior a la cifra censiderada como 
normal en Eurepa. El Dr. Gerpas en su tesis agrega 100 observaciones mds que dan 
un resultado de 36.3 grados, lo que da ima diferencia de 0.9 grade con la cifra de 
Beclard 37.2 grados. 

En 86 observaciones tomadas por ml en Timja en adultoe de 20 a 40 ailos, pertene- 
cientes a distintas clases sociales, obtuve un promedio de 36.24 centlgrades de tempe- 
ratura, con 76 pulsaciones y 20 reepiraciones por minute. 

Parece pues demostrado que hay una baja considerable de la temperatiura del 
hombre en la altiplanicie, en relacidn con la temperatura aceptada como media en 
Eurepa. 

Todas las hip6tesis que pueden hacerse para explicar este fendmeno pueden redu- 
cirse, en mi concepto, a tree: (1) Influencia de la temperatura ambiente; (2) in- 
fluencia de la altura; y (3) influencia de la alimentaci6n. Me limitar^, por el me- 
mento, a las dos primeras, para ocuparme lu^o de la tercera, en capftuloe poster iores. 



60 PROOEEDINGS SEOOKD PAN AMEBICAN SCIEKTIFIO CONGRESS. 

Infiuencia de la Umperatura ambienU. — ^Ya dije que, segtin los c41culo6 del Dr. Gara- 
vito, la temperatura media de Bogotd ee de 12.97. El Dr. Corpas cree que esta baja 
temperatura exterior es una de las causae de la baja de temperatura animal, pues 
^^el cuerpo humano en busca de equilibrio t^rmico tiende a acercarse a ella.'' 

A primera vista esta causa no carece de importancia, pues aimque todos sabemos 
que los animales omeotermos tienen i&edios de defensa que permiten luchar contra 
la temperatura ambiente, tambi^n es verdad que un descenso o un aumento considera- 
ble de temperatura pueden hacer variar la temperatura animal en algunos d^imos 
de grado. Esto parece confirmado por los experimentos de David y los postericn^e 
de Mantcgazza, Fousset, etc. ; pero ninguno de estos observadoree ha hallado una baja 
tan considerable como la que se encuentra entre nosotros, ni aun en atm66feras de pro- 
porci6n higrom^trica mds considerable. 

Entre 247 observaciones de Mantegazza, p>or ejemplo, no ha encontrado, en climaa 
mucho mas frlos que el de Bogotd, sino una temperatura minima de 36® 4'', que alcanza, 
cuando mds,' a ser igual a nuestra temperatura media. 

Agr^gase a esto que las razas tropicales, por vivir en un clima siempre igual, 
luchan por efecto de la costumbre mucho mejor contra los grandes frfos como contra 
los grandes calores; as( las pequefias variacionee de temperatura animal que se observan 
en Europa del verano al inviemo no se encuentran en los tr6picos, al comparar a este 
respecto, los habitantes de los climas mis ardientes con los de los mis Mos; de modo 
que la temperatura ambiente (que no es tan baja para producir un descenso de tem- 
peratura animal), no nos explica la baja considerable de la temperatura animal en la 
altiplanicie. 

Presi&n atmosfirica. — ^Para mantener bus combustiones oiginicas, el hombre necedta 
introducir en cada hora segiin los cilculos de Briiner y Valentin 3130 gramos de oxlgeno, 
que corresponden a 2191 litros al nivel del mar, o sea 450 litros de aire, que se intro- 
ducen en las 15 o 16 respiraciones por minuto, que se consideran en Europa como 
normales, a razon de 500 c. c. en cada una, quitando los 50 c. c. que son expulsados a 
cada expiraci6n. 

Ahorabien.'como en Bogotilapresi6n es de 0.20 cms. de merciu*io menos que a nivel 
del mar, si el oiganismo no dispusiera de medios de defensa, se tendrfa que en los 
21.91 litros de oxfgeno no introducirfa los 31.30 gramos, sino mucho menos; de donde 
resultarfa una gran insuficiencia de las combustiones, que podria explicamos la baja 
de la temperatura humana. 

Pero hemos visto ya que la actividad del metabolismo celular es independiente de 
la cantidad de oxfgeno ofrecido a los tejidos. Los experimentos de Liebig demuestran 
que la presidn no influye sobre la absorci6n de oxigeno,' y aun cuando Truntz ob8erv6 
un aumento, este aumento no duraba sino cuando mis im minuto, y era, segdn el 
mismo autor, debido a la repleci6n de los pulmones. ' 

De la misma manera que el oiganismo no toma sino el oxfgeno que necesita, cuando la 
atm68fera eeti enrarecida se vale de ciertos medios de defensa para tomar todo el que 
le sea necesario. Veamos si de estos medios disponen los habitantes de la altiplanicie. 

Bajo la infiuencia del clima de las alturas, ^'que llevarfa en realidad la disminucidn 
del oxfgeno del aire en relaci6n con la presi6n atmosf^rica, el ndmero de los gl6bulo8 
rojos aumentarfa, en una gran proporci6n, hasta el punto de alcanzar siete y ocho 
millones por milfmetro cdbico en el hombre.'' Seg(in la observaci6n hecha por 
T. Viault, en sf mismo a 4,392 metros de altura en un viaje al Perii, la hipeiglobulia 
se producirfa a partir de los 700 metros. Por medio de esta hiperglobulia aumenta la 
superficie de absorci6n del oxfgeno y puede el oiganismo fijarlo en la misma cantidad 
que a la presi6n ordinaria. Es 6ste, pues, un mecanismo regiilador o de defensa que 
se pone en juego a medidaque la presi6n disminuye. Cuando los sujetos sometidos a 
los experimentos vuelven a la llanura, el ndmero de los gldbulos rojos vuelve ripida- 

1 Ch. RIohet, La ohaleur anlmale. * Liuk, Sdenoe of nutrition. * Journal of Physiology, 1907. 



PUBLIC HEALTH AND MEDICINE. 



61 



mente a su nivel nonnal. Algunoa de loa hechoa que ban servido para la ediGcaci6n 
de esta teoiia ban side vivamente controvertidoe. La cueetii5n, en todo caso, eeti. 
todavia oecura, pero lo que parece demostrado ee que la hiperglobulia de que se tratai 
«a aimplement« perif^rica y que el nllmero de gMbulos rojos del coraz6n y de loa 
gnieflos vaaofl no aumenta." ' 

Loa fligujentes eidmeneB de Bangre, practicados, unoa por mf, y otros, en en mayor 
parte, por el Dr. Jorge Martinez Santamarfa, podiiji damos a^una idea de lo que a 
eate respecto paaa en la altiplanicie. 

Laa nnmeracionea de ^Wbuloa fueron hechaa eu el numerador de Bayem. Algunaa 
hui eido recttficadaa en el Thomas Zeiss. La iiemoglobisa fu^ medida en el aparato de 
Fleischl. 



1 Ohr. Trall««l^tiMDtalnda pbyilolDgle, 1910. 



FBOCEEDIKGS SBOOND PAIT AHEBIOAIT SOIEKTIFIC CONOBBSS. 



«^. 


Eitad. 




SK. 


HOnura. 


XdOll. 


M. 


Sx. 




2d 

1 

20 
30 

Is 

» 

30 

30 

20 

33 

32 
2fl 

20 
40 

23 

2S 

3S 

40 

i 

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86 




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36 
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M 

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no 

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1 

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94 1 






































































































4,7»9,n4 


83.21% 











H4 aquf mis obaervacioDes hechas en Tunja en individuoB de 20 a 40 afioe. 



H^. 


Edad. 


ss. 


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as- 


Nflmeroa. 


EdMl. 


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Como Be ve, estoa 21 aoiliais dim un promedio de 4,547,380 de gUbuloe lojoa y 78 
por ciento de hemoglobina, la que corresponde a un valor globular de 26 diezbillo- 
n^eimoe de milfgnuao.' Pnra los de Bogoti y 17 para lo° de Tunja. 



■ El valor glob 
tenleadD en cuei 
npresentael vh 



itldBd dehemoglobinaquBcontlenecsdii globule rojo, ha sldoobtenldo. 
In sangM, por la slguioole Mnnula; ^~ jfYi^^ipnTSo sn la qua X 
deosidad de la tangre prescEndltndo de la coou dtcliual (looi); II la 
ea 100 gninios de saogre, >■ NelnilnBrodagldbulosroJoa pot 1 mm. C, 



PUBLIC HEALTH AND MEDICINE. 63 

Deede que el Dr. Joige Vaigaa Sudrez practic6 sub anAlisis de sangie, todo el mundo 
creyd (incluBive el autor de este trabajo) que ee trataba de algdn defecto de t^cnica, 
puee nadie podia figurarse que a la altuia de Bogota, hubiera una dismiiiuci6n de las 
hematias en contra de lo que generalmente se admite. 

Fu6 pues, el Dr. Vargas Su^z quien primero llamd la atenci6n sobre tan impor- 
tante asunto y a ml me cabe el honor de venir hoy a confirmar su observacidn. Para 
mayor abundamiento, mis promedios de Bogotd y los del Dr. Vaigas Su&rez, dan una 
cifra casi id6ntiea, siendo de advertir que el autor de este trabajo, no tuvo conoci- 
miento de la teals del Dr. Vargas, sino muoho tiempo despu^s de terminadas sus nu- 
meraciones de Bogota. 

Si el ndmero de mis observadonee tomadas en Timja no fuera tan inferior al de 
Bogot4, aquelloe contribuirfan a afirmar una tesis absolutamente opuesta a la sob- 
tenida por Viault y otros fisidlogos europeos; es decir, que en vez de aumentar nuee- 
tras hematias a medida que ascendemoe, disminuyen. 

Ooncuerdan estoe resultados con la baja de temperatura, lo que quiere dedr que 
nuestra raza es impotente para defenderse contra el enrarecimiento del aire en las 
alturas. 

Pero fuera de la hii>erglobulia y de la hii>erhemoglobinuria hay otros medios para 
eeta defensa que voy a anaUzar. 

Vimoe atr^ que el oiganismo no toma sino el exijgeno que necesita. Vimos tambi^ 
que a causa del enrarecimiento del aire, el habitante de la altiplanicie de Bogota 
no toma en los 21.91 litres, los 31.30 gramoe que se toman a nivel del mar, en el mismo 
volumen. 

Lo primero que se ocurre ee que los habitantes de la altiplanicie suplen con una 
mayor capaddad tordcica esta insuficienda de oxigeno atmosf6rico; que introdu- 
ciendo en cada inspiraci6n un mayor volumen de gas, Uega a absorber los mismos 
31.80 gramos de exfgeno por hora. Pero en 54 capaddades todUdcas que he tomado 
en hombres, he hallado un promedio que alcanza a 1.8, cifra muy semejante a 
la que encontr6 el Dr. Corpas (1.7). £1 problema se reduce entonces a averiguar 
cuinisa respiradones se necesitan en Bogot4 para tomar la cantidad de oxigeno indi- 
cada en peso. He aquf como lo reeuelve el Dr. Corpas: 

Segdn los experimentos de Bruner y Valentin, el hombre toma la cuarta parte del 
oxigeno que pasa por sus pulmones; de mode que para tomar los 31.30 gramos que 
necesita en cada hora, deben pasar por los pulmones, 126.20 gramos que est^ con* 
tenidos, a nivel del mar, en 450 litros de aire. Ahora bien: si en Bogota contiene un 
litro de aire, 0.192 gramo de ex|geno, los 125.20 gramos eetar^ contenidos en 652 
litros de aire, que servir^, a raz6n de 500 c. c. por cada reepiraddn, para 1,304 rech 
piradonee por hora, o sea 21.7 por minuto. 

Como reeultado de 100 observadones, el mismo autor encuentra, como tannine 
medio, 20.9 respiradones por minuto. Como se ve, los dos resultados (el del cdlculo 
y el de la obeervaddn), son sensiblemente iguales y se acercan tambidn a la dfra 
de 20.3, fijada por el Dr. Coindet en la Mesa de An&huac. 

S^gt&n el mismo autor, el ntimero de pulsadones por minuto es, en la altiplanide, 
de 83. De mode que si no hay un mecanismo conpensador reepecto a una mayor 
saperfide de hemoglobina, lo hay por una mayor rapidez en la renovacidn de las 
superficies puestas en contacto para tomar el exfgeno que debe ir a produdr las com- 
bustiones. Lo difidl es saber si este mecanismo alcanza a suplir a aqu^l; si lo que 
lesulta pkir el dUculo matemdtico, resuKa tambi^n en cuanto a la pr&ctica de las 
oombustiones org&nicas, o si en definitiva la folta de superfide hemoglobinica ea una 
de las causas de la baja de la temp«»tura animal en la altiplanicie. 

Begdn mis observadones tomadas en Tunja, no se llega a los mismos resultados. 

Vimos atr^ que la temperatura humana me da un promedio de 36.24, es dedr, 
inferiOT al obtenido por los Drs. Pab6n y Corpas en Bogotd. Ahora bien, estando 
esta filtima pobladdn colocada a un nivel inferior al de Tunja, deberla encontrarse 



64 PBOOEEDINGB SECOND PAN AMEBIOAN 8CIENTIFI0 C0NQBE88. 

en esta una polipnea compensadora y una mayor frecuenda del pulso; no sucede asf, 
sin embargo, sino todo lo contrario, puee como se ve, mis promedioe de 76 pulsacionea 
y de 20 respiraciones, son inferioi-es a los obtenidos en Bogot& por Corpas. 

Si no fuera porque el ndmero de observaciones es todavia insuficiente paia sentar 
una conclusi6n definitiva, podrfamos deducir (agregando estoe dos datos al de la dis- 
minuci6n del valor globular con la mayor altura) que nuestra raza, dcbido a multiples 
circunstancias que enumerar^ al final de este estudio, est^ ataoada de un principio de 
degeneracidn fisiol6gica que la incapacita para defenderse contra la&agreedones de la 
altura. 

Ya se vi6 c6mo la intensidad de las combustiones orgdnicas estd en raz6n directa de 
la.cantidad de alimentos ingeridos, de mode que paracompensar las p6rdidas de calor 
que el oiganismo sufre en la altiplanicie por efecto de la altura, del estado higrom^trico^ 
de la temperatura ambiente, etc., se necesita agregar a los medios de defensa de que ya 
se ha hablado, el de una alimentaci6n muy rica en materiales nutritives. 

Me extenderla demasiado si me pusiera a relatar los experimentos que se ban becho 
sobre esta cuesti6n del aiimento, como medio de defensa contra las causas de enfiia- 
miento, talea como los de Levy, en perros,* las de Viault, en el bombre, las de Richet, 
en curfes,' las de Atwater y las de Rdbner sobre el valor nutritive de los alimentos.' 

Bstas consideraciones, agregadas a que la observacidn diaria y la tesis del Dr. Del 
Rio * dejan comprender que hay una insuficiencia de eliminaci6n de la urea entre 
nosotros, me condujeron a bacer investigaciones sobre la alimentaci6n y luego sobre la 
eliminaci6n azoada de la altiplanicie. En los capltulos siguientes se ver4 el reeultado 
de estas investigaciones. 

LOS ALIMENTOS. 

En el capltulo anterior se hizo el anillisis de uno de los elementos de combu8ti6n, o 
sea el oxfgeno. En el presente voy a hacer algunas observaciones sobre el otro ele- 
mento, o sea el combustible. 

Ya se ha visto que la caUdad de los alimentos iniluye poderosiamente en la intensidad 
de las combiistiones orginicas. Y como, por otra parte, se sabe que las materias ali> 
menticias tienen composiciones distintas segtin la zona a que pertenecen, babla pen- 
sado que la insuficiencia de eliminaci6n de la urea que se nota entre nosotros, pudiera 
ser debida a una insuficiencia de materiales azoados en la alimentacidn. Venian en 
apoyo de esta hipdtesis la consideraci^n de que, por una parte, el aire de las alturas no 
tiene la misma cantidad de 4zoe, en peso, que a nivel del mar, y por otra que no estando 
nuestro suelo cientlficamente abonado para la agriciiltura, pudiera adolecer de una 
nitrificaci6n insuficiente. De modo que el alimento vegetal, origen de todos los 
materiales alimenticios (vease pdgina 53), resultaria con una cantidad de 6zoe insufi- 
ciente para abastecer a las necesidades del organismo, tal como sucede a los cereales de 
Egipto, por ejemplo. 

Es verdad que el estudio de la eliminacidn azoada da datos suficientes para juzgar 
de la alimentaci6n azoada, pero las consideraciones anteriores me ban obligado a 
agregar este capitulo a manera de contra prueba. 

Los andlisis no solamente se ban referido a las materias azoadas, sino a otras materias, 
cuya determinaci6n puede ser de grande utiUdad. Debo confesar que el nt!imero de 
andlisis no ha sido suticiente para sacar conclusiones a este respecto; la falta de tiempa 
para extender mAs este trabajo y mi impericia en estos asuntos (que hizo que los primeros 
andlisis fracasaran por una mala tunica) me impidieron hacerlos m^ niimerosos, pero 
los pocos que voy a presentar, servirAn a lo menos, para dar idea del poder nutritive de 
nuestras materias alimenticias. 

Las materias que he analizado son las que, en mi concepto, forman la ba^ e de nueetra. 
alimentaci6n: trigo, maiz, arvejas, habas, papas, arroz, came y leche. Los anilisis 

» Lambling, loc. cit. » LabW, Les regimes alimentaires. 

«rh. richet, Chaleur anlmale. * Anastaslo del Rio. Tesls para el doctorado, BogotA, 1892. 



PUBLIC HEALTH AND MEDICINE. 65 

verean sobre los siguientee datos: agua, sales mineralee, materias azoadas, mateiias 
grasas y materias azucaradas. 

Ti^CNIGA DB LOS ANAlISIS, 

I. Preparacidn de Uu mueitras. — ^La pulverizaci^n de los granos y demis materias 
destiiiadas al fm^lisis, se ha hecho en im pequefio molino de discos de acero, acana- 
lados. El producto del primer paso se remuele varias veces hasta obtener un polvo 
homog^eo. 

II. Domdo del agua. — Se peean en una balansa de precision, en una cdpsula previa- 
mente tarada, una cantidad cualquiera de la sustanda que se va a analizar (5 gramos 
por ejemplo) se Ueva luego a la estufa a unos 100^ y se mantiene alU durante 24 horas; 
se vuelve a pesar al cabo de este tiempo y la diferenda da el agua. 

III. Cenizas o sales minerdles. — La dipsula que sirvid para dosar el agua se pone 
sobre una parriUa, y con la ayuda de un soplete de gasolina se indnera hasta que 
no queden rastros de carb6n. Se pesa, y el resultado, menos el peso de la cdpsula 
da las cenizas. 

lY,* Materias azoadas, — ^Balland ' aconseja el m^todo de Kgedahl, basado en que 
las sustandas azoadas, calentadas, en preeenda del ^do sulfdrico concentrado, se 
descomponen en ^Uddo caibdnico, agua y amoniaco. Todo el &zoe pasa al estado 
de amoniaco, y despu^, al combinaree con el iddo sulMiico, forman sulfato de 
amoniaco. Basta deecomponer, por un 41cali, la sal formada; separar el amoniaco 
por destilacidn y dosalarlo volumdtricamente. 

Para eeto se pone en un matraz de 500 c. c. de capaddad, 1 gr. de la materia que 
hay que analizar, 10 c. c. de soluddn al 80 por dento de oxalate neutro de potasio 
y 10 c. c. de dddo suIMrico concentrado. Se calienta el matraz directamente, si es 
de vidrio de Jena, o si no, interponi^ndole una maUa de alambre por medio de un 
reverbero Juwel u otro semejante. 

£1 calentamiento debe ser moderado al prindpio, teniendo cuidado de agregar 
unos 15 c. c. de alcohol, cuando la espuma que se forme alcance a llenar las dos 
terceras partes del globo. Una vez que baje la espuma se aumenta la llama y se 
coloca entre el cuello del frasco un embudo, que tiene por objeto evztar que se escapen 
muchos vapores e indicar la presenda del vapor de agua por el niido particular que 
produce al condensarse y caer sobre el fondo del globo; cuando se ha eecapado todo 
eete vapor, se regula la llama de mode de obtener una ebullid<ki tranquila. Los 
vapores de dddo sulfuroso y de &ddo sulftirico se escapan entonces y producen una 
iiritaddn muy molesta en las mucosas de las vlas respiratorias. Cuando el Ifquido se 
deecolora completamente o queda con un tinte ligeramente ambarino (esto sqcede 
una o dos horas despu^ de prindpiada la operad6n), se le quita la llama y se deja 
enMar. Una vez enfriado el matraz, se agregan unos 30 6 4M) c. c. de agua tibia y 
luego se alcaliza con lejla de soda, hasta colorad6n rosada bien marcada de la fenol- 
taleina. 

Despu^-se pone todo el llquido en un globo que estd en comunicad6n con un 
aparato destilador. El llquido desfiUado se redbe en un matraz donde hay unos 50 
c. c. de dddo sulftiiico decinormal. Cuando el Uquido destilado no coloree una 
gota de reactivo de Neeler (yodo-mercuriato de potasio), se suspende la operad6n. 

Despu^ de agregar unas gotas de fenoltaleina, se dosa por medio de soda decenormal, 
la cantidad de dddo que ha quedado libre y de este dato se deduce la cantidad de 
amoniaco desprendido. Sea n el n(imero de centlmetros ctibicoe de soda empleados. 
La diferenda 50 — n es igual al amoniaco, y ^sta multiplicada por 0.0014, da al dzoe 
de 1 gramo de sustanda, el cual multiplicado por 6.25 da la cantidad da materia 
albuminoidea. 



1 BaUand, Ti«R ailments, pdfina 2, 1907. 



66 PBOOEEDINGS SECOND PAK AMEBIOAN BCIBimPIC 00NGBE8S. 

Eflte procedimiento es mejor que el piimitivo de KgeWahl, que consiste en poner 
mercuiio en vez de oxalate neutro, "porque el meicurio fonna combinadones 
amoniaco-meictiricas dificiles de deecomponer que impedii&n la libre deetilaci6n 
del amoniaco." Para impedir que estaa combinadonee se fonnen, se agrega, deepu^s 
del enfriamiento del nuitnuB en que se ha verificado la reacd^ monoaulfuro o hipo»> 
(oafito de aodio, Buatancias que son muy diUcilea de conaeguir, o de conaoguir puiaa 
en el comerdo. 

Por via de enaayo he hedio comparativamente la deecomposicidn del sulfate de 
amoniaco y dosado del 6zoe por este m^todo de destilacidn y por el m^todo volum^trico 
de Deniges, del cual hablar^ al estudiar el dosado del 6zoe total en la orina; s61o me 
han dado dif erencias que no merecen tenerae en cuenta si se considera la simplificacidn 
que sufre el procedimiento. 

Pero todos estos procedimientos adolecen del error de dosar las materias albuminoi- 
deas por el 4zoe; y ya se dijo que hay en los vegetales cuerpos azoados que no son 
albuminoideos y que hay materias albuminoideas que contienen m^s de 16 por ciento 
de&zoe. 

V. MaUrias grtuaa, — Este dosado se ha hecho agotando por el 6ter doe gramos de la 
sustancia en im aparato semejante al de Soxhlet, construldo por el Dr. Eduardo Lleras 
Codazzi. 

La sustancia se coloca en un papel de filtro previamente humedecido con alcohol. 
Encima del tubo que la contiene y en comunicacion con ^1, hay un reMgerador, y 
debajo — ^tambi^n en comunicaci6n — ^hay un globito previamente tarado, que contiene 
unos 5 c. c. de 6ter siilftirico o de 6ter de petr61eo. Se calienta el globito, y el 6ter, al 
evaporarse, disuelve la materia grasa, se condensa en el refrigerador y vuelve a caer 
al globo. Esta operaci6n, se contin(!ia por una hora, poco m^s o menos, teniendo 
cuidado de no calentar demasiado para que no se escape el ^ter. 

El globo es colocado en la estula a unos 100^, y despu^ de unas veinticuatro horas, 
cuando se haya evaporado todo el ^ter, se pesa. El resultado, menos el peso del 
globo, da el peso de la materia grasa contenida en dos gramos de la sustancia que se 
analiza. 

VI. Materias axticaradoi, — Se agotan por el agua 5 gramos de materia, se hace hervir 
el agua de los lavados, filtradoe con algiinas gotas de &cido clorhldrico. Se defeca 
deepu^ por el subacetato de plomo en ligero exceeo. Se filtra, y despu^ de eliminar 
el exceeo de plomo por fosfato o carbonate de sodio se vuelve a filtrar. Se lleva 
despu^ a un volumen determinado, y se doea el azdcar por los procedimientos ordi- 
naries, con licor de Pasteur. 

Para la leche: para el an&lisis de la leche estos m^todos tienen ligeras variaciones. 
El estracto seco se doea sobre 1 c. c. Las cenizas, sobre 5 c. c. previamente secadas 
alaestufa. 

La lactosa sobre 5 c. c. a los cuales se agrega poco a poco 5 c. c. de alcohol a 65^, 
adicionado de 1 por 1,000 de icido ac^tico. Se lleva en seguida sobre un filtro previa- 
mente tarado. El coi&gulo que quede se lava con alcohol, y el If quido filtrado se lleva 
a un volumen determinado y en ^1 se doea la lactosa por el licor de Pasteur.' En el 
co^igulo que queda en el filtro se dosa la materia grasa; deepu^ de extrafda ^ta, se 
pesa y el resultado, menos el peso del filtro y el de las sales, da la caseina. 

Estos tUtimos procedimientos son los que emplea el Dr. Eduardo Lleras Codazzi, 
quf mice ayudante en el Laboratorio Municipal, a quien me toc6 reemplazar diu^mte 
varies mesos. 

Ia came: En la came que es otro de los alimentos animalee que he analizado, s61o 
he dosado las materias albuminoideas sobre 2 gramos de sustancia. 

1 Para el efecto de doear la lactosa debe tenerae en ouenta que 5 gramos de glucosa equivalen a 6.75 de 
laotosa. 



PUBLIC HEALTH AND MEDICIKE. 



67 



RESimrADOS. 





Muestras. 




NAixLl. 


Nflm.2. 


NAm. 3. 


I. TBIOO. 

Affua 


PoreierUo. 
11.10 
1.90 
1.95 
9.80 
2.50 


PoreierUo. 

11.20 
1.80 
2.00 

12.82 
2.60 


Porciento. 
11.20 


Scues minerales 


1.68 


Materia grasa 


2.19 


Mftt^*rlBS asoAd A9 ............ . . . . « 


11.10 


Ax6c&res 


1.55 









Muestras. 




NOm. 1. 


N6m.2. 


NAm. 3. 

PoreierUo. 

12.10 
0.98 
4.85 

13.58 
1.80 


N6m. 4. 


n. MAlZ BLANCO. 

Agua 


Pordento. 

12.00 
1.70 
3.90 

11.10 
2.40 


Pordento. 
11.90 
1.90 
3.90 
8.64 
L56 


Pordento. 
12.00 


Sates minerales 


1.65 


If atfnia Erasa 


5.10 


\f at^riftfi asoadas ..... . . . . . . . , ^ . . 


12.25 


Asticares 


1.90 










Muestras. 




NAm. 1. 


Ntim.2. 


m. ▲BTKJA8. 

Apia. ........ .....T.-r-ir...T....-.TT.T.... .....r.T-,-,...TT.....,.....TTr.T,T 


Pordento. 

12.20 

3.24 

.95 

20.26 

3.46 

13.98 

2.40 

.98 

21.78 
3.46 


Pordento, 
14.98 


fl^iW in*TI«nUefl. .. ^ ,r... , , , r r t,.. . . . r r - r 


3.40 


Materia srasa 


1.50 


M<|t4frfa8 ftf/MUlft?. , r r r , , . , T , T T - T r - . , . r T r , . T . r T , , . r T r , r 


20.06 


Asdcares 


2.27 


• 

nr. HABA8. 

Agllft ...-.- r .,. T r r T t . , , , t . . r . , t r r T x T - T r x T r T 


13.50 


Bales Tn^TiWfOfls . , r . ^ , x ^ x , , , x - . , , . . . ^ . . , . r - 


2.24 


Materia grasa 


1.25 


Matflriaslwoadas 


20.40 


At&cares 


3.10 







T. ABBOK 

Agua 

Sales minerales 

Materia grasa 

Materias azoadas 

Aztkcares 

VI. PAPAS 

Materia grasa 

Materias az<»da8 

AzAcares 



Muestras. 



Norte- 
ameri- 
cano. 



Pordento. 
8 

1.19 
1.60 
7.564 
.145 

NAULl 
1 

1.74 
20 



Del 
puis. 



PoreierUo. 
7.32 
.90 
1.50 
9.264 
2 



Materias asoadas. 



Yn. CABNB DISBirOBASADA. 



Muestras. 



N6m. 1. 



Pordento. 
22.50 



N6m.2. 



PoreierUo. 
22.48 



68436— 17— VOL x 6 



68 



PBOCEEDINOS SECOND PAN AMBBICAK SOIBNTIFIO OONOBESS. 





ICoestras. 




Nrtm. 1. 


Ntlin.2. 


Nflm.8. 


Nllni.4. 


Ntlin.6. 


N(liii.6. 


VUI. Lbchk. 
Manteqoilla 


PormiL 
30 
15 

7 

46 

128 


PormU. 
88 

44 
7.8 
80 
128 


PornUl 

84 

43 

7.2 

41 

125 


PormIL 

81 

42 

7.1 

42 

120 


PormiL 

80 

47 

7 

86 
120 


PormIL 
82 


Lactosa 


47 


Sales 


7 


Casefna 


87 


Extracto seco 


128 






Reaoci<5n 


Anf. 
1,080 


Anf. 
1,081 


Anf. 
1,082 


Anf. 
1,082 


Anf. 
1,081 


Ant 


Densidad 


1,082 





Si 86 comparan los an^jlisis anterioree con lo8 practicados en otroe palaeB, se v^ 
que mis Boepechas, reepecto a la inBuficiencia de materialee nutiitivos y eepedal- 
mente de materialee azoados en nueetros alimentos, eran infundadas. Voy a tras- 
cribir algunoe de eetos an&liais, para que ee pueda establecer la comparaci6n: 

Trigos de los Estados Unidos. — Eetos tienen una compoeicidn muy variada, a causa 
de la diferencia de climae. En los trigos de Francia las diferendas son menoe mar- 
cadas. He aqul los dates que suministra Balland :' 





Trigos de lof Bstados 
Unidos. 


Trigos de Fraocia. 




MAxImtim. 


Mtnimtim. 


Minimum. 


IfAximnm. 


Jigatk r r T 


14.56 

18.96 

2.25 

1.96 


ia80 
7.48 
1.10 
1.42 


laio 

7.68 
LIO 
1.12 


15.90 


WftiftHas asoadaSx . . » . . ^ . . . . ^ 


12.00 


(^asas 


2.00 


finnisas 


2.10 











Como se ve por estos pocos dates comparativos y por el resultado del an^isis de 
las dos muestras de arroz, la una norteamericana y la otra del pais, habrla mas bien 
raz6n para pensar que nuestro suelo es suiicieDtemente rico en materiales nutritivos 
y que nuestros productos alimenticios nada tienen que en vidiar a los de la zona templada . 

Hasta las mismas leguminosas que toman el izoe ' de la atmdsfera, izoe que, como 
se sabe, es insuficiente en las alturas, parece que dispusieran de un mecanismo com- 
pensador, an^ogo al de los animales para el oxigeno, porque su proporci6n de dzoe 
estd en nuestras habas y en nuestras arvejas en la misma proporci6n que en Europa. 
Pero repito que el ntimero de mis anAlisle ha side muy pequefio, y que, por consi- 
guiente, no pueden hacerse sobre ellos sine meras suposiciones. 

Los an&lisis de eliminaci6n azoada que se refieren a observaciones rnks numeroeas, 
compensan, en parte, las deficiencias de aquellos. 



Euminaci6n azo ad a-Gener alidades. 

Si se exceptda una pequefla cantidad de dzoe, que proviene de la desintegraci6n 
de ciertos elementos no ^buminoideos de la alimentaci6n vegetal, todo el dzoe que 
elimina el organismo, proviene de las materias proteicas. 

Resumir^ en el presente capftulo algunas generalidades sobre eliminacl6n azoada, 
acompafiindolas de distintas opiniones de autores extranjeros, a fin de que se puedan 
apreciar mejor los dates que dBi6 en el capltulo siguiente, sobre la eliminaci6n azoada 
en la altiplanicie. 



> Balland, Loc. cit. 

> Reoherchessorlafijationdel'asoteparlesplantes. Analesl'Inst'tutPasteor, 1892, Nt^. 2; -A. Balland, 
Loc. cit, p&gs. 99 y 100. 



PUBLIO HEALTH AND MEDIOINB. 69 

Ya 86 dijo que fu^ liebig quien descubri6 que las albuminoideas tienen izoe y 
quien Bugiri6 la idea de que la cantidad de dzoe ellmmado podiia ser proporcional 
a la cantidad de albtimiDas destruidas en el oiganismo; rnks tarde Bidder y Schmidt 
Iniciaron experimentoe sobre este aaunto. 

La moltoila albunilnoidea aufre en el organismo un estado tan avansado de demoli- 
ckmea, que siendo su peso molecular primitivo de 500 a 600, termina en cuerpos, 
oomo la urea, cuyo peso molecular es igual a 60. Es verdad que la urea no ee el dnico 
prodncto de trasformaci6n de las materias proteicas, pues hay otros de peso molecular 
m4i elevado; sin embaigo, la nutiicl6n es m^ perfecta cuanto mds completamente 
se trasforme la albtimina en urea. 

Parece que la mayor parte de las albuminoideas se destruyen en e^l organismo por 
bidratacidn, como in vitro bajo la accidn de las diastasas proteicas o de los ^dos 
faertes, es dedr, que se fra^entan suministrando icidos aminados, glicocola, leucina, 
alamina, etc., que son oxidados en seguida. En efecto^ los fermentos proteolfticos 
que se han encontrado en los jugos de expreu6n de los te^idos desdoblan las proteicas, 
a la manera de la tripmna y hacen dcidos mono y diaminados; por otra parte, estos 
icidoe diaminados han sido encontrados en los liquidos del organismo y en los 6iganos 
nismos (jglicocola en la orina y en la bills, taurina que proviene de la cistina en la 
bilis, arginina en el bazo, etc.) ^Qu6 se hacen entoncee estos dcidos aminados? Sufren 
verdaderamente la desamidacidn en el lugar. En el curso de la autolisis del hfgado y 
de otros drsanos, los ^dos aminados agrc^ados a los tejidos pierden su grupo A^H' al 
estado de AzH*. Se sabe, ademds, que & alanina ineerida es trasformada en icido 
lictico; despu^ de la separacidn de su grupo AzH' ai estado de AzH' el amonfaco 
es al punto trasformado en urea, que se elimina r&pidamente mientras que el ^do 
deeaminado es quemado m^ lentamente. (Magnus I/evy.) La desa8imi]aci6n de las 
albuminoideas se haifa, pues, por etapas: (1) Desdoblamiento en ^idos aminados; 

(2) Desamidacidn de los dcidos aminados 3' tra8formacI6n del amoniaco en urea. 

(3) Oxidaci6n del &cido desaminado. 

Pero puede suceder que esta dialocacidn no sea completa y que una fracci6n de 
albdmina se escape; se ha pensado, en vista de la preeencia de gruesas mol6culas 
azoadas en la orina, que ^stas representarlan fragmentoe ligeramente oxidadoe, sin 
haber sido previamente divididas, como las que resultan de la hidrolisis por acci6n 
diast^ca.' 

La trasformacidn que lleva la mol^ula albuminoidea hasta el conjunto de despojos 
eliminables, y en especial hasta la urea, se cumple muy rdpidamente. Hacia la 
s^ptima bora deepu^ de las comidas alcanza su miximun, y entre la novena y la 
duod^ima, ha terminado su eliminaci6n. 

La eliminaci6n de los productos no azoados de la trasformacidn de las albuminoideas 
(icido carb6nico y agua), se verifica por la via pulmonar. 

La gran via de la eliminaci6n de los productos azoados es la orina, pues la excreci6n 
por el tubo digestivo no representa sino im 2 por ciento del dzoe total perdido por el 
organismo; las otras p^rdidas son todavfa m^ pequeflas, de aquf que casi todoe los 
experimentadores no hayan tenido en cuenta sino la eliminaci6n urinaria para medir la 
eliminaci6n azoada. 

Azae total, — ^En 99 adultos que eligen libremente su raci6n, Pluyer, Bleitien y 
Blilaud, han encontrado en la orina de las 24 horas 14.95 gramos, por t^rmino medio, 
de dzoe total, o 0.227 gramos por kilogramo de peso vivo, lo que corresponds a un 
consume de 96.467 gramos de albtimina, o 1.464 gramos por kilo de peso vivo; para los 
individuos j6venes bien alimentados que no suministran sino im trabajo mecdnico 
mediocre, la excreci6n azoada de las 24 horas fu6 de 14.37 gramos, que indica la 
de6trucci6n de 93.7 de albumina. En fin, en 27 individuos que sumimstraban im 
trabajo considerable, el dzoe total se elev6 a 16.68 gramos, o sea 0.249 gramos por kilo 
de peso vivo, lo que da una destrucci6n de albtunina de 107.60 gramos 1.688 gramos 
por kilo de peso vivo por dla.? 

Lambling cree que en Francia no se puede adoptar como tannine medio los ndmeros 
que se acaban de leer, los cuales son, en su concepto, demasiado elevados. El deter- 

1 Oley, Ph78iolog;Ie, 1910. * Para oomprender eeta reladdn y^ase piglna — . 



70 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONGRESS. 

mind sobre 79 sujetos de la clase media de Lille y de loe alrededoree, donde, segdn 
dice, 68 general la costumbre de las grandes comidas, una cantidad total de 13.91 
gramoe en los hombres (50 sujetoe) y de 11.74 gramos en las mujeres (29 sujetos) para el 
perfodo de las 24 horas; la alimentaci6n era elegida libremente. Sin embargo, se veri 
adelante por los andlisis hechos tiltimamente en Francia que esta cifra ee muy superior 
a las que da Lambling. 

La repartici6n del dzoe en laa orinas, en caso de alimentaci6n mixta, es, poco m& o 
menos, la siguiente, segiin el mismo autor: 

En urea, 84 a 87 por ciento. En amoniaco, 2 a 5 por ciento. En dcido tirico, 2 a 
3 por ciento. En materias extractivas azoadas, 7 a 10 por ciento. 

Estos ntimeros varfan en limites muy extensos, cuando se pasa de la alimentaci6n 
vegetal a la alimentacidn animal, como se verd por el cuadro siguiente:^ 



Urea 

Amonfaco 

Otros materlalesazoados.. 



R^men mixto. R^gimon animal. R^glmcn vegetal. 




S6.8 (de 79.2 a 88.2) i 80..5 (de 76.9 a 83.41 

) I 4.29 a- . _ , 

8.39 (dell a 8.2) 15.7 (de 10.5 a 17.6) 



4.84 (de 3.5 a 5.6) | 4.29 (do 3.4 a 8.6) 



Khegnie ha notado que cuando se da pan a un perro, la secreci6n gdstrica es m^a 
abundante que cuando se le da leche. Partiendo de este hecho, Rjasawzeff ha 
suministrado a un perro la misma cantidad de ^izoe (4 gramos) primero en forma de 
pan y luego en la de leche; la cifra de la excreci6n azoada fu^, en el ensayo del pan 
dos o tres yeces mayor que en el ensayo de la leche. Parece, pues, que existe una 
relaci6n directa entre la intensidad del trabajo secretor impuesto al e8t<Smago y la 
cantidad de despojos azoados. El trabajo de secreci6n del tubo digestive, serfa, segtin 
eeto, una de las causae de la necesidad de albtimina. 

Las observaciones sobre eliminaci6n azoada deben referiise de preferencia a la 
urea, el amonfaco, el ^do tirico y las bases ptlricas, el dzoe de las bases precipitablee 
por el ^ido sflicotdngstico, y adem^ diferentes relacionee de estos elementos entre 
si y con otros materiales de eliminaci6n urinaria. Para comprender su importanda, 
es precise hacer el resumen del origen de cada uno de ellos. 

Urea. — ^La doctrina de la combusti6n hacfa considerar la urea como resultado de 
la oxidacidn de las albuminoideas, a pesar de la imposibilidad de producir la in vitro 
por medio de los cuerpos oxidantes, pero en 1856, Beauchamp pareci6 haber llenado 
definitivamente este vaclo con el descubrimiento de la producci6n in vitros de 
pequenas cantidades de urea por la oxidaci(5n de las materias albuminoideas, en 
presencia del permangamato de potasio. Al aiio siguiente Saedeler y luego Sub- 
botise objetaron las conclusiones de Beauchamp. El debate, planteado nueva- 
mente por una publicaci6n de Beauchamp y de Ritter, fu6 luego considerado defini- 
tivamente cerrado por los resultados negatives de !]^aen y de Tapeiner. 

Se empez6 luego a dar grande importancia a las reacciones orgdnicas de desdobla- 
miento y de hidrataci6n, y bajo la influencia de los trabajos de Schutzemberger, 
referentes al desdoblamiento de la albdmina en presencia del hidrato de barita, se 
lleg6 a considerar la urea como proveniente de las albuminoideas por simple hidro- 
lisis. Sobre este punto los trabajos de Schutzemberger han side confirmados por loe 
de Drechsel, quieu ha podido separar de la caseina, por medio del dcido clorhldrico, 
hirviendo, bases azoadas complejas: la lisina y la lisalinina que el agua de barita 
desdobla en caliente con produccion de urea. Por otra parte, la arginina, una de 
las bases ex6nicas, suministrada por la hidrolisis de las albuminoideas, es igualmente 
desdoblada por la barita con formaci6n de urea. Pero Drechsel reconoci6, al mismo 
tiempo, que de esta manera no se explicaba sino la formacidn de una pequena canti- 
dad de urea en el organismo. En efecto, en los experimentos de Schutzemberger la 

I Ouimiioih. 



PUBLIC HEALTH AND MEDICINE. 71 

albtimina ee desdoblada en urea y oxiamida (o m^ exactamente, en dcido carlxSifico 
y amoniaco en las proporciones de la urea y de la oxiamida), por una parte, y por 
otra, en una mezcla de dcidos aminados. Se puede calcular que la urea asl separada 
por hidroliflis, no representa sine, aproximadamente, un 10 por ciento del dzoe total 
y que 86I0 los icidos aminados representan el 75 por ciento del &zoe de la mol^ula 
albuminoidea, de donde se deduce que otroe fen6meno6, fuera de la hidrolisis, inter- 
vienen en la formaci6n de la urea. 

Por loe experimentos cl^icoe de Schultzen y Nenki, se sabla desde 1867, que estos 
icidoe aminados pueden constituir un producto hacia la urea: la glicocola, la leucina, 
ingeridas, se trasforman integramente en urea; en esta observaci6n Von Kmerin com- 
prendi6 el icido asp&rtico. Pero hay que notar que los icidos aminados no tienen 
aino un solo dtomo de Az, y la urea tiene dos; es necesario admitir entonces la 
fijaci6n de otro resto de Az. Schultzen y Nenki habfan pensado en el dcido cidnico 
y Salkowski demostr6 que una parte de dicho icido se fija fdcilmente in vitro sobre 
los icidos aminados, para dar lugar a uramidos, que son en realidad ureas sustituidas, 
y que, por otra parte, en el organismo muchos dcidos aminados se trasforman en 
^idos uramfdicos por fijaci6n de dcido cidnico £s este el ptmto de partida de otra 
teorfa de fonnaci6n de la urea; la teorla del dcidociinico, queexplica laformaci6n de la 
urea por sfntesis, semejante a la sfntesis hist6rica de la urea por Woehler, por medio 
del icido ciinico y el amoniaco. E^sta teorfa, desarrollada sobre todo por Hoppe 
Seyler, no tiene base experimental directa en el sentido de que jamis se ha logmdo 
aialar el t^rmino ciinico como punto de partida de toda constituci6n. 

He aquf , segdn Gley, los mecanismos por los cuales los icidos aminados simiinis- 
tran urea: 

I. Ya se vi6 que se han encontrado en todos los 6rganos, y principalmente en el 

hfgado, diastasas que separan el dzoe de los dcidos aminados bajo la forma de amoniaco. 

Esta de8amidaci6n comprende, pues, &zoe del aminodcido, el cual queda desde 

entonces reducido a la condici6n de un simple ^ido graso, cuyo destino se confunde 

con el de los ^idos grasos y las grasas. En cuanto al amoniaco producido, va a en- 

gendrar urea, uni^ndose, eegCoi Schmildeberg, con el icido carb6nico y dejando agua 

en libertad: 

A7TT 
Urea: 2AzH,4-CO,=CO ^^h'"*"^^"^ 

Segtin otroB la urea se deriva del carbonate de amoniaco, previamente formado: 

En loB doB 08800 hay Bfntesis total de urea con deshidratacidn. 

II. Por otra parte, se ha obtenido in vitro carbamate de amonio por oxidacidn de 
los icidos aminados. Es, pues, pooible que estos den por oxidaci6n en el higado, 
carbamato, de donde proviene en seguida la urea por deshidrataci6n: 

Podrfa suceder tambi^n que sobre el grupd COAz H, de un aminodcido se fijara 
otro AzHa y que por una oxidaci6n concomitante se formaia urea (sfntesis parcial ' 
COB oxidaci6n). 8e ha mostrado, por ejemplo, que el oxiamato de sodio da in vitro 
urea oxid&ndolo por el permanganato de potaaio. 

Lambling da grande importancia a la primera de estas teorfas (formacidn de la urea 
por combinaci6n de dcido carb6nico con el amonfaco dejando el agua en libertad) la 
cual ha llamado la atenci6n, dirigido los esfuerzos de los experimentadores y tiene 
en 0U favor la explicaci6n de hechoe muy trascendentales, a saber: 

1. En los herbfv(»os, la ingestidn de las sales amoniacales, sean de dddoe fuertes, 
como el cloruro de amonio, o de ^idoe oig^cos combustiblei, como el citrato, es 



72 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIC C0NQBE8S. 

s^^da de un aumento de la urea excretada. En los camlvoroe y en el hombre eete 
mismo resultado no es obtenido claramente sino con las sales amoniacales de ^dos 
orgdnicos, como el carbonato de amonlaco. La raz6n de esta diferencia se ver& td&b 
adelante. 

Esta teorfa y los dos 6rdenes de hechos que se acaban de sefialar, encuentran una 
veiificaci6n notable en una serie de fen6menos relatives a la acci6n de los ^dos 
sobre la excreci6n de la urea, y del amoniaco. Si el amonfaco y el dcido carb6nico 
son realmente los precuirBores de la urea, la presencia de los ^idos fuertes — es decir 
de cuerpos capaces de fijar s61idamente el amonfaco— debe impedir la formacidn de 
la urea y aumentar la proporci6n de sales amoniacales en la orina, esto es lo que la 
experiencia demuestra claramente. 

2. Se ha visto, en efecto, que en el camivoro el carbonato de amonfaco ingerido 
pasa en la orina al estado de urea; el cloruro de amonio pasa inalterado a la orina, 
porque el amonfaco, fuertemente retenido por el dcido clorhfdrico no puede entrar 
en reacci6n con el dcido carb6nico. Si en el herbivore el cloruro de amonio contribuye 
a la formaci6n de la urea, esto se debe a que la alimentaci6n vegetal lleva consigo 
una superabundancia de bases alcalinas que transformadas en el organismo en car- 
bonate de potasio o de sodio, hacen la doble de8Compo8ici6n con el cloruro de amonio 
y le transforman en carbonato. 

3. Adem^, en el perro y en el hombre la inge8ti6n de dcidos minerales aumenta 
la cantidad de amonfaco de las orinas y disminuye la de la urea porque el &cido 
introducido fija y retiene fuertemente el amonfaco. 

Inversamente, la ingesti6n de dlcalis en el hombre, reduce al mfTiimiinn la excreci6n 
de las sales amoniacales. 

Esta neutralizaci6n de los dcidos por el amonfaco, asf sustrafdo al proceso formador 
de la urea, constituye el mecanismo por el cual el oiganismo de los camfvoros, o del 
hombre, resiste la intoxlcaci6n por los ^idos y preserva de los accidentes graves que 
se producirfan si las bases necesarias para el f uncionamiento normal de los protoplasmas 
vinieran a ser arrancadas a las c^lulas. 

En los herbfvoros este mecanismo regulador no existe. Asf se ve que en esos 
animales la intoxicaci6n por los ^idos termina rdpidamente en accidentes mortalee. 

Los dcidos que se forman en el organismo, en el curso mismo de la desasimilaci6n, 
producen los mismos efectos que si fueran introducidos experimentalmente. Como 
estos dcidos resultan, sobre todo, de la de8agregaci6n de las albtiminas, se ve, en lo 
que concieme a la excreci6n del amonfaco, que la alimentaci6n animal obra como 
la ingestidn de dcidos, y la vegetal, como la de ilcalis. Asf, Caranda ha encontrado 
en sf mismo, para una alimentaci6n vegetal, grms. 0.3998 de amonfaco por dfa; 
para una alimentaci6n, sobre todo, animal, grms. 0.875, y para una alimentaci6n 
mixta, grms. 0.6422. 

La inanici6n (que es una alimentacidn animal) y el ejercicio (que disminuye la 
alcalinidad de la sangre) producen un aumento de la excreci6n del amonfaco, el que 
se ha visto llegar, en la inanicidn, al 10 por ciento del dzoe total, en vez de 2 a 5 por 
ciento que es la suma normal. 

4. Los estados patol6gicos, que causan un aumento de producci6n de ^dos en el 
oiganismo, aumentan la excreci6n del amonfaco por las orinas. En el curso de la 
diabetes y especialmente en el perfodo de coma, la orina contiene propoiciones con- 
siderables de amonfaco, de 3 a 6 gramos por dfa, y en un case de Stadelmann, hasta 
de 12, en vez de 1 a 1.50, cifra normal. Este hecho es debido a la fundicidn r&pida y 
anomud de los protoplasmas celulares y a la producci6n de cantidades considerablee 
de dcidos anormales, tales como el ^ido acetilac^tico y el dcido Boxibutfrico, que 
inundan literalmente el organismo del diab^tico; y es precisamente despu^ de haber 
notado la presencia de cantidades considerables de amonfaco en la orina de los dia- 
b6ticos, cuando Stadelmann dedujo por este hecho una intoxicaci6n dcida y enconthS 
de6pu69 el ^ido Boxibutfrico. Las cantidades de este dcido son frecuentemente. 



PUBLIO HEALTH AND MEDICINE. 73 

en la orina de los diab^ticoe, de 30 a 50 gramoe. Este grado de intoxicacidn &cida 
da, pues, la explicacidn de la amoniuria diabetica. 

Se sabe que eetas reacciones, que dan lugar a la {onnaci6n de urea, se verifican, 
cad en su totaUdad, en el hiigado. 

Loe experimentoe por medio de Ice cualee se demuestra que eete ee el lugar de tal 
fonnaci6n, son suficientemente conocidoe, para no detenerme a relatarlos. 

Amomaco, — ^Al lado de la urea debe hacerse menci6n especial del amoniaco, que 
se encuentra siempre en la orina en pequefias cantidades (1.11 gramos en 24 horas, 
9egtin Maillard); esta cantidad representa la parte del amoniaco que no se ha empleado 
en la formaci6n de la urea. 

En sua investigaciones cMsicas sobre los efectoe de la fistula de Eck, Nenky y 
Pawloff ban visto, con su colaborador Zaleski, que el hfgado recibe por la vena porta, 
aproximadamente, 6.6 gramos de amoniaco por 100 c. c. de sangre; en la vena supra- 
hepdtica no se encuentran m^ de 1.4 gramos, de donde se ha calculado, segtln la 
velocidad de la sangre al trav^ del hljgado, que este 6rgano retiene, en las 10 boras 
que siguen a una comida, en un perro 9.5 de kilos, aproximadamente, 5 gramos de 
amonlikco, lo que correeponde a jd&b de 8 gramos de urea. Al hablar del origen de la 
urea se vi6 cual es el origen del amoniaco; se vi6 c6mo y por qu6 la eliminacidn de las 
sales amoniacales aumenta o disminuye, segdn que la alimentaci6n sea animal o 
vegetal, 6cida o alcalina. 

M^ adelante hablar^ del Indice de imperfecci6n urogen^tica de Maillard, basado 
sobre la relaci6n entre el &zoe del amoniaco y ^te, mis el &zoe de la urea. 

Acido iirico y hates piincaa. — Las nucleo-proteidas constituyen un grupo muy im- 
portante. Son estas siistancias las que forman la mayor parte de los grupos celulares. 
No hay que conlundirlas con las nucleo-alb(iminas o peeudonucleinas, entre las 
cualee se encuentran la vitelina y la caseina. 

Oomo las nucleo-proteidas, las pseudo-nucleinas contienen fdsforo, pero no encierran 
purinas; eetos cuerpoe parecen ser los caracterlsticos de las nucleo-proteidas, o a lo 
menoe del ^do nuclelnico que entra en su con8tituci6n.^ 

Las nucleo-pioteidas son esendalmente formadas por la uni6n del icido nuclelnico 
con diferentee mateiias proteicas, y como estas son extremadamente variables, se 
condbe que las nuclo-proteidas sean muy numeroeas. 

Bajo la influencia de ciertos reactivoe qulmicos por la accidn del jugo g^istrico en el 
oiganiamo, las nucleo-proteidas abandonan un grupo proteico y queda un cuerpo 
llamado nucleina, que se deecompone, a su tumo, en albtimina y en ^ido nucleico. 
Este tiltimo suministra cuatro especies de cuerpoe: ^do fosf6rico, derivados piriml- 
dicoe, bases x^ticas e hidratos de carbono. 

Pero algunas de las proteidas son mds complejas de lo que indica esta f6rmula; la 
nucleina, adem^ de la albtimina y del dcido nucleico, puede contener hipoxantina 
y bases diferentes, tales como creatina, camadna ignotina, novaina. ' Eptos cuerpos, 
que no son unidos al &cido nucleico, son, sobre todo, abimdantee en las nucleo-proteidas 
sacadaa de loe m(!i8culos. 

£n el tube digestive, las albtiminas puestas en libertad por el jugo g^trico, son 
trBsformadas, segdn el i^oceeo habitual, por la clorhidro-pepsina, y en cuanto al 
^kddo nuclelnico, es deecompuesto por un fermento, muy extendido en el organismo; 
la nucleasa, en sua componentes, que son: ^do fosf6rico, un azdcar, adenina, guanina, 
citoeina y elurina. 

El icido fosfdrico, que es ^undo ortofosfdrico, proviene del ^do tlmico, el cual 
encierra todo el fdsforo de las nucleo-proteidas. El azticar no es conocido sine por 
8U8 productos de desdoblamiento. La citosina y la timina, derivados primaries del 
^tcido nucleico. La uracila es un derivado secundario. Estos tres dltimos cuerpos 
son semejantes a la pirimidina. 

Los cuerpos pirimidicos parecen muy inestablee; en el organismo se destruyen 
ripidamente, abandonando ^do carb6nico y urea. 

1 ProL 0. H. Rogert, Digestion at Nutrition, p&g. 518, 1910. 



74 PBOOEEDINOS SECOND PAN AMEBICAN SCIENTIFIC CONQBESS. 

Mds importante es el eetudio de la adenina y de la gnanina. Estaa doe sustanciaa 
pertenecen a las bases ptiricas, de las que hace tambi^n parte el ^do <!irico. 

Fu^ Fischer quien e8tableci6 la eetructura definitiva de la punna. Todas per- 
tenecen a una misma serie, que encierra este nticleo: 

(1) Az-0 (6) 

(2) (5)— Az (7) 
0(8) 

(3) Az— (4) 0— Az (9) 

La numeraci6n que se ha adoptado ^ ^Molita el estudio de loe derivados. Basta, 
en efecto, indicar para cada cuerpo el ntimero correspondiente a los productoe de 
Bustituci6n, para comprender la poeici6n exacta. 

£1 compuesto hidrogenado fundamental ha redbido de Fischer el nombre de 
purina. Conociendo la con8tituci6n de ^ste, se puede comprender Mdlmente cuil 
es la de loe derivados. 

(^) ^'=^^ W AzH (7) 

(^) g^-^ (^) CH (8) 

(3) AzC (4) 

Purina C»H*-Az* ^* ^^^ 

La adenina, por ejemplo, se llama (6) amido-purina, porque resulta de la sustitucidn 
del gnipo (6) CH de la purina por un radical amido (AzH,), de tal manera que la 
formula queda: CgHsAzg. 

De la misma manera se puede comprender, por el simple nombre, la constituci6n 
de todos los dem^ derivados; (6) oxipurina o hipoxantina, reemplazando un H del 
grupo 6 por un (C*H*Az*0) 2 amido, 6 oxipurina, o guanina (C'H'Az'O)— 2, 6 
dioxipurina o xantina (C^*Az*0")-6 amido 2, 8 dioxipurina (C»H»Az*0»)-2, 6, 8 
trioxipurina (CH^AzH)') icido tirico, etc. Siguen luego hadendo las sustitudones 
los otros derivados metilados (monometilxantina, paraxantina, teobromina, teofilina* 
cafeina), cuyos nombres qufmicos no doy por no alaigarme demasiado. 

Las purinas del oiganismo provienen: (1) De la desintegrad6n de las nudeo- 
proteidas de loe alimentos; (2) de la desint^raci6n de las nudeo-proteidas de los 
tejidos. A estas dos fuentes hay que agregar una tercera: la que resulta de la intro- 
ducci6n de derivados pdricos, tales como teobromina, cafeina, etc., una parte de las 
cuales es eliminada por las orinas. Los fermentos que descompomen las nucleo- 
proteidas y ponen el dddo nucl^ico en libertad, son abundantemente extendidoe; 
pues no solamente los jugos digestives, sine todos loe 6rganos y tejidos, son capacee 
de producir tales desdoblamientos. Este es un proceso indispensable para el juego 
natural de la desasimilacidn. 

El fermento que deecompone el dcido nud^nico, la nucleasa, se encuentra en el 
time, el bazo, el ptocreas, la mucosa del intestino delgado, como tambi^n en los 
m(isculos, los gl6bulos nucleados de las aves; en una palabra, la nucleasa existe donde 
quiera que existan nucleo-proteidas. 

El jugo pancre&tico no descompone el dddo nuclefnico; le hace solamente perder 
su car&cter coloidal y lo vuelve dializable; es lo que algunos autoree expreean diciendo 
que cambia el ^ido nudeinico a en iddo nuclefnico b. Esta trasformad6n permite 
al &cido nudefnico difundirse en la pared intestinal. Allf se encuentra con la nucleasa 
y a favor de esta acci6n pone en libertad sue diversos componentee. 

El t^rmino dltimo de la t3*asformad6n de las bases ptiricas es el dcido drico, para 
lo cual interviene la acd6n sucesiva de dos espedes de fermentos: uno desamidante 
y otro oxidante. 



1 Prof. C. H. Roger, Digestion et nutrition, p&g. 621, 1910. 



PUBLIC HEALTH AND MEDICINE. 75 

Los fermentoB desamidantes trasfonnan la adenina y la guanina — o sean los pro- 
ductos piimarioe que provienen del dcido nucleinico — el primero en hipoxantina y 
el 8^:undo en xantina. Un simple proceso de hidraci6n da cuenta del fen6nemo 

Adenina. Hipoxantina. 

C^^Az'-fH'O^C^H^Az^O-fAzH' 

Guanina. Xantina. 

C»H»Az»0+H20=C«H*Az*0+AzH» 

Como 88 ve, el amido, que ocupa la poeici6n 6 en la adenina y la posicidn 2 en la 
guanina, se elimina al estado de amonlaco. 

Los fermentos desamidantes, adenasa y guanasa, descubiertos en el bazo, se encuen- 
tran en la mayor parte de los 6rgano8. 

Los fermentos oxidantes son tambi6n en ndmero de dos: la xantoxidasa, que oxida 
la xantina y la trasforma en dcido tirico y la hipoxantidasa, que hace lo mismo con la 
hipoxantina. Estos fermentos oxidantes no son tan extendidos como los precedentes; 
se les encuentra solamente en el bazo, el hfgado, el intestino, los rifiones, los pulmones 
y los mtisculos. 

Una pcurte del icido (irico es trasformada en el hfgado en urea, segun lo creen todavfa 
algunos autores. Pero esto no quiere decir que, como se crefa antiguamente, el dddo 
tanco sea un producto hacia la lurea, pues jra que se conocen bien todas las trasforma- 
dones de los nucleo-proteidos y las de las bases ptiricas, se ha visto que todos estos 
cuerpos terminan en el &cido tirico, que es el tannine final de la serie, como la urea 
es el t6rmino tUtimo de las trasformaciones que sufren las albdminas.^ Esto me ha 
•ugerido la idea de un nuevo coeficiente urol6gico, de que hablar^ m^ adelante. 

Asoe nlicot&ngsiico, — Se sabe que, sdemia de los cuerpos azoados de funci6n dcida, 
como el dcido drico, o de funci6n d^bilmente b&sica, como la urea, la orina encierra 
ciertas substancias suficientemente b&sicas para formar con el dcido silicottingstico 
combinacionee muy poco solubles o priUrticamente insolubles, an^ogas a las com- 
binadones silicotdngsticas alcal6idicas estudiadas por R. Grodefoy y por G. Bertrand. 

Un eetudio cuantitativo de estas bases urinarias fu^ hecho por Guillemard,' quien 
encontnS variadones importantes, segtin el estado normal o patol6gico de los individuos, 
y diferencias apreciables segtin el sistema alimentido. Posteriormente MaiUard ' 
hizo, a este respecto, observadones muy interesantes y encontrd ima eliminaci6n 
media de 0.60 c. c, en las 24 horas, de este dzoe que para abreviar se ha llamado 
incorrectamente dddo silicottingstico, por ser este dcido el que sirve para precipitarlo. 

De las relaciones urol6gicas hablar^ en el capitulo siguiente. 

EuMiNAadN AzoABA SN LA Ai;nPLANiciE — ^Procbdimientos Empleabos — Resulta- 

D08 ObTENIDOS. 

Es el andlisis qui mico de ias orinas, dice Marcel Labb^,^ lo que simiinistra datos m&s 
numeroeos y mis precisos en el estudio de la nutrici6n. Desde la m^ remota antigQe- 
dad, los medicos lo ban utilizado en la solucidn de los problemas m^ complicados. 
Los m^todos, muy rudimentarios al principio, han ido perfecciondndose poco a poco. 

La importancia de este estudio adquiere mayor inters desde que se trata de 
materiales azoadoe, puesto que, segtin se vi6 atrds, la gran via de eliminacidn de estos 
productoe es la orina. 

Mis observaciones sobre esta materia se iundan sobre 96 andlisis de orinas de indi- 
viduos en estado fisiol^gico. Todos los sujetos fueron examinadoe previamente, y 
hasta donde es posible afirmar, despu^ de im examen detenido, en ninguno de ellos 
se descubrid nada que hiciera pensar en una alterad6n de la salud. Hasta donde 

1 Roger, Loc. dt. 

s Quillemard, Contribution & r6tude des alcaloides de Torine, thtee de Paris, 10Q2. 

s Msillard, Joorn. de Phys. et de Pat. 06n., 15 nov. 9Q6.-15 mars 1909. 

« H. LabMy Des rfiglmes alimentaires. 



76 PBOOEEDINQS SEOOKD PAN AMEBIOAN SOIBNTIFIO C0KGBB88. 

me fu^ poBible, vigils la colerci6n de las oiiiias, y a aquellos en quienes no se pudo 
verificar esta vigilanda, se lee dieron las inetrucciones necesarias a fin de que se recogie- 
ran con el mayor cuidado colectando winas de las 24 hotas, y nada m&B que las de las 
24hoias. 

Con tal objeto, las orlnas se debfan recoger en vasijas lo mejcv lavadas que fueia 
posible. Una primera mixi6n serla ejecutada a una bora cualquiera, y de esa hoza 
en adelante se empezarfa a recoger la orina basta el dfa siguiente a la mismabora, eai 
que se recogerla la tiltima porcidn que bubiera en eee momento en la vejlga, t^endo 
cuidado de no dejar perder la que se emitiera durante las deposiciones. 

Si se consideran las dificultades para conseguir orina en estas condiciones y si se 
tiene en cuenta que para bacer eetos an^disis tuve que empezar por preparar y titular 
desde el primero basta el tiltimo de los reactivos, teniendo, algunas voces, que preparar 
materiaB primas que no se encuentran en Bogota, se comprenderd por qu^ gast^ 
una cantidad de tiempo increfble en verificar estoe anAlisis y por qu4 no alcanc6 a Uegar al 
ndmero de 100, que me bab(a fijado como mfnimim cuando principi^ mis observaciones. 

Las orinas de los andlisis becbos en Bogota, pertenecen, unas a obreros o a sirvientes, 
algunos de ellos asistentes del bospital y otras, las provenientee de la clase acomodada, 
pertenecen, en su mayor parte, a estudiantes y m^icos y a algunos pocoe comerci- 
antes. Estas dltimas fueron mia escasas por la mayor dificultad paia conseguirlas. 

Los anjjliflis de Timja pertenecen mucbos de ellos a individuos de clase social 
acomodada cuyas orinas be podido conseguir y recoger minuciosamente, como m^ico 
que soy de algunas compafiias de seguroe; otras de estas orinas pertenecen a soldados 
de la unidad del ej^rcito que presta la guamicidn en esta ciudad. 

Estos tiltimos individuos est&n alimentadoe con el r^imen que se indicari m^s 
adelante, regimen que por ser algo superior al usado generalmente por nuestras clases 
trabajadoras, no me ba parecido l(5gico incluir, por lo que a sus anAlisis de bus orinas 
respecta, entre estaa 

Por esta circunstancia y por ser relativamente pequefio el ndmero de mis observa- 
ciones de Tunja, be resuelto no dividir en doe partes los cuadros, como los de Bogot4, 
sine sacar un promedio general de todos ellos. 

MfrroDos Emflsados. 

Los andlisis de las orinas se ban dirigido a los siguientes puntos: volumen de la 
orina emitida en 24 boras; densidad, acidez (expreeada en bidr6geno), amonfaco, 
urea, purinas totales (expreeadas en dcido tirico), dcido tirico, bases puricas (expre- 
sadas en xantina), dzoe total, dzoe amoniacal, 4zoe de la urea, &zoe purico total, 
(nticleo purico solamente) ^oe del dcido tirico, dzoe de las bases puricas, anbfdrido 
fo8f6rico para efectos de la relaci6n at6mica. P: Az. Belaciones urinarias. 

Para inveetigar estoe diversos elementos be querido emplear los m^todos mia exactos 
y al mismo tiempo los menos complicadoe. He aqui la de8cripci6n de ellos: 

Acidez. — Slguiendo el precepto de Maillard respecto a la acidez de la orina, de que 
no bay m^todo que no adolezca de empirismo, be resuelto emplear el m6todo directo 
con fenoltaleina, porque segdn el mismo autor, no es menos bueno que los otros, y por 
que, segtin se verd m4s adelante, constituye la primera operaci6n paia la dosificacidn 
del amonfaco. 

Se toman 10 c. c. de orina y se colocan en un globo aforado a 100 c. c. se completa 
el volumen basta la Ifnea del globo, con agua destilada. La mezcla se coloca en una 
fiola de Erlenmeyer y se ie agregan imas tres o cuatro gotas de soluci6n alcob61ica de 
fenolteneina al 1 por ciento; despu6s se vierte gota a gota, con una bureta de Gay 
Lisac, soluci6n decinormal de soda basta la aparici6n del tinte d^bilmente rosado. 

Para obtener la acidez, en gramos, de bidrdgeno por litre, se multiplica por 0.01 
el ntimero de c. c. que se bayan gastado de la soluci6n de soda.^ 

> AlgnnoB ftatora aoonaejan agregar 6 grms. de oxalato de jwUsio para preolpitar las sales de oaloio 
las que obrarlan sobre los f osDatos ouando se agrega la soda. 



FUBUO HEALTH AKD MEDIdKB. 77 

Atoe total.— Ei mismo procedimiento de Ejeldahl de que ya hsihU atr^ con 
algunas variaciones. 

La reacoidn se efecttia con 20 c. c. de orina, 5 c. c. de Boluci6n al 30 por ciento de 
oxalato neutro de potado y 5 c. c. de &cido sulMrico puro. La eepuma que se fonna 
baja casi siempre espont&neamente y es raro que haya que agregar alcohol, como 
cuando se trata de materias alimenticias. 

Una vez descolorado el Ifquido, se deja enfriar, como de coetumbre, agregindole 
unos 30 c. c. de agua tibia. 

Se pone luego unas gotas de soluci6n de fenoltaleina y se agrega, gota a gota, una 
lejfa de soda exenta de carbonato y de 1.15 de densidad, hasta que aparezca la colo- 
raci6n d^bilmente rosada; tan d^bilmente, que desaparezca con 3 6 4 gotas de icido 
sulMrico al d^cimo; despu^s se completa el volumen a 100 c. c. en un globo aforado. 

Para averiguar la cantidad de dzoe en eete licor, se opera por comparaci6n con una 
soluci6n titulada de cloruro de amonio, al 7.65 por ciento, de tal manera que 5 c. c. de 
eeta solucidn, al deecomponerse por el hipobromito de sodio, dan exactamente 0.1 
gramo de &zoe. Se introducen, pues, en el ure6metro 5 c. c. de esta soluci6n, como si 
se tratara de medir urea y luego se hace lo mismo con 5 c. c. del Uquido que resulta 
de la reacci6n, que equivalen alec, de orina. Una simple relacidn respecto a los 
Yoltimenes ocupadoe en cada operaci6n por el &£oe desprendido, mostrar& el dzoe 
contenido en 1 c. c. de orina. 

Amoniaeo. — Se sabe que todoe los m^todos que consisten en destilar la orina en 
preeencia de dlcalis, de cal o de magnesia, de carbonatos alcalinoe o atin terroeoe, dan 
resultadoe err6neoe, por exceso, a causa de una hidrolisis parcial de la urea. Y no es 
verdad, segtin Maillard, que la deetilacidn en presencia del carbonato de sodio o de 
magnesio en el vado y a 45^ o 50^, est^ al abrigo de estas causae de error. Los otros 
m^todoB, si no son susceptibles de erroree quimicoe, lo son de erroree biol6gicoe. 

£1 m^todo de Ronchese, uno de los m&s recientes, es justamente elogiado por Mail- 
lard, Jones y por Guiard y Grimbert; ^ tiene la inmensa ventaja de ser muy exacto, 
muy senciUo y muy rdpido. 

Se sabe, desde los trabajos de Detepine y de Cambier y Brodiet, que las sales amonia- 
cales son trasformadas por al aldheida f6rmica en sales de una nueva base, la exame- 
tileneamida; como esta no suire la influencia de la fenoltaleina, los ^idos primitiva- 
mente combinados al amonfaco, se comportan con este indicador como si estuvieran 
libree; de modo que para encontrar la neutralidad a la fenoltaleina, previamente 
comprobada, hay que agregar una 8oluci6n decinormal de soda, precisamente equiva- 
lente a la cantidad de amonfaco. Este m^todo tiene adem^ la inmensa ventaja de 
dosar al mismo tiempo los dcidos aminados. 

Diez c. c. de orina se aumentan con agua destilada, recientemente hervida para 
que no contenga carbonatos, hasta completar el volumen de 100 c. c, y se neutraliza, 
como ya dije al hablar de la detenninaci6n de la acidez. Por otra parte, se neutralizan 
de la misma manera 20 c. c. de aldheida f6rmica al 20 por ciento (formol del comercio 
dilufdo de su volumen de agua). Se mezclan entonces estas dos soluciones, y como 
se verifica entonces la reacci6n que pone en llbertad los ^idoe de las sales amoniacales, 
los Ifquidos pierden instantdneamente el color roeado. Basta entonces neutralizar 
de nuevo estos dcidos con soda decinormal, para saber la cantidad de amoniaco em- 
pleada en cada litre de orina, pues no hay sine que multiplicar por 0.17 el ntimero 
de c. c. de Boluci6n de soda empleados. Pero como las sales amoniacales hacen retardar 
un poco la aparici6n del tinte roeado, hay que agregar 0.1 por cada 3 c. c. de soda 
gastadoe en la neutralizaci6n final. 

Urea. — ^Mail]^, en un trabajo citado antes, emple6 para medir la urea en la orina, 
el m^todo de Folin, que estd fundado en la hidrolisis de la urea por el cloruro de 
magnesio, fundido a 160^. Se dosa luego el amonfaco por destilaci6n sobre el dcido 
sulfdrico cuartonormal. Del resultado hay que deducir el amonfaco de la orina, 



t Qaiart, at Qrlmbert, Diagnostiqae ohimique, 1912, HaiUard, loo. oit. 



78 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONGRESS. 

previamente medido. L. G. de Saint-Martin prefiere al cloruro de magnesio el de 
litio. El m^todo de la descomposicibn y dosado por la ureasa es bastante precieo 
aunque lento. 

El dosado gaaom^trico ha sido objeto de graves crlticaa; sin embargo, estas crfticas 
ban sido quiz4 exageradas, como lo prueba la concordancia de los resultados obtenidos 
por Maillard y los obtenidos por Desgrez y Ayrignac.* En favor de la rehabilitaci6n 
de este m6todo estd tambi^n la tesis de Ronchese.' 

Resolvl emplear el m^todo gasom^trico, porque si es verdad que adolece de muchos 
errores, ellos pueden corregirse fdcilmente. 

Este m6todo estd fundado en la de8compo8ici6n de la urea por el hipobromito de 
soda, en dzoe, dcido carb6nico y agua; el dcido carb6nico ee retenido, si se opera^ 
con un exceso de soda, y el volumen del dzoe puesto en libertad es proporcional a la 
cantidad de urea contenida en la orina empleada. 

Los aparatos destinados a medir el dzoe son muchos; yo emple^ para estos andlisis, 
como para el dosado del dzoe total, uno construido por el sefior R. Ferreira, segdn el 
modelo de Mercier o del doctor Montoya, compuesto de un tubo en U, con un Ifquido 
en su interior y una de sus ramas en comunicaci6n con un frasco donde se efectua la 
reacci6n. La graduaci6n es arbitraria, m^ adelante se comprenderd por qu^. Laa 
uniones son muy herm^ticas para evitar el menor escape de gas.. 

Uno de los inconvenientes de este m^todo consiste en que los resultados son variables, 
como son variables la pre8i6n y la temperatura. Psura subsanarlo se emplea una 
soluci6n tenue de urea al 2 por mil (adicionada de unos 4 a 6 por 1,000 de fenol puro 
para asegurar su conservaci6n) con la cual se hace un an&lisis, inmediatamente antes 
del de la orina. Sabiendo que 5 c. c. de la soluci6n equivalen a O.OI de urea, se puede, 
por cdlculo, deducir la cantidad de urea contenida en el volumen de orina empleado. 
La correcci6n que se hace de esta manera respecto a la presidn y a la temperatura es 
tan considerable, que sobre una misma orina hice el mismo andlisis por el m^todo de 
Folin y lu^o por el m^todo gasom^trico, operando comparativemente con la soluci6n 
de urea en un aparato calculado para 0.560 c. c. de presidn y 15^ de temperatura, cifras 
que se consideran como medias en Bogotd. El resultado fu^, en el primer case, 
4.998 gramos por litro, en el segundo 5.8 gramos por litro, y segun el ndmero que 
correspondfa al c&lculo del aparato, 8.50. 

Otra causa de error consiste en que la urea no desprende todo el 4zoe; para reme- 
diar esto, muchos au tores emplean una pequefia cantidad de glucosa; pero haciendo el 
anAlisifl por comparaci6n con la solucidn de urea, el inconveniente queda subsanado. 

Por otra parte, el hipobromito no obra solamente sobre la iirea sine tambi^n pone 
en libertad el dzoe del dcido tirico, de la creatinina y de las sales amoniacales. Para 
eliminar el error debido al dcido tkico, se defeca previamente la orina por el subace- 
tato de plomo; otros emplean el ^do fosfotilnt^co. El error debido al amoniaco se 
subsana dosando el amoniaco por el procedimiento de Ronchese y relacionando la 
cifra urea, segtin la f6rmula: Az H'X0.1764 — ^Urea. En cuanto al error debido a la 
creatina, es muy pequeno para que merezca tenerse en cuenta. 

Acido iirico. — A causa de los muchos m^todos que hay actualmente en boga para 
dosar el icido drico, hube de escQger varios para emplear el m^ preciso. El primero 
que emplee fu^ un procedimiento, tamhi^n de Ronchese, que est& fundado sobre la 
precipitaci6n del dcido tirico al estado de urato de amoniaco, por el cloruro de amonio; 
este precipitado se lava con una soluci6n de amoniaco y de cloruro de amonio y 
luego se disuelve a favor de un poco de ^do ac^tico adicionado de biborato y de 
bicarbonate de sodio. En el Ifquido asf preparado, se agrega poco a poco, soluci^n 



t A. Desgres j J. Ayrignac, De rinfluence da regime alimentaire sur la valeur des ooefiQcfcnts urologiques 
3, R. Acad., 1906, pag. 162. 

* A. D. Ronchese, Mdthode de dosage de quelquee compost asot^ Thdses de pharm., Paris, pags. 
43-49. 



PUBLIC HEALTH AND MEDICINE. 79 

decinonnal de yodo con agua de almid6n como indicador hasta la coloraci6n azul. 
Cada centlmetro ctibico de 8oluci6n empleada equivale a 0.0084 de dcido ilrico. 

Este m^todo Uene sus causas de error por la descomposicidn, a veces muy rdpida, 
del yodiiro de alinid6n, que hace que ee agregue un exceso de solucidn de yodo. 

El m^todo del uric6metro con sulfuro de carbono como indicador, es tambi^n muy 
poco preciso, pues a causa de la falta de sensibilidad del indicador, se cometen errores 
por exceso. 

Mltodo de Folin Schoffer. — Despu^s de la defecaci6n de la orina por el reactive de 
Folin (sulfate de amonio y acetate de uranio) se precipita el urate de amoniaco sobre 
100 c. c; el precipitado se recoge sobre un filtro, ee lava y se disuelve en un medio 
sulMrico donde se dosa el dcido Virico por una solucidn titulada de permanganate de 
potasio hasta la no descoloraci6n; 1 c. c. de la soluci6n=0.000375 de dcido Virico. Este 
m6todo tiene el grave inconveniente de que la soluci6n de permanganate se altera 
muy r&pidamente y hay necesidad de titularla con frecuencia. 

El procedimiento que elegf, por parecerme el m^ exacto, fu6 el de Gamier, que es 
el mlsmo que se emplea para las piurinas y de que hablar6 en seguida: 

Purinas totales. Procedimiento de Hycraff Deniges Gamier. — Las bases ptiricas 
tiatadas por el nitrate de plata amoniacal en presencia de una sal de magnesio dan un 
urato doble de plata y de magnesio perfectamente definido. Si se emplea para esta 
precipitaci6a unlicor de plata titulado, se puede, midiendo el exceso de plata no com- 
binado, deducir la que se combin6 en laa purinas, y por consiguiente, el peso de ^stas. 

A 100 c. c. de orina defecada por 26 c. c. de reactivo de Folin, agrdguese una solu- 
ci6n de partes iguales de soluci6n decinormal de nitrate de plata y de otra que con- 
tenga 350 c. c. de amoniaco, 150 gramoe de cloruro de amonio y 50 gramos de cloruro 
de magnesio. Ffltrese, rec6ja0e 100 c. c, agr^esele 10 c. c. de una soluci6n titulada 
de cianuro de potasio (equivalente a la de nitrato de plata) y 1 c. c. de soluci6n al 
un d^imo de yoduro de potasio. Vidrtase gota a gota 8oluci6n decinormal de nitrato 
de plata hasta obtener un Hquido permanentemente turbio. La soluci6n argdntico- 
magnesiana da la combinaci6n de que ya se habl6, con las purinas. El cianiuro de 
potasio se comljina con el nitrato de plata que qued6 libre y como son equivalentes, 
basta dosar con otra soluci6n aigdntica-decinonnal, el cianuro que no se cQmbin6 con 
la plata, con KI como indicador, para saber la cantidad de la 8oluci6n primitiva de 
nitrato de plata que se combin6 con las purinas; ^ta, multiplicada por 0.21 da el peso 
de purina por 1,000 c. c. de orina: pero a causa de la disminuci6n de volumen que se 
efectu6 al verificarse la defecaci6n de la orina, hay que multiplicar este resultado 
por 1.25. 

Como el ^ido urico es una purina, basta aislarlo, precipit^ndolo de la orina defe- 
cada, por el amoniaco, al estado de urato. Este precipitado se lava con sulfato de 
amoniaco al 10 por ciento, se disuelve por medio de una pequetia cantidad de soda al 
2 por ciento en un volumen determinado de agua destilada, y en esta soluci6n se 
veriHca el dosado como para las purinas totales: 

Bases pdricas (expresadas en xantina). — Si en la precipitaci6n de las bases piiricas la 
relaci6n de la plata al niicleo pdrico fuera la raisma que en la precipitaci6n del dcido 
drico, bastarfa, para obtener la cifrade las bases pdricas, restar simplemente la cifra del 
dcido tirico de las cifras de las purinas totales y despuds multiplier esta diferencia por 
la relaci6n entre el peso molecular de la piuina elegida como tipo (xantina, por ejemplo) 
y el peso molecular del dcido tirico. Pero como en el case de las bases cada nticleo 
ptirico fi ja dos dtomos de plata mientras que el ndcleo del dcido tirico no fi ja sine uno> 
la misma cantidad de plata que corresponde 168 partes (una mol^ula) de dcido 
lirico, no representa sine 152:2=76 partes (media mol6cula) de xantina, la diferencia 
de las cifras experimentales multiplicada por la relaci6n 76:168=0.454 expresa 
exactamente en xantina el conjunto de bases puricas. 

Para obtener una expresi6n inequivoca delas bases piSricas hay que elegir una de 
las doe mds abundantes la adenias (151) o la xantina (152), lo que da la misma cifra, 



80 PBOOEEDIKGS 8B00ND PAN AMBBICAN 80IBKTIFI0 00KGBE88. 

vista la igualdad prdctica de los peaoe moleculares. El error proveniente de la infe- 
rioridad de loe pesos moleculares de la adenina (135) y de la hipoxantina (136) debe ser 
compensado en gran manera por la preeenda de la metilxantdna (166) y de la dime- 
tilxantina (180); se puede, pues, considerar como satufactoiia la expresidn de las 
bases puricas en xantina. 

Azoe iiliootungstico, — ^Por haberme side imposible consegair el reactivo, no pude 
verificar este anilisis. Las materias a que ^1 se refiere no tienen ademis grande impor- 
tancia puesto que apenas principian a conocearse, y su importanda ee, per con- 
siguiente, muy discutible. 

FSsforo urinario {en dddo fosfSnoo), — ^El m^todo estd fundado en que ai se vierte 
una 8oluci6n de una sal de uranio (nitrate o acetate), en un liquido que contenga 
fosiatos en medio ac6tico, sin icidos minerales y de una temperatura prdxima a la 
ebullici6n, se obtiene un precipitado insoluble de fosfato de uranio. El fin de la 
reacci6n se conoce por medio de la tintura de cochinilla, con la cual forma la sal de 
uranio, cuando ya no encuentre fosfatos para combinarse, una laca verde esmeralda, 

tambi^n con el forrocianuro de potasio, que da con la sal de uranio un precipitado 
rojo. 

Para hacer m^ c6moda la reacci6n, he titulado la solucidn de uranio de tal manera 
que 1 c. c. sea equivalente a 0.05 c. c. de dcido fo6f6rico por litre de orina. 

La reacci6n se verifica en una cdpsula de porcelana en la cual se pone la cantidad 
mencionada de orina con unas gotas de tintura de cochinilla y 1 c. c. de soluci6n al 

1 por ciento de acetate de sodio cristalizadoj adicionada de 5 por ciento de acido 
ac6tico cristalizable. En una bureta de Mohor que estd sobre la cdpsula se coloca la 
soluci6n de urinario. Una vez que la orina calentada por una Idmpara de alcohol, 
principia a desprender vapores, se deja caer, poco a poco, la soluci6n titulada, hasta 
obtener el tinte verde oscuro. 

Ademds de estos elementos, y a pesar del examen clfnico, bu8qu6 en las orinas en 
experimento sustancias anormales para asegurarme del estado fisioldgico de los indi- 
viduoe. 

RELACI0NE6 UR0l6GICAS. 

Se sabe que los diatintos elementos que encierran las orinas normales son variables 
con la alimentaci6n, la edad, el sexo, el clima, etc. Por osta raz6n se ha dicho que 
no hay orinas normales absolutas sine orinas normales particulares a cada individuo. 

Sin embargo, loe diferentes elementos de la orina guardan entre si relaciones que 
son independientes de su cantidad, y, que por ser bastante fijas, dan muchas ense- 
fianzas respecto del funcionamiento de la nutrici6n. 

He buacado las siguientes relaciones uroldgicas: 

1. Relaci6n uzodrica: Coeficiente de oxidaci6n (Robin) o relaci6n de la utilizaci6n 
de dzoe: 

'"aIt ^^OiT ^-^^ * ^-^ ^^^^ Robin). 

Ya se ha visto que la urea es el t^rmino final de la trasfonnaci6n de las albumi- 
noideas, de tal manera que cuanto m^s perfecta sea la nutrici6n, habrd menos inter- 
medios y la relaci6n Az U:Az se aproximar^ m^ a la unidad. 

P* O* 1 10 

2. Relaci6n del dcido fosf6rico a la urea o al dzoe total —^ — ™in™T()o"*^*^^ ^ 

p2 0* 18 

1 — ^rir=T7r;^=0.18 esta relaci6n es de una constancia notable (I von) cuando se eleva 

Az 1 100 

considerablemente se puede deducir que hay fosfaturia. Esta es relativa cuando la 

cifra P* 0* no pasa en mucho la media (2 por 60 en 24 horas), ea esencial en el case 

p2Q5 

contrario. La relaci6n P' 0* tiene la misma significaci6n; t— 7p* 

3. Relacidn del dddo urico coeficiente de trasformaci6n de las nucleoproUidas. 



FUBLIO HEAUTH AND MEDIOIKB. 81 

Dije antes que el icido tirico y la urea no tienen un origen comtin, y aunque una 
parte del icido tirico es trasformado en urea en el hfgado, no veo que ensefianzas prdcti- 
cas pueda dar la relaci6n entre el icido drico y la urea. Porque suponiendo que haya 
una gran trasformacidn de las ndcleoproteidas, puede estar aumentando el ^ido 
drico al mismo tiempo que la urea, y entonces la relaci6n no podrd ensefLamos nada 
respecto de las trasformaciones en las ndcleoproteidas; o si la urea estd disminuida 
por una d^bil alimentaci6n de albuminoideos propiamente dichos y el ^ido drico 
aumentado por aumento de ndcleoproteidos, esto no querda decir que hubiera un mal 
funcionamiento hepdtico a pesar de que la relaci6n asf lo indicara. Si hay una d^bil 
trasfonnacidn de ndcleoproteidos o diBnnnuci6n de trasfonnaci6n de las albiuni- 
noideas, el coeficiente tami>oco nos ensefiard nada ni respecto a un funcionamiento 
hepdtico, en el primer caso, ni respecto a una mala trasformaci6n de ndcleoproteidos, 
en el segundo grado. De manera que a mi modo de ver, las dos razones de ser del 
coeficiente indicado ban perdido mucho de su importancia desde que se sabe que el 
iddo drico no es un producto hacia la urea. 

Yo me atreverla a proponer que se adoptara una relaci6n entre el dzoe del ^ido 

drico y el dzoe de las purinas totales: j — P~t» ^ <l®<^^i ^^ ^^^ ^^ l^s ndcleoproteidos 

que ha llegado al dltimo grado de desintegracidn fisiol6gica, y el que ha debido llegar 
aUl. 

La investigacidn del dzoe de cada uno de los cuerpos que entran en el segundo factor 
de esta relacidn, complicarla demaaiado las operaciones, complicacidn que no traeria 
quizd mayores ventajas, una vez que se tienen cantidadee de dzoe propordonales. 

Las cantidades que han servido para la relaci6n de que hablo son, por una parte, 
la proporci6n de dzoe del ^do diico por ciento de izoe total y por otra parte, la de 
iaoe pdrico total por ciento de dzoe total. Esta dltima cifra no representa sino el 
iasoe del ^do drico m^ el izoe de las purinas b^cas expreeadas en xantina; es decir, 
que en ellas no figura el dzoe aminado de la adenina y de la guanina; pero sf repreeentan 
una cantidad que es siempre proporcional al dzoe pdrico total propiamente dicho. 
Multiplicando el cociente por ciento, el resultado indicar& la cantidad de dzoe pdrico 
que para cien partes de la dira global, llega al t^rmino normal de su desintegraci6n 
fifliol^ca. Gomo se verd mia adelante si en vez de tomar el tanto por ciento del dzoe 
total se toman las clfras directas del AU y de las BP, el resultado es muy semejante. 

El coeficiente que me atrevo a proponer podrfa tener grande importancia para el 
estudiodeladesintegracidn azoada, de las oxidaciones y desamidaciones orginicas en 
general, y de la de8integraci6n de las ndcleoproteideas, en particolar; ' tendrfa respecto 
de estas quizd la mlsma importancia que el coeficiente de utilizaci6n del dzoe, o 
mejor que el coeficiente de que hablar6 en seguida, tiene respecto de las albuminoideas 
propiamente dichas. 

4. Imperfeeci6n itroginica — coeficiente de oxidacidn verdadero o de los dcidos ffrasos: 
81 se tiene en cuenta la teoria generalmente aceptada hoy sobre la formaci6n de la 
urea, se verd que es hasta cierto punto il(5gico hacer intervenir el dzoe total en el 
coeficiente llamado **de utilizaci6n del dzoe." Cbnsiderando pues que hay cuerpos 
azoados que no son productos hacia la urea, Arthus ' propuso el siguiente coeficiente: 

Az azubba; az amoniacal, Acidos aminados. 

Eete coeficiente fu6 estudiado por Maillard quien lo llam6 coeficiente de imper- 
feccidn urog^nica y mostrd su importancia como que indica adem^ de la intensidad 
de la fimci6n uropoi^tica, el poder de oxidaci6n del organismo sobre los &cidos grasos 
o cadenas carbonadas vecinas, previamente puestas en libertad. 

1 Veose pAgina, 00. * M. Arthus, Prtete de chlmie physiologique, 1906, p&g. 390; nota. 



82 



PROCEEDINGS SECOND PAN AMEBIOAN 8CIENTIFI0 CONGRESS. 



Hay que notar que para medir el amonfaco Malllar emple<S el procedimlento de 
Bonchese, que ee el mismo que he empleado yo, el cual dosa al misino tiempo el 
amonlaco y los ^idos ausinadoe. Lazemberg insiste sobre esta neceeidad de medir al 
mismo tiempo loe icidos aminadoe productores mediatoe de urea, como el amonlaco ^ 
fu6 el quien le di6 al cocficiente la forma notada arriba. 

RE8ULTAD08 INDIVIDUALES DE L08 ANAlISIS. 

En la primera parte de loe cuadros que se ver^ an seguida, se encuentran loe aniilifliB 
hechoB en Bogota, divididos en dos aeries que comprenden la eliminaci6n azoada y 
loeforada y luego la repartici6n del &zoe y la relacl6n del f6sforo al dzoe. En la primera 
eerie se encuentran para cada cuerpo dos columnas que representan la eliminacl6n 
tanto por litro, como en 24 boras. 

En la segunda parte se encuentran los 20 andlisis de Tunja repartidos de la misma 
manera, 8<51o quenoeet^ divididos como los Bogotd, "en clase obrera " y ^'clase acomo- 
dada" tanto porque su ntimero es muy reducido como porque se refieren a individuoe 
alimentados casi todos de la misma manera. 

Por dltimo, los andlisis de cada localidad est^ s^uidos de sub promedios y al final 
Be encuentran los promedios genorales. 

CuADRO I (Serie !•). — Clase obrera — Eliminacidn del dzoe y deljdsjoro, 

[An&lisis de BogotA.] 



Ntim. 



1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 



Alios de 
edAd. 



23 
25 
20 
22 
21 
28 
28 
22 
23 
25 
25 
22 
21 



Profesidn. 



Jornalero.. 

Asistente.. 

Sirviente.. 

Albafiil. . . 

Sirviente.. 

Carpintero 

Jornalero.. 

Gendarme. 

Latonero. . 

Gendarme 

Asistente. 

Sirviente. . 

do 



Densidad 
dela 
orina. 



1,010 
1,022 
1,018 
1,015 
1,016 
1,027 
1,016 
1,027 
1,017 
1,012 
1,016 
1,013 
1,018 



Voliunen 

en 24 

boras. 



Aeidoc en H. 



Asoe total. 



For 
litro. 



2,950 
1,460 
1,850 
2,120 
1,720 
1,660 
1,650 
1,075 
2,250 
1,550 
2,000 
3,300 
1,600 



0.013 
.051 
.035 
.025 
.027 
.031 
.035 
.036 
.018 
.019 
.024 
.005 
.012 



En 34 
boras. 



Por 
litro. 



■r 



0.038 
.048 
.065 
.053 
.046 
.051 
.047 
.038 
.040 
.029 
.048 
.016 
.019 



4.67 
6.60 
8.77 
6.20 
7.63 
8.09 
6.95 
ia89 
5.35 
5.10 
8.00 
8.47 
5.58 



En 34 
boras. 



12.0 

9.63 

16.33 

13.40 

13.13 

13.43 

11.46 

1L70 

12.00 

7.90 

16.00 

11.45 

8.93 





Amonlaco y 




&cido8 




aminados. 


NAm. 






Por 


En 24 




litro. 


boras. 


1 


0.391 


1.15 


2 


.408 


.59 


3 


.714 


1.32 


4 


.918 


1.94 


5 


.969 


1.06 


6 


.935 


1.55 


7 


.068 


.11 


8 


.561 


.60 


9 


.204 


.50 


10 


.255 


.40 


11 


.68 


1.13 


12 


.119 


.89 


13 


.51 


.82 



Urea. 



For 
litro. 



En 24 
boras. 



5.50 

14.00 

13.00 

8.70 

10.00 

11.20 

10.94 

14.21 

7.87 

6.53 

11.23 

7.00 

7.52 



16.22 
20.44 
24.00 
18.44 
17.20 
18.59 
18.05 
14.27 
17.70 
10.12 
22.46 
23.10 
12.00 



Pminas totales 
(en &cido 
t&rico). 



For 
litro. 



0.675 
.721 
.84 
.803 
.709 
.966 
.729 

1.190 
.735 
.735 
.756 
.667 
.735 



En 24 
boras. 



0.93 
1.05 
1.55 
1.70 
1.22 
1.60 
1.20 
1.27 
1.65 
1.14 
1.51 
1.87 
1.17 



Acido t!irico. 



Por 

litro. 



0.30 
.22 
.50 
.583 
.630 
.240 
.227 
.403 
.332 
.084 
.412 
.239 
.294 



En 24 
boras. 



0.88 
.32 
.92 
1.23 
1.08 
.40 
.37 
.43 
.14 
.13 
.82 
.97 
.47 



Bases pAricas 
(en xantina). 



For 
litro. 



0.168 
.320 
.090 
.099 
.035 
.320 
.220 
.350 
.180 
.390 
.15 
.12 
.20 



En 24 
boras. 



Acido 
fosfdrico. 



For 
litro. 



0.40 
.32 
.16 
.20 
.06 
.53 
.35 
.37 
.40 
.45 
.30 
.39 
.33 



1.00 

1.40 

1.50 

1.00 

1.30 

1.60 

1.10 

1.60 

.70 

.50 

1.20 

.60 

1.50 



En 24 

boras. 



3.05 
3.04 
3.77 
3.12 
3.06 
2.66 
1.89 
1.73 
1.57 
.77 
3.40 
1.98 
3.40 



I Lacembdrg, L'amoniaque et I'urine; ^tude d'un nouveau coefficient urlnaire; tb^ de Paris, 1913. 



FUBLIO HBALTH AIXD MBDIGOnL 



83 



OuADBO II (Serie 1*). — Cla$e obrera--EHmiinaei6n dd dgoe y ddfdiforo. 



NAni. 


Aflofde 
edad. 


1 


» 


14 


30 


15 


32 


16 


21 


17 


24 


18 


28 


19 


24 


ao 


24 


21 


34 


23 


22 


28 


28 


24 


32 


25 


30 


26 


38 



Proleaidn. 



Oendarms. 
Cartero.... 
Sinriento.. 
AlbaflO... 
Citrpiiiteio 
Aflistozito . 
Albaflfl... 
Cftrpinteio 
Zapateio.. 
Oendarme. 
Jomatoro.. 
Oendanne. 
Jomatoro.. 



DoMldAd 
dela 
orioft. 



1,021 
l,OBl 
1,018 
1,012 
1,021 
1,026 
1,010 
1,012 
i,Q20 
1,020 
1,015 
1,022 
1,020 



Volamen 
en 24 
horas 

(en Co.)* 



1,890 
020 
1,060 
1,680 
1,270 
1,320 
1,840 
1,500 
1,260 
1,500 
1,470 
1,420 
1,450 



AoidesenH. 



Par 
litro. 



0.024 
.037 
.011 
.025 
.040 
.037 
.031 
.020 
.048 
.012 
.012 
.011 
.060 



En 24 
horas. 



0.031 
.084 
.027 
.042 
.060 
.048 
.041 
.080 
.060 
.018 
.017 
.015 
.078 



Amo total. 



Par 
litro. 



6.424 

14.24 

6.61 

5.60 

0.00 

10.416 

7.118 

4.30 

11.12 

5.00 

5.80 

0.24 

8.60 



En 24 
horaa. 



8.47 

13.20 

13.08 

11.08 

11.43 

17.02 

0.63 

6.45 

13.00 

7.50 

8.66 

13.12 

12.47 



NAni< 



14 
15 
16 
17 
18 
10 
90 
21 
32 
33 
34 
35 
36 



Amonlaooy 

Aoidos 
aminados. 



Par 
litro. 



0.502 

1.275 
.442 

1.182 
.765 

1.513 
.730 
.204 

1.470 
.104 
.272 

1.275 

1.324 



En 24 
horas. 



a66 

i.l7 
.87 

1.08 
.07 

1.99 
.99 
.31 

1.84 
.29 
.39 

1.82 

2.20 



Ursa. 



Por 
litro. 



0.60 
20.20 
11.645 

8.47 
15.058 
24.20 
12.00 

5.235 
16.66 

6.66 

7.293 
16.82 
13.91 



En 24 
horas. 



12.54 
18.58 
23.06 
14.22 
19.12 
31.04 
16.06 

7.83 
20.82 

9.99 
ia72 
23.88 
20.17 



Pnrinas totaiss 
(enAeido 
tkrioo). 



Por 
litro. 



0.696 
1.365 
.504 
.441 
.840 
.819 
.603 
.388 
.714 
.420 
.483 
.766 
.462 



En 24 
horas. 



0.92 

1.25 

.98 

.74 

1.06 

1.07 

.03 

.58 

.89 

.63 

.71 

1.07 

.67 



XoidoMoo. 



Por 
litro. 



0.204 
.777 
.336 
.252 
.399 
.525 
.399 
.20 
.462 
.231 
.204 
.525 
.350 



En 24 
horas. 



0.38 
.71 
.66 
.40 
.51 
.60 
.53 
.30 
.58 
.34 
.43 
.74 
.51 



Bases ptkricas 
(en zantina). 



Por 
litro. 



0.18 
.26 
.06 
.085 
.20 
.13 
.132 
.065 
.113 
.065 
.085 
.104 
.050 



En 24 
horas. 



a23 
.23 
.11 
.14 
.25 
.17 
.17 
.12 
.14 
.12 
.12 
.14 
.07 



Icido 
fosfcrioos. 



Par 
litro. 



1.40 
1.00 
1.10 
1.30 
1.30 
1.60 
1.40 

.50 
1.20 

.70 
1.00 
1.10 

.70 



En 24 
horas. 



1.84 
.02 

2.06 
2.57 
1.64 
2.11 
1.87 
.75 
1.50 
1.05 
1.47 
1.56 
1.01 



CuADRO III (Serie 1*). — CUue obrera-^Miminaeidn del dtoe y ddf69foTo, 



N4ni« 



27 
28 
20 
30 
31 
32 
38 
84 
85 
36 
87 



Afiosde 
edad. 



24 
80 
28 
22 
30 
23 
85 
36 
85 
28 
30 
22 
27 



Profcsi6n» 



ll te)de oordel 

Carmo... 

Sastre 

Jomalero 

.. ..id.. 

Horraro ....... 

Albafln 

Q«ndarme 

Jornalsro. 

Oendanne 

Herrero....... 

Jornalero 

Alhaflfl. 



Densidad 
dela 
orlna. 



1,015 
1,021 
1,015 
1,017 
1,016 
1,016 
1,012 
1,015 
l,0l2 
1,030 
1,015 
1,016 
1,014 



Vdumen 
en 24 
horas 

(en Co.). 



1,450 
1,920 
2,115 
1,730 
2,115 
2,400 
1,800 
2,100 
1.450 
1,100 
1,470 
1,700 
2,740 



AoidesenH. 



Por 
litro. 



0.008 
.000 
.010 
.000 
.000 
.013 
.021 
.015 
.027 
.016 
.016 
.013 
.012 



En 24 
horas. 



a004 
.017 
.040 
.015 
.019 
.031 
.087 
.046 
.080 
.018 
.023 
.030 
.083 



Aioe total. 



Por 
litro. 



5.00 

5.10 

6.50 

5.73 

6.00 

5.93 

5.60 

5.68 

7.722 

0.29 

8.771 

3.80 

4.30 



En 24 
horas. 



7.25 

0.60 
18.74 

9.89 
iO.75 
14.20 

0.90 
i7.45 
11.10 
10.22 
12.00 

6.46 
11.78 



68486— 17— VOL x- 



84 



PB00EEDIKG8 SBOOND PAK AMWBrOATT SOIBlfrTIFIO 00KGBE88. 



OuADBO III (Serie 1*). — Cla»€ abrera-^BHminaa&n del dtoe y dd foBforo, — Ccntmiia, 





Amontaooy 

Addos 
amlnados. 


Una. 


Porinastotalw 
(enAoido 
Moo). 


loldo 


Moo. 


Bans ptirioas 


Acldo 
ioafdrioo. 


N4m. 
























Por 


En 24 


Por 


En 24 


Por 


En 24 


Por 


Bn24 


Por 


En 24 


Par 


En 24 


• 


litre. 


horn. 


litro. 


horai. 


Utro. 


horai. 


litro. 


horai. 


litro. 


horaa. 


lltio. 


horaa. 


27 


0.90 


L80 


5.70 


8.26 


0.899 


0.57 


0.105 


ai5 


0.132 


0.19 


0.60 


0.87 


28 


L270 


8.44 


6.00 


11.52 


.682 


L22 


.221 


.42 


.188 


.36 


LIO 


8.11 


20 


.635 


1.34 


9.571 


20.24 


.680 


1.33 


.200 


.42 


.104 


.41 


1.80 


2.74 


80 


1.118 


1.92 


7.77 


13.44 


.689 


L19 


.252 


.48 


.199 


.34 


1.00 


1.78 


81 


1.270 


2.78 


5.00 


10.75 


.700 


1.50 


.200 


.48 


.230 


.49 


1.00 


2.11 


82 


.890 


.96 


10.00 


24.00 


.680 


1.51 


.178 


.42 


.104 


.24 


1.20 


2.68 


83 


.578 


1.04 


9.90 


17.82 


.872 


.60 


.210 


.87 


.028 


.05 


.60 


1.08 


84 


.840 


.96 


9.219 


28.58 


.671 


8.08 


.252 


.78 


.190 


.58 


.75 


8.82 


85 


.685 


.92 


10.00 


14.50 


.467 


.68 


.815 


.46 


.068 


.09 


1.60 


2.32 


86 


.850 


.98 


17.20 


18.92 


.176 


1.29 


.260 


.27 


.418 


.46 


2.10 


2.31 


87 


.476 


.69 


10.454 


15.86 


.588 


.85 


.378 


.55 


.009 


.14 


1.20 


1.76 


88 


.282 


.48 


7.40 


9.18 


.756 


L29 


.550 


.98 


.92 


.15 


.60 


1.02 


80 


.800 


.82 


6.40 


17.54 


.525 


1.44 


.180 


.49 


.156 


.48 


.80 


2.19 



CuADBO IV (Serie 1*). — CUue obrera — EUminad&n del dzoe y delfSsforo, 



NAm. 


Afioade 
edad. 


40 


26 


41 


82 


42 


28 


43 


30 


44 


20 


45 


20 


46 


26 


47 


26 


48 


23 



ProfDsidn. 



Sirviente 

Jomalero 

id 

Carrero 

Mozo de Cordel 

AlbaftU 

Jomalero 

Pintor 

Sirviente 







Aoidei 


lenH. 


Aioe 


Densidad 
dela 
orina. 


Volumen 
en 24 
horas 

(en CO.). 








Por 


En 24 


Por 




litro 


horaa. 


litro. 


1,012 


1,430 


0.018 


0.027 


7.00 


1,020 


1,170 


.040 


.046 


7.80 


1,020 


1,250 


.028 


.035 


8.00 


1,030 


1,470 


.053 


.078 


9.57 


1,021 


1,460 


.034 


.049 


7.20 


1,020 


1,400 


.025 


.085 


7.56 


1,014 


2,380 


.015 


.085 


4.10 


1,021 


2,150 


.020 


.048 


7.82 


1,022 


1,870 


.036 


.049 


10.00 



En 24 
horas. 



10.00 
9.13 
10.00 
14.07 
10.40 
10.58 
9.76 
16.81 
13.70 





Amoniaooy 

Acidos 
aminados. 


Urea. 


Purinas totales 
(enAcide 
drioo). 


Aoido 


drioo. 


Bases ptSrioas 
(en xantina). 


Aoido 
foafdrkx). 


NAm. 


















Por 


En 24 


Por 


En 24 


Por 


En 24 


Por 


En 24 


Por 


En 24 


Por 


En 24 




litro. 


horas. 


litro. 


horas. 


litro. 


horas. 


litro. 


horas. 


litro. 


horas. 


litro. 


horaa. 


40 


0.221 


0.32 


11.00 


15.73 


0.839 


1.20 


0.450 


0.54 


0.175 


0.25 


L50 


2.14 


41 


.425 


.50 


10.00 


11.70 


.654 


.77 


.200 


.28 


.200 


.23 


2.00 


2.30 


42 


.697 


.87 


6.50 


8.12 


.885 


.48 


.180 


.22 


.092 


.11 


1.20 


1.50 


48 


1.250 


1.84 


11.95 


17.57 


.785 


1.08 


.400 


.50 


.151 


.22 


1.00 


1.47 


44 


.700 


1.01 


13.40 


19.48 


.420 


.61 


.170 


.25 


.113 


16 


2.00 


2.90 


45 


.909 


L36 


9.17 


12.84 


.567 


.79 


.214 


.30 


.159 


.22 


1.00 


1.40 


46 


.255 


.61 


5.00 


1L90 


.523 


1.24 


.180 


48 


.155 


.86 


.90 


2.14 


47 


1.105 


2.37 


10.00 


2L50 


.751 


1.61 


.201 


.42 


.249 


.58 


1.20 


2.58 


48 


1.168 


1.60 


10.10 


17.94 


.799 


1.08 


.856 


.49 


.109 


.15 


2.00 


2.74 



PX7BU0 HEALTH AKD MEDIOIKB. 



85 



GuADBO V (Serie !•). — Close aamodada'^Miminad6n del dzoe y ddfSsforo. 



Htm. 



1 
2 
3 

4 

5 

6 

7 

8 



10 

11 

12 

13 

14 



Afio8d« 
edad. 



ao 

22 
24 
24 
26 
27 
26 
27 
26 
26 
26 
25 
24 
24 



PrafB8i6ll. 



Estudiante. . 
Comeroiaate 
Bstadiante.. 

id 

id 

MMico 

Estudiante.. 

MMico 

Estudiante.. 

id 

id 

Medico 

Estudiante.. 
MiUtar 



Densidad 
dela 
orloa. 



1,022 
1,018 
1,016 
1,020 
1,021 
1,030 
1,020 
1,020 
1,021 
1,021 
1,020 
1,022 
1,022 
1,021 



yolamen 
en 24 
horas 

(en CO.). 



1,660 
1,400 
2,680 
8,100 
1,300 
1,600 
1,000 
1,800 
1,880 
1,820 
1,800 
2,000 
1,360 
1,230 



Aoides en H. 



Por 
litre. 



0.032 
.046 
.020 
.012 
.065 
.027 
.047 
.034 
.027 
.044 
.033 
.012 
.026 
.028 



En 24 
horas. 



0.063 
.062 
.054 
.037 
.071 
.043 
.047 
.061 
.058 
.058 
.051 
.024 
.035 
.027 



JLsoe total. 



Per 
Ittro. 



6.00 
9.223 
5.25 
4.00 

10.00 
7.10 

16.21 

11.00 
6.75 
9.50 

11.60 
6.20 
5.648 
9.58 



En 24 
horas. 



8.30 
12.91 
14.07 
12.40 
13.00 
11.36 
16.21 
19.80 
12.09 
12.54 
20.88 
12.40 

7.68 
11.78 





Amoniacoy 

Acidos 
aminados. 


Urea. 


Purines totales 
(en Acldo 
drioo). 


Aoido trico. 


Bases ptb-icas 
(en xantina). 


AcJdo 
osfdrico. 


NAm. 


























Pot 


En 24 


Pot 


En 24 


Por 


En 24 


Por 


En 24 


Por 


En 24 


Per 


En 24 




litre. 


horas. 


litre. 


horas. 


litro. 


horas. 


litro. 

1 


horas. 


litro. 


horas. 


litro. 


horas. 


1 


a60 


1.00 


8.10 


13.46 


asoi 


1.33 


a262 


a43 


a944 


a40 


1.30 


2.16 


2 


.680 


.95 


11.90 


18.06 


.727 


1.03 


.332 . 


.46 


.178 


.25 


1.50 


2.10 


8 


.621 


1.39 


8.72 


23.40 


.302 


.81 


.148 


.40 


.060 


.18 


LOO 


2.68 


4 


.641 


L68 


6.90 


18.29 


.688 


1.26 


.300 


.96 


.190 


.40 


.80 


2L48 


6 


L290 


1.67 


13.00 


16.90 


.839 


1.08 


.501 


.65 


.148 


.19 


.96 


1.35 


6 


.646 


1.03 


12.00 


19.20 


1.076 


1.72 


.850 


.53 


.328 


.62 


1.00 


1.60 


7 


L211 


1.21 


25.00 


26.00 


1.0825 


1.08 


1.556 


.66 


.240 


.24 


2.40 


2.40 


8 


. noo 


1.69 


16.00 


28.80 


.850 


1.63 


.243 


.44 


.274 


.49 


.76 


L36 





.644 


L02 


12.00 


21.66 


.904 


1.81 


.301 


.66 


.300 


.66 


.60 


1.13 


10 


.612 


.81 


16.10 


21.25 


.7576 


L07 


.180 


.24 


.261 


.34 


1.06 


1.40 


11 


.816 


1.47 


18.00 


32L20 


.640 


.97 


.168 


.30 


.168 


.30 


L60 


2.88 


12 


.225 


.46 


7.20 


14.40 


.840 


1.68 


.261 


.62 


.282 


.56 


1.80 


1.60 


13 


.558 


.75 


7.18 


9.76 


.903 


1.23 


.420 


.57 


.118 


.16 


1.00 


1.36 


14 


.367 


.44 


16.40 


20.17 


1.023 


1.26 


.742 


.91 


.125 


.16 


1.80 


2.21 



CuADRO VI (Serie 1»). — Close ocomodado — Eliminacidn del dzoe y delfSsforo. 



Stm. 



16 
16 
17 
18 
19 
20 
31 
22 
23 
34 
25 
26 
37 
28 



Afiosde 
edad. 



23 
24 
34 
25 
23 
24 
35 
25 
33 
36 
28 
27 
26 
26 



ProfesUtn. 



Qulmico 

Estudiante... 
Hacendado... 
Estudiante... 

id 

id 

id 

Militar. 

Estudiante... 

id 

Comerciante.. 

MMico. 

Estudiante... 
id 



Densidad 


Volumen 


dela 


en 24 


orina. 


horas 




(en CO.). 


1,030 


1,300 


1,021 


1,340 


1,022 


1,800 


1,030 


980 


1,025 


1,250 


1,017 


1,500 


1,014 


1,680 


1,014 


3,740 


1,032 


850 


1,031 


1,000 


1,020 


1,450 


1,020 


1,560 


1,024 


1,260 


1,014 


1,760 



Aoldez en H. 



Por 
litro. 



a 051 
.027 
.020 
.055 
.037 
.015 
.024 
.012 
.040 
.035 
.006 
.050 
.032 
.006 



En 24 
horas. 



0.063 
.036 
.086 
.053 
.072 
.022 
.038 
.083 
.034 
.036 
.009 
.001 
.037 
.009 



Axoe total. 



Por 
litro. 



13.23 

6.27 
10.70 

6.00 
11.30 

9.53 
ia84 

4.85 
13.82 

8.10 

laoo 
laoo 
ia86i 

9.35 



En 24 
horas. 



17.20 
7.06 
19.26 
16.68 
14.13 
14.29 
16.48 

2.63 
11.88 

8.10 
14.50 
16.60 
18. 6S 
16.46 



86 



PBOCEEDINGS SECOND PAN AMEBIOAN SCEBNTIFIO CONGRESS. 



CuADRO VI (Serle !•). — Ckue acomodad(i-—Elim%naci6n del 6zoe y del /6s/oro — Con. 





Amoniaooy 

&cidos 
sminados. 


Uree. 


Purinas totales 
(enAddo 
trkso). 


Addo 


tkrioo. 


Bases p^rfcas 
(en xantina). 


Aoido 
foBfdrloo. 


Nt^. 
























Por 


En 24 


Por 


En 24 


Por 


En 24 


Por 


En 24 


Por 


En 24 


Por 


En 24 




litro. 


horas. 


IHro. 


horas. 


litro. 


horas. 


litro. 


horas. 


litro. 


horas. 


litro. 


- horas. 


15 


L279 


LOO 


20.00 


20.78 


LOSO 


L86 


a508 


a65 


a 247 


a32 


1.80 


%U 


16 


.505 


.80 


8.70 


11.06 


.603 


.93 


.273 


.36 


.190 


.25 


.90 


L21 


17 


.510 


.92 


17.72 


31.90 


.553 


.99 


.231 


.41 


.145 


.27 


ZOO 


3.60 


18 


1.193 


1.17 


25.887 


25.87 


1.701 


1.67 


.609 


.60 


.492 


.48 


LOO 


L86 


19 


.980 


1.23 


2a 66 


25.83 


LOSO 


L31 


.315 


.30 


.826 


.40 


XIO 


2.26 


20 


1.00 


1.50 


14.73 


22.15 


.945 


1.42 


.470 


.70 


.215 


.32 


L30 


LOS 


21 


.949 


1.50 


14.72 


23.26 


.399 


.61 


.150 


.24 


.12 


.18 


L50 


X40 


22 


.440 


1.20 


7.40 


2a 27 


.425 


1.15 


.160 


.88 


.119 


.33 


.70 


L92 


28 


1.453 


1.25 


19.60 


16.86 


.632 


.54 


.401 


.42 


.064 


.05 


2.10 


L80 


24 


1.031 


1.03 


12.22 


1Z22 


1.356 


1.36 


.636 


.64 


.326 


.82 


LOO 


LOO 


25 


.551 


.80 


15.686 


2a 74 


.462 


.67 


.211 


.30 


.113 


.16 


L90 


L88 


25 


.754 


1.17 


16.49 


24.01 


.462 


.72 


.357 


.55 


.047 


.07 


LOO 


L55 


27 


1.072 


1.34 


19.296 


24.12 


.681 


.85 


.506 


.63 


.078 


.10 


2.10 


X62 


28 


.732 


L20 


15.00 


26.40 


.509 


.80 


.wOv 


.67 


.067 


.10 


L20 


2.11 



BLIMINACI6n del AZOB Y del f6sFORO— ANILISIS DB TtJNJA. 



Nrtm. 


Aftosde 
edad. 


1 


30 


2 


44 


3 


29 


4 


42 


6 


29 


6 


38 


7 


20 


8 


45 


9 


24 


10 


22 



Profesldn. 



Abogado.... 

Comerclante 
Ingeniero... 

Medico 

Saoerdote... 
Sirviente.... 
Institutor... 

Soldado 

id 



Densidad 


Volumen 


dela 


en 24 


orina. 


horas. 


1,019 


1,340 


1,016 


1,700 


1,016 


2,000 


1,018 


2,090 


1,021 


1,230 


1,017 


1,930 


1,012 


2,600 


1,015 


2,000 


1,015 


2.900 


1,010 


2,800 



AddesenH. 



Por 
litro. 



En 24 
horas. 



a 031 
.012 
.021 
.012 
.028 
.028 
.010 
.094 
.027 
.013 



a 041 
.020 
.043 
.085 
.027 
.054 
.026 
.048 
.078 
.036 



JLxoe total. 




9.22 
3.80 
7.32 
4.83 
9.58 
8.20 
3.60 
4.50 
4.13 
2.06 



12.35 

6.46 

15.07 

iao9 

1L78 

14.12 

9.36 

9.00 

ILOe 

5.77 





Amoniaco y 




Aoidos- 




aminados. 


Ntim. 






Por 


En 24 




litro. 
0.74 


horas. 




a99 




.28 


.48 




.51 


LOS 




.36 


.75 




.36 


.44 




.52 


LOO 




.40 


L04 


8 


.68 


L36 


9 


.24 


.70 


10 


.20 


.56 



I 



Urea. 



Por 
litre. 



12.00 
7.40 

12.90 
7.90 

16.40 

1L30 
5.80 
5.10 
4.86 
8.43 



En 24 

horas. 



16.08 
9.18 
26.57 
16.52 
2a 17 
2L81 
15.08 
ia20 
13.93 
9.60 



Purinas totales 
(en Acido 
thrico). 



Por 
litro. 



En 24 
horas. 



a 70 
.76 
.46 
. 29 

L02 
.52 
.34 
.76 
.44 
.41 



a93 

L29 

.95 

.61 

L26 

LOO 

.88 

L52 

L27 

L16 



Addotbrico. 



Por 
litro. 



a40 
.55 
.35 
.24 
.74 
.32 
.18 
.41 
.31 
.23 



En 24 
horas. 



a53 
.93 
.73 
.50 
.91 
.42 
.47 
,S2 
.90 
.64 



Bases puricas 
(en xantina). 



Aoido 
fosfdrieo. 



Por 
litro. 



a 132 
.090 
.051 
.020 
.013 
.091 
.070 
.151 
.059 
.061 



1 En 24 


Por 


horas. 


litro. 


a 17 


L40 


.14 


L20 


.10 


LOS 


.05 


.64 


.15 


L80 


.17 


LIO 


.18 


.60 


.30 


.60 


.17 


.90 


.18 


.60 



En 24 
horas. 



L87 
L76 
2.22 
L33 
2.21 
2.02 
L66 
L20 
2.61 
L68 



PUBUG HEALTH AND MEDICINE. 



87 



ANJLLISIS DE TUNJA—ELUONAClbN DEL IZOB Y DEL F6sFORO. 



NAm. 


Afiosde 
edad. 


11 


•21 


12 


21 


13 


22 


14 


22 


15 


24 


16 


22 


17 


21 


18 


21 


19 


22 


20 


22 



ProfBBkSn. 



Boldado 

....id. 

....W., 

....W. 

....Id.. 

....Id. 

....Id-. 

....id. 

....id. 

....Id., 



Densidad 
dela 
orina. 



,016 
,012 
,014 
,015 
,006 
,010 
,014 
,011 
,014 
,012 



Volumen 
en 24 
horas. 



2,450 
3,300 
3,150 
2,950 
3,100 
3,240 
3,020 
2,900 
3,200 
3,000 



Acides en H. 



Por 
litro. 



0.022 
.021 
.021 
.023 
.018 
.021 
.022 
.026 
.021 
.024 



En 24 
boras. 



a054 
.069 
.066 
.06S 
.055 
.068 
.066 
.065 
.067 
.072 



JUoe total. 



Por 
Utro. 



2.94 
3.33 
3.80 
4.10 
3.81 
2.86 
4.44 
4.84 
4.30 
4.60 



En 24 
horas. 



7.30 
10.90 
1L97 
12.00 
11.81 

9.26 
13.51 
14.04 
13.44 
13.80 





Amoniacoy 






Purines totales 








iddos- 


Urea. 


(en4oido 


Acldo 


tkrioo. 




aminados. 






Arico). 






Nt^. 




Por 












Por 


En 24 


En 24 


Por 


En 24 


Por 


En 24 




litro. 


horas. 


litro. 


horas. 


litro. 


horas. 


litro. 


horas. 


11 


a20 


a 49 


4.86 


11.81 


a55 


1.59 


a32 


0.78 


12 


.27 


.89 


4.77 


15.54 


.45 


1.48 


.11 


.36 


13 


.23 


.72 


5.10 


18.07 


.46 


1.45 


.20 


.63 


14 


.20 


.59 


4.90 


14.46 


.42 


1.24 


.18 


.53 


15 


.21 


.65 


6.71 


16.03 


.42 


1.30 


.28 


.87 


16 


.31 


1.00 


3.43 


11.11 


.45 


1.45 


.19 


.62 


17 


.44 


1.33 


5.14 


15.42 


.22 


.66 


.11 


.33 


IS 


.68 


1.58 


5.57 


16.15 


.46 


1.33 


.26 


.75 


19 


.43 


1.53 


4.80 


16.36 


.48 


1.53 


.18 


.68 


20 


.24 


.72 


5.00 


15.00 


.44 


1.32 


.16 


.45 



Bases puricas 
(en xantina). 



Acido 
fosfdricos. 




Los cuadros de la 8^:unda serie eetin tambi^Ji divldidos en ires partes y cada uno 
de los ndmeros corresponde a los mismos individuos que figuran en los cuadros ante- 
riores. En los cuadros, que se verAn en seguida, se encuentra la repartici6n del 
dzoe, segdn los distintos materiales eiiminados en 24 horas. 

El c&lculo del &zoe, que corresponde a cada uno de los materiales, fu^ hecho de la 
manera siguLente: 

Az 14 
Paraobtener el dzoe amoniacal basta multiplicar el amoniaco por r£H5~T7~^'^24. 

Az' 28 
El dzoe de la urea se obtiene multiplicando por la urea a r«ol~Tfx4=^=0.4667. El 

Az* 56 

dzoe de la xantina, multiplicando a esta poT 7^^.YAK~iQt^\t^2^^'^^^' ^^ ^^^ ^®^ 

Az* 56 

&cido drico es igual a p5jT4r""4o*™ir8**^-^^*^^/^' ^® modo que para obtener el 4zoe 

del dcido drico basta multiplicar la cifra obtenida de este dcido en las 24 horas por 
.334, o sacarle la tercera parte. 

El dzoe purico total es la suma de los dos aoteriores. Representa, como ya dije, el 
ndcleo pdrico solamente, y no comprende el dzoe aminado de la adenina y de la 
guanina. 

En estos mismos cuadros se encuentra tambi^n el tanto por ciento del dsoe coix 
que cada uno de estos cuerpos contribuye a la cifra del dzoe total. 

La suma de 6stos tantos por ciento representa la cantidad de dzoe determinado, 
por opoeici6n lo que se llama en el cuadro fracci6n de izoe indeterminado; es decir, 
de todas las sustancias que no han sido dosadas individualmente. 

En las dltimas Ifneas de los cuadros se encontrari el f6sforo de los fostatos el cual 

P* 62 
se obtiene multiplicando la cifra de P*0* por p^'^jgo"^*'*^^' 



88 



PROCEEDINGS SEOOND PAN AMBBIOAN SOIENTIFIO CONOBE8S. 



Hech eeto basta dividir la cifra del &zoe total por la del ideioro para obtener la 

Az 
Telaci6n ponderal del dzoe al f6sfoio -p . Multiplicando esta relaci6n ponderal por la 

31 
relaci^i^inversa de los peeoe at6micoe 7^=2.214 se obtiene el ndmero de dtomos de 4zoe 

que corresponde a un dtomo de fdsforo. 

Esta relaci6n at6mica del dzoe al fdsforo es interesante, porque el denominador 

ijxdica el ntimero de dtomoe de dzoe que deja el oi^ganiBmo mientras se elimina un 

dtomo de f6sforo. Esta representaci6n seria perfecta si se hubiera doeado al mlsmo 

tiempo que el f68foro de los fosfatos, todo el que pueda acompafiarle en formas dife- 

rentes. Se sabe, sin embargo, que esta excreci6n del f6fiforo es muy pequeila; de 

p 
manera que si la relaci6n v- del cuadro no es de una rigurosa exactitude sf se acerca 

mucho a la realidad. 

Cuadro I-II (Serie 2*). — Close ohrera — RepartieiAn del dzoe y reHadAn del/ds/oro al dzoe. 



NAmeroB. 



^soe amoniaoal 

Lsoedelaurea 

isoe del Acido tuioo 

^soe de las bases pArloas 

^soe ptUloo total 

^soc total 

parte del Axoe amoniaoal por 

100 de ^Izoe total 

Parte del Azoe de la urea por 

100 de ^Izoe total 

Parte del &soe de las bases ptii- 

oas por 100 de&Eoe total , 

Parte del 4soe del ijcido tkrioo 

por 100 de Axoe total 

Parte Aioe pOrioo total por 100 

de Atoe total 

Fraoci6n de Aioe determinado 

por 100 

Fraocidn de iioe indetenni- 

nadopor 100 

Anhldndo fosfdrioo 

Fdsforo de los fosfatos 

ReIaoi6n ponderal 

RelacU^n at<5mica 



1 


2 


0.06 
7.68 
.204 
.180 
.474 
12.00 


0.40 
0.64 
.106 
.118 
.224 
0.63 


7.02 


6.06 


63.17 


83.26 


1.60 


1.22 


2.46 


1.10 


3.06 


2.32 


76.04 


00.66 


24.06 
0.06 
1.20 
0.30 

20.60 


0.86 

2.04 

.80 

10.82 

23.00 



8 


4 


6 


6 


7 


1.06 
11.20 
.306 
.060 
.366 
16.32 


1.60 
8.61 
.411 
.073 
.484 
13.40 


1.30 
8.08 
.361 
.022 
.383 
13.12 


1.30 
8.68 
.134 
.101 
.326 
13.43 


aio 

8.42 
.123 
.002 
.266 

11.46 


6.43 


11.04 


10.62 


0.68 


1.16 


(B.60 


64.26 


61.10 


64.62 


73.47 


.86 


.64 


.17 


1.42 


.80 


1.87 307.00 


2.76 


1.00 


107.00 


2.23 


3.61 


2.92 


2.42 


1.87 


71.16 ; 79.80 


74.64 


76.72 


76.43 


28.84 

2.77 

1.21 

13.49 

29.00 


20.20 

2.12 

.03 

14.41 

31.90 


26.46 

2.06 

..90 

14.68 

32.30 


28.28 

X66 

L16 

11.68 

26.60 


23.67 

1.80 

.82 

13.97 

30.00 



8 




0.40 
6.66 
.144 
.136| 
.280] 
1L70 

4.10 

66.92 

1.16 

1.23 

1.39 

62.60 

37.60 

1.72 

.76 

16.60 

34.60 



0.41 
8.26 
.247 
.147 
.394 
12.00 

3.42 

66.83 

1.22 

2.06 

3.28 

75.63 

24.47 

1.67 

.60 

17.30 

38.60 



10 



0.33 
4.71 
.043 
.166 
.200 
7.90 

4.18 
59.63 

2.10 
.54 

2.64 

66.44 

33.56 

.77 

.84 

23.23 

61.40 



Ntimeros. 



^soe amoniaoal 

itoo de la urea 

Lsoe del ^do 6rioo 

itoe de las bases piMcas 

^soe pArioo total 

^soe total 

parte del &soe amoniaoal por 

lOOde&zoe total 

Parte del isoe de la urea por 

100 de &Boe total 

Parte del Axoe del Acido t!^co 

por 100 de Azoe total 

Parte de &soe de las bases ptbi- 

cas por 100 de &£oe total 

Parte &soe pi^rioo total por 100 

Aioe total 

Fraooldn de Asoe determinado 

por 100 

Fraoddn de Asoe indetermi- 

nado por 100 

Anhldrido fosfdrioo 

Pdsforo de los fosfotos 

Relaoi<5n ponderal 

Relaoidn atdmica 



11 



0.92 
10.48 
.273 
.110 
.383 
16.00 

5.75 
65.37 

1.71 
.60 

2.40 

73.52 

26.48 

2.40 

1.05 

15.24 

33.70 



12 



0.32 
10.78 
.322 
.143 
.465 
11.45 

7.79 

73. n 

2.81 

1.25 

4.06 

85.62 

14.38 

1.06 

.86 

13.31 

20.50 



13 



0.67 
5.70 
.157 
.118 
.275 
8.02 

7.54 

62.78 

1.76 

1.33 

3.09 

73.31 

26.00 
2.40 
1.05 
8.49 

18.80 



14 



0.54 

5.88 
.127 
.065 
.212 

8.47 

6.37 

60.08 

1.60 

1.00 

2.50 

77.95 

22.05 

1.84 

.80 

10.50 

23.40 



15 



0.06 
8.f>7 
.237 
.085 
.322 
13.26 

7.27 
65.83 

1.79 
.64 

2.43 

75.53 

24.47 

.92 

.40 

33.00 

73.00 



16 



17 



0.72 
10.7f» 
.220 
.040 
.260 
13.20 

5.50 
82.26 

1.68 
.31 

1.99 

89.75 

ia25 

2.06 

.91 

14.37 

31.70 



1.63 
6.64 
.164 
.051 
.215 
11.06 

14.75 

50.93 

1.48 
.46 

1.94 
76.58 

23.42 
2.57 
1.12 
9.89 

21.90 



18 



19 



0.80 
8.02 

.i7o; 

.092; 
.262 
11.43 

6.08 
78.04 

1.40 
.81 

2.30 

87.32 

12.68 

1.64 

.72 

17.26 

38.20 



1.64 
14.01 
.230! 
.062 
.292 
17.92 

9.15 
83.20 

1.29 
.84 

L63 

93.98 

6.02 

2.11 

.92 

18.39 

40.70 



20 



0.81 
7.50 
.177 
.063 
.239 
9.48 

8.50 
78.70 

1.75 
.66 

X41 

80.61 

ia39 

1.87 

.82 

11.62 

25.70 



PUBLIO HEALTH AND MEDIOIKE. 



89 



CuADBO lU-IV (Serie 2*).~02aM obrerch-ReparUei&n dd dgoe y rdaei&n ddfdrforo al 

dzoe. 



NADuraf* 



^loe amoniaoftl 

delanreft 

I del Addo Moo 

iioe do las bas6S pAiioM 

lIOo pAiloo total 

^100 total 

parte del Aioe amoniaeal por 

100 de Aioe total 

Parte del &Eoe de la urea por 

100 de ^Izoe total 

Parte del Aioe del Addo tkrloo 

por 100 de Aioe total 

Parte del&xoe de las bases p6- 

fioas por 100 de Aioe total. . . 
Parte Aioe pMoo total por 100 

AaoetoUl. 

Fraodte de Aioe determinado 

por 100 

Fraooite de Aioe indetermliia- 

do por 100 

Anhldrido fosfdrioo 

FMbro de los fosfatos 

Relaeidn ponderal 

Belaeidn attf mioa 



21 


22 


23 


24 


26 


26 


27 


28 


29 


0.26 
8.68 
.IOC 
.044 
.144 
6.46 


1.62 
0.72 
.193 
.061 
.244 
18.90 


0.24 
4.66 
.118 
.044 
.157 
7.60 


0.82 
6.00 
.143 
.044 
.187 
8.66 


1.60 
11.14 
.247 
.061 
.298 
13.12 


1.81 
9.41 
.170 
.026 
.196 
2.47 


1.07 
8.86 
.060 
.070 
.120 
7.26 


2.01 
6.88 
.140 
.182 
.272 
0.60 


1.11 
9.44 
.140 
.161 
.291 
13.74 


3.47 


11.63 


3.19 


3.70 


11.42 


14.63 


14.77 


20.74 


8.06 


66.28 


60.92 


62.18 


67.73 


88.99 


76.46 


68.10 


66.62 


68.70 


1.66 


1.39 


1.61 


1.66 


1.88 


1.36 


.09 


1.44 


1.10 


.68 


.87 


.60 


.61 


.89 


.20 


.99 


1.34 


1.10 


2.23 


1.76 


2.10 


2.16 


2.27 


1.66 


1.68 


2.78 


2.29 


61.98 


88.81 


67.42 


68.60 


97.68 


01.66 


69.56 


79.04 


79.06 


88.02 

.76 

.33 

19.54 

43.80 


16.60 

1.60 

.65 

21.38 

47.30 


82.68 

1.06 

.46 

16.30 

36.00 


86.41 

1.47 

.64 

13.63 

29.90 


2.32 

« 1.66 

.68 

19.22 

42.60 


8.46 

1.01 

.44 

28.34 

62.70 


30.46 

.87 

.38 

18.06 

41.90 


20.96 

2.11 

.92 

10.63 

23.80 


20.96 

2.74 

1.20 

11.45 

25.80 



80 



1.68 
6.27 
.143 
.126 
.268 
9.89 

16.99 

68.40 

1.44 

1.25 

xeo 

82.08 

17.02 

1.06 

.47 

21.04 

46.60 



Nomsfos. 


81 


82 


83 


34 


85 


86 


87 


88 


89 


40 


4^floe MnoiriacaK 


X25 
5.02 
.144 
.180 
.824 
10.75 

20.98 

46^70 

1.34 

1.67 

8.01 

60.80 

80.70 

2.11 

.92 

11.47 

25.4 


a 18 
11.20 
.140 
.068 
.222 
14.20 

5.49 

78.87 

.98 

.62 

1.60 
86.96 

14.04 
2.68 
1.17 

12.14 

26.9 


a86 
&32 
.123 
.018 

9.90 

&69 

84.04 

1.24 

.19 

1.48 

94.16 

5.84 

1.08 

.47 

21.06 

46.6 


.078 
18.84 
.260 
.216 
.475 
17.46 

4.47 

76.45 

1.49 

1.29 

2.78 
83.70 

16.80 
2.82 
1.01 

17.23 

8&1 


0.76 
6.77 
.154 
.038 
.187 
11.19 

6.79 

6a50 

1.88 

.20 

L67 
68.96 

81.04 
2.82 
1.01 

11.08 

24.5 


a77 
8.88 
.090 
.160 
.269 
11.22 

6.86 

78.68 

.80 

L51 

2.81 
87.85 

12.15 
2.81 
1 

11.22 

24.8 


a58 
7.17 
.196 
.061 
.246 
12.90 

4.60 

55.58 

1.51 
.40 

1.91 

n.99 

28.01 

1.76 

.77 

19.27 

42.7 


0.80 
4.28 
.811 
.065 
.866 
6.46 

6.04 

66.25 

4.88 

.85 

5.68 

76.97 

28.08 

L02 

.44 

14.40 

82.5 


a67 
&18 
.164 
.168 
.822 
11.78 

5.68 

69.44 

1.89 

1.84 

2.78 

77.85 

22.15 

2.19 

.96 

1L12 

24.6 


0.26 


Asoe de la nraa 


7.84 


A.aoe del Acklo dHoo 


.180 


Aaoe de las bases p^blcas 

Axoeptlrloo total 


.002 
.272 


JLsoeiot&l 


10. 


parte del 4aoe amoniaoal por 
100 deisoe total 


2.60 


Parte del Asoe de la urea por 
100 de Axoe total 

Parte del 4soe del 4cido drloo 
por 100 deisoe total 

Parte del 4soe de las bases 
pOiicas por 100 de&soe total. 

Parte 4soe poiloo total por 
parte Asoe porloo total por 
lOO&soetotaL 

por 100 


74.40 

LOO 

.08 

2.72 
08.72 


Fraoddn de Aaoe Indetermi- 
nadopor 100 


21.28 


Anhidrfdo Ibsfonoo 


2.14 


Fdsforo de los fo3hit08^ X 


.08 


Rdaddn ponderaL 


10.75 


Relarl<!^n at<Ttni<ni 


28.8 







GuADBO V-VIII (Serie 2*). — Cla$e aeomodadar—RepartiMn del dioe y relaei&n dd 

/6$/oro (U dzoe. 



Ndmeros. 


41 


42 


48 


44 


46 


46 


47 


48 


r' ^K>e amoniaical 


0.U 
5.46 


0.71 1.52 
8.70 . 8.20 


0.88 
0.07 
.083 
.060 
.142 
10.40 
7.98 
87.21 
.80 

.67 
L45 

96.64 
8.86 
1.27 
&19 

8L1 


1.12 
6.99 
.100 
.081 
.181 
ia68 
10.64 
66.62 
.96 

.76 
LH 
68.92 
81.08 
.61 
17.84 
8&4 


0.61 
5.66 
.143 
.133 
.276 
0.76 
6.02 
66.86 
1.47 

1.86 
2.88 

64.71 

85.29 
.98 

10.49 

28.2 


1.96 
11.71 
.140 
.196 
.836 
16.81 
11.60 
60.66 
.83 

1.16 
1.99 

88.26 

16.75 
1.13 

14.88 

82.9 


1.82 


J kioe de la urea. 


8.87 


- Ltoe dd icido ilrioo 


1.076 .078 .197 
.084 .040 .081 
.160 .113 .278 

0.13 10 14.07 


.168 


J kioe de las bases Ddncas 


.006 


Aioe irtlrioo totAl ^ ^ .s^^.s. 


.218 


Asoe totAi T , 


18.70 


Parte del 4soe amoniaeal por 100 de 4soe total. 
Parte del &soe de la urea por 100 deisoe total. 
Parte delAxoedeiddo Moo por lOOdeAsoe total 
Parte del &soe de las bases ptiricas por 100 de 
4ioe total , . . . . ..... 


4.47 7.10 

69.80 37.90 

.88 .78 

.90 ' -40 


10.80 

58.28 

1.40 

.67 
1.97 
71.06 
28.96 
.64 
2L98 
48.7 


0.08 

61.00 

1.19 

.40 


Parte4ioepmioo total por 100 &M>e total 

Frarf!i<)ii de 4ioe detflrmlruido por 100 


1.78 
66 

0.18 
20.2 


1.13 
46.13 
58.87 
.66 
16.88 
84 


1.60 
72.81 


PraccUSnde&soeindetennliiadoporlOO 

Anhidrfdo fwf^W^ . 


27.60 
L20 


Rela(d6n ponderal 


L43 


Rftefitfn at^^to^ . ... 


SL4 







90 



PBOOEBDIKGS 8E00KD PAK AMBBIOAK 80IBKTIFI0 OOKOBEBS. 



GuADBO V-VIII (Serie 2*).— CIom ocomodadtt-'ReparHeiAn dd dzoe y relaei&n del 

fdsforo al 6xo€ — OontiQiia. 



Ntbneros. 



ksoe amonlacal 

i.so6 de la urea 

kioc del Aoido flrioo 

i.foe de Ifls bases pdiioas 

Lioepdnoo total 

Lxoe total 

parte del &toe amooiacal por 

100 de 4soe total 

Parte del &«>e de la area por 

100 del &aoe total 

Parte del &soe del 4cido drlco 

por 100 de &«>e total 

Parte &£oe pOnoo total por 100 

del &soe total 

Parte &zoe pt^rioo indetermi- 

nado por 100 de &toe total. . , 

Anhidrldo fosfdiico 

Fitaforo de los fosratos 

Belacidn ponderal 

Relacidn atdmica. 



a82 
6.38 
.144 
.147 
.291 
8.80 

9.88 
76.87 

1.77 

90.25 

9.75 

2.16 

.95 

8.69 

29 



0.79 
8.48 
.154 
.092 
.246 
12.91 

0.13 

65.22 

.80 

73.83 

26.67 

2.10 

.92 

14.06 

3L1 



8 



1.14 
10.52 
.134 
.066 
.200 
14.07 

8.10 

74.77 

.47 

84.31 

16.60 
2.68 
1.17 

12.01 

26.1 



L88 
&54 
.821 
.147 
.468 
12.40 

11.13 

68.87 

1.10 

83.36 

16.64 
2.48 
1.08 

11.44 

25.5 



1.38 
7.89 
.277 
.070 
.347 
13 

10.61 

60.19 

.64 

78.69 

26.41 
1.25 
1.54 

23.85 

62.8 



6 



086 
&96 

.1771 
.191 
.3681 
11.36 

7.48 
78.88 

1.68 
89.60 

10.40 
LOO 
1.70 

16.26 

36 



1 

11.67 
.184 
.088 
.272 

16.21 

6.17 

71.99 

.64 

79.83 

20.17 
2.40 
1.05 

15.45 

34.3 



8 



1.21 
13.44 
.147 
.180 
.327 
19.80 

6.62 

67.88 

.01 

76.16 

23.86 

1.36 

.60 

33.56 

74.3 



10 



084 
10.06 
.187 
.206 
.393 
12.09 

6.62 
79.27 

1.62 

88.98 

11.02 

1.13 

.49 

26.90 

57.3 



0.07 
0.93 
.080 
.125 
.205 
12.64 

6.34 
79.11 

1 

86u07 

13.93 

L40 

.61 

20.62 

46.4 



NtUneros. 



isoe amoniacal 

^Koede la urea 

del ^ido drico 

.toe de las bases pdrlcas 

ksoepdrlco total 

Parte del axoe amoniacal por 

100 de &soe total 

Parte del Asoe de la urea por 

100 de izoe total 

Parte del &Eoe de Aoido drioo 

por 100 de&zoe total 

Parte del &soe de las bases 

ptkioas por 100 izoe total... 

Parte ilsoe purloo total por 100 

de&£oe total 

Fracoidn de Aioe determinado 

por 100 

FriBccidn de Asoe Indetermln- 

ado por 100 , 

Anhidrldo fosfdrioo 

Fdefbrode los fosfatos 

Relacidn ponderal 

Relacidn atdmioa 



11 



1.21 
15.03 
.100 
.110 
20.80 

6.72 

72.46 

4.70 

6.26 

10.06 
88.22 



11.78 
2.88 
1.25 

16.70 

37 



12 



0.79 
6.72 
.174 
.200 
12.40 

6.21 

64.19 

1.40 

1.66 

3.06 
63.46 



36.64 

1.60 

.70 

17.71 

39.2 



13 


14 


16 


16 


0.63 
4.55 
.190 
.059 
7.68 


0.36 
9.41 
.304 
.055 
11.78 


1.37 
12.50 
.217 
.108 
17.20 


0.66 
5.44 
.130 
.092 
7.06 


8.22 


3.06 


7.96 


9.35 


69.24 


70.88 


72.74 


76.49 


2.46 


2.68 


1.26 


1.69 


.77 


.47 


.63 


1.30 


3.22 
70.66 


3.06 
85.99 


1.89 
82.50 


2.99 
88.83 


29.32 
1.36 
.59 
13 
28.8 


14.01 

2.21 

.96 

12.37 

27.4 


17.41 

2.34 

1.02 

16.86 

37.3 


11.17 

1.21 

.53 

13.21 

29.2 



17 



0.76 
14.89 
.137 
.099 
19.26 

3.05 

77.81 

.71 

.51 

1.22 
82.68 



17.42 

3.00 

1.57 

12.27 

27.2 



18 


19 


0.96 

11.84 

.200 

.177 

15.68 


0.91 
12.05 
.130 
.147 
14.12 


6.12 


6.44 


75.45 


86.34 


1.27 


.92 


1.29 


1.04 


2.56 
84.13 


1.96 
93.74 


16.87 

1.86 

.81 

19.26 

42.6 


0.26 

2.28 

.99 

14.28 

31.6 



20 



1.24 
10.33 
.284 
.177 
14.39 

8.68 

73.31 

1.64 

.81 

3.46 
83.34 



16.66 

1.96 

.85 

16.81 

37.3 



Ndmeros. 



Lsoe amoniacal 

ksoede la urea 

dellUsido drioo 

itoede las bases pdricas 

isoe ptMoo total 

Lsoe total 

Parte del &soe amoniacal par 100 de &soe total 
Parte del Azoe de la urea por 100 de Asoe total. 
Parte del Aioe del Aoido orico por 100 de &Eoe. 
Parte del &soe de las bases pdrioas por 100 de 

<Lsoe total 

Parte &zoe purico total por 100 &Eoe total 

Fraocidn de Azoe determinado por 100 

Anhidrldo fosfdrioo 

Fdsforo de los fosfotos 

Relaoldn ponderal 

Relacidn atdmioa 



31 



1.24 ! 
10.85 
.060 
.066! 
.146 
16.48 
7.62 
65.84 
1.47 

.40 

.87 

74.23 

2.40 

1.05 

15.69 

34.7 



22 


28 


24 


0.99 


1.03 


0.85 


9.46 


7.86 


6.70 


.137 


.140 


.214 


.121 


.018 


.117 


.248 


.158 


.331 


12.62 


11.88 


8.10 


7.91 


8.67 


10.49 


75.56 


66.17 


70.37 


1.01 


1.18 


2.64 


.97 


.15 


1.44 


1.98 


1.33 


4.06 


85.45 


23.83 


15.06 


1.92 


1.80 


1 


.84 


.78 


.44 


14.67 


16.23 


18.41 


32.6 


33.7 


40.8 



25 



0.66 
9.68 
.10(^ 
.059 
.159 
14.50 
4.55 
66.76 
.60 

.41 

1.10 

27.59 

1.88 

.82 

17.68 

39.1 



26 


27 


0.96 


0.10 


11.20 


11.27 


.196 


.210 


.026 


.087 


.221 


.247 


15.50 


13.58 


6.19 


8.10 


72.26 


82.90 


1.25 


1.54 


.17 


.27 


1.42 


1.81 


20.13 


7.19 


1.55 


2.62 


.68 


1.14 


22.79 


11.91 


50.4 


36.4 



38 



1.06 
13.33 
.324 
.037 
.361 
16.46 
6.44 
74.85 
1.36 

.22 

1.68 

17.13 

3.11 

.93 

16.80 

37.3 



FUBLIO HEALTH AND MEDIOIKE. 



91 



CuADRO I'll (Serie 2).—R€partici6n dd dzoe 6 rilacidn ddfdsforo al dzoe. 

[AnAUsis hoohos en TuQja.] 



Ntkmeros. 




amoninoal 

de la area , 

del Acido Ailoo 

de las bases pAiioas 

Asoe pdrlco total 

Azoe total 

Parte del 4xoe amonJacal por 

100 de &ioe total 

Pftrte del &soe de la urea por 

100 de &zoe total 

Parte del &soe del Addo tirico 

por 100 del 4«>e total 

Parte del 4soe de las bases 

ptaicas por 100 de &ioe total . . 
Parte del azoe pt^rico total por 

100 de &zoe total 

FraockSn del&ioe determinado 

por 100 

Fraocidn del &soe indetermina- 

do por 100 

Anhidro fosfdrlco 

F<toforo de los fosftitos 

Relacidn ponderal 

Relacidn atdmtca 

Ndmeros. 

ksoe amoniacal 

de la urea 

ksoe del &cido Arico 

^soedelas bases pdrlcas 

^zoe pt^rico total 

Lsoe total 

Parte del &soe amoniacal por 

lOOdeisoe total , 

Parte del &soe de la urea por 

100 del &zoe total 

Parte del 4soe del Addo Arico 

por 100 de &ioe total 

Parte del 4zoe de las bases 

pAricas por 100 de&zoe total. . 
Parte del acoe pArico total por 

100 de 6.toe total 

Fracddn del&soe determinado 

por 100 

Fracddn del &soe indetermina- 

do por 100 

Anhidro fosfdrloo 

Fdsforo de los fosfatos 

Reladdn ponderal 

ReiackSn atdmica 



0.81 

7.50 

.18 

.062 

.242 

12.35 

6.56 
60.73 

1.46 
.50 

1.96 

77.75 

22.25 

1.87 

.82 

14.90 

11.1 



0.89 

4.28 

.81 

.0601 

.37 

6.46 

6.04 
66.25 

4.83 
.85 

5.68 

76.97 

23.03 

1.02 

.44 

14.40 

32.5 



8 



0.87 
13.40 
.243 
.087 
.280 
15.07 

5.77 
82.28 

1.59 
.25 

1.84 

89.89 

10.10 

2.22 

.97 

15.55 

34.4 



0.62 

7.n 

.167 
.018 
.185 
10.09 

6.14 
76.41 

1.68 
.18 

1.86 

86.27 

13.73 

1.33 

.58 

17.33 

38.5 



0.36 
9.41 
.804 
.055 
.350 
11.78 

8.06 
79.88 

2.58 
.47 

3.05 

85.99 

14.01 

2.21 

.90 

12.37 

27.4 



0.30 

10.18 

.14 

.062 

.202 

14.12 

2.12 

73.10 

.08 

.44 

1.42 

76.64 

23. 3C 

2.12 

.93 

14.10 

51.2 



0.86 

7.04 

.16 

.0701 

.23 

9.36 

11.32 

75.21 

1.70 
.75 

2.45 

88.98 

11.02 

1.56 

.69 

15.30 

33.9 



8 



0.93 

4.75 

.27 

.1101 

.38 

9.00 

10.33 

52.74 

3.00 

1.22 

4.22 

67.29 

32.71 

1.20 

.52 

17.30 

38.3 



0.58 

6.41 

.30 

.060 

.36 

11.95 

14.85 

52.89 

2.61 
.52 

3.13 

60.87 

39.13 

2.61 

.93 

12.85 

28.4 



10 



0.46 
3.31 
.31 
.001 

.88 
6.77 

7.80 

57.37 

3.64 

1.12 

4.76 

69.93 

30.07 

1.49 

.65 

8.88 

12.3 



11 


12 


0.39 


0.73 


5.92 


7.26 


.23 


.12 


.93 


.185 


.323 


.305 


7.20 


10.99 


5.36 


6.64 


82.22 


66.05 


4.55 


1.09 


1.29 


1.68 


6.84 


3.77 


93.42 


75.46 


6.58 


24.54 


1.47 


1.49 


.64 


.65 


11.35 


16.91 


24.09 


37.04 



13 



14 



15 



0.59 

7.51 

.21 

.131 

.341 

11.97 

4.97 

66.26 

1.75 

1.18 

1.93 

73.15 

26.84 

1.58 

.60 

17.35 

35.3 



0.49 

6.75 

.18 

.118 

.298 

13.09 

4.05 
55.00 

1.49 
.98 

3.47 

60.52 

39.48 

2.36 

.63 

11.72 

25.9 



0.54 

7.49 

.26 

.070 

.330 

11.81 

4.57 

63.42 

2.20 

.593 

.793 

70.78 

29.22 

3.17 

.94 

12.56 

27.8 



16 



17 



18 



19 



a82 

5.19 

.20 

.134 

.339 

9.26 

8.96 

56.72 

3.31 

1.506 

3.718 

69.39 

30.61 

1.94 

.85 

10.76 

23.8 



1.09 

7.19 

.11 

.053 

.163 

13.46 

8.13 

53.73 

.82 

.895 

1.215 

74.07 

25.93 

1.20 

.52 

25.77 

57.00 



1.38 

7.54 

.25 

.072! 

.322 

14.04 , 

9.83 I 
53.53 I 

1.85 i 
.513 

2.363 

65.72 

34.28 

1.20 

.52 

27.38 

60.6 



1.26 

7.17 

.19 

.106 

.296 

13.44 

9.37 
53.34 

1.41 
.79 

2.20 
64.91 

35.09 
2.56 
1.12 

12.00 

26.6 



20 



0.59 

7.00 

.15 

.263 

.413 

13.80 

4.23 

51.23 

1.09 

1.18 

2.27 

57.73 

42.27 
2.70 
1.18 

11.69 

25.9 



Promedios de Bogotd, 





Clase 
obrera. 


Clase 
acomodada. 


Promedios 
genoraks. 


Densidad 


1.018 
1.727 
.037 
11.29 
1.37 
16.84 
1.12 
.52 
.26 
1.18 
7.86 
.174 
.006 
.270 
10 
69.71 


1.021 
1.590 
.044 
13.69 
1.16 
21.21 
1.12 
.62 
.26 
.95 
9.90 
.174 
.092 
.6226 
6.99 
72.11 


1.019 


Volumen en 24 


1.668 


Aoides(enH) 


.040 


Asoe total 


12.44 


AmnnfAiV> V A'HdOfl ftJOifV^doil . . . , „ . , 


1.26 


TTrea 


19.02 


Burlnas totales (en&ddoilrioo) 


1.12 


Acido drico .a - T 


.62 


Bases nOricas (•!> zantlna) , - - r - - , . . . . 


.26 


>«<>© aim>nlacal ^ r - r r , . , . . . 


1.04 


.mthf A» la urea 


8.88 


>soe del Arldo Aflco 


.174 


.Boede las b^um i>(lri'^a9 .s. 


.004 


.loepftrlno total! 


.368 


Parte'del Asoe amoniacal por iOO de Asoe totie^l.^ 


8.49 


Parte del Asoe de la urea por 100 deAioe total 


7a 91 



92 



PROCEEDINGS SECOND PAN AMBBICAN SCIENTIFIC CONGRESS. 



Promedios de BogtM — Contin6a. 



Parte del &«>e del &oido Arico por 100 de Asoe total . . 
Parte del &soe de las bases pdnoas por 100 Axoe total. 

Parte del Aoldo tlrico total por 100 de Asoe total 

Fiaccidnde&soedeterminadoporlOO 

Fracddn de Azoe indetermlnado por 100 

Indlce de imperfeocidn ureog6nica por 100 



Coeflciente de trasformacidn de los ntideoproteldeos por 100. 

Anhldrido fostdrico 

Fdsforo de los (osratos 

Relaoidn ponderal 

Relaoi6n at^mioa 



Oaie 


Claae 


obrera. 


AOOTnodada. 




1.54 


1.28 


.86 


.68 


2.30 


1.96 


82.10 


81.00 


17.99 


18.94 


12.64 


8.86 


04.48 


65.8 


1.91 


1.97 


.76 


.86 


14.86 


15.80 


1:32.9 


1:35 



Promedios 



1.41 

.76 

2.17 

81.58 

18.42 

10.09 

1:64.82 

n:02.90 

1.94 

.81 

15.82 

1:33.9 



{ 



Promedios de Tunja. 



Densidad 1014 

Volumen en 24 horas 2548cc 

Acidez (en H) 068 

Azoe total 11. 19 

Amoniaco y dcidos aminados 89 

Urea 15.40 

Purinas totales (en ^ido drico) . . 1. 22 

Acido tirico 56 

Bases ptiricas (en xantina) 229 

Azoe amoniacal 75 

Azoe de la urea 7.10 

Azoe del dcido tirico 18 

Azoe de las bases ptuicas 11 

Azoe ptuico total 29 

Parte del 4zoe amoniacal por 100 

de dzoe total 6. 70 

Parte del 4zoe de la urea por 100 

dedzoe total 63.44 



Parte del 4zoe del dcido tirico por 

lOOdedzoe total 1.62 

Parte del &zoe de las bases ptuicas 

por 100 de dzoe total 98 

Parte del &zoe pdrico total por 

100 de dzoe total 2. 60 

Fracci6n de dzoe determinado 

por 100 72.74 

Fracci6n de izoe indeterminado 

por 100 27.26 

Coeficiente de trasfonnacidn de los 

nucleoproteidos por 100, 1 60. 23 

Coeficiente de trasformacidn de los 

nucleoproteidos por 100, II 60. 07 

Anhidrico fosf6rico 1.86 

F^sforo de los fosfatos 81 

Relaci6n ponderal 21. 22 

Relaci6n at^ica 1:46. 9 



Promedios geneniUi. 



Densidad 1. 016 

Volumen en 24 horas 2.103 

Acidez (en H) 054 

Azoe total 11. 81 

Amoniaco y dcidos aminados 1. 07 

Urea 17.41 

Purinas totales (en dcido drico). . 1. 17 

Acido tirico 54 

Bases ptiricas (en xantina) 27 

Azoe amoniacal 89 

Azoe de la urea 7. 99 

Azoe del ^ido tirico 096 

Azoe de las bases ptiricas 102 

Azoe pdrico total 148 

Parte del dzoe amoniacal por 100 

de 4zoe total 7. 59 

Parte del dzoe de la urea por 100 

dedzoe total 67.17 



Parte del &zoe del dcido tirico por 

100 de dzoe total 

Parte del dzoe de las bases pdri- 

cas por 100 de &zoe total 

Parte del ^oe pdrico total por 

100 de &zoe total 

Fracci6n de &zoe determinado 

Fraccidn de ^oe indeterminado. . 
tndicede imperfecci6nureog6iiica. 
Coeficiente de trasformaci6n de los 

ndcleoproteidos por 100, I 

Coeficiente de trasformaci6n de los 

ndcleoproteidos por 100, II 

Anhidrido fo8f6rico 

F6sforo de los fosfatos 

Relaci6n ponderal 

Relacidn aUSmica 



1.51 
.87 

2.38 
72.76 
22.84 

9.92 

62.52 

62.48 

1.90 

.81 

18.27 

36.56 



PUBLIC HEALTH AKD MEDICINE. 



93 



Di8cusi5n db LOS Rbsultados Obtbntoos. 

Si 86 quiere sacar alguna ensefianza del cuadro de promedioe de los noventa y seis 
an^isis en general, de cada clase social en particular, es indispensable conocer el 
lesultado de an^lisis hechoe redentemente en Europa y tenidos sdll como precisoe. 

La comparaci6n posterior entre loe resultadoe obtenidos en Bogotd y los obtenidos 
en Tunja, noe dar& preciosas ensefianzas sobre el metabolismo azoado entre nosotros. 

Antes de hacer comparaciones y como punto de partida, voy a permitirme trascribir 
el cuadro de resultadoe medios obtenidos por Maillard, el cual es considerado en 
Francia ''como uno de los documentos m^ completos que se poeee en la hora actual 
sobre la orina del hobre con regimen mixto, puesto que los andlisis se hicieron por loe 
procedimientoe m^ precisos conocidos hasta entonces y que cada una de las cifras 
del cuadro representa el promedio de sesenta determinaciones/' Tiene ademds, en 
el caso presente la inmensa ventaja de que los resultados fueron obtenidos casi en su 
totalidad y con ligeras variaciones, por los mismos m^todos de andlisis empleadoe 
por mi. 

He aquf estoe promedios de eliminaci6n en veinticuatro horas: 

Parte del ^oe del ^do tirico 

por 100 de izoe total 1.43 

Parte del &zoe de las bases ptiri- 

cas por 100 de dzoe total .22 

Parte del dzoe silicottigstico 

por 100 de dzoe total 57 

Fracci6n determinada de 4zoe 

por 100 88. 86 

Fracci6n indeterminada de 

&zoepor 100 11.15 

Anhidrido fosf^rico 2.19 

Fdsforo de los fosfatos 96 

Relaci6n at6mica 1:37.9 



Volumen 


1.810 


Addez (en hidr6geno) 

A moniftco . . . t t .,,,,,,- 


.045 
1.11 


Urea 


27.64 


Purinftfl biiflicM 


.10 


A zoe total 


15.87 


Azoe amoniacal 

Azoe de la urea 

Azoe ptirico total 

Azoe del 4cido tirico ; . . . 


.91 
12.09 
.262 
.227 


Azoe de las bases pMcas 

Azoe silicottingstico 

Parte del izoe amoniacal por 
100 de izoe total 


.035 
.090 

5.73 


Parte del dzoe de la urea por 100 
de izoe total 


81.29 



Si se comparan estos resultados con mi cuadro de promedios se observan diferendas 
considerables en la mayor parte de las dfras: diferendas que no pueden atribuirse a 
errores de ttoiica porque, como ya dije, los an^isis se hideron por los mismos m^todos 
que emple6 MaHlard y algunos procedimientoe mia precisos no conoddos en la 6poca 
en que hizo sus an&lisis este distinguido fisidlogo. Adem&s, los reactivos fueron 
titulados con el mayor escruptilo y usando medidas de las m^ precisas conoddas, 

Analicemoe separadamente: 1^. Los productos de desintegrad6n albiuninoidea. 
2^. Los de de8integrad6n ndcleo proteica: (3°) dzoe total. (4^) izoe indeterminado. 
(5**) fdsforo. (6**) addez. 

I. Productos de denntegraci&n albuminoidea. — ^Lo primero que llama la atend6n al 
hacer la comparad6n de los dos promedios es que hay en los mfos una disminud6n de 
la urea (de 10.23) disminud^n m^ considerable que la encontrada por el Dr. del Rfo 
pues 61 encontr6 en algunos casos hasta 36 gramos en las 24 horas. Es posible que esta 
deeproporci6n de cifras obtenidas en la misma localidad sea debida a que el Dr. del 
Rio al medir la urea por el procedimiento gasom^trico no elimin6— o no lo hizo hasta 
donde es posible hoy — ^las causas de error debidas a las variadones de temperatura y de 
pred6n atmosf^ca asi como las causadas por el icido drico, las bases pdricas y el 
amoniaco. 

Esta disminud6n de la excred6n de la urea entre noeotros en parte relativa 
porque hay al mismo tiempo una disminud6n del izoe total diferenda que es de 4.06 
en las 24 horas. Pero se ver4 que la primera es tambi^n real si se compara la dira 



94 PROCEEDINGS SECOND PAN AMEBICAN SCIENTIFIC C0N0BE8S. 

que representa la relaci6n entre el dsoe de la urea y den partes de &zoe total que es 
entre noeotros de 67.17 y en Eiuropa 81.29 segdn Maillard: y eegtin DeQg[rez y Aysignac, 
quienes se fundan en un gran ndmero de an&lisis, ee como eigne para loe diferentes 
regfmenes: 

Regimen l&cteo absolute 86, regimen mixto (leche nuevoe vegetalcs) 86, regimen 
mix to (lacto-vegetariano) 81, regimen mixto d^bilmente cameo, 82, regimen mixto 
(vegetariano absoluto) 78. 

Comparando abora loe andlisis de Tunja con loe de Bogota, observamoe una diferen- 
cia en favor de 6etoe de 3.62 para la cifra de la urea y de 7.47 para la relaci6n entre 
el dzoe total y la urea. Dato muy intereeante que debe tenerse muy presente para 
las conclusiones de este estudio. 

Es verdad que para dosar la urea emplee m^todoe diferentes de los del experimen- 
tador cuyos datos estdn sirviendo de comparaci6n pues 61 emple<5 el de Folin en tanto 
que yo emple6 el gasom^trico; pero las causas de error de que adolece este tiltimo 
fueron corregidas en gran parte; por otra parte el error si existi6 debi6 ser por exceso 
por falta do una completa precipitaci6n del dcido drico y de las bases pdricas; por 
dltimo; existe el antecedente de la igualdad de los resultados obtenidos por Desgrez 
y Ayrignac con el m^todo gasom^trico y los de Maillard con el de Folin. 

En cuanto al amonlaco, se observa, en los anilisis de Bogotd un aumento de 0.15 
con respecto al cuadro, lo que estd de acuerdo con la disminucidn de la urea. 

En los andlisis de Tunja se observa al contrario una disminuci6n; pero si en vez de 
tener en cuenta la sola cifra del amonfaco se considera la del dzoe amoniacal con rela- 
ci6n al dzoe total, se ver& que esta diBminuci6n no es sino aparente pues hay en favor 
de los an&lisis de Tunja, un aumento de 1.07 con relaci6n al cuadro que sirve de 
patr6n. 

Hay pues siempre una relaci6n, mis o menos exacta entre la disminucidn de la 
urea y el aumento del amonfaco. 

Es de notar que para medir el amonfaco emple^ el procedimiento de Ronchese, con 
las mismas correcciones con que lo emple6 Maillard. 

Como se hace m^ patente esta diferencia, es comparando los fndices de inperfec- 
ci6n urog^nica que son, segtln el cuadro del autor copiado arriba, de 6.58 por ciento. 
Aplicando el calculo a los an&lisis de Donze y Lambling, se encuentra 6.12. 

Estas cifras varfan segtin Lauzenberg^ con el regimen alimenticio: El r^lmen 
licteo da valores mis d^biles (4.28) y el camoe miis fuertes (6.31). (Es decir menores 
que los obtenidos por VaQlard con regimen mixto). El vegetariano da valores medios 
(5.21). 

Cualquiera que sea el valor que se atribuya a loe resultados que menciono, es precise 
observar que existe entre nosotroe un aumento de este coeficiente, mucho mayor para 
las clases pK)bre8 que para las clases acomodadas. Y que el promedio de Tunja que 
se refiere a individuos m^ mal que bien alimentados, es mayor que el de la clase 
acomodada de Bogotd. 

Es verdad que todavfa no se c<fnocen bien las variaciones fisiol6gicas de este coefi- 
ciente, pero dada la desproporci^n que existe entre las cifras apuntadas y las obtenidas 
por mf , es precise concluir que existe entre nosotroe (y quizi un poco m^ en Tunja 
que en Bogotd) una imperfecci6n en la transformaci6n de las albuminoideas o sea una 
insuficiencia de la actividad global del oiganismo para el conjunto de estos tres fen6- 
menos: separaci6n reductiva o hidrolftica del amonfaco, oxidaci6n de los 4cidos grasoe 
y deshidrataci6n del carbonato de amonfaco, lo que se comprenderi fdcilmente si 
se recuerdan las trasformaciones que su&en los amino^idos que llegan hasta la urea; 
de aquf que este fndice haya side llamado tambi^n coeficiente de oxidaci6n verdndero 
o de los ^idoe grasos. 



1 Tesis de Paris, 1812. 



PTTBLIO HEALTH AND MEDICINE. 95 

Eete aumento de la imperfecci6n urog^ca puede ser debido: a la calidad del 
regimen alimenticio, a una inmificiencia hepdtica, a una lentitud de laa oxidacionee o 
del metaboliflmo en general, laa qua a su tumo pueden depender de otras tantas causaa 
qua analizar^ m&B adelante. 

(a) El regimen cameo aumenta y el regimen vegetaiiano disminuye el coeficiente 
en cuestidn: eeto porque, como se vi6 atr&B los dcidos, que se fonnan en el organismo, 
icidoB que reeultan sobre todo de la deeintegraci6n de los albuminoideos animalee, 
retienen fuertemente el amoniaco y le impiden seguir su tranirfonnaci6n hada la 
urea. 

Entre noeotroe no parece que se deba atribuir a esta causa el aumento del coefi- 
ciente I^ porque la observacidnnos ensefia que nuestras clases acomodadas consumen 
mucha menos came que la que se consume en los palses latinos de Europa (menos 
camlvoros que los sajones). 

8egtin se deduce de los autores que he podido consultar a este respecto, la cifra 
media de came consumida por cada individuo en Paris es, como se ver4 m^ adelante, 
superior al miximum de nuestras clases acomodadas: (2°) Porque el aumento es mayor 
en las clases pobree cuya alimentaci6n es especialmente vegetaiianae bidrocarbonada 
y (3^) porque los mismos andlisis de las orinas dejan ver que, al menos en Bogotd, 
no hay un aumento de la acidez pues esta cilra es inferior la obtenida por Maillard, 
lo que indicarfa mis bien un predominio del regimen vegetariano. 

(b) Podria mis bien pensarse en una insuficiencia hepdtica, teniendo en cuenta 
que el Indice de imperf ecci6n iurog6nica es mucho mayor en nuestras clases trabajadoras 
las que, como se sabe ingieren una gran cantidad de alcohol en la chicha, bebida que 
constituye en muchos de estos individuos casi la totalidad su alimentaci6n. 

(c) Pero puesto que la cifra es tambi^n elevada en las clases acomodadas, fuerza es 
concluir que si la causa de que acabo de hablar existe o puede existir por la insufi- 
ciencia de la alimentaci6n animal que obligarfa a recargar las vfas digestivas con un 
exceso de alimentos vegetalee lo que serfa causa de insuiiciencia hepdtica hay otros 
datos consignados en el curso de este estudio que no podrfan pasar inadvertidos como 
son: la baja de temperatura, de gl6btilos rojos y de hemoglobina, lo que obliga a creer 
en una lentitud entre nosotros de todas las trasformaciones orginicas quizi por insu- 
ficiencias glandulares que traen consigo insuficiencias de fermentos. 

Ahora: llevando las cosas hasta donde es posible, al terreno de un r^^en alimenticio 
semejante, podrfan como ya dije, considerarse los sujetos de mis experimentos en 
Tunja como pertenecientes a la '^clase obrera" de Bogot4. 

Hay en aqu^llos un aumento con relaci6n a 6stos, aumento que no estarfa en rela- 
ci6n con la ligera disminuci6n de gl6bulos rojos y de temperatura. Adelante se veri 
alguna explicaci6n a este fen6meno, pero serla imprudente f ormular conclusidn alguna 
dado el pequefio ntimero de mis observaciones de Tunja con relaci6n a los de Bogotd. 

II. Producios de desintegraddn ndcleo proteidica: Indice de su trQns/ormaci6n. — 
Obs^rvese que las cifras que repreeentan el acido drico y las bases ptiricas son casi 
id^nticas en el cuadro de Bogotd (0.78) y en el de Maillard (0.77). Muy ligeramente 
aumentados en el de Tunja (0.81): lo que indica que la alimentaci6n nucleo-proteica 
es casi la misma entre nosotros y los individuos que sirvieron de ob8ervaci6n a Maillard. 
Pero hay mis: comparando las dos cifras, en que estdn divididos los promedios de 
Bogoti se ve que casi son id^nticas en la *'clase obrera'' y en la clase acomodada lo 
que, dada la diversidad de regimenes alimenticios, parece a primera vista inex- 
plicable; pero si es verdad que nuestros obreros no consumen todo el caf^, el te y el 
cacao que consumen las clases acomodadas, consumen en cambio chicha, la que por 
sus levaduras da gran cantidad de purinas y por su alcohol y sus toxinas, destmye 
probablemente una gran cantidad de nticleoproteidas orginicas. 

Si se comparan las cifras que representan el porcentaje en reladdn con el izoe total, 
se veri que nosotros ingerimos o destruimos una mayor cantidad de ndcleo proteidas, en 



96 PBOOEEDINGS SECOND PAK AMBBIOAN SOIBlfrnFIO C0KGBES8. 

relaci6n con las albuminoideas. Pero a pesar de la igoaldad de las cifras, el desa- 

cuerdo vuelve entre mis anilisis y los que ban servido de comparacidn con los europeos, 

si se divide la dfra de las purinas en sus dos factores: icido drico y bases ptiricas, hay 

para el primero un deficit en mis anAlims de 0.16 en los anjUims de Bogota y de 0.12 en 

los de Tunja, y para la 8eg:unda un aomento de 0.17 en los de Bogota y de 0.19 en los de 

Tunja. 

Despu^ de observar que mis anAlisiH de estas sustancias fueron hechos por los mismos 

procedimientos que emplearon Donze y Lambling, Maillard y Boudrez con algiinaa 

variaciones respecto al icido drico por procedimientos mis modemos y por un estudio 

detenido de los distintos m^todos (veise pig. 78-79) es precise concluir que hay entre 

nosotros un aumento de los t^rminos intermedioe de la tranflformaci6n de los nticleoe 

proteidas, a expensas del tannine final de estas transformaciones; sucede, por consi- 

guiente, algo muy semejante a lo que pasacon la deeintegraci6n de las albuminoideas 

con la sola dif erencia de que en el case presente (probablemente por la menor interven- 

ci6n del higado) la dif erencia no existe entre la clase acomodada y la clase obrera, pero 

al estudiar larelaci6n, veremos que hay entre los anilisis de Bogoti y los de Tunja, una 

dif erencia en contra de 6stos. 

Queda pues, desde este punto de vista, justificado mi coeficiente detran8{ormaci6n 

de las ndcleoproteidas que podrf a llamarse tambi^n de oxidaci6n o de de6amidaci6n 

vistoB los distintos grados de deeintegraci6n porque pasan estoe cuerpos (v6anse pig. 

73 y siguientes). 

^ ^ . Az A. U. 

Este coeficiente ^^ p >p 

es, segdn mi cuadro de anilisis de Bogoti, de 64.87 por ciento con mha dif erencia de 
0.80 en favor de la clase acomodada y de 60.23 en los promedios de Tunja; es decir, 
que hay una dif erencia en favor de Bogoti de 4.64. 

Para poder juzgar del valor de este coeficiente, voy a hacer dgunas comparaciones: 
aplicando el cilculo a los promedios de Maillard resulta 80.84 es decir ima cifra que 
difiere de las mfas (promedios generates) En 18.32 desigualdad muy proporcional a la 
que existe entre los indices de imperfecci6n ureog^nica. 

Si en vez de tomar el porcentaje del izoe total se toman las cifras directas de izoe 
del icido drico y de purinas totales los resultados son naturalmente muy semejantes 
y dan: Guadros de Tunja, 60.70; cuadros de Bogoti, 62.90. Cilculo aplicado a los 
resultados de Maillard, 86.64. 

Esta segunda forma es la que se encuentra en los promedios marcada con el Ndmero 
II. 

Y, continuando las comparaciones: si se aplica ahora el cilculo a los restiltados 
obtenidos por Bouchez ^ — quien hizo anilisis de su propia orina — poni^ndose dif erentes 
reglmenes de alimentaci6n — se encuentran cifras un poco superiores a las de Maillard 
como se veri en s^uida. Pero antes debo advertir que, para los promedios que copio, 
he tenido que prescindir de algunos anilisis cuyos dates no tenia completes en el 
estudio mencionado: 

Regimen mixto ordinario, 86.36; regimen mixto con nucha came, 91.86; regimen 
licteo, 91.02; alimentaci6n disminuida, 84.05; regimen licteo vegetariano rico en 
hidratos de carbono, 88.41. 

Podria sacarse en conclusi6n de las cifras anteriores — que quizi por provenir de un 
individuo sujeto a un regimen alimenticio mis rico que los sujetos en quienes experi- 
ments Maillard dan cifras un poco superiores a^tas — que el regimen animal aimienta 
el valor del coeficiente y los regfmenes vegetariano ehidrocarburados y la alimentaci6n 
insuficiente lo disminuyen: ensefianzas que, al ser confirmadas con un mayor ndmero 

1 A. Bouchez, Recherches sur la composition de I'urlne normal de I'homme, Jour, do Phys. et de Path. 
O^., enero 1912. 



PUBUO HEALTH AND MEDIOINE. 97 

de observaciones, concordarfan con lo6 estudios hechos tiltiinamente aobre las oxida- 
sas de la came y en general con el de las citadas de las albuminoideas de origen 
animal. 

No pnede negarae tambi^n que hay cierta proporci6n de dif erencias con los anilisis 
de Maillard y con los mfos, entre el cuadro sacado de los estudios de Bouchez y el 
copiado anteriormente de Desgrez y Aiiignac ref erente este tiltimo a la relaci6n entre 
la urea y el dzoe total. 

Goncordarfan tambi^n los datos apuntados, con las observaciones de que habl6 hace 
poco de las insuficienciade la alimentacidncamea en la altiplanicie de Bogotd alimen- 
taci6n que es casi nula en las clases pobree. Pasaria, en suma aJgo semejante a lo 
que pasa con el coeficiente de utilizacidn del &zoe. 

III. Azoe total que es en el cuadro modelo 15.87, en nds promedios generates alcanza 
apenas a 11.81 y en los cuadroe de Bogotd se nota una dlferencia de 2.30 a favor de las 
clases acomodadas. Si, por un error imprevisto, no se bubiera hecho figunur entre los 
obreros a airvientes, que, son por lo regular individuos bien alimentados, esta dife- 
lencia serla mucho mayor. 

Las cifras apuntadas representan para los promedios generales, segtin los cdlculos 
que quedaron anotados atrds (vedse pag. 57) de 73.71 de albdmina por cada individuo, 
o sean 353.81 calorfa y en los cuadros de Bogotd: 77.75 de albtimina o 373.20 calorias 
para las clases obreras y de 84.94 de albtimina, o sean 407.71 calorfas para las clases 
acomodadas. 

Aplicando el cilculo a los andliflis de Maillard se obtiene una diferencla en contra de 
mis sujetos de ob8ervaci6n de 122.30 calorfas. En cuanto a los andlisis practicados en 
Tunja, se aproximan las cifras siendo inferiores a las de la clase obrera de Bogota. 

Queda pues demoetrado, que bay entre nosotros un deficit de mateiiales albumi- 
noideos aun en nuestras clases acomodadas. 

lY. Azoe iruieterminado por dento de dzoe total. — Entre todos los estudios que se 
ban consultado no he encontrado otros, siquiera citados, a este respecto que los de 
Maillard y Dans^ y Lambling y Bouchez. Los resultados del primero dan 11.15 por 
ciento y los de Dans^ y Lambling 11.71; los de Bouchez dan una cifra muy inferior, 
en tanto que los mlos dan: en los promedios generales 22.84, en los de Tunja 27.26, 
y en los de Bogotd 18.42, con un pequefLo aumento para la clase obrera. La desigual- 
dad de estos resultados se debe en primer lugar, a que los dltimos de los autores citados, 
midieron la creatinina y el primero las bases predpitables por el dcido silicotdngstico 
BUBtancias que no figuran en mis andlisis. Pero aun hadendo esta correcci6n hay 
dempre en mis promedios im aumento de la cifra en cuesti6n; veamos como puede 
ser explicado este aumento: 

El dzoe indeterminddo pertenece, sobre todo, a la creatinina a los dcidos uropro- 
teicofl (con el urocromo) al dcido hipurico y a las bases predpitables por el dddo sill- 
cotdngsticD. Recordemos algo sobre el origen de estos cuerpoe. 

P. La creatinina es im hidrato de la creatina de la cual proviene, y este queda en 
Ubertad en la tra8formaci6n de muchas nucleo-proteidaa en cuya compoeiddn entra,^ 
de mode que habiendo un aumento de purinas, es natural que haya tambidn un 
aumento de la creatinina y aiendo 68ta el prindpal factor de la fracddn de dzoe inde- 
terminado, x>odriamo8 de esta manera explicamos el paralelismo entre el aumento de 
esta f racci6n y la de las purinas tanto en mis andlisis con relad6n a los europeoe, 
como en los de Tunja respecto a los de Bogotd. 

Loe vegetales contienen tambidn creatina; de mode que el regimen vegetaiiano 
aumenta la proporddn de la creatinina en las orinas. 

S®. Guando la dislocad6n de las albuminoideas es imperfecta, cuando el desdobla- 
miento o la de8amidaci6n de los dddos aminados o la oxidad6n del dddo desaminado 
no es completa se encuentra en la orina mayor cantidad de dddo oxiprotdco asf como 

1 Professor C. H. Roger, Loo. dt. pig. 250. 



98 PBOOEEDINGS BEOOND PAN AMEBIOAK 80IENTI7I0 OOKOBESS. 

de &cido8 aloxiprot^co y urog^nico ^ es dedr que el aumento de eetOB dddos eetk en 
raz6n directa del Indice de imperfecci6n urog^nica. 

3®. La oiina de veinticuatro horas del hombre normal no contiene por tannine 
medio sino un gramo de icido hipdiico (bajo forma de hipnratos). Loe hipuratos son 
mis abundantes en la orina de los herbfvoros que en la de loe camlvoros y estos 
aumentan con la alLmentaci6n vegetal. Sabiendo que el dcido benzoico entra en 
la sinteais del icido hipdrico se comprenderd fdcilmente la influencia del alimento 
vegetal en este aumento y si como ya lo inainu6 atr^ y como se demostrard m&s ade- 
lante, nuestra alimentaci6n es muy poco camea y casi totalmente vegetariana tam- 
poco serfa rare que los hipuratos estuvieran en mayor proporci6n en la oiina del 
hombre en la antiplanide. Ademis, como la glicocola (que como se sabe es un 4cido 
monoaminado de la serie alif^tica) entra tambidn en la composici6n del &cido hipti- 
rico, quiz& pudiera explicarse, en parte, de esta manera, la correlaci6n entre el aumento 
del &zoe indeterminado y la diszninuci6n de la urea con el r^^imen v^getariano. Si 
se tiene en cuenta la importante participaci6n de los icidos aminados en la f onnaci6n 
de este (iltimo cuerpo. 

No estd por dem&s advertir que el dddo hiptkico es una de las sustandas cuya to- 
maci6n se atribuye a encimas de trabajo negative es decir de cuya influencia resulta 
una reacci6n con ab8orci6n de calor. Encimas que operarlan por consiguiente, 
segdn Duclux y Lambling, slnteeis an^ogas a las de la granulaci6n clorofiliana. La 
sfntesis del icido hiptirico parece que tenga lugar en el rifL6n. 

4®. Ya dije todo lo que se sabe respecto a las bases precipitables por el 4cido silico- 
tdngstico. Respecto a bus variaciones en la orina, nada cierto se sabe hasta el pre- 
sente. 

SerCa interesante aveiiguar cual de estos cuerpos que forman la dfra de &zoe inde- 
terminado estd en mayor propord6n, desgraciadamente (quizd excluyendo uno o doe 
de ellos) no se conocen todavia procedimientos para medirloe exactamente. 

5®. Fds/oro. — En cuanto al fdsforo de loe fosfatos se encuentra una cifra id^dca en 
los anilisb de Bogotd y en los de Tunja, a pesar de una ligera disminucidn en los pro- 
medioe de estos tiltimos del anhidrido fosfdnco. Comparando los promedios geneiales 
de mis andlisis con el cuadro modelo, hay a primera vista una disminud6n en los pri- 
meros; pero si se reladonan estos resultados a los del dzoe total, hay al contrario, un 
aumento por lo cual la relad6n ponderal y la reladdn at6mica son mavores en el 
cuadro adoptado como punto de comparad6n; la tiltima relad6n es de 36.05 en mis 
promedios y 37.09 en el cuadro modelo. 

Esto querrfa dedr que nuentras se elimina im dtomo de f6sforo se ftliminR entre 
nosotros una cantidad un poco menor de &zoe, lo que estd de acuerdo con la mayor can- 
tidad de purinas en relad6n con el dzoe total, pues se sabe que la mayor parte del f6s- 
foro urinario proviene de la desintegrad6n de las nucleo-protddas. 

Esto dltimo explicaria tambi^n por qu6 el fdsforo eetk relativamente en mayor can- 
tidad en los promedios de Tunja que en los de Bogotd. 

6^. Acidez, — Hay un aumento de la addez en los andlisis de Tunja, probablemente 
porque estos an&lisis se refieren a individuos sujetos en su mayor parte a ejerdcios 
musculares continuados y mds camfvoros que a los que se refieren los an^isis de 
Bogota. En estos tUtimos hay una pequefLa dlsminud6n, la cual podria ser atiibuida 
al predominio de la alimentad6n vegetal; este aumento y esta disminuci6n respecto 
de la addez, son por lo dem^ muy pequefilos para darles mayor importanda. 

Como consecuencia final y resumen de estas interpretaciones, se desprende el hepho 
de que eziste en la altiplanide de Bogotd una insuficienda de la utilizad6n del dzoe 
tanto en la forma albuminoidea como en la nucleo-protdca, insufidencia que se tra- 
duce en las orinas por un exceso de los tdrminos intermedios del metabolismo a 
expensas de los t^rminos finales; conclusi6n que concuerda con la baja de la tempera- 
tura y la disminud6n de la superfide hemoglobfnica. 

> Profesor E. Qkj, Loo. dt. 



FUBLIO HEALTH AND MEDIOINB. 99 

Quiere esto dedr que hay entre nosotros una inactividad en las trasfonnaciones 
orginicas y eepecialmente en las oxidaciones. 

^A qu6 es debida esta inactdvidad? 

Vimoe atr&s que el oi^ganismo animal no es como un homo cuya temperatura puede 
elevarae a volimtad con uxia mayor cantidad de combustible. De manera que si las 
combustdones bajan en personas que tienen recuraos para proporcionarse toda clase de 
alimentofl — siendo estos alimentos de compoaicidn qufmica igual a los empleados en 
otras regiones como lo he demostrado por mis an&lisis — es forzoeo concliiir que, al menos 
el factor mds importante de esta deficiencia de combustiones no ee la cantidad de 
combustible aino se debe a otras causas que dependen probablemente de una dege- 
neraci6n fisLol^gica en los individuos. 

Hay casi s^^uramente entre nosotros una disminuci6n de los fermentos encaigados 
de verificar estas trasformaciones y especialmente de oxidasas. 

La insuficiencia de estos fermentos debe provenir de una falta de actividad de las 
gUndulas encargadas de secretaries: hip6te8is que seria muy interesante confirmar 
y sobre la cual dejo adelantados los hechos demostrados con este estudio. 

En un estudio muy bien elaborado y documentado que presents el Dr. Luis Felipe 
Galder(5n al Segundo Gongreso Medico Nacional, sobre sindromos poliglandulares en 
la antiplanicie y que fu^ justamente elogiado, Uega entre otras a las siguientes con- 
clusiones: (1^) Son frecuentes en la altiplanicie los sindromos poliglandulares y pre- 
dominan en ella los causados por hipofunci6n; (3^) existe en la altiplanicie un infan- 
tiliamo visceral hep&tico, de origen hipofisiario, compatible con la integridad funcional 
del higado, pero que lo predispone a la insuficiencia y lo inhabilita para la superac- 
tividad que suscitan los climas c^dos; (5^) las cardiopatias de las menopausia, fre- 
cuentes en la altiplanicie, implican el tratamiento por la opoterapia ovariana. 

Las causas de la disminucidn de la actividad org^mica pueden ser m(Utiples, 861o 
hablar6 de tres, para no extenderme demasiado, que son en mi concepto las que merecen 
mib atencidn; es la primera la influencia de la zona de que me ocupar^ en las con. 
clufliones, y las otras dos son ambas reladonadas con nuestras costumbres: la vida 
sedentaria y la clase de alimentaci6n. 

El hombrede la antiplanicie, sobre todo el hombre pertenedente a clase social un poco 
elevada, pasa su vida en una quietud casi abeoluta y entr^gado a un ejerdcio intelectual 
permanente y forzado. Desde muy tempranaedad concurre alaescuelapiimaiia, donde 
s61o se le dejan algunas horas de descanso, y el resto del dla lo pasa en un recogimi- 
ento absolutOy dedicando muy poco o ning^ tiempo para atender a desanollo flsico. 

Nuestros colegios de educacitfn secundaria son todos escasos de espacio y si en 
algunos de elloe se distrae algdn tiempo para los juegos y la gimnmria no se les dedica 
el tiempo neceeario ni se hacen con m^todo. Por otra parte, todavfa no se han acli- 
matado entre nosotros los m^todos modemos de instroccidn, con los cuales se aprende 
mucho y se trabaja poco intelectualmente: todavfa se fatiga el cerebro de los j6venes 
con una cantidad excesiva de estudios, muchos de los cuales estto aichivados por 
indtiles en todo pais civilizado. 

Y si esto se dice de los hombres otro tanto podrfa decirse de las mujeres en cuanto 
a la vida sedentaria se refiere. 

De aquf que el Dr. Galder6n diga en la tiltima concluaidn del estudio meneionad o : 
''La higiene escolar de la altiplanicie debe velar por los piogresos del desanollo ffsioo 
y proveer a su deficiencia con cambios de clima adecuadoe a la actividad fisioldgica 
de las glindulas que lo rigen." ' 

A las concluaiones del Dr. Calderdn sobre insufidencias poliglandulares paedo agre- 
gar que en mi pr&ctica de laboratodo he tenido ocasidn de encontrar--«n eximenea 
hechos para la compafilas de seguros— az6car en las orinas de individuos cuyo ex am e a 
clfnico no d^a sospechas de perturbaci6n de salud alguna. 

1 libro del 8«giiiido CoDgntD ICMloo NMioiHa Colombtew 
68436— 17— VOL x- 



100 PB0GEEDIK6S SEOOND PAN AMEBIOAN 80IENTIFI0 COKOBE8S. 

Seria inteiesante praoticar a este respecto en individuoB en aparente estado fisiold- 
gico, experimentos semejantes a loe que» en enfermoB, practiqu^ respecto de insafi- 
ciencia hepdtica, bajo la direccidn del profesor Roberto Franco y que condenad en 
un estudlo que fu6 enviado al Seg^undo Gongreeo Medico Nacional Colombiano. 

Un hecho interesante en la alimentacidn conaiBte en que el habitante de Bogota 
consume menos came que im europeo, aun haciendo la comparaci6n con palses de 
raza latina que como se sabe son menos camlvoios que los sajonee. En efecto aeg&n 
estadlsdcas citadas por Labb^,^ cada habitante de Paris consume, por t^rmino medio, 
260 gramos de came en las veinticuatro horas; y por datos que he podido recopilar 
tanto en la Plaza de Games como en la Oficlna de Higiene y Salubridad, se ver& que 
en Bogotd este consumo es mucho menor. 

En el afio de 1912, afio en que el consumo ha Uegado al mdximo, se expendieron 
en Bogotd, aproximadamente y por t^rmino medio, a raz6n de 1,188 arrobas por dia, 
k) que corresponde para 120,000 habitantes a 124 gramos por persona. El milximum 
de este consumo no alcanza, segtin se ha podido averiguarlo, entre las clasesacomodadas 
a 160 gramos por persona; es decir a igualar siquiera las cilras medias de Paris; y en la 
mayor parte de los trabajadores Uega a cero. 

Esto se debe, en parte, a la falta del uso entre nuestras clases pobres, de cames baratas 
como las de caballo, etc., que tanto consumo tienen en Europa. 

Pero hoy no alcanzaria a dar el promedio apuntado arriba, pues parece que cada 
dia van haciendo m^ mella entare nosotros las teorias sobre culpabilidad del regimen 
cameo en la producci6n de la arterio-esclerosis y de la vejez prematura: asi, el ntimero 
de reses sacrificadas, que venla como en todas partes, aumentando con el aumento de la 
poblaci6n, y que de 22,954 que fu^ en 1910 babfa ll^;ado en una progreei6n no inte- 
mimpida, a 25,659 en 1912, no ha sido en el afio de 1913 hasta fines del mes de junio 
sino de 11,530, es dedr, que probablemente no alcanzard ni a 24,000 o sea a una clfra 
inferior a la del afio anterior. 

Yo s^ de muchas familias bogotanas que han proscrito la came de su alimentacidn, 
impresionadas por temores que muchos medicos contdbuyen a fomentar, con lo cual 
hacen un grave mal en mi concepto. Pues si se exceptdan muchas enfermedades en 
las cuales debe prdubirse la came por tiempo m^ o menos largo, todo ser humane ne- 
cesita comer came, y necesita comerla en mayor cantidad de la que entra en nuestra 
alimentaci6n, como lo voy a demostrar: 

£1 oiganismo necesita de albuminoideas; las causas de esta necesidad todavia no 
son bien conocidas, pero sf estk bien demostrado que ellas existen. 

81 se examinan los an^jlisis de alimentos que figuran en el capftulo tercero, se verd 
que hay algunos vegetales, sobre todo entre las leguminosas, que contienen casi tantos 
materiales albuminoideos, como la came. P^ro las cifras dadas en estos anilisis, 
como las dadas en todos los an&Usis de alimento, tienen el grave Inconveniente de ser 
deducidas del dzoe total, procedimiento que como ya dije, no es exacto, porque hay 
en los vegetales olzas materias azoadas (iddo azoico, amonlaco, creatina„ etc.) que no 
son albuminoideas; de modo que para subvenir a stis necesidades de albdmina, tiene 
el oiganismo, a regimen vegetaiiano, que ingerir una gran cantidad de alimentos, lo 
que recaiga en sumo grade las vfas digestivas. Es quizd este imo de los motives pcnr 
los cuales casi todos los que van de aquf a Europa, notan que all! se come una mucho 
menor cantidad de alimento. ''Adem^, la experiencia nos ensefia,'' dice Roeeer 
lutblando de los vegetales licos en albdmina' ''que no podemos hacer uso s61o de 
^stos en muestra alimentacidn. Contienen una gran masa de cerulosa y ademis de 
que esta masa indigesta es nociva por su volumen hay que agregar que su presencia tiene 
respecto al jugo gdstiico, un papel de inhibicidn. Un alimento albuminoideo debe 
presentarse al estado de pureza, es dedr, desprovisto de sus envolturas menos atacables, 
para que sea ^Udlmente digerible, para que pfovoque una secrecidn gdstdca dtil. 

> M. Labb^ 1m r^gtmes aliniMitalrM. 

* P. T. Roeser, La 6hlml« aUmentain, Etudes de physlolosie gdiidcale, 1005. 



PUBLIC HEALTH AND MEDICINE. 101 

Hay que notar, ad^mis, que el almid6n contenido en grandes proporciones en los 
vegetales, favorece en el intestino la pululaci6n del bacilus amilobacter, agente de 
una fermentaci6n dcida cuyoe productos no quedan sin acci6n sobre la economla" y 
m^ adelante agrega: '^ Loe despojos de la nutrici6n son numerosos aun cuando se haga 
uao de la came, pero ee predso reconocer que en este dltimo caso son menoe nocivos." 
M. Bikel demo6tr<S en un estudio citado por Boruttau ' que los procesos de putre- 
facci6n produddos en el intestino del perro son tanto mis intensos cuanto mds rica 
en vegetalee sea la alinientaci6n y que Uegan al mfnimun con el r^men cameo 
abeoluto. 

Por otra parte, la came es el 6nico alimento que tiene acci6n, especffica sobre la 
8ecreci6n g&strica. Cuando se introduce en el e8t6mago, evitando toda excitaci6n 
psfquica, pan papilla de almid6n y albdmina de huevo crudo o cocido, * 'estas sustancia 
se muestran inertes en presenda de la mucosa g^trica, y pueden permanecer as! por 
varies dfas sin otra modificaci6n que una fermentaci6n ptitrida. 

''La mezcla de came y de almid6n, el caldo, el extracto de came y con mayor raz6n la 
came pura, provocan la aparici6n de un jugo dotado de un jxKier digestive real y la 
dige8ti6n asl comenzadase contindaautom&ticamente.''^ Este efecto muy notable 
ee producido por una acci6n especlfica refleja sobre los centros nerviosos, y puede 
ser aprovechado con ^xito para estimular el apetito de los convalecientes cuando la 
excitaci6n psfqiiica inicial hace falta. 

Pero hay una cuesti6n que intereea de mode mds directo el hecho que se estd tra- 
tando de interpretar y son los estudios hechos en estos tiltimos aflos sobre la impor- 
tancia de la came en el estlmulo del metabolismo celular, por la presencia en ellos de 
fermentos activos, sobre todo de peroxidases y de catalasas que no son destruidas por 
el calor. La leche contiene tambi^n muchos de estos fermentos; pero algunas razonee 
referentes a la digestibilidad, la hacen menos recomendable. H. Busquet,' dcepu^ 
de experimentos muy cmdadosos y muy interesantee, en los cuales alimentaba ranas, 
mantenidas en equilibrio ponderal, unas con came de ranas otras con came de vaca 
y otras con cari^e de cordero, dedujo que la raci6n de mantenimiento so realiza mejor 
en la rana, con la ingesti6n de came de rana que con la de vaca o la de cordero, y que 
en las ranas en inanici<5n, un aumento pondend determinado se obtiene con un aporte 
de albdmina menor con la ingestuSn de una came especifica, que con la de cames 
extrafias. 

''Estas nodones nuevas relatlvas a la asimilacidn azoada permiten la comprensidn 
i&cil de hechos muy conocidos en le fisiologfa de la nutrid6n; la variabilidad de la 
necesidad de alblimina, segtin el alimento ingerido, se desprende, como consecuencia 
inmediata, de estos experimentos. Mientras la albtimina se aleja mds de las albtiminas 
especfficas, mayor ser& la cantidad neceearia para el mantenimiento del equilibrio 
aeoado." De mode que al tratar de mantener este equilibrio solamente con alimentos 
v^;e tales, serfa ^ta una causa mis, agr^ada a las que ya mendon^ atr&s, para aumentar 
la rad6n alimentida con perjuicio de las vfas digestivas. 

Las albtiminas que m^a convienen al hombre son, en consecuencia, las que provienen 
de los mamiferos. 

Estos datos concuerdan admirablemente con lo que a eete respecto dice Ardelbalden 
sobre la cuesti6n de la necesidad de albtimina. 

Si es verdad que la proteolisis diG:e8tiva consiste en una demolici6n, mis o menos 
profunda, del e£fido molecular de las albdminas, seguida, en la mucosa intestinal y 
quizi en el hfgado, de una recon8tituci6n en proteicas sangafneas especfficas, propias 
para determinado organismo, esta reconstmcci6n implica un primer desperdicio, que 
puede ser considerable. Esta reedificaci6n debe hacerse, en efecto, por la ley del 
minimum, es decir, que la proporci6n entre los di versos productos de la hidrolisis aiges- 

1 H. Bonittaa, Jonr. de Fhys. et Path. Ofo., 1012, enero. 

* Estracto pablicado en el Jurtial ottado, Tumo IX, 1907. 

• Bosqtiet, Contrlbotion k raode de la valeur nutritive eomparte dee albmnines ^trangteee et dee 
albnmlnei ipedflqoes ches la grenoalle, Joor. de Fhys. et de Path. Q4n., 16 de mayo de 1009. 



102 PROCEEDINGS SECOND PAN AMEBICAN SCIENTIFIC CONGBESS. 

tiva que puede ser empleado en la recoiistrucci6n del nuevo proteico, debe regularse 
segiin la cantidad de aqu^l cuyos f ragmentoe eetdn en menor cantidad . Cuando luego 
las proteicaa sangulneas, asl construiaas, se ofrecen como alimento a las diversas espe- 
ciesque tienes necesidad de las materias azoadas, volverd a comenzar la misma opera- 
ci6n de demolici6n y recon8tarucci6n, naturalmente con un nuevo desperdicio. " 

Asf se comprenderia como, para hacer frente a la reconstruccidn o al sostenimiento 
de esos protoplasmas, el organismo tiene necesidad de disponer de una cantidad con- 
siderable de albtimina, tanto mds considerable cuanto mds se aleje de las albuminas 
especlficas. 

Por dltimo si la came fuera nociva para el organismo, las razas sajonas no tendrian 
ya el vigor superior que conservan. 

Si 86I0 el regimen carneo fuera la causa de la arterio-escleroslB, no existirfa esta 
enfermedad en los mamlferos herbivores. 

En resumen: para una mejor utilizaci6n del dzoe alimenticio y una mejor marcha 
de las transformaciones orgdnicas, el hombre necesita de una alimentaci6n rica en al- 
buminoideas animales especialmente en came. 

Pero no quiere esto decir que el regimen alimenticio humane deba ser solamente 
carneo. Hay en los vege tales, fuera de las materias azoadas, hidratos de carbono y 
sales minerales que son de suma utilidad; la celulosa misma contribuye, en gran 
manera, a mantener despejadas las vfas digestivas, preparando asf el campo para una 
mejor absorci6n. 

El hombre no es un animal solamente carnivore, como no es solamente herbfvoro. 
La conformaci6n misma de su aparato masticador, desde la di6posici6n de su articula- 
ci6n t^mporo-maxilar hasta la forma y disposici6n de su sistema dentario, indican que 
estd constituido para el regimen mixto. De mode que los que en estado fisioldgico 
(entendiendo por fisiol6gico el organismo cuyas partes funcionan normalmente) pre- 
tendan someterse a un regimen absoluto, sea vegetariano o cameo, pecan contra la 
misma naturaleza. 

Y continuando sobre el mismo tema de nuestro regimen alimenticio: tiene la 
cMcha alguna influencia en el retardo de los procesos del metaboKsmo org4nico? 

El asunto me ha pareddo de tanta importancia que lo he hecho objeto de un estudio 
especial. 

RBSUMBN Y C0NCLU8I0NB8. 

En general, en un sujeto en buenas condiciones higi^nicas las funciones de nutrici6n 
alcanzan un nivel normal, cualquiera que sea la cantidad de comburente de que dis- 
ponga el organismo, y cualquiera que sea la temperatura atmosf^rica, a favor de ciertas 
funciones orgdnicas de compensacidn (hiperglobulia o hiperhemoglobinuria y mayor 
frecuencia de la respiraci6n y del pulso) y a favor de un aumento del combustible 
(alimentos). 

Por otra parte parece demostrado: 

I. Que en la altiplanicie de Bogotd la nutrici6n sufre un retardo el cual se re vela: 

1. Por un descenso de la cifra media de la temperatura humana. 

2. Por una insuficiente transformaci6n de los materiales azoados en el organismo, 
insuficiencia que se traduce a su tumo. 

(a) En una disminucidn de la relaci6n entre el dzoe de la urea y el dzoe total. 

(b) En un aumento del fndice de imperfecci6n ureog^nica de loe dcidos grasos. 

(c) En un aumento de los tannines intermedios de transformaci6n de los nticleo- 
proteidos (bases pdricas) a expensas del tannine final de estas mismas transformaciones 
{icido drico). 

La relaci6n que he encontrado entre este tiltimo fen6meno y los diferentes grades de 
nutrici6n me ha inducido a proponer un nuevo coeficiente urinario cuya explicaci6n 
detallada se encuentra en diferentes capftulos de este trabajo. 

(d) En un aumento de la cifra del Az indeterminado. 

II. Este retardo de la nutrici6n no se debe a una disminuci6n de combustible porque, 
adem^ de que se encuentra tanto en las clases pobres como en las clases acomodadas, 



PUBLIC HEALTH AND MEDICINE. 103 

una cantidad normal de izoe en las orinafl, se ve por los andlisis que hice de los 
principios alimenticios, que ^stoe son por lo menoe tan ricoe en nueetra altiplanicie 
como en la zona templada. 

Pero esto no excluye el que en las clases no acomodadas pueda tener influencia la 
insuficiencia de la alimentaci6n y el uso de la chicha, bebida que parece ejercer una 
acci6n depresora sobre la nutrici6n general. 

III. La causa de este retardo es probablemente una deficiencia oig^ca en la 
elaboraci6n de los fermentos encargadoe de verificar el metabolismo celular, especial- 
mente de oxidasas. Y como se sabe que estos fermentos son elaboradoe por diwtintag 
gUndulas del organismo, pudi^ramos decir en otras palabras: insuficiencia poliglan- 
dular a este respecto. 

IV. Todas estas manifestaciones de un retardo en la nutricidn, parecen m^ bien 
aumentar que disminuir con la altura, como se ve por la comparaci6n de las observa- 
ciones tomadas en Bogoti y en Tunja, ciudades de alturas un poco diferentes. 

Pero^ cu&l es la causa eficiente de esta deficiencia org^inica? 

£1 problema es demasiado dlKcil para x>oderle dar actualmente una Boluci6n y 
serfa petulancia pretender hacer mis que formular teorlas m^ o menos aceptables y 
dejar que otros le den la solucidn sads&M^toria. 

Algunas consideraciones me inducen a creer que la causa en cuesti6n tiene una 
relaci6n con la zona en que vivimos, entre ellas la observaci6n hecha por todo viajero 
de la depresidn volitiva de la apatla muscular de los habitantes de la zona inter- 
tropical. 

Pero^ cudl es esa causa? Teorlas y teorias pueden emitirse. 

Quizd no deje de tener alguna influencia la pobreza de nuestra alimentacidn en 
albuminoideos animales asf como lo eedentario de nuestra vida; aunque esto Ultimo 
puede ser m^ bien efecto que causa. 

Algunos creen que la {alta del cambio de estaciones, la constante repetici6n de 
una misma sen8aci6n, enerva los sentidos e influye sobre la nutrici6n general, a la 
manera que una luz igualmente coloreada acaba por producir perturbaciones visuales 
e intele .*tuales o que la repetici6n del mismo manjar que no se cambia acaba por 
producir perturbaciones digeetivas. 

En alguna otra parte he lefdo la teorla de que la tierra en su movimiento de rotacidn 
acumula mayor cantidad de icido carb6nico en el ecuador, lo cual parece encontrar 
una confinnaci6n en la diferencia de dcido carb6nico, a ftivor de loe thSpicoe, si te 
coroparan ani^lisis (como los del Profesor Lewy practicadoe en Bogotd) de la atm6^ 
fera intertropical con loe de la zona templada. 

Si esto es asf, quizd pudiera este fen6meno damos la explicaci6n de porqu^ la vida 
vegetal adquiere mayor robustez en los tr^picos y porque las razas animales degeneran 
aUf. 

*' Porque el icido carb6nico/' segtin Bobor, Hasselbaalch y Erogh, ''influye sobre 
las oxidaciones orgdnicas aun dentro de loe Hmites fisioliSgicoe.*' **E8," dice Burder- 
man, **un depresor morboso," y pudiera ser, por su exceso entre nosotroe, lo que 
Luciani llama *'acciones permanentes que producen retardos en la nutricidn." 

Finalmente, ^debemos considerar como consecuencia, o m43 bien como causa inme- 
diata de enta insuficiente elaboraci6n, la disminuci6n de la superficie hemogl6bica, 
o sea la di8minuci6n del ntimero de gl6bulos rojos sin aumento de la carga hemo- 
globfnica? 

I iene el enrarecimiento del aire influencia sobre el retardo de nuestras combus- 
tiones? T.a respuesta categ6rica es demasiado diffcil, pero se pueden hacer algunas 
anotariones al reded or de ella. 

Parece por una parte demostrado, en estudios experimentales hechos por distintos 
autores, que a medida que se asciende hay una hiperglobulia o hiperhemoj^lobinuria 
compensadora del enrarerimiento del aire. 

Por otra parte, otras observaciones hechas en la zona t6rrida, concuerdan con 
las mfas en esta falta de compensaci6n. 



104 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIO CONGRESS. 

En efecto, el Dr. Joe^ G. Hem&ndez de Caracas ^ encontr6 en aquella ciudad, 
893 metros sobre el nivel del mar, un promedio en 25 individuoB de 3,840,000 gl6buloe 
rojoe por milimetro cdbico. 

Ouatro afios despu^s, el Dr. Joige Vaigas encontr6 en Bogotd en 33 obeervadones 
un promedio muy semejante al mfo y anot6 la relaci6n entre sua obeervacionee y las 
de Del Rfo sobre di8minuci6n de la urea, asf como el descenso de la temperatuia 
humana en Bc^td. 

Esta falta de compensacidn trae como consecuenda un aporte menor de oxlgeno 
y por consiguiente, una disminuci6n de las oxidaciones. 

Pero recu^rdese que loe autoes que ban encontrado la compensaci6n ban experi- 
mentado en individuos sometidos por corto tiempo a la influencia de la altura y que 
en extranjeros reci^n llegados a nuestra altiplanicie si se ba encontrado esta com- 
pen8aci6n. 

Por otra parte, tan to los estudios de los doctores Hernandez y Vargas como los 
mios, se refieren a individuos que ban vivido la mayor parte de su vida en la altura 
o al menos en la zona t6rrida. 

Cualquiera dirla que no se cumple en nosotros esta ley fisiol6g:ica puesto que 
falta la compensacidn de que bablo; pero compengaddn que implica en este caso 
hiperfuncidn — qmere decir aumento de trabajo y el aumento de trabajo trae consigo 
el cansancio precoz. ^No podria suceder que a la maneracomo el coraz6n se fatiga 
mis fdcilmente en las grandes alturas, pudiera venir tambi^ una bipofunci6n de 
los 6rganoB bematopoieicos, bajo la influencia prolongada de un aire enrarecido? 

Adem^ el oxlgeno es un gran excitante de las funciones de nutrici6n como lo 
I»^eban sus excelentes resultados y los del aire pure en los enfermos con biponu- 
trici6n. De aqul que no 861o las oxidaciones se encuentren disminuldas en nosotros, 
sine casi todas las reacciones del metabolismo. 

Abora bien: existe en la zona templada, por lo menos durante medio alio una 
doble condici6n que bace la atm6sfera mucbo m^ densa: baja temperatvra y bajo 
nivel sobre el mar. Mientras que en nuestra zona tropical bay una condici6n per- 
manente de encarecimiento: en las regiones Mas por la altura y en las partes bajas 
por el calor. 

He abf, en mi concepto, una posible influencia favorable del cambio de estaciones, 
sobre las funciones del metabolismo celular. 

Esta diferencia en la accividad del metabolismo explica por qu6 se siente menos 
intense el frio en las zonas templadas — aun con estados bigrom^tricos i5:uales y con 
temperaturas mis bajas — ^y por qu6, utiUzdndose mejor los principios alimenticios 
se ve mds vida en los individuos adn con mds pequefias cantidades de alimentos. 

En todo caso el becbo de la insuficiente nutrici6n entre nosotros parece demos- 
trado; falta buscar la explicacidn y probarla experimentalmente. 

Pero entre tanto algo puede bacerse para remediar el mal: 

1. Dar grande importancia a la educaci6n flsica de loe nifios, porque, como dice 
Bedict, ''el trabajo muscular es un estfmulo, no s61o inmediato sine sostenido de la 
actividad celular" y dar la preferenda a aquellos ejercicios que desarrollan la capa- 
ddad tordcica. 

2. Lucbar :ontra el uso de la cbicba. 

3. Quitar de la mente del pueblo la idea de que la came es perjudicial para el 
bombre sano, a fin de bacer la alimentaci6n mds rica en albuminoideos animales que 
son un gran estlmulo de la nutrici6n general. 

1 J. Q. Horn&Ddes. The Number of the red oeUs. Pan Amerioan Medical Congress, 1895. 



PUBLIO HEALTH AND MBDIOnTB. 105 

INFLUENOU DE LA CHICHA SOBRB EL BfETABOUSMO AZOADO. 

Por CALIXTO TORRES UMASA. 

La chicha es la bebida ordinaria de nuestro jmeblo; es una especie de cerveza que 
proviene de la fermentaddn del mafs pero hay dos drcunstacias que hacen de ella 
una bebida infinitamente mis nociva para el ofganiBmo que la cerveza. 

Efl la primera que el malz no contiene sino menos de la mitad de la glucosa que 
enderra la cebada y la seg^unda que ee muy diffcil desamdlar en el grano el fermento 
que debe trasftmnar el almid6n en azt&car. For eataa razonee, la industiia ha tenido 
que apelar a on im>cedimiento tan laigo que convierte la fermentacidn en una ver- 
dadera putrefacci6n; pues ademds del alcohol tienen tiempo de deearrollarBe otraa 
■uatancias mucho m6m nocivae que ^ete. 

Debemos al ilustre profeeor colombiano Dr. Liborio Zerda, el primero y mSm com- 
plete estudio de los divereoe productoe de f ermentaci6n a que da lugar el procedimiento 
que hoy se emplea para la preparaci6n de la chicha. 

'*E8te eetudio lo hizo el Dr. Zerda hace ya cercadeSO alios y aunque," segdn lo 
hace notar muy juiciosamente el Dr. Pablo Garcia Medina,^ ''en este espado de 
tiempo la quimica biol6gica ha hedio grandes adelantos y modificado muchas teorfas, 
fu6 este tribajo tan complete, priv6 en 61 un criterio tan seguro y un m^todo tan 
rigurosamente dentifico que hoy parece hecho a la luz de esos adelantos. '' 

Es en el dltimo perfodo de la fermentaddn de la chicha, perfodo que puede llamarse 
de putrefetcci6n, cuando se desarroUa una tomaina que encQntr6 el Dr. ISerda. 

£1 Dr. F. J. Tapia lo ha demostrado de una manera muy sendlla. Toma un poco 
de maiz, sufidentemente reblandeddo para que pueda formarse lo que se ha llamado 
masato, cuyo verdadero olor estd casi oculto por el de los Uteres que se desarrollan 
simultdneamente. Galentando este mazato, de manera que los Uteres se evaporen, 
queda una masa de olor pdtrido intense como de cad&ver en descompo8ici6n, lo cual 
da una idea de las diversas alteradones que sufriri el mafz durante este dltimo perfodo 
de verdadera putr^acd6n. 

He aqul la compo8ici6n de la chicha, al terminarse esta fermentaci6n, segdn los 
anilisifl del Dr. Zeida: 



Oiamos. 

Alcohol 65.00 

AddoUctico 4.30 

Otros&ddos L85 

Azticar (sacarosa, glucosa y azdcar 
invertida) 10.65 



Ormmot. 

Almid6n 10.80 

Materias azoadas 6.27 

Glicerina 7.70 

Acdte que contiene la sustancia 
t6xica L60 



Pero la chicha asf compuesta no se da al consume sino mezclada con agua y miel, 
con lo cual se forma un Ifquido que por sufrir la fermentad6n alcoh61ica viene a 
quedar con mayor cantidad de alcohol que d primero jMfo con mucho menos sustandas 
nutritivas. 

En tres litres de chicha que, m^ o menos, consume un trabajador de la sabana de 
Bogota, hay 340 gramos de alcohol es dedr como si tomara media botella de aguardiente 
mis una gran cantidad de los elementos t6xicos propios de la chicha. 

Las alteradones espedales que produce la chicha en el oiganismo, estudiadas per 
el Dr. Jos6 Gomez ' alteradones distintas de las del alcoholismo ordinario, y que 
son casi id^nticas a las de la pelagra; los experimentos practicados por el Dr. Zerda 
en aninudes y d anilimw mismo de la chicha, me hideron penaar que esta l>ebida 
puede tener alguna influencia inmediata en d retardo de la nutrid6n de nuestro 
pueblo de la altiplanide. 

Con d objeto de investigar esta influencia me dirigf al Mlnisterio de la Guerra para 
solidtar que se pusieran a mi dispo8ici6n seis individuos de tropa y tuve la fortuna 

iSesloiiesolBnafioM del oentfloarlode Colombia, lOia tJot6aoiiiei,tlehlelil8iiio. 



106 PROCEEDINGS SECOND PAN AMEBICAN SCIENTIFIC CONGRESS. 

de aer debidamente atendido tanto por el Sefior Miniatro como por el Sr. Coronel 
Baldlzar, Jefe de la 6uarnici6n de Timja, y por el Dr. Acevedo, ofidal de sanidad 
de la misma, quienes confxibuyeron en gran manera a que los experimentos se llevaran 
a cabo con absoluta preci6i6n. 

En la. dnica parte en donde eetos enaayos pueden llevarse a cabo con la abacduta 
exactitud que el case requiere, ee en el cuartel donde los eujetos est&n aometddos a una 
rigurosa diaciplina y por consiguiente obaervan exactamente el regimen y las instnic- 
ciones bajo la vigilanda de sua auperiorea. 

Para hacer mia inveetigacionea mnplee un m^todo aemejante al que emple6 el Profea(»r 
MaiUard en el ej^rcito francos, cuando eetudi6 la influencia del vino sobre la excreci6n 
del 4zoe y del f6eforo. 

Elegi aeia aujetoa bien conformadoa, en buen eetado de aalud y entregados a su vida 
ordinaria de cuartel. 

Todoa ae aometieron a un regimen conatante que obaervaron cada uno aeia dfaa, dividi- 
doa ^stoa aeia dfaa en dos perfodoa de a trea: en el aegundo perfodo agregaron a su 
alimentaci6n 200 c. c. de diicha al almuerzo y otroe 200 a la comida. 

Como por lo demda el regimen era exactamente el miamo, laa variacionea que ae 
obaervaran en este 61timo perfodo representarlan la influencia de la chicha en la elimi- 
naci6n urinaria; pero como eata bebida tiene cierta cantidad de matenales azoadoa 
los individuos ingerfan ^atos en mayor proporci6n, dato que debe tenerse en cuenta al 
hacer la comparaci6n de los promedios. 

Como era ifhposible practicar seis andlisis de orinaa completas en menos de cuatro o 
cinco dlas, reaolvf, para que no se produjera una fermentacidn de las orinas que altera- 
Ha los resultados, dividir los sujetos en dos grupos, cada uno de los cuales se someti6 
durante los seis dias al mismo regimen no s61o alimenticio sine de ejercicios (estos eran 
los ordinarios del cuartel sin salir al terrene). 

El r^orimen alimenticio era el siguiente, es decir casi el ordinario del cuartel: 

Desayuno: Agua de panela, 300 c. c; pan de munici6n, 90 gramos. Almuerzo: 
Sopa, 1.500 c. c; came, 60 gramos; pan, 45pramos. Comida: Mazamorra, 1.600 c. c; 
came, 60 gramos; papas, 960 gramos; panel a, 90 gramos. Lo que da por dia y por in- 
dividuo las siguientes cantidades de materiales utilizables: 



Allmentos. 


Canti- 
dades por 
homhre. 


Materias 
proteicas. 


Qrnsas. 


Hidratos 

de 
earbono. 


Panela 


Oramos. 
110 
135 
130 
150 
960 




09.00 


Pan 


8.70 
22.32 
16.76 
16.00 


0.19 

23.35 

6.00 

9.60 


76.20 


Came 




Malz 


2 86 


Paoas 


192.00 






Total 




64.37 


39.14 


368.85 









Estos cdlculos ban sido deducidos de mis an&lisis personales de alimentos, cuyoa 
resultados son casi id^nticos a los de Band y a los de Alquier. 

Si se quiere conocer la cantidad de energla puesta a diflposici6n del organismo por 
esta raci6n, hay que multiplicar cada uno de estos elementos por los coeficientes calo- 
rfficos: he aqui el valor de la raci6n: 

Materias proteicas 64. 37X4. 4= 283. 23 

Grasas 39.14X9.4= 367.92 

Hidratos da earbono 368.85X4.1=1,512.29 

Total de calorlas 2,163.44 



PUBLIC HBALTH AND MEDICINE. 



107 



Lo6 anilisis de las onnsia han sido piacticados por los miamos procedimientos y con 
las mifimas precauciones de los aTiiJIims del estudio sobre NtUriddn en Bogotd. 

Los cuadros que se verdn en seguida representan para cada individuo el promedio de 
los tres andlisis de cada perfodo y al fin de cada serie de cuadros se encontrar&n los dos 
promedios generates que servirdn de comparaci6n: el del perfodo de ab8tenci6n de 
chicha y el del perfodo de chicha. 

Las orinas fueron recogidas con todas las precauciones necesarias para impedir la 
fermentaci6n amoniacal y ademis, para mayor seguridad se medfa la acidez tan to a su 
llegada al Laboratorio como en el memento del andlisis; este se principiaba por aquellas 
sustancias mis ^iles de descomponer. 

Periodo de abstenddn de chicha — elvminaddn del dzoe. 



N6m. 



Aftos 

de 
edad. 



1 
2 
3 
4 
6 




24 
22 
21 
21 
22 
22 



Tem- 
pera- 
luia. 



36.6 
36.6 
36.7 
36.5 
36.9 
37.0 



Polso. 



88 
84 
74 
82 
76 
78 



Res- 
pira- 

CwDOS. 



20 
18 
18 
20 
19 
20 



Densi- 

dadde 

laorlna. 



1,015 
1,010 
1,016 
1,013 
1,014 
1,015 



Volu- 
meii en 

24 
boras. 



2,900 
2,800 
2,450 
3,300 
3,150 
29,502 



Acldex eo H. 



Por 
Utro. 



0.027 
.013 
.023 
.021 
.021 
.023 



En 24 
horas. 



0.78 
.036 
.054 
.060 
.066 
.068 



Azoe total. 



Por 
Utro. 



4.13 

2.06 
2.94 
3.33 
3.80 
4.10 



En 24 
horas. 



11.95 
5.77 
7.20 
10.99 
11 97 
12.09 



Nfim. 



1. 
3. 
3. 
4. 
5. 
6. 



Amonlaco 

y 4cidos 

aminados. 


Urea. 


Purinas 

totales(en 

&cido t^co). 


Acido tiico. 


Bases ptirlcas 
(enxantina). 


Por 


En 24 


Por 


En 24 


Por 


En 24 


Por 


En 24 


Por 


En 24 


litros. 


horas. 


Utro. 


horas. 


Utro. 


horas. 


Utro. 


horas. 


Utro. 


horas. 


0.24 


0.70 


4.86 


13.93 


0.44 


1.37 


0.31 


0.90 


O.a'iO 


0.171 


.20 


.66 


3.43 


9.60 


.41 


1.16 


.23 


.64 


.081 


.179 


.20 


.49 


4.86 


11.81 


.65 


1*59 


.32 


.82 


.104 


.355 


.27 


.89 


4.71 


15.54 


.45 


1.48 


.11 


.36 


.151 


.508 


.23 


.72 


6.10 


16.06 


.45 


1.45 


.20 


.63 


.114 


.359 


.30 


.59 


4.90 


14.46 


.42 


1.34 


.18 


.53 


.109 


.333 



Acldo 
fosTdrico. 



For 
Utro. 



0.90 
.60 
.60 
.45 
.50 
.80 



En 24 
horas. 



3.61 
1.68 
1.47 
1.49 
1.58 
3.36 



Periodo de abstenddn de chicha — eliminaciSn del dzoe y relaci6n delfdsforo al dzoe 

(Cuadro I). 



Ntimeros. 

1 


1 


2 


3 


4 


5 


6 


ktoe amoniacal 

Axoe de la urea 


0.58 

6.41 

.30 

.062 

11.95 

4.85 

52.89 

2.61 

.52 

3.L3 

60.87 

39.13 

2.61 

.93 

12.85 

28.4 


0.46 

3.31 

.21 

.065 

6.77 

7.80 

57.37 

3.64 

1.12 

4.76 
69.93 
30.07 

1.49 
.65 

8.88 
12.3 


0.39 

6.92 

.23 

.093 

7.20 

5.36 

82.22 

4.56 

1.29 

5.84 

93.42 

6.58 

1.47 

.64 

11.25 

24.9 

1 


0.73 

7.26 

.12 

.185 

10.99 

6.64 

66.05 

1.09 

1.68 
2.77 

75.46 

34.54 

1.49 

.65 

16.91 

37.4 


0.59 

7.51 

.31 

.131 

11.97 

4.97 

65.26 

1.75 

1.18 
7.93 

73.16 

26.84 

1.58 

.69 

17.35 

35.3 


0.49 
6.75 


Azoe Acl'^o rtrico, 


.18 


Asoe de las bases pdricas 


.118 


Azoe pfirico total 


13.09 


Part, del Ac. amoniacal porJ.00 de &zoe total 


4.05 


Part, del Az. de la urea por 100 de Azoe total 


55 


Part, del As. del &cido por 100 de Arico total 


1.49 


Part, del Az. de las bases ptiricas, por 100 de &zoc 
total 


.98 


Part, del Az. ptirico total, por 100 do Axoe total 

Fraccldn de A z. determlnado I'.or 100 


2.47 
60.52 


FnM*ci<^n 'le a z, indetenniTH^do por ino . 


39.48 


Anhidrido fosfdrlco 


2.36 


Fdsforo de los fosfatos 


.63 


Relacidn ronderal 


11.72 


Relacidn atdmica 


26.9 







108 FBOCEBDINOS SECOND PAK AHBBIOAN SOlEIJTlFiO 00NGBB88. 

Periodo de cAtcfto — elvmnaeiSn del dtoe y de purina. 





Afios 

de 
ed»<L 


T«m- 


Polso. 


R«s- 

pirs- 

oiones. 


dAdde 
laoriiUL 


Volo- 
menon 

24 
boras. 


Addesenh. 


lioetoteL 


Ntkm. 


Per 
Utio. 


En 24 
bom. 


Per 
Utio. 


En 24 
boras. 


1 


24 
22 
21 
21 
22 
22 


86.2 
86.4 
86.5 
86.6 
36.8 
36.7 


88 
82 
72 
76 
76 
74 


20 
17 
18 
10 
10 
20 


1,008 
1,010 
1,014 
1,011 
1,014 
1,012 


2,100 
8,240 
8,020 
2,000 
8,200 
8,000 


0.018 
.021 
.022 
.026 
.021 
.024 


0.065 
.068 
.066 
.066 
.067 
.072 


8.81 
2.86 
4.44 

4.84 
4.20 
4.60 


11.81 


2 


0.15 


8 


18.40 


4 


14.04 


5 


15.44 


6 


18.80 







NUm. 


Amoniaoos 

7&cido8 

amliiadoB. 


Urea. 


Pnrinas tota- 

lesenioido 

tkrioo. 


Aoidotlnoo. 


Bases jpAri- 
cas(en 


AcidofDS- 
fdiioo. 




Pot 
litio. 


En 24 
boras. 


Por 
Utio. 


En 24 
boras. 


POT 

Utro. 


En 24 
boras. 


Por 
Utio. 


En 24 
boras. 


Por 
Utro. 


En 24 
boras. 


Por 
Utio. 


En 24 
boras. 


1 


0.21 
.81 
.44 
.58 
.48 
.24 


0.66 
LOO 
L33 
L68 
L53 
.72 


6.71 
3.43 
5.14 
5.57 
4.80 
5.00 


16.03 
U.U 
15.42 
16.15 
15.36 
15.00 


0.42 
.45 
.22 
.46 
.48 
.44 


L80 
L45 
.66 
L33 
L53 
L82 


0.28 
.19 
.11 
.26 
.18 
.15 


a87 
.62 
.83 
.75 
.58 
.45 


0.068 
.118 
.048 
.091 
.091 
.132 


0.196 
.382 
.145 
.201 
.291 
.806 


a70 
.60 
.40 
.40 
.80 
.90 


2.17 


2 


1.04 


8 


1.20 


4 


1.20 


5 


2.66 


6 


2.70 











Periodo de Mcha — Repartici^n del dzoe y rdaci&n ddfdeforo al dzoe. 



NtUneros. 


1 


2 


3 


4 


5 


6 


A,coe Amoniaeal 


0.54 
7.49 
.26 
.070 
.330 
1L81 
4.57 
63.42 
2.20 
.593 
2.793 
70.78 
29.22 
2.17 
.94 
12.56 
27.8 


0.82 
5.19 
.20 
.139 
.389 
9.15 
8.96 
56.72 
2.21 
L508 
3.718 
09.39 
30.61 
L94 
.85 
10.76 
23.8 


LOO 

7.19 

.11 

.053 

.163 

18.40 

8.13 

53.73 

.82 

.395 

L21 

74.07 

25.93 

L20 

.52 

25.77 

57.00 


L38 
7.54 
.25 
.072 
.322 
14.04 
9.83 
53.53 
L85 
.513 
2.36 
65.72 
34.28 
L20 
.52 
27.38 
00.6 


L26 

7.17 

.10 

.106 

.296 

18.44 

9.37 

53.34 

L41 

.790 

2.20 

64.91 

35.09 

2.56 

L12 

12.00 

26.57 


0.50 


Acoedela area 


7.07 


Azoedel Aoido drico 


.15 


Azoe de las bases nArioas .• 


.263 


A soe ptbrioo total 


.418 


A aoe total 


13.80 


Parte del Asoe amoniaoal pcv 100 de AsT 


4.28 


Parte del &zoe de la urea por 100 de AsT 


5L28 


Parte dol 4zoe del Acido mloo por 100 de AeT 


1.00 


Parte del &«>e de las bases pAncas por 100 de AsT 

Parte del &zoe pflrioo total nor 100 de AsT 


L18 
2.27 


FVft/»ri<Sn d« A*0« rtflfrmlnftdo . ^ , ... 


57.73 


Fnvvti^ndeAso^indetennJnado 


42.27 


Anhidrido fos(<5rlco 


2.70 


F6sforo delos fosfatos 


L18 


Rel^ido ponderal 


11.60 


Relacidn £U<)mloa 


25.0 







PROMEDI08. 



I. Periodo de abstencidn de 

chicha: 

Denaidad 1. 013 

Volumen en 24 horas (c. c . ) . 2. 925 

Acidez 061 

Azoe total 10.41 

Amonlaco y 4cido8 amina- 

doe 70 

Urea 13.20 

Purinas totalee 1. 32 

Acido drico 67 

Basespdricas 270 



I. Periodo de abstencidn de 

chicha — Gontinda: 

Anhidrido fosf 6rico 1. 87 

Azoe amoniaoal 58 

Azoe de la urea 6. 16 

Azoe del ^ido drico 25 

Azoe de las basee pdricas. . . 161 

Azoe pdrico total 41 

Parte del &zoe amoniacal 

por 100 de &zoe total 5.57 

Parte del &zoe da la urea 

por 100 de &zoe total 59.03 



PUBLIC HEALTH AND MEDICINE. 



109 



PB0MBDI08 — continda. 



I. Perlodo de ab8tenci6n de 

chichft — Continda: 
Parte del dzoe ^ido drico 

por 100 de &zoe total 2.04 

Parte del dzoe de las bases 
pdricas por 100 de &zoe 

total LOS 

Parte del dzoe pdrico total 

por 100 de izoe total 3. 09 

Fraccidn de &zoe determi- 

nado por 100 67. 64 

Fracci6n de dzoe indeter- 

minado por 100 32. 36 

F6eforo de los foafatos 81 

Ilelaci6n ponderal 12. 85 

Relaci6n at6mica 1:28. 5 

Indice de imperfecci6n urog^ 

nica 8. 71 

Indice de transformacidn de los 
ndcleo proteidos 60.09 

II. Perfodo de chicha: 

Denaidad 1. Oil 

Volumen en 24 horas 3. 076 

Acidez 055 

Azoe total 12.60 

Amonlaco y icidos ami- 

nados 1.15 

Urea 14.84 

Purinas totalee 1.26 

Acido drico 60 

Bases pdricas 30 



II. Perfodo de chicha — Con- 
tin da: 

Anhidrido fosfdrico 1. 96 

Azoe amoniacal 95 

Azoedelaurea 6.93 

Azoe del dcido drico 20 

Azoe de las bases pdricas. . 11 

Azoe pdrico total 31 

Parte del izoe amoniacal 

por 100 de dzoe total. . . 7. 39 
Parte del dzoe de la urea 

por 100 de dzoe total 55 

Parte del dzoe del ^ido 
drico por 100 de dzoe 

total L59 

Parte del izoe de las bases 
pdricas por 100 de dzoe 

total 87 

Parte del dzoe pdrico total 

por 100 de dzoe total.... 2. 46 
Fraccidn de dzoe determi- 

nado por 100 64. 85 

Fraccidn de dzoe indeter- 

minado por 100 35.15 

Fdsforo de los fosfatos 86 

Relacidn ponderal 15. 06 

Relacidn atdmica 33. 34 

Indice de imperfeccidn urog^nica 10. 20 
Indice de transformacidn de los 
ndcleo proteidos 57.92 



DBDUCCI0NB8 DB LOS PR0MEDI08. 

Comparando los promedios, de los doe perfodos vemoe que hay en los s^undoe (perfodo 
de chicha) con relacidn a loe primeros, no dando mayor importancia a la pequefia baja 
de temperatura: 

Una diaminucidn de ladensidad de la orina, de la acidez, del dcido drico, del dzoe 
de la urea en relacidn con el dzoe total; del dzoe del dcido drico, y del de las bases 
pdricas con relacidn al dzoe total, del dzoe determinado y del indice de trasformacidn 
de los ndcleoB proteidos. 

Un aumento: del volumen de la orina, del dzoe total, del amoniaco, de las bases 
puricas, del anhidrido foafdrico, del dzoe amoniacal con relacidn al dzoe total, y de la 
imperfeccidn urogdnica. 

Nada mds elocuente que estos resultados para establecer la concluaidn franca, de 
que la chicha produce una inhibicidn sobre los procesos nutritives. 

Esta influencia retardante, quizd no sea debida al alcohol por la pequefia cantidad 
que ingirieron loe sujetos de mis experimentos, porque no se verificaron los cambioe 
en el pulao y en la respiracidn que producen pequefias cantidadas de alcohol, y 
porque el Profesor Maillard tuvo que concluir un trabajo semejante al mfo, con el 
dicho vulgar de que un vaso de vino no hace dafio. 

No sucede lo mismo con el vaso de chicha, la coal debe muy probablemente su 
accidn retardante sobre la nutricidn, a la tomaina descubierta por el Dr. Zerda y que 
a la manera del fdsforo del dxido de carbono, del arsdnico, de la morfina, etc., 



110 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONGRESS. 

determina variaciones inmediatas en el funcionamiento qufmico normal del organismo 
en lo6 procesoB de nutricidn general, y por consiguiente, en las excreeiones urinarias 
en particular. 

No tengo la pretensi6n de creer que mis reeultados sean de una infalibilidad absoluta, 
pero sf que los experimentos han aido hechos con el m^ escrupuloso cuidado y por los 
mejores procedimientos hasta hoy conocidos. 

Es esta una prueba m^ de que la chicha es un veneno y de que el Gobiemo debe 
propender por cuantos medios est^n a su alcance para impedir su uso. 

Si es verdad que todos los ej6rcito8 usan el alcohol a dosis moderadas como alimento 
energ6tico (el aguardiente en Rusia, el vino en Francia y Espaiia, la cerveza en Ale- 
mania, etc.) deberia elegirse para nuestros soldados una chicha en que la fermentaci6n 
no Uegara al estado de putrefacci6n a que generalmente llega, o una cerveza barata. 
De esta manera el cuartel serla una escuela para ensefiarles a los hombres de nuestro 
pueblo, ya que no a dejar la bebida, cosa punto menos que imposible, al menos a 
cambiarla por una menos dafLosa y a hacer uso de otras sustancias alimenticias, deri- 
vadas tambi^n del mafz, pero no dafiosas como la chicha. 

The Chairman. It is very difficult to follow this paper into all 
the complete details that are given. He brings into the paper evi- 
dence of nutritive retardation in the highland of Bogota. Body 
temperature is lower. The amount of urea in the urine is less. The 
number of red cells, instead of being increased, as it is stated to be 
in the highlands, is diminished in that table-land of Bogota. The 
pulse is somewhat accelerated and the respiration also, as a sort of 
compensatory respiratory and circulatory function. There is, there- 
fore, a diminution of exudation of nitrogen and the utiUzation of 
nitrogen also. He behoved for a time this might be due to the 
difference in the composition of the foods, since the nitrogen com- 
ponents of foodstuffs were found to be less than in other climates. 
He found that this was not so; that the composition of foods in the 
table-land of Colombia is exactly the same as in the Temperate Zones. 
As a side issue, but working in the same direction, he investigated 
the action of the common beverage of the country, chicha, of which 
he spoke when the question of pellagra came up, and he finds that 
this chicha, an alcohoUc beverage from the fermentation of maize, 
exerts also evidently a retarding action upon this nutritive function, 
which he thinks may bo duo to the action of the ptomaine it was 
found to contain by one of his colleagues. 

I do not quite understand his theory of this retarding function. 
One of his points (there are two) I imderstood weU. He believes, 
suggesting without giving it as a positive opinion, that the rapid 
rotation of the earth increases the amount of carbonic acid in the 
atmosphere in the Tropics, thus causing this retardation of nutritive 
function. The other point is the absence of seasonal changes; that 
is, that there is a monotony in the landscape, a monotony in every- 
thing about, that in the same manner there is a monotony of Ught, 
a monotony of sound, which may produce serious disturbance in 
the nervous system. 



PUBLIC HEALTH AND MEDIOIKE. Ill 

The CHAiBBfAN. The following papers, largely previously presented 
conference papers, have been courteously submitted to Section VIII 
by their writers. As a matter of record they will be included in the 
proceedings of the section : 

Tratamiento de la coqueluche, by Rodolfo Kraus. 

Ingerto testicular, by Antonio F. Celesia. 

Vacunoterapia de la conjimtivitis granulosa, by E. B. Demarfa, 
Salvador Mazza, y Hector Rebay. 

Tratamiento de las apendicitis agudas, by Ekirique J. Corbellini. 

The Chaibman. I beg to state that through the courtesy of the 
authors the following printed pamphlets have been presented to 
the Congress through Section VIII : 

Investigaciones sobre el cultivo de la rabia por el m6todo de No- 
guchi, by R. Kraus and B. Barbara. Las Ciencias, Libreria y Casa 
Eklitora de A. Guidi BuiFarini, Buenos Aires. 

El carb6n animal en la terap^utica y en la higiene, by R. Kraus 
and B. Barbara. Las Ciencias, Libreria y Casa Editora de A. Guidi 
Buffarini, Buenos Aires, 1915. 

Terap6utica heterobacteriana, by R. Kraus and S. Mazza. Las 
Gencias, Libreria y Casa Editora de A. Guidi Buflfarini, Buenos Aires, 
1914. 

Contribuci6n al estudio del tratamiento operatorio de los quistes 
uniloculares vohuninosos y extrasinusales del maxilar superior, by 
Diogenes Massa. Talleres Gr&ficos de Juan Perrotti, Buenos Aires, 
1915. 

Profilaxia de la tif6idea por la vacunaci6n en la Reptiblica Argen- 
tina, by Salvador [Mazza. Las Ciencias, Libreria y Casa Editora de 
A. Guidi Buffarini, Buenos Aires, 1915. 

Adjournment at 1.20 p. m. 



GENERAL SESSION OF SECTION Vm. 

New Ebbitt Hotel, 
Monday afternoon, Jarmary 5, 1916. 

Chairman, J. D. Gatewood. 

The session was called to order at 2 o'clock, by the chairman. 

The following papers were presented: 

Changes in the food supply and their relation to nutrition, by 
Lafayette B. Mendel. 

A safe and sane milk supply, by John Weinzirl. 

Proyecto de ordenanza reglamentaria del comercio de leche de 
consumo en Buenos Aires, by Ricardo Sarmiento Laspiur. 

CHANGES IN THE FOOD SUPPLY AND THEIR RELATION TO NUTRITION. 

By LAFAYETTE B. MENDEL, 

Professor of Physiological Chemistry , Sheffield Scientific School, Tale University. 

In the type of civilization with which we are most familiar there are two fundamental 
elements — supplies of food energy and supplies of mechanical energy. Since, at 
present, partly because of geographical conditions, these do not necessarily (or even 
in general) occur together, there is a third essentisd factor, the line of transport.* 

A comprehensive consideration of any one of these factors, such as the food supply, 
can not be completely dissociated from its relations to the others. The development 
of commerce among nations having adequate means of communication has, for exam- 
ple, rendered the distribution of food materials easy and developed a sense of security 
(under normal conditions) against failure of food supplies. The growing organiza- 
tion of transportation facilities has encouraged the introduction of dietary changes 
never thought possible or even contemplated a few generations ago. Incidents 
associated with the altered distribution of wealth have improved the nutrition as 
well as other conditions of living among that large group of our population which has 
been termed the "healthier well-to-do classes." 

The supply of food energy and its availability where needed are interrelated closely 
with a variety of factors, the bearing of which upon the problem at hand is not always 
evident upon the surface. Some of these features may be classified superficially as 
follows: 

1. Food production. 

2. Food preservation and food conservation. 

3. Transportation facilities. 

4. Customs in diet. 

5. Changing industrial and social conditions, and other economic and hygienic 
factors. 

I Dickson, U. N.: The Redistribution of Mankind. Presidential Address to Section E (Geography) at 
the Birmingham meeting of the British Association, September, 1913. Report British Association for the 
Advancement of Science, Birmingham 1013, pp. 536-546. London 1014. 

112 



PUBLIO HEALTH AND MEDIGIKE. 113 

Food production, — ^The problem of food production is the fundamental concern of 
agriculture. How profoundly its practices are being changed by the progress of science 
and the mechanic arts is familiar to every observant person. The food supply has 
been increased in part through more intensive methods of agriculture, in part through 
the enormous extension of areas suitable for cultivation. In view of the increase of 
population it has been a favorite pastime for scientists to calculate the possibilities 
of the food supply of the future and to venture prophesies involving the prospect of 
impending failures. A forecast by Sir William Crookes of the relatioms between the 
probable increase of the world's supply and demand of wheat, ''the most sustaining 
food grain of the great Caucasian race,'' was widely discussed when his estimates were 
published. In a Presidential Address to the British Association for the Advancement 
of Science in 1898 Crookes said: 

Should all the wheat-growing countries add to their (producing) area to the utmost 
capacity, on the most careful oilculation the yield would ^ve us only an addition of 
some 100,000,000 acres. stippl3dng, at the average world yield of 12.7 bushels to the 
acre, 1,270,000,000 busnels, just enough to supply the increase of population among 
bread eaters till the year 1931. ♦ ♦ ♦ Thirty years is but a day in the life of a 
nation. Those present who may attend the meeting; of the British Association 30 
years hence will judge how far my forecasts are justified. 

Fifteen years later Prof. Dickson said: 

Half the allotted span has now elapsed, and it may be useful to in<]uire how things 
are going. Fortunately, this can be easily done, up to a certain point, at any rate, 
by reference to a paper published recently by Dr. j. F. Unstead, in which compari- 
sons are given for the decades 1881-1890, 1891-1900, and 1901-1910. Dr. Unstead 
shows that the total wheat harvest for the world may be estimated at 2,258,000,000 
bushels for the first of these periods, 2,575,000,000 for the second, and 3,233,000,000 
for the third, increases of 14 per cent and 25 per cent, respectively. He points out 
that the increases were due "mainly to an increased acreage," the areas being 
192,000,000, 211,000,000, and 242,000,000 acres, but also "to some extent (about 8 
per cent) to an increased average yield per acre, for while in the first two periods this was 
i2 bushels, in the third period it rose to 13 bushels per acre." 

If we take the period 1891-1900. as nearly corresponding to Sir William Crookes's 
initial date we find that the succeeaing period shows an increase of 658,000,000 bushels, 
or about half the estimate increase required by 1891, and that attained chiefly by 
"increased acreaffe. " But signs are not wanting that increase in this way will not go 
on indefinitely. We note (alro itom Dr. Unstead's paper) that in the two later periods 
the percentage of total wheat produced which was exported from the United States 
fell from 32 to 19, the yield per acre showing an increase meanwhile to 14 bushels. 
In the Russian Empire the percenta^ fell from 26 to 23, and only in the youngest of 
the new countries — Canada, Australia, and Argentina — do we find lar^ proportional 
increases. Again it is sigpiificant that in the United Kingdom, which is, and always 
has been, the most sensitive of all wheat-producing coimtries to variations in the 
floating supply, the rate of falling o£f of home production shows marked if irregular 
diminution. 

Looking at it in another way, we find (still from Dr. Unstead 's figures) that the total 
amount sent out by the great exporting countries averaged in 1881-1890, 295,000,000, 
bushels; 1891-1900, 402,(500,000; 1901-1910, 532,000,000. These quantities represent, 
respectively, 13, 15.6, and 16.1 per cent of the total production, and it would appear 
that the percentage available for export from these regions is, for the time at least, 
approaching its limit — ^i. e., that only about one-sixth of the wheat produced is avail- 
able from surpluses in the r^ons of production for making good deficiencies elsewhere. 

There is, on the other hand, abimduit evidence that improved agriculture is begin- 
ning to raise the yield per acre over a large part of the producing area. Between the 
periods 1881-1890 and 1901-1910 the average in the United States rose from 12 to 14 
bushels; in Russia, from 8 to 10; in Australia, from 8 to 10. It is likely that in these 
last two cases at least a part of the increase is due merely to more active occupation of 
tresh lands as well as to the use of more suitable varieties of seed, and the effect of 
improvements in methods of cultivation alone is more apparent in the older countries. 
Diuing the same period the average yield increased in the United Kingdom from 28 
to 32 bushels, in France from 17 to 20: Holland, 27 to 33; Belgium, 30 to 35; and it is 
most marked in the German Empire, for which the figures are 19 and 29. 

In another important paper Dr. Unstead has shown that the production of wheat 
in North America may still in all likelihood be very largely increased by merely 



114 PROCEEDINGS SECOND PAN AMEBIOAN SCIENTIFIC CONGBESS. 

increasing the area under cultivation, and the reasoning by which he justifies this 
conclusion certainly holds good over large districts elsewhere. It is of course impos- 
sible, in the present crude state of our Imowledge or our own plant, to form anv accu- 
rate estimate of the area which may be the use of suitable seeds or otherwise, become 
available for extensive cultivation. But I think it is clear that the available pro- 
portion of the total supply fnnn *' extensive" sources has reached, or almost reached, 
its maximum, and that we must depend more and more upon intensive farming, with 
its greater demands for labor. 

The average total area under wheat is estimated by Dr. Unstead as 192,000,000 acres 
for 1881-1890, 211,000,000 acres for 1891-1900, and 242,000,000 acres for 1901-1910. 
Making the guess — ^for we can make nothing better — that this area may be increased 
to 300,000,000 acres, and that under ordinary agriculture the average yield may even- 
tually be increased to 20 bushels over the wnole, we get an average Imrvest of 6,000^- 
000,000 bushels of wheat. The average wheat eater consumes, according to Sir 
William Orookes's figures, about 4} bushels per annum; but the amount tends to 
increase. It is as much (according to Dr. Unstead) as 6 bushels in the United King- 
dom and 8 bushels in France. Let us take the British figure, and it appears that on 
a liberal estimate the earth may in the end be able to feed permanently 1,000,000,000 
wheat eaters. "If prophecies based on population statistics are trustworthy, the 
crisis will be upon us before the end of this century. " * 

Interesting as such speculations are, despite the number of uncertain variables with 
which they necessarily deal, they fail to take into consideration the altered pros- 
pects arising out of the modem increasing knowledge of the science of nutrition. It 
is by no means improbable that progress in food chemistry and the study of metabolism 
will point the way to substitutes for what is now regarded as a staple foodstuff. We 
shall see what changing customs in diet have already brought about in many instances. 
If corn, for example, does not satisfy the requirement of a staple crop for human con- 
sumption, it is not at all unlikely, in view of information already available, that small 
addenda of other foods may suffice to supplement it so as to produce a more perfect 
ration. 

One may appropriately recall here that evidences of adequate nutrition are available 
from people nourished in most diverse ways in different parts of the world. Even 
if the wheat problem were to become one of urgency within an appreciable i)eriod, this 
need not necessarily be construed into a forecast of an actual shortage of food. Within 
a few months attention has been directed to the possibility of growing in the United 
States at least two plant products which may serve as human foods. One of these is 
proso millet, the other grain soxghum or kaoliang, both of which have long been known 
in other parts of the world as constituents of the diet of mankind . Both of these seeds 
can be milled like the familiar cereals and s^ved Uke these or transformed into culi- 
nary products after admixture with flour, which enables them to be prepared for baking. 
The peculiar agricultural advantage in such crops lies in the fact that they are drought 
resistant. Proso will grow when and where the staple small grains that require moist 
regions fail. Kaoliang represents a tropical annual plant which can by cultivation 
be extended north as far as Indian com on this continent. The dietary possibilities 
of both proso and kaoliang have already been tested in a semipublic way.' 

Food preservation and food conservation. — ^The preservation of food affects the food 
supply by making it possible to utilize in times and places of relative scarcity products 
which are available in a season and region of abundance. From an early period 
preservative methods have been employed. Some of them are so familiar that they 
are frequently not even recognized as belonging in the category of food preservation. 
Desiccation, canning, pickling, salting, smoking, low temperature, freezing, special 
chemicals — these are some of the factors that enter into this aspect of our theme. 
The significance of most, if not all, of these procedures is more largely economic than 
hygienic. 

1 Dickson, H. N.: kx^ cit. p. 6S5. 

• See Hanaen, N. E.: Proso and KaoHang as Table Foods. South Dakota Agrioultoral Bxpariment 
Station BuU. 158, March, 1015. 



PUBLIC HEALTH AND MEDICINE. 115 

The cold storage methods now in use represent a comparatively recent development 
of the preservation problem. 

According to Sherman, only since about 1893 have the quantities of food materials 
placed in cold storage been large enough to have an appreciable effect upon market 
conditions. As an illustration of its efficiency, recent experiments have shown that 
fresh fish — a food product *notably subject to speedy deterioration — may be preserved 
frozen, by the best cold storage processes, without undergoing any important change 
lor at least two years. ^ 

Modem bacteriology has placed upon cleanliness a preservative value which may 

appear surprising in respect to its efficiency, particularly in conjunction with low 

temperatures which inhibit the development of microorganisms detrimental to foods. 

As an example of what such sanitary precautions can accomplish in the case of readily 

deteriiurating milk, Sherman states: 

Three American dairy farms exhibited raw milk at the Paris Exposition of 1900, 
one of them sending weekly shipments throughout the summer, each of which was 
kept on exhibition m the raw state without spoiling until the next shipment arrived. 
It was difficult to convince the jury of European experts of the fact tnat cleanliness 
and cold were the only preservatives needed to accomplish the keeping of raw milk 
in a fresh sweet condition for two to four weeks in midsummer .^ 

Precisely such methods, combined with modem trsCnsport facilities, have made i t 
possible to extend the range of milk supply in our laige cities literally hundreds 
of miles and to bring an indispensable food at a reasonable price into every home. 
There is, indeed, a profound difference between marketing milk in the familiar 
manner now practiced and the older mode of distribution when goats or cows were 
driven in front of the home to be milked there. 

Probably no single preservation device excels tiiat of desiccating the materials. 
In the absence of moisture decay is arrested. Where the ^ater content of a natural 
food is not unduly large it can often be dried readily with success. Dried meats, 
fish, and fruits have Icmg belonged to the list of preserved foods. In the case of prod- 
ucts comparatively rich in water, particularly liquid or semiliquid foods, successful 
methods of desiccation have awaited the perfection which is beginning to manifest 
itself at the present day. Aside from the element of cost, the use of heat to expel 
moisFture has the objection that it alters the product in some cases so that it is no longer 
dietetically acceptable . Heat also may remove desirable volatile ingredients . Flavors, 
which play a very important rdle in rendering a food acceptable to the consumer 
are not always thermostabile. 

Modem industry is likely to oveitK)me many of the difficulties by the device of 
desiccation at lower temperatures either in a vacuum or a currait of air. A most 
Mtislactory instance of this ia seen in the case of milk. Condensed and evaporated 
milks are likely to be superseded by dried milk of which superior grades are already 
being manu&urtured. The successful desiccation of milk— a product of which seven- 
eighths is water — with the retention of the solubility on which the practical appli- 
cations largely depend, and with its nutritive virtues presumably intact, is an up-to- 
date accomplidiment. 

The possibility of a satisfactory outccone of the efforts now being made in the milk 
industry deserves more than passii^ notice. Milk not only is a valuable food ; it is at 
present an indispensable component of the diet during growth, and no entirely satia&u^- 
tory method of preservation has hitherto been devised. With one American brand of 
dried milk as the chief component of the ration, several investigators, including 
myself, have raised small animals into a second generation. If the best dried milk 

I Smith, C. S.: A Study of the Infloenoe of Cold Storage Temperatures upon tbe Chemical Compodtioii 
and Nutritive Value of FUh. Biochemical Bulletin, 1913, ill, 64; Perteweig, W., and Gies, W. J.: A 
Fartber Study of the Chemical Composition and Nutritive Value of Fish Subjected to Prolonged Periods 
ol Cold Storage. Italdeai, 1918, Ui, 09. 

t siMrman, H. C: Food Prodoots. New York, 1914, p. fiS. 

68436— 17— VOL X 



116 PBOCEEDINGS SECOND PAN AMEBICAN SCIBKTIFIO 00KQBES8. 

of the future shall be shown to retain eymi the more subtle physiological properties, 
Buch as its antiscorbutic potency, it will represent good achievement. 

The expression "food conservation'' is used in the present discussion perhaps not 
in accord with a strict definition but rather in the broader current sense in which we 
speak of the conservation of other resources. The growing use of by-products finds its 
exemplification in the food industries as well as in other branches of commerce; and 
directly or indirectly this affects the problem of food supply. In some instances the 
use of the by-products has rendered the production of a food which x>therwi8e could 
not be marketed advantageously profitable and therefore possible. The meat industry 
presumably afifords instances where the price of edible parts has been kept within 
reasonable limits by the increasing market value of what was once merely worthless 
refuse. Tankage belongs to the latter category. The refinement of this aspect of 
modem industry impressed itself upon me in seeing the fine hairs in the ears of cattle 
fattening for market clipped for the special manufoicture of expensive "camel's-hair" 
brushes; and likewise in observing the careful removal and collection of the seeds 
from raisins introduced into commercial mince meat. From these supposedly worth- 
less seeds valuable raisin oil was subsequently extracted. The by-products of the 
sugar industries are notably important. Part of them are literally used to get gold. 
The residues from the desaccharification factories are rich in nitrogen which is in 
part converted into sodium cyanide. Tons of this have been exported to the Trans- 
vaal where it has been used for extracting the precious metal by the well known 
cyanide process. 

For tUe food supply it is more important that in many instances what was in the past 
regarded as refuse or a useless dietary constituent has been converted into edible 
products. Sometimes, as in the case of grain products, In the distilleries, breweries, 
etc., by-products now s^rve as cattle feeds and thus indirectly conserves the food 
supply of man. In other instances new human foods have been devised. Cotton- 
seed oil, oleo oils from beef, and other fats are no longer despised as constituents of 
the diet. In some cases chemistry has aided to alter the &ts into a suitable texture 
and consistency for culinary purposes. Slaughterhouse blood finds its way into 
food products. Com simps and glucose sugars artificially prepared from cheap sources 
of starch have survived the propaganda of prejudice and now represent one of the 
cheapest sources of wholesome nutriment. Deteriorated products such as old butter 
are * ' renovated " and returned into the food treasury. Hydrogenated &ts are a modem 
innovation. 

The digestive functions of man offer a barrier to the successful use of certain agri- 
cultural products as human nutrients. Complete digestion is a prerequisite to ade- 
quate nutrition. Cellulose, which is so widely distributed in plants, is unutilized 
by man because it is indigestible. It is theoretically conceivable, however, that 
cellulose can be converted into available carbohydrate by chemical procedures. 
Other plant constituents, wholesome in themselves, are often practically unutilized 
in the alimentaty tract because they are protected by impervious coverings. In 
such cases the physical texture of the product is at &ult. The alimentary utilization 
of the foodstuffis, particularly the indispensable proteins, in conmon foods such as the 
legumes and cereal grains is fax below what potains in most animal food products. 
Some presumably valuable vegetable proteins can not be used as food by man because 
his digestive juices can not get at them in the condition in which they are usuaUy 
exhibited for use. Improved culinary methods and procedures for extreme comminu- 
tion, particularly after desiccation, may alter this situation in coming years. A 
beginning has already been indicated by H. Friedenthal in the case of certain green 
vegetables. The growing use of nut products and nut pastes, and the widespread 
popularity of the readily digested peanut butter, prepared from an article which is 
looked upon as difficult of digestion in its imperfectly comminuted form, shows what 
industries can do to overcome dietary prejudices or domestic ignorance, by enhancing 
palatability and digestibility. 



PUBUC HEALTH AND MEDICIll^. 117 

Of all the foodstuffs, the proteins offer the most serious problem. They represent 
the Indispensable staple for tissue construction; they are produced at the greatest 
expense. The quantitative aspects of the protein requirement of man have been 
warmly debated in recent years. One extreme view of the superiority and con- 
sequent liberal need of protein was expressed by Liebig ^ as follows: 

Everyi^iiere throughout orguiized nature, where animal life is developed, we find 
the phenomena of life depending on the presence of albumen. The continuance of 
life IS indissolubly connected with its presence in the blood; that is, in the nutrient 
fluid. In so far as the notions of formation, nutrition, or the nutiitive property are 
inseparable from that of a substance whose properties and composition are collected 
in the word albumen, only those substances are in a strict sense nutritious articles 
of food which contain either albumen or a substance capable of being converted 
into albumen (p. 346). 

The "plastic foods'' of Liebig were the proteins. Accordingly he says again: 

All these orp;anized tissues, all the parts which in any wav manifest force in the 
body, are derived hrom the albumen of the blood; all me albumen of the blood is 
derived from the plastic or sanguigenous constituents of the food, whether animal or 
vegetable. It is clear, therefore, that the plastic constituents of food, the ultimate 
source of which is the vegetable kingdom, are the conditions essential to all production 
or manifestation of force, to all those effects which the animal organism produces by 
means of its oigans of sense, thought, and motion (p. 366). 

The other extreme is represented by the modem so-called '4ow protein" advocates. 
From the debate on this topic it has become probable that, although some views as 
to the importance of protein in the dietary have been exaggerated, a liberal factor 
of safety must be allowed. In any event protein has lost the special significance 
which it assumed in Llebig's day as the unique source of energy. As a guide in the 
consideration of the protein supply of the future we may recall the attitude of Prof. 
Rubner, an expert in the field of nutrition study, before the Fifteenth International 
Congress on Hygiene and Demography at Washington in 1912: 

Nutrition in the cities has at all times a tenden<^y toward refinement, but in former 
times, when the classes lived strictly separate, the food materials were also very 
different within the city walls. The food of the nobility was different from that of the 
middle class, and the latter from that of the poor people. Among the materials 
successfully used in the culinary art a high place has always been held by the meat 
of mammals, fowls, and fishes. These meats were the chief part of the meal, other 
foods of vegetable origin, as salads and vegetables, sweets, and flour foods being added. 
Bread remained in the background . The traditions of this culinary art have remained 
the same down to our days. This diet of the upper classes is the only one which 

Srovides the pleasures of me table; it is rich in proteid and fat; it is not voluminous, 
oes not overburden the stomach, tends less to ooesity than any other diet, keeps the 
body even of a lazy man in good condition, and does not overwork die digestive 
functions. The less well-to-do reduce, of course, the amount of meat, but they use 
in its place bread and potatoes. This is called a mixed diet. When the barriers 
between the classes fell, the middle classes gradually rose to the more luxurious 
food of the formerly privileged classes. 

It is a fact that tlie diet of the well-to-do is not in itself physiologically justified: 
it is not even healthy^ for, on account of false notions of the strengmening effect ox 
meat, too much meat is used by young and old and by children, and this is harmful. 
But this meat diet is pubUcly sanctioned; it is found in all hotels; it has become 
international and has supplanted almost everywhere the characteristic local culinary 
art. It has also been adopted in countries where European culinary art was unknown. 
Long ago the medical profession started an opposition to the exa^erated meat diet — 
long before the vegetarian propacimda was started. It was maintained that flour- 
foods, vegetables, and fruit should oe eaten in place of the overlarge quantities of meat. 

The descendants of those well-noorished classes are, on account of many influences, 
especially the school and the indoor life, not always the strongest part of the nation » 
but since in recent times bodily exercises have become general they are again de- 
cidedly in the ascendency. 

iTonLiebig,J.' FmiiilUBrL«tt«noiiClitmi8try. SdedUkm. London, 18(1. 



118 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONGRESS. 

The sanitary condition of the great mass of industrial workers and their children, 
and of people of very small earnings, are different. Keare we find a decided deteri- 
oration of the body, as is amply shown by the recruiting for military purposes. In 
spite of continuous migration from the country to the cities, conditions are little 
changed. The social surroundings of a great city are decidedly imfavorable to the 
maintenance of a strong race. Among the many factors which cause this decrease of 
bodily efficiency nutrition is not the least. 

The industrial workers coming from the country to the city can not well get along 
with their former simple diet because the cheap food materials which are easily 
obtained, as bread and potatoes, contain too little proteid. They undoubtedly need 
an increase of proteid material. Neither can they find in the city the food condi- 
tions to which they had formerly been used; but they accommodate themselves rap- 
idly to new conditions, coming into the new surroundings, as they usually do, without 
a family. Just as under the doctrine of political equality the lower classes try to 
attain the luxurious table of the well to do, so it is not 8iu*pri6ing that industrial work- 
ers coming from the country to the cities accommodate themselves to the new die- 
tary forms. 

The workingman does not want proteid, leguminous food, milk, etc., to improve 
his vegetable diet; he wants simply meat, not because he needs it, but because it b 
for him a matter of pride to follow as best he can the other classes in his diet. The 
difficulty is that the cost of meat is considerably higher than in the country where 
food can usually be obtained without the aid of dealers, and where many foodstuffs 
are raised on one's own land. 

The importance of the conservation of protein has led to numerous investigations 
of the economy of this food stuff which need not be discussed here.* 

Transportation facilities, — ^The concentration of population in restricted areas is nec- 
essarily limited by the possibilities of the food supply. The latter is the corollary of 
finding suitable accomodations for increasing numbers. Within less than a century 
nearly every region of the globe has been tapped by railways or waterway fecilities 
to permit the more uniform distribution of things. The competition of the different 
lines of transportation has been an interesting phase in the exchange of commodities, 
among which food has been conspicuous. The end is not in sight, for with the added 
possibility of preserving foods at reasonable cost a new chance for distribution has 
arisen. American wheat has long traversed a continent by train or crossed an ocean 
in a steamer's hold, but the sight of Australian meats in the London market, of Call- 
fomian fruits and vegetables in Boston, of eggs from China in Chicago, or of Wisconsin 
milk in Manila was reserved for the present generation. In earlier days the dietary 
habits of peoples were developed on the basis of the native products of the soil. Now, 
when the means of transportation are no longer primitive, specific demands can read- 
ily be satisfied by importation. This is particularly exemplified where certain habits 
of taste have persisted longer than the local sources of supply. 

Customs in diet. — ^To one who has given little thought to the subject, the dietary 
habits of a community or nation may appear as something fairly fixed from generation 
to generation. This is, however, far from a correct view. Adequate nutrition may 
be exemplified alike among the meat and blubber eating Eskimos and the strictly 
v^etarian Hindoos. But particularly where the dietary instincts have led mankind 
to adopt a more div^sified mixed ration one may discover shifts of custom and changes 

1 The following is a partial list of monographs dealing with some aspects of this topic: Chitten- 
den, R. H.: Physiological Economy in Nutrition. 1904; Chittenden, R. H.: The Nutrition of ICan, 
1907; McCay, D.: The Protein Element in Nutrition, 1912; Rubner, M.: Volksem&hrungslragen, 1908; 
Rubner, M.: Wandlungen in der Volksem&hrung, 1913; Hindhede, M.: Protein and Nutrition, 1918; Men- 
del, L. B.: Theorien dos Eiwcissstoffwechselsnebstelnlgen praktischen Konsequenzen derselben, Ergeb- 
nisse der Physiologie, 19X1, xi, 418-525; Mendel, L. B.: Nutrition and Growth. Harvey Society Lectures, 
1914-15. 



PUBLIC HEALTH AND MEDICINE. 119 

of eatLQg habits within comparatively short periods. A comprehensive survey of this 
feature of dietetics and an examination of the underlying causes would furnish inter- 
esting physiological, sociological and economic details. A few typical illustrations 
must suffice to indicate these interrelations between customs in diet and the food 
supply. 

The use of fresh fruits has been enormously extended among the progressive peo- 
ples of temperate zones within the past two decades. Some of these food products, 
such as orchard fruits, have long been favorites in the dietary and because of their 
superior keeping qualities have been avsiilable over long periods of the year. The 
output of orchard fruits has kept pace with the growth of population. The value of 
the products of the orchard in the United States in 1840 was about $8,000,000; a 
recent census report gives the figure as $140,867,000. Among other types of fruits 
proportionately greater increases are noted. '* Small fruits" contributed $30,000,000; 
grapes, $22,000,000; citrus fruits, $23,000,000; other tropical and subtropical fruits, 
$2,000,000; to the production of fruits in the United States in 1909. Many of these, 
like the orange and grapefruit, have become prominent in the diet of the well to do 
because of the readiness with which they can be obtained at a reasonable price every- 
where during most of the year. Science, the mechanic arts, and business organiza- 
tion have combined to revolutionize the distribution and marketing, as one may 
learn in studying the work of the Califomia Fruit-Growers' Exchange. The once 
enormous losses from decay have been greatly reduced and the marketed products 
are of a superior quality. 

There is a physiological justification for the increasing prominence of fruits in the 
diet of the better classes and its extension throughout all seasons of the year. With 
the growing use of highly digestible foods and the exclusion of indigestible food resi- 
dues, with the widespread employment of milled cereals largely freed from cortical 
parts, with the tendency to exclude the ''coarser'' vegetables or limit their inclusion 
in the menus of the better classes, the absence of ''roughage" in the diet, combined 
with other features of modem living, helps to induce habitual constipation in certain 
classes of society. The fruits serve a useful purpose in counteracting this tendency 
by promoting the movement of the bowel — hence the expression, "An apple a day 
keeps the doctor away. ' ' 

The familiar adage just quoted has been converted into an advertising slogan in 
some of the apple-growing States of the West. This leads me to call attention to the 
potent force ot advertising in creating a demand for food products of most varied sorts. 
The same agency which has created a nation-wide mania for chewing gum and has 
initiated in all ranks of society a senseless habit of mastication which was until a few 
years ago limited to the overlooked improprieties of childhood, has been reflected in 
the food market. The ready-to-eat "breakfast foods" in hi^y advertised, neat, and 
attractive packages, have replaced the less expensive cereals long sold in bulk. The 
change is not merely one of the container or package; the contents no longer are the 
nme. Oatmeal, for example, has lost some of its former popularity as a breakfast 
dish with the inroad of com flakes and wheat foods. The breakfast staples have been 
changed by the modem advertiser; and illustrations of his ingenuity might be ex- 
tended to include numerous food products. Except from the standpoint of extreme 
economy the innovations have as a rule been wholesome and usually in the interest 
of food hygiene. The purity of the products has not infrequently siurpassed the 
honesty of the advertisement. 

Most of us can recall the days when meat or eggs, or both, formed an indispensable 
part of the early meal in the United States. At present there are signs everywhere, 
at least among those classes which are not engaged in more vigorous muscular work, 
of a simplification of this meal by the exclusion of meat and the substitution of cereals 
and fruits. This is an approach to the traditional breakfast of continental Europe. 



120 PKOCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONGRESS. 

It is not easy to analyze the underlying causes for such dietary changes; they are not 
solely physiological nor economic in origin. Buhner has remarked that sometimes 
revolutions occur in the field of popular nutrition. The introduction of the potato in 
many extensive regions is cited as an illustration. 

It might be supposed that bread, ''the staff of life," remains essentially what it baa 
been in days gone by. This food product, however, furnishes an example of the 
evolution of a food indiistry. Bread making is gradually becoming a factory problem. 
The magnitude of this may be appreciated from the statement that the baking indus- 
try is to-day capitalized at over 1270,000,000; yet housekeepers still make 70 per 
cent of the product used.^ With increasing efficiency and range of distribution the 
use of bakers' bread is certain to increase; just as butter, pickles, mustard, etc., are 
no longer exclusively home-made products. As soon as larger corporate interests be- 
come involved in the food industries, altered methods of manufacture are likely to be 
introduced when they seem both profitable and feasible. Food innovations are not 
readily introduced in the home, but in the factory they frequently become questions 
of dollars and cents. In the manufacture of baked goods the cost of production baa 
been modified by the substitution of dried milks for fresh milk and of vegetable fats 
for the more expensive butter. The manufacture of yeast has become specialized into 
an important industry which reacts upon the public with the cleverly advertised 
admonition to ''eat more bread." 

Wheat has unique properties which adapt it to the production of bread as we now 
know it. Other seeds are competing for recognition. New "flours" are proposed. 
The proao and kaoliang flours already mentioned are among them. Even cottonseed 
"flour" is clamoring for recognition. When glutenous adjuvants are supplied to 
cereals which lack them, and when more science is infused into the art of baking, new 
bakery products are likely to arise. 

The use of fats in the diet is .doubtless increasing in the United States. It is esti- 
mated that the consumption of butter alone reaches 23 to 24 grams (three-fourths to 
four-fifths of an ounce) , or approximately 200 calories per person per day. An inspec- 
tion of the dietaries in the public establishments of half a century ago, as they are 
reported in the treatises of that period,' reveals the important part taken by bread 
in the regimen. Butter was often entirely omitted in the daily allowances of asylums, 
prisons, military groups, and other typi<»l institutions. Frequently the diet lists of 
those days call for bread and molasses or bread and milk. Bread without butter or 
some other fat is now the rarity, at any rate in American homes. Despite the dis- 
couragement which the oleomargarine industry has received from legislation, ofttimea 
unwarranted, the use of butter substitutes is spreading as the price of the original 
product is increasing. Here too the advertising billboards are already pointing out 
the future way. Butter substitutes are not only used directly in the meal, but are 
finding a wide field of application in the cooking and baking processes of the kitchen. 

Another change in diet customs is seen in the growing use of cheese in American 
homes. This wholesome article has long been appreciated at higher value in Euro- 
pean countries than in our own. Nuts and nut foods are becoming more popular, in 
part as the result of the modem vegetarian propaganda which reconmiends them as 
''meat substitutes.'' The value of the peanut crop is about $20,000,000. Sherman 
remarks that ' ' to speak of nuts as ' meat substitute ' is natural under present conditions 
and reflects the prominence which has been given to meat and the casual way in 
which nuts have been regarded for some generations. Looking at the^matter in 
evolutionary perspective, it might be more logical to speak of meats as ' nut substitute ' 
instead." 



> These statistics and related statements are taken (irom Duncan, R. K.: Some Chemical Problems of 
To-day. Chapter on Bread. 
* For example, in Pereira, J r A Treatise on Food and Diet. New York, 184S. 



PtraUC HEALTH AND MEDICINE. 121 

The cuirent «zl«iiaiv« uw of sucroM in the bvm of refined cuie eupu or beet augu 
exemplifies what the cheapening of an article of commerce caa accompliab in the S»li 
ol diet. Althou^ sucrose has a considerable fuel value in the wganiam its dietary 
uae is (ntnitil)' dictated by consideralaonB of flavor. Opinioiu are occasionally 
divided as to the place ol tUs sugar in the dietary. It aeenu as if the extnmM of 
refinement which have made commercial suoose in a chemical sense the purest <A 
aU purchasable foodstuffs had exceeded all requirements of nutrition or dictates of 
the palate. The addition of a blue dyeetuS to give a white appearance to the final 
product rapreeents one of the peychological vmluee which are often more ridiculous 
than costly. Surely for most uses the artificially colored white sugar has nothing 
except a false standard to recommend it in place of tlie natural cream colored sugar. 

It is likely that the succulent vegetables will play a larger part in the table of 
American households. Dr. C. F. lAngwwthy, Chief of Nutrition Investigations in 
the Office of Experiment Stations at Washington, says; 

One of the marked differences between the daily fare to-day and that of GO years igo 
consists in the increased supply of green and succulent veKetablee, a clan of food 
used, as their namee imply, for their refreshing and palatable qualities mwe than for 
their total nutritive value. Not many years ago the winter's supply of vegetables in 
all southern countries was limited to root crops and a few other staples, sud) as onions 



d preservinff industry, have made succulent vegetables 
tnd available in one fimn or another foe almost every 

The popularity of groan v^etablee is beginning to be reflectod in the canning indus- 
tries where the variety of such products is being extended rapidly and the f nnfng 
procen has already developed into an impratant enterprise. To the m«e familiar 
commercial lists including tomatoes, com, peas, and beans, there are being added 
asparagus, beets, okra, pumpkin, sweet potato, rhubarb, nuerkraut, spinach, and 
•qnaah. The extent of this canning industry and its growth in a single decade is 
shown statislicaUy, as tollowa: 





ItOft 


• I» 




CMta. 


V»U». 


Cmm. 


Vitm. 






at 

s 

Its 
OT 

u 
1 


Si 

l,tt!.HT 


























I 

















































I Lwcvtthf , C. r.: Onm VtfMaUn ud Tbrir ITi 
ISll, p. B. 

■ Finn BttUoc, A. W.; Kathodi FaUn«d In tba i 
Aptcnltm, BulMtai 1«8, WtrtdofUn, IBll. 



itntlMStM. AoHrioiB PMd locDiMl, OM. U 



122 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONGRESS. 

The indirect effects of the antialcohol campaign now vigorously conducted in many 
countries are seen in the stimulation of trade in so-called temperance drinks. It 
comes as a surprise to an old-timer to see buttermilk retailed over the bar of the 
American saloon. The grape-juice industry has grown by leaps and bounds; and 
this alcohol-free natural product is veritably becoming one of the national drinks. 
I am informed from expert sources that the production of American unfermented 
grape juice in the year 1914 amounted to 4,593,750 gallons in the Chautauqua belt 
alone. Other fruits, also, are likely to figure in the new field of use here opened. 
It is stated that 25 per cent of the apples grown in American orchards never enter 
into the food supply of the nation. This has been a stimulus to the food conserva- 
tionists to transform the unused materials into new forms of food. Apple sirup and 
concentrated cider have been suggested as new products for utilizing surplus and 
cull apples.' The expert of the Department of Agriculture remarks: 

What the commercial future of the two products will be remains to be determined 
under actual marketing conditions. The department has every confidence in the 
feasibility of making tne two products where the apple supply and the manufac- 
turiuR conditions are suitable. The development of tnis infant industry must now 
be left in the hands of the progressive American manufacturer. A process which 
will make pure, fresh cider available as a summer drink at our soda fountains should 
open up a new and valuable market for the juice of surplus apples. Whether young 
America will eat apple sirup on his bread and his mother use it in her kitchen must 
be decided by the American people. 

Similar considerations are being applied to other fruits now wasted. 

The *' dairy lunch" rooms of our cities and larger villages represent an innovation 
in dietary practice. The dinner pail and the lunch basket filled with homemade 
food have given way to "ready-made" meals. To one group of persons the lunch 
rooms represent a welcomed escape from the more expensive luxuries of the con- 
ventional restaurant; likewise a possibility of substituting old-fashioned pastry and 
cereal dishes for the usual dining-room meal rich in meat. To another increasing 
class, however, they offer a means of reducing the labor of the household by the 
device of a public eating place. The recent interesting study of a familiar chain 
of these *' dairy" restaurants, published under the auspices of the Sage Institute 
by Gephart and Lusk,' show that the popular sandwich meal of the lunch counters 
is by no means a cheap diet for the working classes who have a limited allowance 
to spend for food. Attractive as the highly profitable service of the "dairy lunch" 
may be, with its congenial environmental features, it can not compete with "home 
cooking" from the standpoint of economy. This lesson needs to be brought home 
to a nation which is continually discussing the high cost of living. Domestic arts 
should not become relegated entirely to corporate enterprise. 

CJianging social and indiistrial conditions and other economic and hygienic factors. — 
Rubner has pointed out an interesting effect of commerce in food on nutrition: 

Most conservative as to the food question, is the farmer, though in the country, 
too. man^ changes are taking place. He has frequent contact with the city, but 
he has still plenty of food material, though not always quite suitable to the purpose. 
I have noticed a very unfavorable influence of urban food requirements on the milk- 
producing districts of some regions of Switzerland and Germanjr, which is so charac- 
teristic that it deserves consideration. The milk-producing resions of the Bavarian 
highlands and of Switzerland had formerlv an extremely healthy, strong, and tem- 
perate population. Milk was largely used as a food, and the excess of production 
was placed on the market. In the course of years the communities gradually estab- 
lished central diaries in which the fat is withdrawn from the milk by means of cen- 
trifugal machines to produce cream and butter. The impoverished milk is partly 

1 See Qore, H. C. : Apple Sirup and Concentrated Cider: New Products for UtUiKing Surplus and < uU 
Apples. Yearbook of the Department of Agilculture for 1914, Washington, 1915, p. 227. 

« Gephart, F. C, and Lusk, O.: Analysis and Cost of Ready-to-Serve Foods. Press of the America* 
Medical Association, Chicago, 1915. 



PUBUC HEALTH AND MEDICINE. 123 

returned to the fanners. The milk produces are paid in cash for their product, 
but a poor and insufficient food takes now the place of a former hoalthy one. The 
money now goes to the saloons. The potato conquers a new t rritory. Instead 
of the butter which was formerly used, cheap fats are now bought; in short, the 
change of diet is exactly such as we find with the poorer working p<>pulation in the 
cities. The effects are exactly the same. Physical deterioration in such districts 
becomes more and more pronounced, reaching finally a low level. This is a very 
serious condition, which attracts attention and which must be combated f)y all pos- 
sible means. 

Rubner believes, further, that the industrialization of nations is attended by a 
change in body weight, not because the race has changed in itself, but because the 
nutritive conditions have changed for a large number of laboring people through 
migration to the cities. To-day only a small proportion of the industrial establish- 
ments are in rural communities, where the living conditions are favorable. The 
problem of the underfed is thus closely related to the distribution of the food supply. 

The present European war is affording an opportunity to study the relation of the 
food supply to unexpected economic and territorial conditions. From the stand- 
point of Germany the situation is unique in view of the exclusion of food normally 
obtained in large amounts from abroad. Russia, America, and other countries have 
hitherto furnished wheat, rice, butter, lard, eggs, and many other foods, along with 
cruder feeds, which in turn were applied to animal production. These sources have 
been threatened or entirely cut off. With true scientific acumen the German nation 
has started a public propaganda of advice intended to meet the situation thus imex- 
pectedly created.* The export of native products, such as sugar and rye, is to be 
restricted ; the feeding of materials suitable for human consumption to cattle is to be 
greatly decreased and conservation of food values ordinarily lost in the processes of 
conversion into animal tissue accomplished; unjustifiable waste is to be avoided not 
only in the trade at large, but in the individual kitchen. The elaborateness of the 
investigation is indicated by such details as the reminders that 20 grams of fat per 
capita are lost in the sewage waste of Berlin every day, and that this ought to be 
prevented. The people are assured, on the authority of eminent scientists, that they 
need not fear intelligently instituted changes of dietary r^me as something inimical 
to health. 

The laws of nutrition and suitable dietetic advice are being proclaimed and dis- 
tributed in popular form.^ The more liberal use of plant products (rich in carbo- 
hydrates) in place of meats (rich in proteins and fats) is urged. As a move in the 
direction of economy in nutrition the gradual substitution of the regimen of south 
German households in place of the excessive meat diet of the northern provinces is 
urged. Even a cookbook for war times is freely supplied.' 

The experience of the commissary department of the United States Army in Cuba 
during the campaign of 1898 has taught the mistakes not only of disregarding local 
conditions, but also of falling to grasp important dietary principles and to inculcate 
them where the lessons are needed. 

No presentation of the problems of the food supply would be complete without an 
appreciation of what the growing science of physiology and the chemistry of foods is 
contributing to mankind. The calorie idea in nutrition, the outcome of an imder- 
standingof the transformation of energy in the living body, has been fruitful in more 
ways than one. It has taught people to think of the uses of food from a more rational 
standpoint and has furnished an intelligible basis for constructive institutional die- 
tetics, as well as the nutrition of the individual. Food is beginning to be regarded 

>See ElUbAcher, P.: Die Deutsche Volksemahrtmg tmd der Englische Aoshungenmgsplan. Ft. 
Vieweg A Sobn, Braunsehweig, 191A. 

> For example, in pamphleU such as " Ernfthrung in der Kriegsxeit," ein Ratgeber von Prof. Dr. Paul 
Sltobacher, Frau Hedwig Heyl, Prof. Dr. Carl Oppenhelmer, Prof. Dr. Max Rubner und Prof. Dr. Nathan 
ZonU. Braunschweig, 1916, pp. 16. 

» For example, the "Kriegskochbuch," von Frau Hedwig Heyl. Berlin, 1915. 



124 PBOCEEDINGS SECOND PAN AMEBIOAN SCIENTIFIC CONQBESS. 

as fuel for the human OTganiflm— -eomething that must be provided in determinable 
amoimts. Malnutrition and imdemutrition have received a new popular significance 
in the discussion of human efficiency. 

This is not the place to discuss the limitations of the calorie idea in nutrition or 
of some of the current conceptions of the rdle of the individual nutrients— the pro* 
teins, fats, carbohydrates, and inorganic salts. There is a well-founded growing 
belief that an important part in nutrition is played by substances which are not 
identical with the familiar foodstuEfs mentioned and which, despite the minimal 
amounts thereof present in the diet, may nevertheless be indispensable for growth 
and the maintenance of life. They have been called ''accessory diet factors" or 
<< vitamins.*' We may conceive of them as stimulating certain ph3r8iological 
processes and as essential to certain functions. 

The lubricant is quite as important to a machine as is the energy-furnishing fuel. 
So these diet accessories may have a peculiar usefulness. They are apparently some* 
times easily impaired by heat; in the language of the chemist, they may be thermo* 
labile. Hence the use of heat for preserving or sterilizing foods suggests new diffi- 
culties. They may sometimes be lost in the wastes of the modem technical processes, 
as in the milling of cereals. This has been demonstrated in the case of '' polished" 
rice. They may be sensitive to other agencies involved in the change from fresh to 
salted or "prepared " or preserved foods. 

These topics represent the border line of our knowledge of to-day. Enough facts 
are known, however, to justify the interest which the subject is receiving. Scurvy 
has long been recognized as a disease related to diet and the antiscorbutic and curative 
virtues of certain food products like lemon j uice were early learned by experience. To 
these so-called "deficiency diseases," beriberi and possibly pellagra, rickets, and 
Barlow's disease may be added. I have discussed special features of this question 
elsewhere.' They help to explain the occasional faUure of one-sided dietaries, and 
possibly the incidence of disease in groups of people living through ignorance under 
restricted conditions of diet, in institutions, on expeditions, on shipboard, during 
famine, and sometimes amid plenty. 

The danger, if there be such, of a lack of imrecognized diet accessories is probably 
greatest in the exclusive use of "artificial" foods which have experienced extensive 
alterations in the course of their commercial preparation. In the present stage of our 
knowledge variety of food, including fresh foods of many descriptions, may be wel- 
comed on this ground alone. Canned goods, glucose, margarine, refined sugar, highly 
milled cereals — ^in themselves skillfully produced specimens of modem technical 
progress — should be supplemented with fresh foods for safety until our knowledge haa 
grown to supersede the uncertainty of present-day ignorance about unappreciated 
deficiencies of the diet. If the factory and organized business have introduced "arti- 
ficial'' products, modem industrial organization and transportation have likewise 
increased the possibilities of physiological liberality in diet. The studies of the past 
few years on the physiology and chemistry of the ripening of fruits is only one indica- 
tion of how science is enlarging the possibilities of the food supply through an under- 
standing of underlying factors. Useful investigations on the date, the banana, the 
apple, and other fruits have already been instituted by our Government. 

The recent progress in the physiological chemistry of the proteins illustrates a trend 
that is likely to affect feeding practices in the future. The protein molecule is com- 
posed of a group of unlike chemical units many of which appear to be indispensable 
for the nutritive functions. The animal body can not constmct all of these syntheti- 
cally, hence it is dependent upon a supply thereof in the diet. The proteins of com- 
mon foods furnish unlike yields of these essential units or tissue "building stones." 

1 Ifendol, L. B.: Natritlon and Qrowth. The Harvey Society Lectures, 1914-15. Also Joomal of the 
American Medical Association, May 8, 1915, p. 1539. The literature of the subject is presented there in soma 
detail. 



PUBLIC HEALTH AND MEDICINE. 125 

It is accordingly becoming apparent that a well-selected ration must furnish these in 
both quantitative and qualitative sufficiency. Com and the by-products of the 
maize kernel are notably inadequate for good feeding results unless they are supple- 
mented by other protein-containing foods. The relative economy of the addition of 
supplementary proteins, such as are preeent in dried blood or milk products, to a 
ration that is inexpensive, but inefficient by itself, suggest new standards in our feed- 
ing practices. A small addition of an adequate protein may be far more advantageous 
for producing gains in animal husbandry than large amounts of cheaper proteins which 
supplement the deficiency of the basal ration less well . ' Our agricultural experiment 
stations are becoming alive to the opportunities here opened. Fodder analysis has 
taken a new turn.' It is probable that protein feeding in the future will be based on 
the known chemical structure of the feeds quite as much as on the results of past feed- 
ing experiments. Here, as so often before, the investigations of what is sometimes 
contemptuously referred to as "pure'' science have furnished results of great impor- 
tance to practical nutrition. Sir William Crookes, whose f recast of the failing wheat 
supply has been referred to, could scarcely foresee that the progress of physiological 
chemistry might in itself nullify the contentions which he vigorously defended. 

A corollary of a better understanding of the principles involved in the field of human 
nutrition is the improvement of household science and the domestic arts. Herein 
lies the significance of the notable "home economics movement" of the preeent time. 
Nutrition and its relation to the food supply are in no small measure a problem of the 
home. Just as the lessons of modem science are permeating the practices of up-to- 
date agriculture, so they ought to influence and modify the periormance of the house- 
hold. The latter has been described as a social institution employing certain material 
agencies which include the provision of food and clothing. Its relations to other social 
institutions are manifold. Upon industry, for example, the household exerts an 
influence by maintaining the physical vigor and efficiency of the worker; and industry, 
in turn, a£fects the home by the character of the supplies which it furnishes. We are 
told that the household is the ultimate agency in the distribution of economic wealth 
to individuals. ' What the wage earner really secures and the wife and children 
secure depends upon the efficiency with which the household turns the wage income 
into economic good and, at the same time, supplements it by the income equivalent 
of household work. The contribution of productive housework is too little empha- 
sised. The home can become responsible for malnutrition and insanitary living. 
An appreciation of food costs, of efficient marketing, of the "casual sequence of food 
&om the farm to the dining room, ** of the preparation of food for the table, surely ia 
of fundamental import in every home. The culinary art, upon which so much may 
depend, is in danger of deteriorating in the homes of this country. The admonition 
to "cook at home " should be passed on to the less well-to-do classes and the education 
of their young in the applications of domestic science should be warmly defended. 
No baker's bread equals the best home-made product. Too few women of the working 
classes are equipped to meet the demands which the home should properly make 
upon them. 

> CL Osborne, T. B., and Mendel, L. B.: Feeding Experiments Hoisting to the Kutritive Value of the 
Proteins of liaise. Journal of Biological Chemistry, 1913, xiv, 31; American Journal of Physiology, 1918, 
(a), xxxl, 10; Nutritive Properties of Proteins of the Maize Kernel. Journal of Biological Chemistry, 1914, 
(b), XTiii, 1. Osborne, T. B.: The Nutritive Value of the Protehis of Maize. Science, 1913, xxxvii, 185. 
Osborne, T. B., and Mendel, L. B.: The Comparative Nutritive Value of Certain Proteins in Growth, and 
the ProUem of the Protein Minimum. Journal of Biological Chemistry, 1915, xx, 351; Protein Minima for 
Mahitenance. Ibid, 1915, xxii, 341. 

* Cf. NoUau, E. H.: The Amino-acid Content of Certain Commercial Feeding Stuffs and Other Sources of 
Protein. Journal of Biological Chemistry, 1915, xxi, 611; Orindley, H. S., Joseph, W. £., and Slater, M. E. : 
The Quantitative Determination of the Amino-adds of Feedingstufls by the Van Slyke Method. Joumai 
of the Amerioan Chemical Society, 1915, xxxvii, 1778. 

*Ct Andrews, B. B.: A Course in Hooiehold Economics. Joumai of Homo Economics, February, 
191S, p. 2d. 



126 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONGRESS. 

Many years ago Liebig wrote, in hie Familiar Letters on Chemistry: 

Among all the arts known to man there is none which enjoys a juster appreciation 
and the products of which are more universall>r admired than that which is concerned 
in the preparation of our food. Led by an instinct, which has almost reached the dig- 
nity of conscious knowledge, as the unerring guide, and by the sense of taste, whicn 
protects the health, the experienced cook, with respect to the choice, the admixture, 
and the preparation of food, has made acquisitions surpassing all that chemical and 
physiological science have done in regard to the doctrine or theory of nutrition. In 
soup and meat sauces he imitates the gastric juice; and by the cheese which closes the 
banquet he assists the action of the dissolved epithelium of the stomach. The 
table, supplied with dishes, appears to the observer like a machine, the parts of 
which are harmoniously fitted together and so arranged that, when brougnt into 
action, a maximum of effect may be obtained by means of them. The able culinary 
artist accompanies the sangui^nous matter with those which promote the process 
of solution and sanguification m due proportion; he avoids all kinds of unnecessary 
stimuli, such as do not act in restoring the equilibrium; and he provides the due 
nourishment for the child, as well as the old man, as well as for both sexes. 

Even Liebig, the great scientist, could not adequately visualize the application of 
science in the kitchen . Man no longer depends upon his instincts alone for guidance in 
the affairs of life; otherwise progress would indeed be slow. Instruction in domestic 
science ought to become a means of solving the problems of applied nutrition; and the 
best interests of the home — economic as well as social — call for better domestic service, 
a discipline into which woman will enter "mit Lust und Liebe. " 

We have seen that the problem of food supply is not one which can be dismissed by 
the social philosopher or solved by the calculations of the economist. It is highly 
complex with its involvement of factors and interests in agriculture, commerce, indus- 
try, and nutrition. Here, as in other domains, there is opportunity for an interplay of 
science and the arts, of experience and investigation. To attempt to foretell the 
future seems more like an act of ill-considered rashness than a keen intellectual venture . 
The truth can only be approached scientifically. We are beginning to learn what 
real food values mean. There is as yet no ideal ration. The world menu is not 
in sight. Fitting, indeed, on this occasion are the words of Prof. Rubner: 

The nutrition of the great mass of the people is a question of the highest importance, 
deserving far more attention than it has hitherto received. All the great countries 
ought to have a central authority, a food commission, which should concern itself 
exclusively with the far-reaching questions of the well-being of the people. The 
material as it lies before us to-da>[ is very incomplete but sufiSces to indicate the main 
lines of useful work. The nutrition of the masses has so far been mostly studied with 
regard to political economy and according to methods and viewpoints which do not 
always withstand the tests of the physiology of nutrition. Only by means of the 
physiology of nutrition is it possible to carry on exact research. 

The nutrition of the masses is to us a problem which may be approached and im- 
proved from many sides. It is necessary that not only the hygienists in the narrower 
sense take up the stru^le for betterment but that also the great army of men. who are 
truly humane in their hearts, shall take their places beside us. The battle which 
we have to carry on is not only against unavoidable and natural difficulties; we must 
not for^t that human society includes many elements, unwiUii^ to make the least 
concession to a humanitarian movement, persons whose prosperity is selfishly held 
superior to the welfare of their neighbors and who will oppose such a movement 
with all tiie means at their command. Let us hope that our opponents will, at the 
last, rejoice with us in a triumph of the Humane Idea. ^ 

1 Rubner, M. : The NutriUon of the People. Journal of Home Economicfl, 1913, v. 1. 



PUBLIC HEALTH AND MEDICINE. 127 

A SAFE AND SANE MILK SUPPLY. 

By JOHN WEINZIRL, 
Univtrnty of Washington. 

There are three large phases to the milk problem which may be summed up in three 
words — dollars, dirt, and disease. The three phases must all be solved before we 
have solved the milk question. Nor is one of these phases more important than 
another for milk which does not pay for itself will not long be produced, dirty milk 
will not be used when the people are informed, and milk which carries disease will 
eventually be barred from sale. It is the purpose of this i)aper to consider these three 
phases separately and collectively in order to discover, if possible, a sane solution of 
this perplexing question. 

THE FINANCIAL ASPECT. 

Until quite recently milk was produced under primitive conditions at a moderate 
cost which was roughly proportional to its food value. Although the food value has 
not changed materially the cost has increased decidedly, due largely to the increased 
cost of production. A certain part of this increase is due to economic conditions over 
which the dairyman has no control; another part, and this is probably the larger, is 
due to the changed methods of handling the product. Formerly, cheap bams, simple 
vessels, and common labor sufficed ; now certified milk is produced in costly stables 
under a sanitary elegance which rivals that in our homes, with apparatus that is 
elaborate and expensive under expert supervision which is required for its care and 
management. The increase in price from 5 cents a quart to 10 cents, then 15 cents, 
and sometimes to 20 cents became necessary, and even now certified milk is not 
generally profitable. It is quite obvious that certified milk is essentially a luxury 
beyond the means of the vast majority of our population, and can only be indulged in 
by the wealthy. Evidently certified milk as a solution of the milk problem is doomed 
to fedlure. It is probably unnecessary to state what is meant by certified milk, for it 
has been adequately described in many sources.' The ideal of certified milk has been 
of inestimable value in an educational way for it has taught us many things. It has 
taught us what clean milk means and how dirt can be eliminated ; that bacteriologically 
clean milk is essential; and that disease germs in milk can and must be eliminated. 
To accomplish this task has been eminently worth while, and we diall always value 
this service, but it is certain that simpler means must be foimd to accomplish the 
ends sought. Fortunately the work of Harding ^ and of North * has shown that this 
can be accomplished and that milk of an excellent quality can be produced without 
elaborate equipment and at reasonable cost. Intelligent care and a modest bonus 
for a superior product are the essentials for accomf^iriung the end in view. Beiate 
discussing this further it is desirable to consider the question of diseases carried by 
milk. 

THE PROBLEM OF DISEASE. 

That milk is a carrier of disease germs is now common konwledge and many well 
authenticated epidemics testify loudly to the fact. The problem of how to make 
milk safe as food has been attacked in a number ofVays; all, however, fall under two 
principles, viz, either prevent the entrance of disease bacteria to the milk or kill the 
disease bacteria which may happen to enter. Of these two principles the former is 
plainly the ideal, and acting on this plan inspected milk and certified milk have been 
produced . Doubtless dairy inspection and milk certification have done much to lessen 
milk-borne disease, but it is quite obvious that inspection will not detect all diseased 

> Boa M. Ifilk and its Relation to the Public Health. U. S. Pub. Health A Marine Hospital Service, 
s Harding, Roehle, Wilton and Smith: The Effect of Certafai Dairy Operations upon the Oenn Content 
oflCilk. 
• North: The Dairjrmao v. The Dairy. Am. Jour. Pub. Health, v. 0, 519, 1015. 



128 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONQBESS. 

animals or attendants or discover and close all the avenues by which disease organ- 
isms may enter the milk supply. The epidemic of sore throat which occurred near 
Boston ^ was carried by one of the superior dairies, and doubtless disease germs find 
their way into certified milk more often than we are wont to believe. The American 
ideal of certified milk fails mainly, however, because it results in too expensive a 
product for common use. . 

In Europe the tendency has been to follow the second principle, viz, to kill the 
disease bacteria which may enter the milk supply. This was done empirically for 
centuries by simply boiling the milk at home ; more recently pasteurization has been re- 
sorted to, and this method is rapidly gaining favor in America as well. The greatest 
objection to these methods is the cooked flavor imparted to the product, but even 
this is largely overcome under present methods of pasteurization, and apparently we 
are slowly outgrowing our prejudices against pasteurized milk. While pasteurization 
adds somewhat to the expense, this factor is balanced by the saving affected in added 
keeping qualities of the product. If the pasteurizing has been properly done, we 
may assume that the problem of disease citfried by milk is solved, for as Rosenau ' 
points out, '^ there is not a single instance on record in which a milk-borne outbreak 
[of disease] is recorded from the use of pasteurized milk." While this solution may 
not be the most ideal one it is a practical solution which we may accept for the pres- 
ent as the best available and on the whole as quite satisfactory. If an occasional 
consumer objects to paateiuized milk, the certified product would still be available. 

Many sanitarians have objected to the conclusion at which we have arrived on the 
ground that pasteurization is practiced on milk frequently highly polluted by manure; 
they have rightly held that while pasteurization rendeied such milk safe, it did not 
chiuige its filthiness and unfitness for h\iman food. This contention must be granted, 
and this brings us to the third aspect of the milk problem. 

THE PROBLEM OF EUUINATINO FH/TH. 

At the present time the task of eliminating dirt from milk presents the most serious 
difficulties, and is the most important phase of present sanitary endeavors. This 
problem resolves itself into two distinct phases: First, the problem of finding the most 
suitable method of detecting dirt in milk; secondly, bringing the evidence home to 
the dairyman and making him respond to the new demands. Let us first consider the 
methods of detecting filth in milk. 

Three methods are in use more or less commonly, viz: (1) Determining the total 
number of bacteria present in the milk, assuming this to be an index of its cleanliness, 
and fixing a limit beyond which the count may not go, otherwise sale ia forbidden; 
(2) determining the number of B. coli present and setting a similar standard; (3) 
determining visible dirt, and again making a standard for purity. To these the writer 
now desires to add another: (4) Determining B. sporogenes and creating a standard 
of purity. 

It is well known that the total count depends upon other factors as well as upon 
dirt, for time and temperature may cause a high count in an otherwise clean milk; 
doubtless such milk should be barred from sale, but it does not reach the real question, 
which is the amount of dirt present in it. Again, if the milk is pasteurized, the total 
count fails utterly to indicate dirt. Since the use of pasteurized milk is rapidly 
increasing, the ultimate failure of the total coimt ia obvious. 

As to determining the number of B. coli and using the data to indicate manure, this 
method will fail for the same reasons that the total coimt must fail. In addition, the 
determination of B. coli requires rather too elaborate a technique to make it generally 
available. Up to the present time the method appears to have gained little favor. 

1 Winslow: An Outbreak of Ttmsil litis or Septic Sore Throat in Eastern Massaohusetts and its Relation 
to an Infected Milk Supply, Jour. Inf. Dis., X, 1, 72, 1012. 
s Rosenau: The Milk Question, 1912. 



PUBLIC HEALTH AKD MEDICINE. 129 

When the test is made sufficiently early and before the milk is pasteurized it has been 
ahown ^ that the method is an excellent one for the purpose. The dairy in which the 
method was applied received its supply from a comparatively limited area and from 
•nly 20 dairymen. Special endeavors were made to produce only superior milk. 

At present the determination of visible dirt appears to be in greatest fovor and has 
proved itself a valuable asset to the sanitarian in checking up supplies. The ease 
with which the determination is made and the telltale nature of the evidence presented 
speak highly in its fttvor. The Wizzard Sediment Teeter ' has proved very satisbc- 
tory in our hands. Indeed, the method leaves little to be desired so long as the pro- 
ducer does not become wise and adopt clarification methods such as heavier strainers 
or centrifugation. Obviously the method will fail as soon as better clarification 
methods are adopted. Such clarification can not lessen the number of manure bactoria 
in milk or the soluble portion of the manure, but rather aids in their better distribution. 
From these considerations it is quite clear that we have no method for determining 
manural pollution which does not fail at some critical point, the total count, and B. 
coli determinations fail in milk that has been held for some time or has been pasteur- 
ized, and the sediment test fails after clarification. 

To overcome these difficulties is the purpose of the B. sporogenes determination as 
an indicate^' of manural pollution as proposed by Weinzirl and Veldee.* B . sporogenes 
is an intestinal organism, and hence indicates manure when found in milk; it does not 
multiply at ordinary temperatures at which milk ia held, and so it truly indicates the 
pollution even of milks kept for varying periods of time and at varying temperatures; 
it produces spores but these are not killed by pasteurization and, finally, the oiganism 
can be easUy and quickly determined. 

The method for determining B. sporogenes, as we now use it, is as follows: Milk is 
dispensed in ordinary test tubes and solid paraffin sufficient to make one-eighth inch 
layer is then added and the whole sterilized. Five cc. of milk are added and the tubes 
heated to 80^ G. for 10 minutes. The tubes are rapidly cooled, the paraffin hardens 
and produces an ansrobic culture in which the B. sporogenes grows when incubated 
at 37^ C. for 48 hours. The gas produced by the fermentation of the lactose lifts the 
paraffin plug some distance, and this is taken to indicate B. sporogenes as present. 

Thus far we have not attempted to establish a standard of purity or limit beyond 
which the presence of B. sporogenes would condemn the milk and doubtless the line 
to be drawn will vary for different localities. In 1,088 samples from 20 producers 
analyzed by Weinzirl and Folder ^ it would appear that the presence of B. sporogenes 
in 5 cc. samples of milk would condemn about 20 per cent of the milk under compara- 
tively fttvorable conditions. Perhaps 2 or 3 positives out of 5 samples of 5 cc. each 
would give a fairer standard and a broader basis for judging the purity of the milk. 
The above analyses have shown, however, that B. sporogenes compares very fovorably 
with B . coli as an indicator of manural pollution when visible dirt is taken as a standard , 
and both are superior to the total bacterial count when the latter is made from agar 
plates incubated 48 hours at 37"^ C. 

THE MILX PBOBLSM AS A WHOLE. 

While we may dissect the milk problem and examine each part separately, to really 
sdve it we must consider it as a whole. We have made exceUent progress, but thb 
has scarcely been jnropOTtional to the work done, due largely to the failure to see the 
pfoblem in its entirety. 

We must have cheap milk, clean milk, and safe milk. Of these three purposes, the 
last, safe milk, may fairly be regarded as solved; the consumer has the choice of two 

1 Wfliiisirl, Jolm, and Fekter, H. A.: UnpabUshed dftta. 

* Wisard Sedimoit Tettflr The Cnamerj Paokago UIg. Co., Chicago, U\. 

• Wefaixirl and Veldee: Am. Joar. of Pub. Health, 5:9*^02:1015. 



130 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONGRESS. 

possibilities, either pasteurized milk or, if his purse permits the indulgence, certified 
milk. As to cheap milk, this problem will solve itself when the dairyman is not com- 
pelled to install expensive equipment; when care is made superior to bams and 
machinery; when demonstration will supersede the score card. If the score card is 
retained at all, the resulting product must receive at least nine-tenths of the score, 
while the equipment and method should receive perhaps one-tenth of the credit. It 
is doubtful, however, whether the score card should be retained. A rating based 
upon the available laboratory tests would appear to be the better plan. Grading the 
milk on the basis of such laboratory tests into A, B, and C grades, and requiring 
these grades to be placed on the bottles or containers, will come nearer to solving the 
cleanliness problem than the clumsy and costly methods now in vogue. 

SUMMARY. 

To sum up the problem of a safe and sane milk supply, we find: 

(1) That pasteurized milk, when the ptoceea has been properly carried out, is safe 
80 far as disease is concerned; certified milk is also satisfactory in this respect. 

(2) That a sane milk supply must be free from excessive dirt. To eliminate dirt, 
the milk should be rated on the basis of laboratory tests, such as: (a) Total count; 
(6) B. coll determination; (c) visible dirt test; (d) B. sporogenes determination. 

The milk should be graded according to the laboratory tests in A, B, and C grades, 
and these placed upon bottles and containers in which the milk is sold. 

(3) That a sane milk supply must be cheap enough to be within reach of the com- 
mon people. For this purpose certified milk is a failiu^; on the contrary, if dairy 
demonstration supersedes dairy inspection, and laboratory tests the score card in 
grading milk, when care is made sup^or to equipment in bams and machinery, 
then a clean milk may be had at a reasonable price as well. 



PROYECTO DE ORDENANZA REGLAMENTARIA DEL COMERCIO DE 
LECHE DE CONSUMO DE BUENOS AIRES, ARGENTINA. 

Por RICARDO SARMIENTO LASPIUR, 
Secretario de la Asiatencia Pdblica de Buenos Aires, Argentina. 

CAPh-ULO I. — CONDICIONE8 DB LA. LBCHB. 

ARTfcuLO 1. La leche destinada al consumo debe ser la mezcla perfecta del pro- 
ducto del ordefio completo de por lo menoe cuatro vacas sanas, blen mantenidas y cuida- 
das y que no se hallen en los dfas inmediatamente anteriores ni en los primeroe dfas pos- 
teriores a la parici6n, obtenido y tratado en condidones higi^nicas hasta el momento 
de su consumo y sin agregados ni sustracciones ni alteraciones de ninguna especie. 
A fin de alcanzar ese deeiderdtum en la medida posible en nuestro medio y propender 
al mejoramiento progresivo del producto, la leche de consumo en el municipio se clasi- 
ficard en las categorias que se especifican en los artfculos siguientes, y su producci6n, 
introducciiSn, dep<3sito, transporte y expendio se sujetar&n a las prescripdones de la 
presente ordenanza. 

Abt. 2. Se considerard leche de piimera calidad certificada y s61o se permitir4 que 
en tal caiicter o bajo tal denominaci6n se introduzca al munidpio, depodte, trans- 
porte, venda u ofrezca en venta dentro del mismo la leche que retina los siguientes 
requisites: 

1^. Tener por lo menos 3 por ciento de materia grasa (goidiura). 

2®. Tener por lo menos 11.5 por dento de sustanda seca, comprendida la materia 
grasa. 

3*. Tener un grade de addez no menor de 15 grades Domic ni mayor de 20 grades. 



PX7BLI0 HEALTH AND MEDIOIKB. 181 

4*. No coagulane al scmketerla a la ebuUiddn, ni formar copos o grumoe ni coagulane 
al mezclarla con doe voces su volumen de alcohol a 70 voldmenee por dento. 

5^. Sometida a cualquier procedimiento de examen, debe mostnuBe perfectamente 
limpia. 

6^. No content en nuM^ momento, hasta ser entrogada al consumidor, mia de 
60,000 microbios por e. c. 

7^. Estar edempre a una iiemperatuia de 10^ o menos. 

8^. Ser entrogada al consumidor dentro de las 20 horas de <xdefiada. 

9°. No haber suMdo modificadones de ninguna espede, debidas a la intervenddn 
de agentos ffsicos o qui micos. 

10^. Ser produdda, envasada, rotulada y transportada en la forma que se indica m&B 
adelante. 

La leche que no llene los requidtos 1^, 2°, o 3^, caerd en comiBO, sin perjuido de 
apUcaise el artfculo 8, si se comprueba que ha sido adulterada. Por d exeeeo de 
addez, se apUcar& en cada case una multa de 50 pesos. 

La infracddn de los requisites 4^ o 5^ 8er& penada con multa de 50 pesos cada ves. 
Ademis, a fin de que el Interesado se coloque en condidones de produdr leche in- 
objetable a esos respectos, se prohibird la introducd6n y venta de la leche en d muni- 
dpio durante los dnco dlas subsiguientes a la comprobad6n. La leche caerft en 
comiso. 

Ouando la leche presente mis de 60,000 microbios por c. c, se avisaii al interesado 
a fin de que adopte las medidas necesarias para evitar el inconyeniente. £1 aviso 
se repetiii toda vez que se haga la misma comprobaddn. Pero la administraddn 
sanitaiia podr& prohibir la introducddn y venta de la leche en d munidpio, si se 
comprueba que con irecuenda tiene mis de ese ntimero de microbios, d d ntimero de 
microbios supera en grandes propordones al indicado odd interesado no adopta las 
medidas susodichas. La leche caeri en comiso. 

La iniracddn dd 7^ requiaito 8er& penada con multa de 80 pesos. Si se comprueba 
que la leche no tiene la temperatura exigida por no haberse aplicado a los medios 
necesarioB para cons^gulrlo, la multa ser6 duplicada. La leche caeri en comiso. 

Ladd 8^ requidto ser& penada con multa de 50 pesos cada ves. La leche caeri en 
comiso. 

La dd 9^ requidto seri penada con.multa de 100 pesos la piimera vez, de 200 pesos 
la segunda y con d retire definitivo dd permiso paraintervenir en cualquier forma 
en d comerdo de leche de primera calidad c^tificada la t^xfera. La leche caer& 
en comiso. 

La dd 10^ requidto, si no tiene una pena espedalmente establedda, seri penada 
con multa de 5 a 100 pesos, seglin la gravedad de la falta, condder&ndose como dr- 
cunstanda agravante su repetid6n. Pero la administraddn sanitaria i)odr& prohibir 
en cualquier memento la introducci6n y venta de la leche, d conddera que ha 
d^ado de ofrecer sufidentes garantlas de salubridad. 

Art. 3. Se condderard leche de primera calidad y sdlo se permitlri que en tal 
car&cter o bajo tal denominad6n se introducca al mimidpio, depodte, transporter 
venda u ofrezca en venta dentro dd mismo la leche que redna los siguientes requidtos: 

1°. Tener por lo menos 2.7 por dento de materia grasa (gordura). 

2?, Tener porlo menos 10.7 por dento desustancia seca, comprendida la materia grasa. 

3^. Tener un grado de addez no menor de 15 grados Domic ni mayor de 20 grades. 

4^. No coagularse al someterla a la ebullicidn, ni formar copos o grumes ni coagularse 
al mezclarla con im volumen igual de alcohol a 70 voltimenes por dento. 

5"^. Puesta en la cantidad de un litro, despu^s de bien revuelta, en im redpiente 
cilfndrico de vidrio incol(»x> y de f ondo piano, cuyo diimetro, sea mis o menos igual a 
la mitad de la altura de la columna f ormada por la leche, no debe dejar depodtar 
sedimento apreciable despu^ de una hora de repose. 

68436— 17— VOL X 10 



182 PBOCEEDINQS SECOND PAN AMBBIGAN SCIENTIFIC CONGBESS. 

6^. No contener en ningdn momento, hasta ser entrog&da al comsumidor, m^ de 
500,000 microbioe por c. c. 

7°. liegar a la ciudad a una temperatura de 15*^ o menos. 

8^. Estar aiempre a 10^ de temperatuia o menos, deepu^ de dos horas de su entind* 
a la ciudad. 

9^. Ser entrogada al consumidor dentro de las veinte boras de su entrada al muni* 
dpio. 

10**. Ser introducida, depositada, envasada, rotulada, transp(»ladA y entr^gada al 
consumidor en la forma que se indica mis adelante. 

La leche que no llene los requisitos 1*^, 2*^, o 3^, caerd en comlso, sin peijuicio de 
aplicarse el artfculo 8°, si se comprueba que ba aide adulterada. Por el exceso de 
acidez, se aplicari en cada case una multa de 30 pesos. 

La in£racci6n de los requudtos 4° o 5** seri penada con multa de 30 pesos cada vez. 
Si la comprobaci6n ba side en el memento dd arribo de la lecbe al municipio, se pro- 
bibiri su introducci6n y venta en el mismo durante los diez dias subsiguientes, a fin- 
de que el interesado se coloque en condiciones de enviar lecbe inobjetable a esos res- 
pectos. La lecbe caeri en comiso. 

Guando la lecbe contenga m^a de 500,000 microbios por c. c. se avisaii al interesado, 
a fin de que adopte las medidas necesaiias para evitar el inconveniente. El aviso 
se repeturd toda vez que se baga la misma comprobaci6n. Pero la administracidn 
sanitaria podrd probibir la intrbducci6n y venta de la lecbe en el municipio, si en 
tree extoenes sucesivos efectuados con 15 dfas de intervale por lo menos se comprueba 
que el n6mero de microbios supera en grandee proporciones al indicado o si el interesado 
no adopta las medidas susodicbas. La lecbe que contenga mis de 500,000 microbios 
caeri en comiso. 

La lecbe que llegue a la ciudad a mis de 15° de temperatura caeri en comiso. 

La infracci6n del requisite 8*^ seri penada con multa de quince pesos. Si se com- 
prueba que la lecbe no tiene la temperatura exigida por no baberse aplicado los medioe 
necesarios para conseguirlo, la multa seri duplicada. La lecbe caeri en comiso. 

La del requisite 9*^ seri penada con multa de veinticinco pesos cada vez. La lecbe 
caeri en comiso. 

La del d6cimo requisite, si no tiene una pena especialmente establecida, seri 
penada con multa de cinco a cincuenta pesos, eegta la gravedad de la &dta, conaiderin- 
doee como circunstancia agravante su repetici6n. Pero la administracidn sanitaria 
podri probibir en cualquier memento la introducci6n y venta de la lecbe, si conaidera 
que ba dejado de ofrecer suficientes garantias de salubridad. 

Art. 4. La lecbe de primera calidad podri ser pasteurizada. En tal case, salvo 
los requisites 6^ y 9^ del articulo 3, deberi reunir antes y despu^s de la pa8teurizaci6n 
todos los requisitoe del mismo articulo y ademis los siguientes: 

V*, No contener mis de 2,000,000 de microbios por c. c. antes de ser pasteurizada. 

2^. No contener en ningtin memento, deepuis de pasteurizada y basta ser entregada 
al consumidor, mis de 200,000 microbios por c. c. 

3^. Ser entregada al consumidor dentro de las 20 boras de pasteurizada. 

La primera in£racci6n del requisite I*' de este articulo seri seguida de un aviso 
al interesado, la segunda seri penada con multa de 100 pesos, la tercera, con multa 
de 200 pesos y la cuarta seri seguida de la im)bibici6n de introducir o vender lecbe 
pasteurizada de primera calidad en el municipio. 

La primera infracci6n del requisito 2^ de este articulo seri seguida de un aviso 
al interesado, a fin de que adopte las medidas necesarias para evitar el incon- 
veniente, y las infracciones subsiguientes con una multa de 100 pesos cada vez. Peio 
la administracidn sanitaria podri probibir la introducci6n y la venta de la lecbe 
en el municipio, si en tres eximenes sucesivos efectuados con quince dlas de inlervalo 
por lo menos se comprueba que el ntimero de microbios supera en grandes proporciones 
al indicado o si el interesado no adopta las medidas susodicbas. La lecbe que deepu^ 
de pasteurizada contenga mis de 200,000 microbioe por c. c. caeri en comiso. 



PUBUC HEALTH AND MEDICINE. 133 

La infnicci6n del requisito 3<* de este artfculo seri penada con multa de 25 pesos 
cada vez. La leche seri comiaada. 

Las indacciones a los demis lequiaitos que debe llenar la leche pasteurizada de 
primera calidad tendr&n las penas indicadas en el artfculo 3. 

Art. 5. Se considerard leche de segunda calidad y b61o se peimitiri que en tal 
caricter o bajo tal denominaci6n se introduzca al municipio, defKwite, tianspofte, 
venda u ofresca en venta dentro del mismo la leche que redna los aiguientes requisitos: 

1*. Tener una denaidad de 1,029 a 1,034, inclusive, a 15® de temperatura. 

2^. Tener per lo menos 2.5 por ciento de materia graaa (gordura) en los meses de 
septiembre, octubre y noviembre y 2.7 por ciento en los otros meses del afio. 

3*. Tener por lo menos 10.5 o 10.7 por ciento, respectivamente, de sustancia seca, 
contada la materia graaa, segtin se trate del primero o segundo periodos indicados 
en el ptoafo precedente. 

4?. Tener un grade de acidez no menor de 15 grades Domic ni mayor de 20 grados, 

5**. No coagularse al aometerla a la ebullici6n, ni formar copos o grumes ni coagularse 
al mezclarla con im volumen igual de alcohol a 70 voldmenes por ciento. 

6^. Puesta en la cantidad de medio litre, despu^s de bien revuelta, en un recipiente 
cilfndrico de vidrio incoloro y de fondo piano, cuyo ditoetro sea mis o menos igual 
a la mitad de la altura de la colunma formada por la leche, no debe dejar defKwitar 
■edimento apreciable despu^s de media hora de repoeo. 

7®. No contener en ningdn memento, hasta ser entregada al consumidor, m^ de 
5,000,000 de microbios por c. c. 

8^. Llegar a la ciudad a una temperatura de 20® o menos. 

9®. Estar aiempre a 15® de temperatura o menos, despu^s de dod horas de eu entrada 
a la ciudad. 

10**. Ser entregada al conaimiidor dentro de las 24 horas de su entrada al municipio. 

11<*. Ser introducida, depositada, envaaada, rotulada, tranaportada y entregada 
al consumidor en la forma que se indica mis adelante. 

La leche que no llene los requisitos 1®, 2**, 3®, o 4® caerd en comiso, sin perjuicio 
de aplicarse el articulo 8, si se comprueba que ha side adulterada. Por el exceso de 
acidez. se aplicar^ en cada case una multa de 15 pesos. 

La infracci6n de los requisitos 5® o 6® seri penada con multa de 15 pesos cada vez. 
Si la comprobaci6n ha side en el memento del arribo de la leche al municipio, se pro- 
hibir& su introducci6n y venta en el mismo durante los veinte dfas subsiguientes, a 
fin de que el interesado se coloque en condiciones de enviar leche inobjetable a eeos 
respectoe. La leche caerd en comiso y serd inutilizada. 

Cuando la leche contenga mis de 5,000,000 de microbios por c. c, se avisari al 
interesado, a fin de que adopte las medidas necesarias para evitar el inconveniente. 
Las tres primeras comprobaciones en tal sentido ser&n seguidas del mismo aviso. 
Pero, si despu^ de esto, en tres eximenes sucesivos efectuados con quince dlas de 
intervale por lo menos, se comprueba que el ndmero de microbios supera al indicado, 
ae prohibiri la introducci6n y venta de la leche en el municipio. La leche que 
contenga m^ de 5,000,000 de microbios por c. c. caerd en comiso y seri inutilizada. 

La leche que llegue a la ciudad a mis de 20® de temperatura caeri en comiso. 

La inhracci6n del 9® requisito serd penada con multa de cinco pesos. Si se com- 
prueba que la leche no tiene la temperatura exigida por no haberse aplicado lee 
medios necesarioe para conseguirlo, la multa serd duplicada. La leche caerd en 
comiso. 

La infracci6n del 10® requisito serd penada con multa de 15 pesos cada vez. La 
leche caerd en comiso y serd inutilizada. 

La infracci6n del requisito 11®, si no tiene una pena especialmente establecida, 
serd penada con multa de cinco a treinta pesos, segdn la gravedad de la falta, con- 
siderdndoee como circunstancia agravante su repetici6n. Pero la administraci6n 
sanitaria podrd prohibir en cualquier memento la introducci6n y la venta de la leche, 
si considera que ha dejado de ofrecer suficientes garantias de salubridad. 



134 PBOGEEDINQS SECOND VJLN AMEBICAN 8CIEKTIFIG CONGBESS. 

Art. 6. La leche de segtinda calidad podrd ser pasteurizada. En tal caao, salvo los 
requiaitos 6^, 7^, 8^, y lO'' del articulo 5, deberd reunir antes y despu^s de pasteurizada 
todos los requisitos de ese mismo articulo y ademis los siguientes: 

1^. No contener m^s de 300,000 microbios por c. c. despu^ de'pasteurizada y antes 
de salir del establecimiento donde ha suMdo la pasteurizacidn. 

2^. Si ha side pasteurizada fuera del municipio, no contener mia de 400,000 micro- 
bios por c. c. en el memento de llegar a ^1. 

3^. Ser entregada al consumldor dentro de las 24 horas de la pasteurizacidn. 

La primera infracci6n de los requisitos 1*^ y 2^ de este articulo serd seguida de un 
aviso al interesado. En las infracciones subsiguientes se incurrLrd en multa de 
100 a 500 pesos, segdn la cantidad de leche de que se trate y la gravedad del case, 
considerdndose como circunstancia agravante la repetici6n de la falta. Si la leche 
ha sido pasteurizada fuera del municipio, en lugar de las multas indicadas, podr& 
prohibirse su introducci6n y venta en ^1 durante 1 a 30 dfas, teniendo en cuenta las 
mismas circunstancias. 

La infracci6n del requisite 3*^ de este articulo serd penada con quince pesos de 
multa cada vez. La leche caerd en comiso y serd inutilizada. 

La de los otros requisitos dard lugar a las medidas y penas indicadas en el articulo 5. 

Abt. 7. Se prohibe la introducci6n al municipio y el dep6sito, transporte, venta u 
ofrecimiento en venta dentro del mismo, de leche, cualquiera sea su categoria, que 
tenga color, olor, gusto o consistencia anormales, o que contenga saugre o pus. 

Las infracciones del presente articulo serdn penadas con multa de 15 a 100 pesos o 
uno a seis dias de arresto, segdn la gravedad del case, considerdndose la repetici6n de 
la falta como circunstancia agravante. 

A quien incurra dos veces en las penas mds graves se le retirard por el t^rmino de 
un afio el permiso para intervenir en cualquier forma en el comercio de lecheria. La 
leche serd comisada e inutilizada en todos los cases. 

Abt. 8. Igual prohibici6n que la expresada en el articulo 7 rige para la leche de 
cualquier categoria a la que se haya sustraido en cualquier forma una parte de su 
crema o gordura o se haya agregado agua u otra sustancia cualquiera, comprendidas 
las llamadas ''conservadoras.'' 

Los infractores del presente articulo incurrir^n en la pena de cien pesos de multa 
o seis dias de arresto la primera vez, doacientos de multa o doce dias de arresto la 
segunda y retire definitive del permiso para intervenir en cualquier forma en el 
comercio de lecheria la tercera. La leche caerd en comiso. 

Art. 9. Salvo las leches de que se trata en los articulos 13 y 14, se prohibe la intro- 
ducci6n al municipio y el dep68ito, transporte, venta u ofrecimiento en venta dentro 
del mismo de toda leche que por sus condiciones no eet^ comprendida en alguna de 
las categorias especificadas en los articulos 2, 3, 4, 5 y 6, respectivamente, de esta 
ordenanza, bajo pena de 100 pesos de multa a la primera infracci6n, 200 a la segunda, 
retire definitivo del permiso para intervenir en cualquier forma en el comercio de 
lecheria a la tercera y comiso de la leche en todos los cases. 

Art. 10. Se prohibe introducir leche al municipio y depositarla, transportarla, 
venderla u ofrecerla en venta dentro del mismo en otro car&cter o bajo otras deno- 
minaciones que los indicados en los articulos 2, 3, 4, 5 y 6 y en los correlacionados con 
ellos, ni en forma que pueda inducir a error acerca de la categoria a que pertenece 
la leche sogdn las prescripciones de la presente ordenanza. Se excepttian, en lo 
que se refiere al caricter y denominaci6n con que se presenten, las leches de que se 
trata en los articulos 12, 13 y 14, pero estas leches y todas las andlogas que puedan 
destinarse al consume, cualesquiera sean su mode de preparaci6n, modificaciones, 
clases o uses, deberdn ser introducidas al municipio y depositarse, transportarse, 
venderse u ofrecerse en venta dentro del mismo, indicando en la forma establecida 
mia adelante a qu6 categoria de las esx)ecificadas en los articulos susodichos per- 
tenecen o a cual de esas categorias pertenece la leche con que han sido preparadas. 



PUBUC HEALTH AND MEDICINE. 135 

A los que infrinjan el presente artfculo se les decomisard la leche y aplicardn las 
penas establecidas en el articulo 9. 

Art. 11. Las leches pasteurizadas, ademis de las condiciones establecidas en lotf 
artfculos 4 y 6, deber&n satisfacer las siguientes: 

1^. Haber side libradas de sus impurezas por algdn procedimiento mecdnico que 
no separe completamente la crema. 

2^. Haber side sometidas en seguida, en.toda su masa, por lo menos a 85*^ de tem- 
pera tura durante un minuto. 

3^. Haber sido enfriadas, inmediatamente despu^s de calentadas, a 10 o 15 grades 
de temperatura o menoe, segtin se trate respectivamente de leche de primera o segunda 
calidad. 

4^. Haber sufrido las operaciones antedichas dentro de las catorce horas de orde- 
fiadas. 

5^. No haber sido calentadas o pasteurizadas por segunda vez. 

6^. Haber sido sometidas a esas operaciones en aparatos aprobados por la adminis- 
traci6n sanitaria. 

No se permitird la introducci6n ni venta de leche pasteurizada que no satisfaga 
estos requisitos, y quien infrinja las disposiciones de este artfculo, despu^ de un 
primer aviso, incurrird en el decomiso de la leche y en multa de 100 a 200 pesos, segdn 
la gravedad del case, consider&ndose circunstancia agravante la repetici6n de la 
falta. 

Art. 12. S61o se tendrd por leche esterilizada la que despu^ de limpiada en la 
forma prescrita en el articulo 11 haya sido sometida dentro de las catorce horas de 
ordeilada a algdn procedimiento de esterilizaci6n por el calor de reconocida eficacia 
y cuyo envase se haya cerrado herm^ticamente durante el calentamiento y se man- 
tenga igualmente cerrado hasta su entrega al consumidor. 

Se prohibe la introducci6n y la venta de leche esterilizada que no llene las con- 
diciones aquf establecidas, bajo pena de comiso del producto y multa de 100 a 200 
pesoe cada vez, segtin la gravedad del caso, considerdndose como circunstancia agn^ 
vante la repetici6n de la falta. 

Art. 13. Las leches matemizadas o humanizadas y las anilogas, especialmente 
deetinadas a la alimentaci6n de los nifios o de enfermos o convalecientes, deberdn 
ser preparadas con leche que satisfaga por lo menos los cinco primeros requisites 
especificados en el artfculo 5, que no se halle comprendida en los artfculos 7 y 8 y 
librada de sus impurezas en la forma prescrita en el artfculo 12. Todas estas leches 
deberdn ser esterilizadas en la forma establecida en el artfculo 12. 

Los que infrinjan el presente el artfculo incurrirdn en las penas indlcadas en el 
artfculo 12 o en los artfculos 7 u 8, segtin los cases. 

Art. 14. Las leches especiales fermentadas (Kefir, etc.) deberdn ser preparadas con 
leche que satisfaga por lo menos los cinco primeros requisitos especificados en el artfculo 
5, no se halle comprendida en los artfculos 7 y 8 y esterilizada en la forma prescrita en 
el artfculo 12, correspondlendo a las infracciones de lo aquf establecido las penas indi* 
cadas en el artfculo 13. 

Art. 15. Se prohibe introducir al mimicipio y depoeitar, transportar, vender a 
ofrecer en venta dentro del mismo, leche que sea la mezcla de distintos ordefios o de 
partidas de leche recibidas en horas distantes entre si. La leche ordefiada o recibida 
por la mafiana no debe ser mezclada con la ordefiada o recibida por la taide, ni in- 
versamente. 

Los que infrinjan el presente artfculo incurrirdn en el comiso de la leche y en multa 
de 150, 100 o 50 pesos, respectivamente, cada vez, segtin se trate de leche de primera 
calidad certificada, de primera calidad o de segunda calidad. 

Art. 16. Qnien deliberadamente o sin cerciorane primero de la calidad a que 
pertenece la leche segtin las prescripciones de la presente ordenansa, la introdozca, 
deposite, transporte, venda u ofreeca en venta en el municipio como de mejor calidad 



136 PROCEEDINGS SECOND PAN AUBBICAN SCIENTIFIC C0NQBE3S. 

que a la que realmeate p«rteiiece, incuiriri en multa de 100 pewe U primen vez, 
doacientoB peaoa la Begimda y en el retiro definitivo del penniw pus intervenir en 
cualquier forma en el comercio de lecherte la tercem vet. 

Abt. 17. Se prohibe congeUr la leche o agtegarle leche congelada, bkjopenade 100, 
50 o 25 peeoe de multa, leepectivamente, segdn se trat« de leche de primen calidad 
certificada, de primera calidad o de segunda calidad . 




^^ ^ 




Kxt. 18. S^vo los arttculoB 7, 8, 16 y 17, loademiB del presente cspftulo no se aplican 
a la leche producida en loa tambos urbanoe y entregada al conaumidor inmedistamente 
de ordefiada. 



CApiruLO ] 



CtiLKS, AFABATOa, 



Dl LOS BNTABB8, 

H^airUIAS KN OENBBAL. 

Am. 19. Pan el envaae, medida y manipulacioues de la leche sdio se permitiii el 
luo de recipientea y iltile« de hieiio o acero con eetafiado gmeao y de botellaa devidrio 
incoloro. 8e piohibe expreeamente unr recipientee de cobre, zinc, latiin, pLomo 
hieno emplomado o nutdara. 



PUBUO HEALTH AND MEDIOIKE. 137 

EsoB recipientes deber&n ser de limpieza y deeinfeccidn Mciles. Los met41ico8 ser&n 
am cofltura y tendr&ii sua ftogukw redondeados y lae botellas serto de fondo piano. LO0 
de dofl litioe o mis de capacidad tendi^n la boca suficientemente ampHa como para 
pennitir mtroducir c6modameiite la mano de on hombre adulto. LO0 mis pequefios 
sef^n de tal forma y dispoeicidn que su intmor pueda limpiane a cepillo ttcil y com- 
pletamente. 

L08 recipientes usados para medir la leche deben estar provistos de asa o mango 
apropiados, de tal mode que la mano del que ks maneja no se ponga en contacto con la 
leche. 

AsT. 20. Las tapas de los envases y recipientes deben Uenar las mismas condiciones 
que ^stos, especificados en el precedente artfculo. 

Si se trata de envases empleados en el transporte de la leche, ser&n de cierre herm6- 
tico y la tapa recubriri los hordes de su boca o abertura. Si de envases especialmente 
destinados a tenerla en depdeito en locales fijos, las tapas deberto recubrir por aniba 
y por fuera la boca y el cuello del recipiente y podr&n no ser ajustadas. 

Se prohibe expresamente usar trapos, papel, paja, madera o materias anilogas y aros 
de goma que contenga pbmo o est^n agrietados, para tapar los recipientes o como inter- 
mediaries para cerrarioe. 

Para ei cierre de botellas se permite el uso de tapas de loza, porcelana y vidiio y de 
placas de papel especialmoite preparadas y que deberim usarse una sola ves. 

Abt. 21. Los recipientes de que se trata en el articulo 19 y las t»puB deben hallane 
iempre en buen estedo de conservaci6n, es decur, en condiciones que permitan sua 
sidl limpieza y desinfeccidn. 

Se prohibe ezinresamente el uso de los que tengan su superficie interna oxidada, asf 
toomo de los que por bus abolladuras u otros desperfectos no se hallen en las oondicione 
fusodichas. 

Abt. 22. Las cantillas o robinetes de los recipientes y, en general, todas las que se 
hallen en contacto con la leche, serin metilicas y bien cubiertas interior y exterior- 
mente por una capa gruesa de estafio, de mode que en ning^&n case pueda formane 
caideniUo. Interior y exteriormente serin peifectamente lisas y dispuestas de tal 
manera que su limpieaa y desinfeccidn sean ttciles. 

Abt. ^. Los aparates, miquinas, grandes dep6Bdtes, etc., empleados en la manipu- 
~~'^Kd6n o tratamiento de la leche deben ser en todas las partes que entren en oontracto 
con ella de material impermeable y peifectamente liso. Se prdbibe expresamente 
emplear en esas partes, cobre, sine, lat6n, plomo, hienro emplomado o madera. 

Abt. 24. No se expedirin pennisos para dedicane en cualquier fonna al comerdo 
de lecherfti, sin cerdorarse primero de si el interesado tiene todos los elementos indi- 
cados en este capitulo, y que deba emplear, en las condiciones aqui estableddas. 

Los infractorea de loa artfculoa 19, 20, 21 o 22 incurrixin en multa de 5 a 20 peaoa, 
aegtin la gravedad de la ftdta, conaiderindoee como drcunatancia agravante au repe- 
ticidn. Ademis, los recipientes, dtilea, ti^Ms, etc., me n d onadoa en eeoa articulos, 
aerin marcadoa la primera ves que ae hallen fuera de laa condidonea exigidaa y 
deatruidoa la aegunda ves. 

A loa infractorea del artlculoa 23 ae lea retirari el penniao correapondiente hasta 
tanto ae pongan en laa condidonea exigidaa. 

OAPItULO m. A8BO DB BBOIPIBNTBS, tTILBS T OUIDADO DB hk LBOHB BN GBNBRAL. 

Abt. 25. Loa redpientea, tapaa, miquinaa, dtilea, etc., a que ae refiere el Capitulo 
II, ddberin hallane aiempre limpioa por dentro y fuera y no uaaiae para tranaportar, 
goatdar o medir otra auatanda que la leche, ni, en general, para otroe finea que aqueUoa 
a que eet&n deatinadoa. 

Se pn^be eapedalmente beber. en laa medidaa o redpientea, bajo pena de dies 
peaoa de multa. 



188 PROOEEDINQS 8E00ND PAN AMEBIOAK SCIBNTIFIO C0KGBE8S. 

8e deja establecido expresamente que se coofiidenhL sudo todo ledfttente, dtil, 
etc., de lo8 referidoe en este articulo, que tenga olor a leche agna o cualquier okr 
extnfio, aunque en 61 no se noten reetos de leche o de otras sustandas. 

Abt. 26. La limjaesa de loi recipientes, utensilioB, etc.» a que se refiere el articulo 
25, debe ef ectuane tratindoloi primero con una sduddn calienta y extendida de aoda 
o con lechada de cal, enjuag&ndoloe abundantemente despu^ con agua caliente, de 
manera que no quede resto alguno de soda o cal, y anojando finahn^ite un chono 
de agua hirviendo aobie toda su superficie interna. En seguida de limpiadoe, se pon- 
dr&n boca abajo ep. un sost^n deetinado a ese efecto (escunidor) y en un lugar libre de 
moscas, de polvo y de toda otra causa de sudedad o contaminacidn. No deben 
colocarae boca abajo sobre el suelo. Teniendo vapor de agua a disposicidn, en lugar 
de efectuar la estenlisacidn con agua hirviendo, puede hacerae con un chono de vapor . 
Lo mismo, si se dispone de cualquier otro medio de esterilizacidn, 6rte puede ser 
aplicado en lugar del agua hirviendo. 

Art. 27. Toda penona que se dedique al comerdo de ledieria, que redba de otra 
un redpiente con leche, esti obligada a devolvteelo limpio, bajo pena de dnoo pesos 
de multa. Exlmese de esta obligaddn a los que reparten leche a domidlio redbida 
de comerciantes o empresas con establedmientoe donde pueda hacerse la limpieaa 
instalados en la capital y siempre que la redban en los mismos envases que han de 
servir paia el reparte, no la sometan despu^ a trasvasami^itoe de ninp^nit eepede y 
dsfvuelvan a los mismos los tanos vacfos en seguida de terminado el reparto. De 
acnerdo con lo que antecede, en las estaciones fenoviarias no deberi pcesentane a 
embarque ningdn envase que no est^ limpio, ni deben transportarse dentro del 
munidpio otros envases vacios y sin limpiar m^ que los que se vayan vadando o se 
ha3ran vadado en el reparto a dcmiidlio. 

No se pennitir& la salida de la Capital de ningtin redpiente sudo. 

Abt. 28. Los redpientes que contengan leche deber&n estar siempre perfectamente 
cerrados con su tapa correspondiente, salvo durante los mementos en que se eche o 
extraiga leche, bajo pena de dnco pesos de multa. 

Abt. 29. No se permite tiasvasar la leche de un redpiente a otro, ni someteria a 
manipulaciones de ninguna espede, en la via pdblica, en las estaciones ferroviarias, 
en comdones, ni, en general, al aire libre. Estas operaciones deben efectuarse en un 
local espedalmente destinado a ese efecto. Se exceptdan los cases en que, per rotura 
del redpiente, sea necesario echar su contenido a otro, a fin de evitar la p^rdida de 
la leche. 

Los iniractoree de este articulo incurrirdn en multa de diez pesos. 

Art. 30. Se prohibe soplar con la boca la superficie de la ledie para apartar la crema 
cualquier cosa, o hacer tal operad6n con los dedos. 

Abt. 31. Los redpientes que contengan leche, aunque estdn cerrados, no deben 
dejarse expuestos en las veredas u otros lugares de la via ptiblica, ni al polvo o a las 
moscas, ni al sol, ni a cualquier causa de nidedad o contaminacidn. 

Abt. 32. De los tanques o depdsitos provistos de canilla la leche deberd extraerse 
por esta dltima, y nunca por la boca o abertura superior. 

Abt. 33. Al lado de todo tanque con canilla debe haber un soporte especial para 
colocar el redpiente del comprador mientras se echa en dl la leche que se va midiendo. 

Abt. 34. Con la ledie no deberd guardarse mis que manteca, crema y otros pre- 
jMurados o derivados de la leche incapaces de comunicarle bus olores. 

Art. 35. Los infractores de los artfculos 28, 29, 30, 31 o 32 incunir&n en multa de 
100 pesos. 

Art. 36. Paia mantener fresca la leche podrin emplearse cimaras frigorfficas, 
aparatos refiigeradores, heladeras o cubas con hielo, que deberdn ser de limpieza y 
desinfecddn Mdles y hallarse siempre en buenad condidones de conservaddn y de 
aseo. 



PUBLIO HEALTH AND MEDICINE. 189 

Las heladeras y cubas deber&n tener revettimiento met&lico interior inoxidable y 
estar bamizadas o pintadas con pintura impermeable y blanca o de color claro. 

No se otoigar&n los permisoe correspondientes, a quienee no tengan eetoB elementos 
de refrigeraci6n en la medida neoesaria para la cantidad de leche con que operen o 
comercien y en las condiciones aqui establecidas. A loe que infrinjan el preeente 
artfculo se les aplicari 10 pesos de multa y no se les permitir4 la venta de leche hasta 
que se coloquen en las condiciones exigidas. 

Art. 37. En todo local donde se limpien redpientes deberd haber un servicio de 
agua caliente, capaz, por lo menos, de producir en una sola sesidn o en un chorro con- 
tinue una cantidad de agua hirviente igual a la mitad de la cantidad de lecbe con que 
se opere o comercie. Esta proporci6n no regiri para las f&bricas o usinas, que deber&n 
tener instalaciones especiales para la limpieza de los recipientes, aprobados por la 
administraci6n sanitaria. 

La Mta de cumplimiento de este artfculo dar& lugar a las medidas y penas indi- 
cadas en el artfculo 36. 

Abt. 38. Toda el agua usada en los establecimientos de lecherfa deberi ser potable. 

Esta disposicidn comprende atin a los establecimientos productores o remitentes de 
leche de fuera del municipio, a quienes no se les permitird introducir sus productos, 
so pena de comisdrselos a su lle^EKla, mientras la administraci6n sanitaria no se cer- 
dore en lo poeible de la calidad de las aguas que emplean. 

Abt. 39. Los redpientes en que se introduce la leche al municipio deben venir 
cenados bajo sello, que para los envases met^icos serd de plomo, de mode que no 
puedan ser abiertoe sin que ello se note, deede el memento en que el remitente los 
entrega a quien haya de transportarlos hasta aquel en que loe recibe el consignatario. 

La leche que llegue en redpientes no sdlados o cuyo sello haya side violado caerd 
encomiso. 

Abt. 40. En las usinas o f&bricas de lecherfa, las leches de distintas calidades 
deber&n ser tratadas aparte, en locales o Becci6nes especiales y separadas para cada 
una, provistos de su maquinaria y equipo correspondientes completes. Lo mismo 
para la fabricaci6n de manteca, deberd haber en ellas un local o Becci6n especial y 
aparte, donde se har&n todas las operaciones, comprendido el descremado de la leche 
y el depute de la leche destinada a descremaree. 

Los infractoree del presente artfculo incurrir&n en multa de 100 a 500 pesos, segtin 
la gravedad de la fedta. Si loe establecimientos en que 3 se infrinja se hallan fuera 
de la Capital, no se les permitird la introducd6n de leche al munidpio, so pena de 
decomistoela, por uno a veinte dfas, segtin la gravedad de la falta, a no ser que pre 
fieran abonar la multa que les corresponderfa si se hallaran dentro de ella. 

Al establecimiento que no tenga el local o 8ecd6n especial y aparte para tratar una 
determinada calidad de leche, no se le permitird vender o introducir leche de esa 
calidad. Al que fabrique manteca y no tenga un local o secd6n especial y aparte 
para ello, no se le permitird la introducci6n o venta de ninguna clase de leche. 

OAPfrULO IV. CONDiaONES ESPECIALES DE ENVA8E T ROTULADO DE LA LECHE SEOl^N 

8U CALIDAD. 

Art. 41. La leche de primera calidad certificada serd entregada al consumidor en 
botellas Ilenadas, cerradas y selladas en el lugar de pioduccl6n y provistas de dlpsula 
que proteja la tapa y la boca de la botella. 

Previa solidtud del interesado, la administraci6n sanitaria podr& permitir el use 
de recipientes meUUicoe, cuando se trate de remitlr a un mismo consumidor una canti- 
dad de leche mayor de veinte litroe cada vez. 

Botellas y redpientes metdlicos serin entregados con el derre intacto al consumi- 
dor, es decir, con su sello entero. 



140 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONGRESS. 

Lo6 iDfractoree de eete artfculo incurriiin en multa de cincuenta peeoe. La leche 
de las botelias o recipientes metilicofl que se hallen con el sello roto antes de entre- 
garias al consumidor caerd en comiso. 

Art. 42. Los recipientes de que se trata en el artfculo anterior deber6n Uevar 

impresa en las c&psulas o en etiquetas pegadas a los mismoe, en letras negras y Mdl- 

mente legibles, la slgulente leyenda, en que constari el dk y la hora en que ha sido 

<ndefiada la leche: 

Leche de primera calidad certificada. 
Vigilada deede su proaucdto j>ar la AdministiaciiSn Sanitaria. 

Especial para niiios y enfermos. 

Puede consumirse cruda. 
Ordefiada el dfa a las ... . 

Las cipsulas y las etiquetas deberdn ser blancas. 

Art. 43. Los recipientes en que se introduzca la leche de primera calidad al muni- 

cipio deber&n venir provistos de una etiqueta atada o pegada, respectivamente, 

8eg6n sean envases met&licos o de vidrio, de ocho por cuatro centfmetros de dimen- 

8i6n por lo menoe y de color bianco, en que consten en letras de molde, de color rojo 

y bien legibles, la calidad de la leche, el ntimero de litres que contiene el recipiente, 

el dla y hora de embarque con destine a la capital, el nombre y apellido de su pro- 

ductor, el de la estaci6n fenroviaria de donde la leche es expedida, el nombre del 

destinatario y la direcci6n de su establecimiento en Buenos Aires, en la siguiente 

forma: 

Leche de primera calidad". 

Litros 

Embarcada en , el dfa a las 

Productor 

Destinatario Calle , No.. . 

Cuando el remitente sea alguna empresa o establecimiento que recoja la leche de 
distintos productores para enviarla a Buenos Aires, serd su nombre el que deberi 
figurar en la etiqueta, en lugar del del tambero o productor, precedido de la palabra 
"Remitente." 

Cuando la leche sea pasteuriiada o esteiilizada, deberi constar 6sto en la etiqueta, 
poniendo en su primer rengl6n, respectivamente: "Leche de primera calidad pas- 
teurizada" o "Leche de primera calidad esteiilizada." 

Art. 44. Cuando la leche de primera calidad se introduzca al municipio para ser 
pasteurizada, la etiqueta de que se trata en el artfculo 43 ser& amarilla y la leyenda 
de la misma estar& impresa en letras negras. En ^sta deberi constar el destino 
inmediato de la leche, poniendo en su primer rengl6n: "Leche de primera calidad 
paia pasteurizar." 

Art. 45. En el reparto a domicilio, la leche de primera calidad deber& ser trans- 
portada y entregada al consumidor en recipientes met^cos o de vidrio cerrados y 
sellados en el lugar donde hayan sido Uenados. 

Los envases serdn entregadoe al consimiidor con su sello intacto, bajo pena de- 
veinticinco pesos de multa. 

Art. 46. Los recipientes de que se trata en el artfculo precedente deber&n eetar 

provistos de etiqueta blanca, pegada al envase en lugar visible, con la siguiente 

leyenda, en letras de molde, rojas y ficilmente legibles, donde conste el nombre del 

vendedor y la direcddn de su establecimiento, o, si no tiene establecimiento, su 

domicilio: 

I.>eche de primera calidad. 
Ia» nillos y enfermos deben consimiirla hervida. 
(Aquf ei nombre y apellido del vendedor.) 
(Aquf la dlrecci6n de su establecimiento, o, a defecto de ^ste, de su domicilio.) 



PUBUC HEALTH AND MEDICINE. 141 

Cuando la leche sea pasteurizada, deberd cooBtar dsto en la etiqueta y adem&B el 
nombre de la Mbrica o iiaina donde haya aido pasteurizada y el d(a y la hora en que 
e efectu6 la operaci6n, resultando asi la leyenda de la etiqueta en la siguiente tonna: 

Leche de primera calidad pasteuiuada. 
Lo6 nifios y enlennoB deben consumirla hervida. 

Pasteurizada pw o en el d(a a las — 

(Aqui el nombre y apellido del vendedor.) 
(Aqu( la direcci6n ae su establecimiento, o, a defecto de 6ete, de su domicilio.) 

Los dot primeros lenglones de la leyenda (dcmde se indica la calidad de la leche 
y la manera c6mo debe ser, consumida), tanto para la leche cruda como pasteurizada, 
0er6n en letras de doble tamafto que el resto de la misma. 

Art. 47. Previa solidtud en cada case del interesado, la Administraci6n Sanitaria 
podrd permitir el uso de tanques con canilla para el transporte de la leche de primera 
calidad en el reparto a domicilio, siempre que el interesado y eeos tanques satisCagan 
todas las condiciones establecidas en el articulo 82 y que ademis los tanques sean 
sellados en el lugar donde se llenen y esten dispuestoe de tal modo que la leche pase 
del tanque al recipiente del consumidor sin ponerse en contacto con al aire. 

En tal caBO, los tanques llevar&n en la forma indicada en el articulo 51 un letrero 
indicador de la calidad de la leche y de la manera c6mo debe ser consumida. 

Si se trata de leche pasteurizada en la Capital, los tanques deber^ ser Uenados 
en el lugar de pasteuiizad^n. 

AsT. 48. Los recipientes en que se introduzca la leche de segunda calidad al mu- 
nicipio deber6n venir provistos de una etiqueta atada al envase, de echo por cuatro 
centimetres de dimensi6n por lo menos, de color verde, y en que consten, en letraa 
de color negro y bien legibles, los dates especificados en el articulo 43 y en la forma de 
leyenda allf indicada. 

Si se trata de leche esterilizada, la etiqueta vendrd pegada a las botellas, en lugar 
visible, y seri blanca, con la escritura en verde. 

Abt. 49. Cuando la leche de primera calidad se introduzca al munidpio para ser 
pasteurizada, la etiqueta de que se trata en el primer pteafo del articulo precedente 
ser4 amarilla y la leyenda de la misma estari impresa en letras negras. En ^ta 
deberd constar el destine inmediato de la leche, poniendo en su primer rengl6n; 
"Leche de segunda calidad para pasteurizar." 

Art. 50. Paia el reparto a domicilio de la leche de segunda calidad, la leche ser& 
transportada en tanques con canilla o robinete, de la capacidad que se quiera, o en 
redpientes o tazros de echo litros de capacidad como mJTimum. 

Los que deseen entregar envasada esta leche al consumidor, deberdn usar botellas 
e envasee metdlicos cerrados y sellados en el lugar donde hayan side llenados. En 
tal case, los redpientes ser6n entregados al consumidor con su sello intacto, bajo 
pena de dnco pesos de multa. 

Art. 51. Los redpientes de que se trata en el primer pteafo del artfculo precedente 

deber&n llevar pintado, estampado, grabado o soldado sobre el costado, en letras de 

molde de tree centfmetros de altura y medio centimetre de grueso por lo menos, el 

siguiente letreio: 

Segunda calidad. 
Consdmase hervida. 

Si se trata de leche pasteurizada, el letrero serd asf : 

Segunda calidad pasteurizada. 
Consdmase hervida. 

Estos letreros ser&n de color que resalte sobre el del redpiente, y por su forma y lugar 
deberdn ser bien visibles y legibles. En los tanques o redpientes con canilla deberin 
hallaree de 5 a 10 centfmetros sobre la canilla. 



142 PROCEEDINGS SECOND PAN AMBBICAN SCIENTIFIC CONGRESS. 

Abt. 52. Loe recipientes de que se trata en el segundo pimio del artfculo 50 de- 

ber&n eetar provistos de etiqueta blanca, pegada en lugar visible^ con la fliguiente 

leyenda, en letras de molde, verdes y I4cilmente legibles, donde oonste el nombre 

del vendedor y la direcci6n de su establedmiento, o, si no tiene establedmiento, su 

domidlio: 

Leche de eegunda calidad. 

Consdmase hervida. 

(Aquf el nombre y apellido del vendedor). 

(Aquf la direcci6n de su eetablecimiento o, a defecto de ^te, de su domicilio.) 

Si se trata de ledie pasteumada, la leyenda seri modificada de acuerdo con lo 
dicho en el artfculo 46. 

Los doe primeros renglones de la leyenda (donde se indica la calidad de la leche y 
la manera cdmo debe ser consumida), tanto para la leche creuda conK> pasteumada, 
ser&n en letras de doble tamafio que el resto de la misma. 

Abt. 53. La leche pasteunzada no debe ser guardada, depositada, <rfrecida en venta, 
ni vendida o entregada al consumidor en recipientes cerradoe y sellados, a menos 
que haya side envasada en esa forma en el lugar donde ha side pasteuiizada. 

Art. 54. La administracidn sanitaria, cuando lo estime necesario para el mejor 
cumplimiento de esta ordenanza, y preyiniendo a los int^resados con cuatro meses de 
anticipaci6n, podri exigir que los recipientes met^icoe Ueven, adem^ de loe dia- 
tintivoe aquf estableddos, una raya de color que est^ de acuerdo con esos distintivos. 
Tambi^n podrd exigir, previniendo a loe interesadoe con cuatro meses de anticipaci6n, 
que loe envases de otras leches o derivados, no mencionadas en este capftulo, Ueven 
etiquetas o letreros en la forma que mis convenga al mejor cumplimiento de la preeente 
ordenanza. 

Abt. 55. Las etiquetas atadas de que deben venir provistos los envases en que ae 
introduce la leche a la capital deber^ ser guardadas por lo menos dunmte dos meses 
por los comerciantes que abran los recipientes y teneree siempre anegladas en orden 
cronol6gico. Arregladas en eeta forma ser&n pueetas a di8posici6n de loe inspectores 
de la Admin]straci6n Sanitaria, toda vez que ^stos lo soliciten. 

Abt. 56. Todo el que venda leche dentro del munidpio deberd llevar un libro 
foliado, sellado por la administraci6n sanitaria y convenientemente dispuesto, en 
que anotari diariamente, en orden cronol<5gico y sin dejar renglones en bianco, en 
seguida de recibir cada partida de leche, los siguientes dates relatives a la misma: 
fecha y hora en que recibe la leche, ntimero de litros redbidos y ndmero de tarros y 
botellas en que la recibe, calidad de la leche (si es de primera calidad certificada, de 
primera calidad ode segunda segtin las disposiciones de la presente ordenansa, y si 
es cruda, pasteurizada, etc.), nombre del tambero, productor o empresa de quien la 
redbe, estad6n ferroviaria donde la leche es embarcada para remitirla a Buenos Aires 
y ubicad6n del tambo o establedmiento de donde se le remite o adonde va a buscarla, 
si la compra en eeta Capital. 

Este libro se hallari siempre en el establedmiento del vendedor, o, si ^ete no tiene 
eetablecimiento, deberi Uevarlo en el carro. 

Art. 57. Todo el que dentro del munidpio venda leche al por mayor o para revender, 
deberd llevar un libro foliado, sellado por la administracidn sanitaria y conveniente- 
mente dispuesto, en que anotari, en orden cronol6gico y sin dejar renglones en bianco, 
en seguida de entregar cada partida de leche, los siguientes datos relatives a la misma: 
fecha y hora de la entrega, ntimero de litros de leche y de tarros y botellas en que la 
entrega, calidad de la leche (en la forma indicada en el artfculo precedente), nombre 
del comprador y direcd6n de su establedmiento, o de su domicilio, si no tiene estable 
dmiento. 

Este libro deberd hallarse siempre en el establedmiento del que vende leche al 
por mayor o para revender. 

Las anotaciones especificadas en este artfculo podr&n Uevarse con las de que se 
trata en el artfculo precedente en un mismo libro convenientemente dispuesto. 



PUBLIC HEALTH AND MEDICINE. 143 

Art. 58. Todo tambero o productor que remita a la Capital leche de primera cali- 
dad cerdficada o leche de primera calidad y toda firma o empresa que remita leche 
de cualquier dase procedente de mis de un productor, o pasteurizada o sometida a 
otras operacionee despu^ de redbida del productor, deberd Uevar uu libro en la 
fonna indicada en loe artfculos 56 y 57, en que anotard, en la forma all! tambidn indi- 
cada, cada partida de leche enviada a la Capital y loe siguientee datoe relativoe a la 
misma: lecha y hora en que remite la leche a la estacidn de embarque, ntimero de 
litroe remitidoe y n^ero de tarros y botellas en que la remite, calidad de la leche, 
nombre de la persona, firma o empresa a quien la remite y direcd6n de su estableci- 
miento. Cuando remita leche a varies consignatarios, la leche enviada a cada uno 
se considerard como una partida distinta a loe efectos de las anotaciones. 

Abt. 59. La leche que llegue a la Capital fuera de las condidones estableddas en 
los artlculos 43, 44, 48, o 49 caerd en comiso. 

Los infractoree de los articulos 42 o 45 incurrirdn en multa de 25 pesos y comiso de 
U leche; los del artfculo 46, en 15 pesos de multa y comiso de la leche; los del articulo 
50, en 10 pesos de multa y comiso de la leche; y los de los artlculos 56 o 57, en 50 
pesos de multa. 

Los infractoree de los artlculos 51 o 52 incurrirdn en cincuenta pesos de multa la 
primera vez, cien pesos la segunda y en el retire definitivo del permiso para intervenir 
en cualquier forma en el comercio de lecheria la tercera. La leche ser& comisada en 
todoe loe cases. 

A los infractores del articulo 53 se lee comisard la leche y se les apUcari una multa 
de cincuenta pesos, si se trata de leche de primera calidad, y de 25 pesos, si de segunda 
calidad. 

A los del articulo 55 se les comisard la leche y se les aplicari una multa de veinti- 
dnco pesos la primera vez, 50 la segunda y 100 pesos la tercera y las sucesivas. 

A loe del articulo 58 no se les permitir& la introducci6n de leche al municipio du- 
rante 5 a 15 dlas, eeg&D. la gravedad de la falta, para juzgar la cual se tendri en cuenta 
tambi^n la calidad de la leche. £1 interesado podrd cambiar eea pena por el pago 
de una multa de 50 a 150 pesos, segdn la gravedad de la falta. 

Art. 60. La administrad6n sanitaria no otorgari loe x>emiiso8 correspondientes, sin 
eomprobar piimero si el interesado dispone de los dementos necesarios para dar cum- 
plimiento a lo estableddo en el presente capltulo, en las partes que le atafien. 

CApfrULO V. LOCAL DE MANIPULACIONE8, DBPdSITO T PREPARACKSn DE LA LECHE 

PARA LA VENTA. 

Art. 61. Toda persona, firma o empresa que se dedique al comercio de lecheria 
dentro del munidpio, o sea, que compre o que venda leche para comerdar, estd obli- 
gada a tener un local especial para depositar en d la leche y para efectuar en d las 
manipulaciones y preparaci6n de la leche para la venta, entendi^ndose por depositar 
a(in el simple hecho de guardarla por cualquier tiempo y por manipulad6n o prepara-. 
d6n, adn el simple trasvasamiento de la leche de un recipiente a otro o la simple 
operad6n de limpiar un tarro, recipiente o (itil de cualquier clase, empleado en el 
comercio de lecheria. 

Cuando esta otdenanza se refiere al establecimiento de un comerciante de lecheria 
dentro de la Capital, debe entenderse que habla del local de que se trata en el pre- 
sente articulo, si el comerdante no tiene otro establecimiento. Asimismo, en el 
cunBo de esta ordenanza, y tratdndose de lo que est^ dentro del municipio, se llamanl 
aimplemente local de manipulaciones al local de que se trata en el presente articulo. 

Art. 62. £1 local de manipulaciones no podrd estar en casas de inquilinato, ni 
en casas antihigi^nicas. 

A quince metros de d no deberd haber caballerizas, gallineros, ni ningunain8talaci<5n 
semejante o capaz de producir males olores, de atraer las moscas en gran ntimero o 
de cargar la atm<3efera de polvos que puedan llegar hasta el local. 



144 PBOCEEDINQS SECOND PAN AMEBICAN SCIENTIFIO CONOBESS. 

£1 espacio libre que lo rodea etrtari cubierto de piso 861ido, de material impermeable 
y Buperficie lisa, por lo meno6 en un ancho de tree metroe. 

Art. 63. £1 local de manipulaciones congtaii de doe piesaa de material (obra de 
fdbrica), secas, con abundante luz natural, bien ventiladas, freecas, ain maloB 
olores, suficientemente amplias como para que las operadonee a que eet6n destinadas 
puedan hacerse c6modamente en buenas condiciones y sin amontonamiento de coBas, 
dispuestas de tal modo que su limpieza y desinfecci6n sean ttciles y que la leche se 
exponga lo menos posible a contaminaciones y mantenidas siempre en buen estado 
de conservaci6n y aseo. £n cuanto a la constnicci6n, disposicidn, utilaje y man- 
tenimiento de las doe piezas que constituyen el local de manipulaciones, debeiin 
llenaise por lo menos las siguientes condiciones: 

1*^. Tendrin piso sdlido, impermeable y liso, de cemento, baldosa, mosaico o ma- 
terial an^ogOy con las junturas bien tomadas con cemento, y provisto de desagtle 
dispuesto de manera que no se desprendan emanadones en el interior del recinto. 

2^ . Las paredes estar^ re vestidas hasta dos metros de altura por lo menos, de baldosas 
esmaltadas o piedras andlogas, de color bianco, con las junturas bien tomadas con 
cemento impermeable. 

3^. £1 resto de las paredes serd de superficie lisa y pintado con pintura blanca e 
impermeable. 

4**. £1 cielo raso serd s61ido (no de papel), liso y pintado de bianco. 

5^. Los dngulos formados por las paredes entre si y con el piso serin redondeados. 

6^. Cada pieza tendri por lo menos una ventana o una puerta, suficientemente am- 
plias, abiertas sobre la calle o un patio abierto o sobre un zaguin que d^ a la calle o 
a un patio abierto, a no ser que tengan claraboyas que aseguren la entrada de la luz 
y la ventilaci6n necesarias. 

7°, Sus aberturas exteriores estardn provistas de tela metdlica, que impida la en 
trada de las moscas. 

8^. Se comunicardn directa e inmediatamente entre si, por una puerta que se 
cierrc automiticamente y que se abriri s61o para pasar. 

9**. Las piezas no estar&n en comunicaci6n directa con letrinas. 

10^. Si se comunican directamente con alguna habitacidn, sea ^ta dormitorio o 
no, las puertas de comunicaci6n estardn provistas de algdn mecanismo de cierre 
automitico y s61o se abririn para el paso de las personas. 

11^. No serdn usadas como dormitories, ni para habitaci6n de enfermos, ni para 
ningdn fin dom^stico. 

12^. Habrd en cada pieza una escupidera con agua. 

13**. Las tapas de las mesas que sea necesario tener en ellas serin de material sdlido, 
liso, impermeable e inoxidable. £1 resto de las instalaciones, apai)atos y muebles 
(mesas, bancos, estantes, dispositivos para tener los recipientes, escurridores, etc.) 
0erin del mismo material, o, en su defecto, estarin pintados con pintura impermeable 
y blanca. 

14^. £1 pintado del local y de sus instalaciones, muebles, etc., se renovari en 
cuanto se halle manchado o en mal estado de conservacidn. 

15^. Los recipientes vacios y limpios que se hallen en el local de manipulaciones 
deberin estar siempre tapados, o, si estin destapados, colocados boca aba jo en escu- 
rridores u otros dispositivos apropiados. 

16^. £1 local seri abundantemente ventijado todos los dfas, y ^1 y todo lo que hay a 
dentro de ^1 estarin siempre libres de polvo, telarafias, tierra y reetos o resfduos de 
residues de cualquier especie. 

17^. No debe echarse o extenderse sobre el piso ninguna sustanda pulverulenta, 
tal como aserrin, arena, etc. 

18®. Para la limpieza no se usari nunca la eecoba seca ni el plumeio. Debe usarse 
el trapo y el lavado. 



PUBLIC HEALTH AND MEDICINE. 145 

19®. En ningnna de las piezas dei local deben pennanecer nifios ni otras personas que 
no tengan que hacer en el manejo de la leche. 

20®. No deben entrar a ellas animales dom^sticoe de ninguna eepe?ie. 

Abt. 64. Una de las piezas del local seri especial y exclusivamente destinada al 
depMto, envase y preparaci6n de la leche para la venta. 

En ella no se procederd a la limpieza de recipientes ni utensilioe. 

Deberd estar provista de los elementos necesarios para mantener frla la leche que se 
guaide. 

En ella no podrto guardarse mis que la leche, derivados de la misma incapacee de 
comunicarle olores extrafios, huevoe frescos y otros productos de granja en envases 
herm^ticamente cerrados. Ni deberd haber en ella mis que lo que sea necesario para 
los fines a que est4 destinada, ni ningtin dtil, tarro o recipiente vacfo que no est^ 
limpio y seco. 

Art. 66. La otra pieza del local de manipulaciones seri especial y exclusivamente 
destinada a la limpieza de recipientes y utenailios. 

En ella no se guardard la leche, ni ninguno de los productos que deben y pueden 
estar en la otra, segtin lo dicho en el artfculo precedente. 

f^stard provista de una pileta para el lavado, de material impermeable y liao, de 
dimensiones proporcionadas a las necesidades, convenientemente dispuesta para 
aquel fin y con servicios de agua corriente, caliente y frla. 

En esta pieza no deberd haber mis que los elementos necesarios para la limpieza y 
secado de los recipientes y utensilios, recipientes y utensilios listos para limpiarse y 
los ya limpios, durante el tiempo en que se est^n escurriendo. 

En ella habrd guardado siempre un delantal limpio de repuesto o un juego de ropa 
de los indicados en el artfculo 66 por cada persona de las que intervengan en las opera- 
ciones que se efectden en el local de manipulaciones. 

Abt. 66. Las personas ocupadas en las operaciones que se efectdan en el local de 
manipulaciones deberdn usar delantal largo o pantalones y saco o blusa limpios, blan- 
cos y lavables. 

Art. 67. En el local de manipulaciones, si 61 no estd anexo a algdn otro estable- 
cimiento de lecheria del mismo propietario, donde ya se tenga el libro de que se tiata 
en seguida, deberd haber un libro foliado, sellado por la Administraci6n Sanitaria, en 
que los inspectores de la misma dejardn constancia de sus inspecciones y de las obser- 
vaciones, instrucciones, avisos, etc., que hagan o den a su propietario. 

En las tisinas o fdbricas de lecherfa tambi^n deberd tenerse el libro de que aquf se 
trata. 

Art. 68. Las disposiciones del presente capftulo comprenden tambi^n a las usinas 
y fdbricas de lecheria, las que deberdn darles cumplimiento en cuanto les sean apli- 
cables, bajo pena de cincuenta a cien pesos de multa, segtin la gravedad de la falta. 

Art. 69. Losinfractores de los artfculos 61, 62, 63, 64, 65, 66 o 67, incurrirdn en multa 
de cinco a cincuenta pesos, segdn la gravedad de la falta. 

No se otorgardn por la Administracidn Sanitaria los permisos correspondientes, sin 
comprobar pnmero si el interesado dispone de todos los elementos necesarios para 
cumplir lo dispuesto en este capftulo. 

CAPfrULO VI. VBNTA DE LECHE EN PUE8T08 FU08 — ^LBCHBRfAS. 

Art. 70. Consid^rase lecheria todo puesto fijo de \ enta de leche al detalle al pu- 
blico consumidor, adonde ^ste va a buscar la leche que compra. 

Art. 71. Dichos establecimientos deberdn tener en el frente un letrero que diga 
** lecheria,'* y este letrero no podrd ser usado por establecimientos donde no se venda 
leche en las condiciones indicadas en el artfculo precedente. 

Art. 72. Las lecherfaa constardn por lo menos del local de que se trata en el capftulo 
y y del local de venta o despacho al pdblico. 



146 PROCEEDINGS SECOND PAN AMERICAN SOIENTIPIO CONGRESS. 

Art. 73. El local de despacho deberd estar al frente, es decir, dar a la calle, y toner 
por lo meuos una puerta a la misma, que permita el acceso inmediato y directo del 
pdblico que va a comprar leche. 

Estard en comunicacidn directa con la pieza donde se depoaite y prepaie la leche 
(la indlcada en el art. 64), pero no con la destinada a la limpieza (la indicada en el art. 
65). 

En cuanto a su consirucci6u, dispo8ici6n, utensilios y mantenimiento, deber^ satis- 
facer loe requisitoa indicados en loe artfculos 62 y 63, salvo las condiclones 5*, 6», ?•, 8», 
15* y 19* de este dltimo artfculo, y con la diferencia de que la pintura podr& no ser 
blanca, bastando que sea de color claro, y de que la chapa del mostrador debeht ser 
blanca o de color claro. 

Art. 74. En las lecberfas, la leche de primera calidad y la de segunda calidad 
podrdn A enderse sueltas al consumidor, es decir, serle entr^ados en los reclpientes que 
lleve a ese efecto. 

Art. 75. La leche en despacho deber^ estar en depdsltos o tanques sin canilla, 
provistos de tapa que recubra la abertura superior, sus hordes y el cuello del recipiente, 
y colocados en aparatos refrigeradores, heladeras o cubas con hielo, si la temperatura 
amhiente es superior a la que debe tenor la leche segdn su calidad. 

Art. 76. Los tanques o depdsltos mencionados en el artfculo precedente se hallar&n 
a la ^ Ista del publico y de mode que los clientes puedan leer los letreros de que se 
trata en seguida. 

Los que contengan leche de primera calidad Uevar&n el siguiente letrero, en la 
forma, lugar y dem^ condiclones indicadas en el artfculo 51: 

Leche de primera calidad. 
Los nifios y enfermos deben consumirla hervida. 

Los que contengan leche de s^^nda calidad llevarin de igual manera este letrero: 

Leche de segunda calidad. 
Consdmase hervida. 

Si la leche es pasteurizada, el primer rengl6n de esoe letreros dii& como sigue: 
''Leche de primera calidad pasteurizada" o ''Leche de segunda calidad pasteurizada," 
segdn se trate de una u otra calidad de leche. 

Si los recipientes estin guardados, encerrados o cubiertos, de tal modo que no se 
vean sus letreros, ^tos deberdn ir, en la forma ya indicada, sobre la pared de la heladera 
Cuba, etc., donde loe recipientes se hallen colocados. Pero 6st06 llevar&n siempre los 
letreros susodichos, aunque est^n guardados, encerrados o cubiertos. 

Art. 77. La leche deberd extraerse de esos depdsitos o tanques por su abertura 
superior, a la vista del cliente, por medio de una medida provista de mango lazgo, a 
manera de cuchar6n, y despu^ de remover bien el Ifquido con la misma, a fin de 
quo todos la reciban con igual cantidad de gordura. 

Art. 78. Cada tanque o depdsito estard provisto de su medida especial y 6sta deberd 
permanecer continuamente dentro del dep6sito respective, colocada de tal modo que 
la parte del mango por donde se toma para usarla no est6 sumeigida en la leche. 

Art. 79. El dep6sito y su correspondiente medida serdn limpiados por lo menos 
cada veinticuatro horas y ademds toda vez que se vaya a echar en el primero leche de 
otra partida (art. 15). 

Art. 80. Al lado de cada tanque o dep6sito habrd un soporte o una percha para 
poner o colgar en ^1 la tapa del mismo durante las operaciones de echar o extraer 
leche. La tapa se colocard en ellos boca abajo siempre. 

Art. 81. Los depdsitos deetinados a la leche de primera calidad no serdn nunca 
usados con la leche de segunda calidad, ni los destinados a esta tUtima con la de pri- 
mera calidad. 



PUBLIC HEALTH AND MEDIOIKE. 147 

Abt. 82. La Admini8traci6ii Sanitaria podr6 permitir que la leche en despacho 
se tenga en recipientes con canilla, dempre que el intereeado disponga de loe elementoa 
de limpieza y esteiilizaci6n necesarios para mantenerloe en perfectas condiciones de 
hjgiene y que a la vez eeos recipientes satifl&gan Iob requisitos ya eetablecidoe en esta 
ordenanza y adem^ loe siguientes: 

1^. La canilla deberi eer de constituci6n simple, sin rosea y ttdlmente desmontable. 

2^. El recipiente deberi estar dispuesto de tal modo que no se pueda extiaer la 
leche por la canilla, sin que el Ifquido sea agitado de tiempo en tiempo. 

3^. El mecaniBmo para agitar la leche deberi ser tal que no haya ningimft piesa 
que se mueva en el interior del recipiente ni en contacto con el Ifquido. 

Para usar esta clase de recipientes loe interesadoe debedb solicitar en cada caso 
una autoriaaddn especial de la Administraddn Sanitaria. 

Art. 83. Debajo de cuanto letrero se coloque en las lecherias, relative a la leche 
que venden, deber& ponerse siempre el aviso ya indicado sobre la forma en que debe 
ser consumido el producto, en letras de igual tamafio y color. 

Art. 84. En las lecherfas que tengan mesas para servir leche o sus derivadoe o 
preparadoe a clientes que vayan a consumirlos allf mismo, el lugar donde se hallen 
las mesas estari separado por medio de una baranda por lo menos del despacho de 
leche al publico que la compra para llevtoela, de modo que los clientes que conciuren 
a las mesas se hallen a una distancia de tree metroe cuando menos del mostrador y de 
los depMtos de que se trata en el artfculo 75 y siguientes. 

El acceso al lugar de despacho s61o se permitiril a las personas que vayan a comprar 
leche para llevtoela. 

Art. 85. En las lecherfas, adem^s de la venta de leche, s61o se permitiril la de 
huevos frescos, quesos frescos y sin olor pronundado, crema, manteca, cuajadas y 
productos an^ogoe derivadoe de la leche, miel y otros jmxiuctos de granja conservadoe 
y vendidoe en envasee cerrados en el lugar de producci6n, todo lo cual deberi deposi- 
tarse y tenerse en condkdones que no atndgan las moscas y no puedan comunicarle 
olores eztrafios a la leche. 

Tambi^n podrin tenerse y venderse masas secas y pan para ser consumidos en las 
mesas del local. 

Pero ni loe quesos, ni ninguno de loe productos no derivadoe de la leche podrin 
ser tenidoe ni vendidoe en las lecherfas en cantidades tales que hagan perder a estos 
establecimientos su verdadero car&cter o que influencien en lo m^ minfmo el cuidado 
y las condidones de la leche. 

Art. 86. Toda lecheria anexa a una chocolaterfa, confiterfa, reetaurant o cualquier 
otro negodo deber& estar completamente separada de ^l, y las puertas que la pongan 
en comunicaci6n con €i deberdn ser de cierre automdtico y abrirse tinicamente para 
pasar. 

Art. 87. Las personas que atiendan el despacho usar&n camisa blanca y c(Hrbata e 
indumentaria exterior como la indicada en el artfculo 66. 

Art. 88. En toda lecheria se llevar& un libro como el indicado en el artfculo 67. 

Art. 89. El permiso que otorgue la Administracidn Sanitaria a las lecherfas deber& 
hallaiBe en el local de despacho, a la vista del ptiblico, en un cuadro con vidrio. 

Art. 90. No se otorgar&n por la administraci6n sanitaria los permisos correspon- 
dientee, sin cerdorarse primero de si el intereeado dispone de los elementos neceearios 
para satisfacer las prescripdones contenidas en eete capftulo. 

La Administraddn Sanitaria podr& prohibir la venta de leches de primera calidad 
certificada o de primera calidad a las lecherfas que por su mal mantenimiento u otras 
causas no ofrezcan garantias sufidentee de entregar esas leches al consumidor en las 
condidones exigidas en esta ordenanza. 

Los infractores de loe artfculos 71, 84, u 86 incurririn en dncuenta pesos de multa. 
Se les clausurard el establedmiento, si deepu^ del segundo aviso y de vencido el 
plazo que les sefiale la administrad6n sanitaria, no se colocan en las condidones 
exigidas. 

684Se— 17— VOL X 11 



148 PB00EEDIN6S 6E00NI> PAK AMEBIOAK 80IEKTIFI0 G0N0BE88. 

Los de lo6 articulos 73, 80, 85, 87, 88, u 89 incunrir^ en multa de cinco a dncuenU 
pesos, seg^ la gravedad de la falta. 

Los de los artfculos 75, 77, o 78, en multa de treinta pesos, si se trata de leche de 
primera calidad, y de quince pesos, si de segunda calidad. 

Los de los artfculos 76 u 83, en multa de dncuenta pesos la primera vez, de den 
pesos la segunda y retiro definitivo del permiso para intervenir en cualquier forma 
en el comercio de lecheria la tercera. En los cases de infraccidn del artfculo 76, 
adem^ de la multa, la leche caer& en comiso. 

Los del artfculo 79, en multa de treinta pesos, si se trata de leche de primera calidad, 
y de quince pesos, si de segunda calidad. La leche puesta en el depMto que do 
haya side limplado previamente serd decomisada. 

Los del artfculo 81, en multa de dncuenta pesos y comiso de la leche que se halle 
en el dep<3sito o tanque destinado a leche de otra calidad. 

OAFfruLo vn. ybnta de lbchs a domiciuo; ysndbdobes ambulantbs; rbpabti- 

DORES; CABROS T DBlCiS VEHfCULOS DB RBPABTO. 

Art. 91. Bajo pena de den pesos de multa y comiso de la leche que transporte, 
no se usard ningtin carro o vehfculo para el transporte o venta de ledie a domicilio 
que no haya side previamente aprobado y registrado por la Administraddn Sanitaria. 
£1 carro o vehfculo que circule en la vfa ptiblica, sin estar aprobado y legistrado, 
8er& detenido hasta que el interesado abone la multa susodidia, corriendo por su 
cuenta los gastos de dep^to, y sin responsabilidad para la admini8traci6n sanitaria 
por los deterioros que pueda sufrir durante su detenci6n. 

Los carros y dem^ vehfculos de reparto o venta de leche a domicilio ser&n con 
eldsticos, completamente cerrados, con paredes, piso y techo aisladores, revestidos 
interiormente de chapa met&lica inoxidable y bien unida, y estadin provistos de 
dep^tos para hielo y para el agua de descongelad6n, de manera que la leche pueda 
mantenerse en ellos a la temperatura que corresponda segtin las prescripdones de 
la presente ordenanza y que no se acumule agua en el interior del vehfculo. Estardn 
totalmente pintados de bianco, salvo las ruedas, que podrin ser pintadas de cualquier 
otro color. La pintura serd impermeable. 

Esos vehfculos serdn de limpieza y desinfeccidn fddles y deberin mantenerse 
siempre en buen estado de con8ervad6n y aseo, interior y exteriormente. 

Si las canillas de los tanques de la leche salen al exterior del vehfculo, estar^ 
ptovistas de una cubierta especial, convenientemente dispuesta para exduir toda 
causa de contaminad6n. 

Los vehfculos podr&n ser de tracd6n humana, animal o mecdnica. 

Art. 92. Los vehfculos llevardn pintado, en negro y en caracteres de molde, en 
una de las paredes laterales o en la posterior, el ndmero de su registro en la admi- 
nistrad6n sanitaria, precedido de las inidales A. S., el nombre de la empresa, firma 
o persona por cuenta de quien se vende la leche que transportan, la direcd6n del 
respective establecimiento o del domicilio del vendedor, si no tiene establedmiento 
alguno, y un letrero indicative de la calidad de la leche o de las leches que trans- 
portan y de la manera c6mo deben ser consumidas. 

Para la leche de primera calidad certificada, este dltimo letrero serd tal como se 
indica en el artfculo 42, suprimiendo el rengl6n 5^. Para las leches de primera calidad 
y de segunda calidad, tal como se indica en los artfculos 46, y 52, respectivamente. 

El numero de registro y las iniciales que lo preceden, asf como los renglones donde 
se indica en los letreros la calidad de la leche y la manera c6mo debe ser consumida, 
serdn en letras de echo centfmetros de altura por uno y medio de grueso, por lo menos, 
y todo el reeto de lo que debe ir eecrito sobre el carro, en letras de cinco centfmetros 
de grueso, cuando menos. 

La leche vendida, ofrecida en venta o presentada para la venta como de una calidad 
que no est^ indicada o anunciada en el exterior del vehfculo en la forma establedda. 



PUBUC HEALTH AND MEDICINE. 149 

caer& en comiso, y el infractor incurrird en multa de cincuenta pesos la primera vez, 
cien peeoe la segunda y retiro definitive del permiso para interveuir en cualquier forma 
en el comercio de lecberia la tercera. 

Siempre que no se trate de maniobras de mala fe, que tienen penas especialmente 
establecidas, las dem^ infracciones del presente artfculo serdn penadas con multa de 
cincuenta pesos. 

En los cases de que se trata en los dos p&rrafos precedentes, el veblculo ser^ detenido, 
en las condiciones establecidas en el artlculo 91, basta tanto se abone la multa im- 
puesta. 

Art. 93. Se prohibe Uevar en el pescante recipientes de cualquier clase, sin leche^ 
o con lecbe, comprendido el jarro xxmAo como medida, que tampoco se Uevard colgado 
de la cintura, bajo pena de diez pesos de multa en todos los cases y detenci6n del 
veblculo, en las condiciones ya establecidas, basta tanto se abone la multa. 

Recipientes y medida ir&n siempre guardados en el interior del veblculo. 

Abt. 94. En los veblculos de reparto no se llevari agua ni ninguna otras sustancia 
o cosa mis que lecbe, crema, manteca y otros derivados de la leche, siempre que 
eatisfagan ^stos las condiciones indicadas en el artlculo 85, y los recipientes a ellos 
destinados. 

Se probibe tambi^n llevar en ellos, perros o cualquier otro animal y usarlos para 
otro destine que para el transporte de la lecbe, adn fuera de las boras de reparto. 

A los infractores de este artlculo se les aplicard ima multa de cinco a cincuenta pesos, 
eegdn la gravedad de la falta, para apreciar la cual se tendrd en cuenta la calidad de 
la leche que transporten en el veblculo, y se les detendrd ^te, si se balla en la via 
ptiblica, en la forma y por el t^rmino indi cades en el artlculo precedente. 

Art. 95. Se probibe trasvasar la leche de los recipientes en que se transporta a otros, 
con objeto de bajarla o sacarla del veblculo en estos dltimos y ecbarla de aqul en el 
recipiente del consumidor, bajo las penas establecidas en el artlculo 93. 

La lecbe que se venda o reparta suelta, deberd ser ecbada directamente del tanque 
tarro en que se transporte a la medida y de aqul al recipiente del consumidor. 

Art. 96. Los repartidores y los vendedores ambulantes de lecbe usardn la indumen- 
taria exterior indicada en el artlculo 66, bajo las penas establecidas para los infractores 
de este artlculo. 

Art. 97. Todo repartidor, por su cuenta o por la de otro, llevard siempre consigo una 
libreta numerada que lo acreditar^ como tal, expedida por la Administracidn Sani- 
taria, mediante el page de su costo. Esta libreta llevard el retrato del repartidor y el 
texto de la presente ordenanza y ademds constarin en ella los siguientes dates: nombre 
de la persona, empresa o firma por cuenta de quien se hace el reparto y direcci6n del 
respective establecimiento, nombre y apellido del repartidor, ubicaci6n de su eetable- 
cimiento, o, si no tiene ninguno, de su domicilio, nacionalidad y edad del repartidor^ 
ndmero del permiso del establecimiento respective y n(!imero de registro del carro 
que usa el reparticor. La libreta tendri veinte p^iginas en bianco, donde los inspec- 
tores de la Administraci6n Sanitaria anotardn los avisos y observaciones bechas al 
repartidor y las infracciones cometidas por ^te, con indicaci6n de causas y de fecba. 

Al repartidor que no lleve consigo la libreta durante el reparto se le aplicari una 
multa de 15 pesos las tree primo-as voces y de 50 las suceaivas y se le detendrd siempre 
el carro, en las condiciones ya establecidas, basta que la presente y abone la multa 
impuesta. 

Art. 98. A los lecberos ambulantes o repartidores que por el deficiente manteni- 
mlento del veblculo u otras causas no ofrezcan suficientes garantlas de entregar al 
consumidor la lecbe de primera calidad certificada o la lecbe de primera calidad en 
las condiciones exigidas en esta ordenanza, la administraci6n sanitaria podrd pro- 
hibirles vender o repartir esas clases de leches, so pena de decomis&rselas, aplicarle& 
una multa de cien pesos y detenerles el veblculo en las condiciones y por el tormina 
indicados en el artlculo precedente. 



150 PBOCEEDIKQS SECOND PAN AMEBIOAN SOIENTIFIO OONGBBSS. 

OAPtrULO ym. PBBSONAS QUB INTBBYIBNBN BN BL COMBRCIO DB LBCHBRfA, BN 

OBNBRAL. 

Art. 99. Del reparto, venta y maiiipulaci6n de la leche no se ocupard ninguna 
persona afectada de enfennedades contagiosas que puedan trasmitirse por intermedio 
de la leche, o de llagas supurantee, dlceras, erupdoneB o eczemas supurantes o hdmedoe 
de los brazos, manos o cara, ni que lleve vendajee en estas mismaa partes. 

Art. 100. Toda persona ocupada en el reparto, venta o maDipulaci6n de la leche 
estari provista de un certificado m6dico expedido por la administracidn sanitaria y 
que deberd ser renovado anualmente, bajo pena de cincuenta pesos de multa. 

Art. 101. Las personas de que se trata en loe precedentes artfculos deben mante- 
nerse siempre aseados y, en particular, cuidarin de tener sus manos limpias. 

CAPiTULO IX. produoci6n db la lbchb db prdcbra caubad cbrtificada. 
1. yACAS tnoDvctoMAa; sus ooNDlcloirBa t bstaoo samrabio. 

Art. 102. El lote productor de leche de primera calidad certificada constard de 
cuatro vacas cuando menos. La edad de los animates no pasarA de doce alios. 

Art. 103. Las vacas destinadas a producir esa leche seWoi examinadas individual- 
mente y tuberculinizadas por un veterinario de la administraci6n sanitaria antes de 
entrar a formar parte del lote productor. 

Despu^, serdn examinadas por el mismo por lo menos una vez al mes y tubercu- 
linizadas cuantes voces ^1 lo considere necesario para descartar cualqtder sospecfaa 
de tuberculosis. 

La tuberculinizacidn se repetiri por lo menos cada afio. 

Art. 104. Las vacas que reaccionen como tuberculosas a la inoculaci6n de tuber- 
culina o que presenten signos clfnicos de tuberculosis ser&n marcadas a fuego con 
una T en el tercio superior de la tabla izquierda del cuello. Las que den reacci6n 
dudosa, con una D, en la misma forma y lugar. Unas y otras serin immediatamente 
separadas y aisladas, y sacadas del establecimiento dentro de un plazo de 48 horas. 
Aunque dejaran de reaccionar en lo suceeivo, no podr&n nunca formar parte del lote 
productor ni volver al establecimiento. 

Las que al examen clfnico o bacteriol6gico resulten afectadas de cualquier enfer- 
medad serin inmediatamente separadas y aisladas, hasta que el veterinario oficial 
las considere sanas o declare que su leche no ofrece inconveniente ni peligro alguno 
Entre tanto, su leche no seri utilizada. Si considera que ellas deben ser definiti- 
vamente eliminadas del lote productor, serin sacadas del establecimiento en el plazo 
' de 48 horas. 

Se prohibe expresamente utilizar para la producci6n de leche de primera calidad 
certificada, o tener dentro de los establecimientos que la producen, vacas que no tengan 
008 cuatro mamas fntegras y en capacidad de funcionar plenamente, como tambi^n 
dedicar a la producci6n de tal leche o tener dentro del lote productor vacas afectadas 
de cualquier trastomo digestivo acompafiado de diarrea. 

Art. 105. Las vacas que formen el lote productor serin sefialadas con un broche 
numerado que se les aplicari en la oreja. 

Con ellas no se colocari nunca, en el establo, ni en los potreros, ni en parte alguna, 
ninguna vaca que no haya sido antes tuberculinizada y examinada por el veterinario 
oficial y declarada sana por 61. Tampoco podrin estar con ellas animates de otras 
especies o vacas destinadas a producir leche de otra calidad. 

Art. 106. Quince dfas antes de parir, las vacas serin separadas del lote productor, 
colocadas en establos o potreros especiales y mantenidas aquf hasta despu^ de ocho 
dfas de la parici6n. Durante el tiempo de separaci6n, su leche no seri utilizada. 
Pasado este plazo, y previo examen del veterinario oficial, podrin volver al lote 
productor, pero sin su temero, que desde ese memento no tocari mis a la madre ni 
estari a su lado. 



PUBLIC HEALTH AND MBDIOIKB. 161 

Abt. 107. De todo traBtomo de la salad o novedad notadoe ea las vacas se dar& 
aviso inmediato a la administraci6n sanitaria, que dispondr& en seguida su visita por 
on veterinaiio. Entre tanto, deede el primer momento, el animal serd retdrado del 
lote productor y su leche no serd utilizada hasta que el veterinario oficial lo ordene. 

Art. 108. A efectos de dar ciunplimiento a lo dispueeto en los artfculos anterioree, 
en todo establecimiento dedicado a la producci6n de leche de primera calidad certifi- 
cada habr& potreros o establos especiales para el lote productor, para los animales 
destinados a formar parte de ^1 y atin no examinados, para los afectados o los sospe- 
chosos de tuberculosis o que por cualquier otra causa haya que retirar definitivamente 
del lote productor y, finalmente, para colocar la vacas durante el periodo de la parici6n. 

Los abrevaderos de eeoe potreros no ser&n comunes ni prdximos, debiendo haUarse, 
cuando sea posible, a distancia de por lo menos cien metres unos de otros. 

Las personas dedicadas al cuidado y ordefio de las vacas del lote productor o que 
manejen su leche no atender^ los animales reaccionantes o sospechoeoe de tuber- 
culosis, y s61o podr&n hacerlo con los otros cuando el veterinario oficial lo permita. 

Abt. 109. La administraci6n sanitaria hard examinar desde el punto de vista qulmico 
y bacteriol6gico una vez al mes por lo menoe, muestras colectivas de leche del lote 
productor, recogidas con las garantfas necesarias. Esas muestras se recoger&n de 
la mezcla de la leche de cincuenta vacas cuando m&s. 

En case de comprobarse en esas muestras agentes infecciosos que puedan proceder 
de las vacas, se hsxia las investigaciones clfnicas y bacteriol<5gicas individuales nece- 
sarias para descubrir el animal infectante. 

Cuando la administraci6n sanitaria o el veterinario oficial lo estimen conveniente, 
podrdn recogerse muestras colectivas o individuales de leche, de productos patoldgicos, 
de forrajes, aguas y, en general, de todo lo que se requiera para asegurarse del buen 
estado sanitario de los animales y de las condiciones de la leche. 

Abt. 110. Los interesados podrdn hacer asistir sus animales por el veterinario 
particular que estimen conveniente, pero el veterinario oficial deberd ser enterado 
siempre del tratamiento a que se los someta. 

Los animales enfermos no ser4n tratados por ninguna persona que no tenga el tftulo 
de m^ico veterinario. Ni aun medicamentos caseros (suUato de soda, etc.) podrin 
administrirseles sin la intervenci6n del veterinario. 

Art. 111. Las vacas del lote productor no serdn tratadas con medicamentos de 
acci6n en^igica o capaces de pasar a la leche. Se prohibe eepecialmente adminis- 
trarles dloe, irsenico, em^tico (tdrtaro estibiado), arcolina, hel^boro bianco, prepara- 
dos mercuriales, yodo, eserina, pilocarpina, estricnina y otros alcaloides. La leche 
de las vacas tratadas con estos medicamentos no podrd ser utilizada hasta pasados 
cuatro dias de ceeado el tratamiento. 

Art. 112. Cuando la Administracidn Sanitaria lo considere necesario podrd exigir 
que las vacaa sean vacunadas o sometidas a tratamientos prev^itivos contra determi- 
nadas enfermedades que las amenacen. 

Art. 113. En los establedmientoe productores de leche de primera calidad certifi- 
cada se llevar& un libro dispuesto en la forma que indique la administracidn sanitaria, 
donde se anotard respecto de cada vaca el n(!imero que tenga, su reeefia (rasa, edad, 
pelaje, sefias particulares, sefiales, marcas, etc.), la fecha del primer examen del vete- 
rinario oficial y su resultado, fecha de instalacidn en el lote productor, fechas en 
que fu^ servida y de la parici6n, las exclusiones temporariaa del lote productor, con 
i2idicaci6n de fechas, duraci6n y motives, y las visitas sucesivas a que haya side 
flometida por el veterinario oficial, con indicaci6n de fechas, resultadoe y prescripcionee 
u obeervaciones a que haya habido lugar. 

Este libro estari siempre a dispoeici6n del veterinario inspects. 

Art. 114. En esoe establecimientos, por lo menos dos voces por semana se medlri la 
cantidad de leche que d6 en el dia cada vaca y se registrar^ el dato en un libro especial, 
que estari siempre a di8poaici6n del veterinario inspector. Laa anotaciones ser^ 
conservadas durante seis meses. 



152 PBOOEEDINGS SECOND PAN AMEBIOAN 60IENTIFI0 CONGBESS. 

3. ALnaNTAa6K DK las YACAS PBODUCTORAS DB UCBB DB PBIMBBA CAUDAD CBBTIFIGADA. 

Art. 115. Los potreroe o cuadros donde se alimenten las vacas a pastoreo serin 
altos, libres de pantanos o charcos y de todo otro dep<5eito de aguas contaminadas o no 
potables, no inundables por las aguas superficiales ni subterr&neas y provistos de 
buenos pastos naturales o artificlales. 

En ellos, ni a una distancia de cien metros de ellos, no habrd chiqueros, estercoleroe, 
ni otras habltaciones de animales, dep<3sit06 de residues o establecimientos que despi- 
dan maloB olores. 

Tampoco habrd en ellos, ni a cien metres de ellos, caddveres de animales, carrofias, 
huesos u otros restos de animates muertos. 

Adem^, la ubicaci6n de esos potreros serd tal que los animates no est^n en ningdn 
case obligados a transitar a distancia menor de cien metros de esas habitacionee, 
dep<58ito8, establecimientos y restos. 

Art. 116. Ademds de la alimentaci6n a pastoreo podr& administrarse a las vacas los 
siguientes forrajes: 

(a) Heno (paste seco) de buena calidad, bien cosechado, de color fresco y olor ard- 
mitico , libre de plantas t6xicas, mohos (no serd ardido) y polvo. 

(b) Paja de cereales de la misma calidad y estado. 

(c) Afrecho de centeno y de trigo. 

(d) Avena, cebada, centeno y mafz, molidos, rotos o aplastados. 

(e) Harina de semilla de lino. 

Los granos y harinas serdn de buena calidad y en buen estado de conservacidn. 

Quien desee administrar otro forrajes pedird previamente autorizaci6n a la admi- 
nistraci6n sanitaria. 

No se permitird en ningdn caso que los animates consuman forrajes capaces de pro- 
ducir diarrea u otros trastomos, de comunicar a la leche olor o gusto extrafios o de 
disminuir su calidad. 

Art. 117. El agua de bebida de los animates, asi como toda el agua usadacon cual- 
quier fin en los establecimientos productores de leche de primera calidad certificada, 
debe haber side reconocida potable por la Administraci6n Sanitaria. 

Cada potrero tendrd su abrevadero especial, separado de toe que pertenecen a toe 
potreroe vecinos. 

En los abrevaderos no se lavari ropa, ni las manoe, ni recipiente alguno, ni se 
cumplird ningdn fin domdstico, ni otros, capaces de ensuciar o contaminar el agua. 

Se hattardn siempre limpios y provistos de agua limpia y fresca. 

Estardn emplazados en lugares altos y de tal mode que alrededor de ellos no se formen 
charcos o barro, donde los animates puedan echarse. Tambi^n se evitard que 
junto a ellos o a su alrededor se acumule el estidrcol de los mismos animates. 

Art. 119. No se permitirdn los cambios bruscos de rdgimen alimenticio. 

£1 pasaje del rd^men seco at de paste verde, e inversamente, serd gradual. 

En la dpoca de los pastes tiemos, si dstos ocasionan diarrea, los animates mantenidos 
a pastoreo recibirdn un suplemento de paste seco, a fin de evitar ese inconveniente. 
Lo mismo, se adoptard iguat procedimiento, si la alimentaddn exdusiva con paste 
verde de cuatquier clase produce ese trastomo. 

Art. 119. En todo eetabtecimiento de los indicados habrd un local especiatmente 
destinado at depdsito y conservaci6n de los forrajes, de dimensiones proporcionadas 
ft las necesidades, bien ventilado, seco, limpio y emplazado en un lugar alto. 

S. CAMPO T B8TABL08 DB LAS VACAS PBODUCTOBAS DB LBCHB DB PBmBRA CALTOAD CEBTinCADA. 

Art. 120. Los animates podrdn ser tenidos en establos todo el aflo o en ciertas 
dpocas de 61, pero se tes dari siempre, salvo que el mat tiempo no lo permita, por lo 
menoe cinco horas diarias de soltura at aire libre, en potreros como toe indicados eu el 
artlculo 115. 



FUBUO HEALTH AND MEDIODSTE. 158 

Art. 121« Cuando loe animales sean mantenidos continuamente a campo y no haya 
6Btab1o6 para eHos, habr& en cada potrero por lo menos un tinglado o cobertizo de doa 
aguaSy de dimensiones proporcionadas al ndmero de vacaa que haya eo ol potrero, con 
tabique mediano, piso impermeable y idcil de limpiar, y orientado y dlapueeto de tal 
modo que loe animates puedan protegeree en 61 de las lluvias y del viento. 

Be evitari que en 61, y sus alrededores se acomulen deyecciones o el agua de las 
Uuvias, o se Idrmen baches, a fin de que los animales, en lo poeible, no se ensucien, 
sobre todo al echarse. 

Aht. 122. Los establos se hallarftn emplassados sobre un terrene alto. Sus pisos 
ser&n de cemento en toda sa extensi6n o de material andlogo, impermeable, y tendrdn 
una inclinaci6n que permita la corriente de los Uquidos hacia bocas de desajE^fle cu- 
biertos con rejilla y en conexi6n con el sistema de drenaje. La superficie del piso 
se hallard a 20 centfmetros por lo menos sobre el nivel del suelo que rodea el establo. 

En cuanto a lo dero^, los establos deberdn satisfacer las condiciones indicadas en 
los artfculns siguientes. 

Art. 123. El sistema de drenaje terminar& en pozos adecuadamente construidos y 
estari dispuesto de tal modo que sus emanadones no refluyan al establo. 

Art. 124 Las paredes del establo* hasta dos metros de altura por lo menos, ser&n 
de material (obra de ttbrica) y revestidas de cemento impermeable y liso o de baldosas 
o azulejoB, con las junturas bien tomadas con cemento. 

Los ingulos formados por las paredes entre sf, hasta esa altuia, y por ellos y el piso 
ser^ redondeados, para facilitar la limpieza. 

Art. 125. El resto de las paredes y los cielo rasos podr&n ser de madera cepillada. 
Si son de material (obra de f&brira), tendrdn su superficie lisa. En todos los casos, 
salvo que se hallen reveetidos de material impermeable, estar&n pintados con lechada 
de cal o alguna pintura impermeable de color claro. 

Art. 126. En la constniC€*i6n del establo no habrd nada de madera mds que lo 
indicado en el artfculo precedente y las puertas y ventanas. Los parantes o columnaa 
de sost6n interiorps, los tabiques de separaci6n de los animates, las rejillas para el 
pasto, comederos, bebederos, etc., ser&n de hierro, cemento armado o material, im- 
permeables, con sus superficies lisas y sus aristas y hordes redondeados. 

Art. 127. El establo tendri suficientes dlmensiones como para que cada vaca 
disponga de treinta metros ctibicos de espacio libre, cuando menos. 

El cielo-raso se hallarA en sus partes mis bajas a 5 metros por lo menos de altura sobre 
la superficie del piso. 

Art. 128. La orientacldn, construcci6n, disposicidn y ventllaci6n del establo 
mtin tales que el aire intmor se mantenga tresco, seco y agradable y que no haya 
corrientes de aire en el recinto. 

La temperatura del establo se mantendrd entre 16 y 18 grados. 

Las ventanas serdn de dimensiones y en ntimero suficientes para que haya por lo 
menos 12,600 centfmetros cuadrados de abertura por cada 30 metros cdbicos de espacio 
libre interior. Estar&n situadas en forma que la luz se distribuya abundante y uni- 
formemente en todo el establo y se abrir&n hacia adentro, sobre eje horizontal inferior, 
de suerte que al entrar el aire vaya hacia arriba. 

£1 establo estari provisto de ventiladores de tiraje interceptables a voluntad, en 
ndmero y con dimensiones suficientes para que por c»da 30 metros cdbicos de espacio 
libre interior haya por lo menos 376 centfmetros cuadrados de abertura de yentilaci6n. 

Ajbt. 129. La di8posici6n interna del establo serd del tipo o modelo llamado holand6s» 
en lo que serefiere a la forma como serin tenidos los animales. 

La superficie ocupada por cada vaca serd pequefia. Tendrd una longitud tal que 
loe excrementos caigan natundmente en la canaleta de deyecciones que correrd detrda 
de los pies posteriores de los animales. Su ancho serA tambi6n reducido, de modo 
que quede espacio para los pies cuando las bestias se acuesten, pero que sea impoaible 
a 6stfi8 ladearse y alejar los cuartos tiaseros de la susodicha canaleta. 



154 PBOOEEDINQS 3B00in> PAN AMEBIOAK SCIBNTIFIC G0NQBE88. 

Las canaletas de deyecciones tendr6n diecis^ centimetros por lo menos de pro- 
fundidad en todas bob partes, ser&n constaruidas de cemento u otro de lot materiales 
indicados para el piso del establo y adecuadamente inclinadas y dr^iadas. 

Los comedoxM y bebederos ser&n bajoe, de mode que los animales, al echarse, puedan 
extender su cuello y cabeza pw encima de elloe. Su fondo no estard a mia de 15 
centfmetros sobre la superficie del piso circundante. 

Abt. 130. En los establos dispuestos de tal manera que las vacas est^n opuestas por 
BUS partes posteriores habdl un espacio por lo menos de 2.50 metroe entre los border 
exterioree de las canaletas de deyecciones opuestas. 

El establo estari provisto de pasillos para servir los alimentos a los animales sin 
tesnet neceeidad de pasar por entre ellos ni molestarlos. 

Los pasUloB y caminos y todos los espacios que se hallen detr&s de las vacas serin 
p<v lo menos tan altos como los lugares ocupados por ellas. 

Art. 131. Seri preferible que cada vaca tenga su comedero y bebedero aparte. 
Estos ser&n metilicos o de otro material impermeable, inoxidables y de ficil Umpiesa. 

Art. 132. Todo establo tendri su servicio de agua corriente convenientemente 
dispuesto y que baste para todos los prop<3sitos. 

Si las vacas son ordefiadas en el establo, en un lugar adecuado de ^te o en conexi6n 
con ^1 habri un servicio de agua caliente con todo lo necesario para lavarse las manos 
(pileta o gran palangana, jab6n, cepillo y toallas o lienzos limpios). 

Art. 133. Se tratari por todos los medios posibles de que el establo est6 siempre 
libre de moscas. 

Puertas y ventanas estarin provistas de tela metdlica, a fin de impedir su entrada. 

Art. 134. Todo el establo estari construido, dispuesto y mantenido de tal mode 
que la limpieza y desinfeccidn sean ttciles. 

Los establos se hallarin siempre limpios, libres de tiena, polvo y telarafias. 

Si las paredes y cielo-raso son blanqueados con cal, el blanqueo se repetiri cada seis 
meees por lo menos, previo raspaje del antiguo. 

Los excrementos ser&n retirados tan frecuentemente como sea necesario para evitar 
en lo posible la produccl6n de males olores y que las vacas se ensucien. Por lo menos 
serin sacados dos voces pw dfa. 

Diariamente se haii una limpieza completa del establo. 

Los pilones o recipientes donde se sirven los alimentos a los animales se limpiarin 
despu^ de cada comida. 

Cada cinco dfas por lo menos, el piso de todo el establo, comprendidos los lugares 
donde se hallan las vacas y las canaletas de deyecciones, las paredes hasta la altura de 
2 metres y todo lo que est^ dentro de la misma altura, serin lavados a fondo, a cepillo 
y con abundante agua. 

En los establos no habri deshechos, basuras, ni nada que no sea necesario para su 
buen mantenimiento o para el cuidado de los animales. 

Art. 135. Si el establo es de madera en sus partes superiores, sobre ^1 no habri de- 
p6sitos de forrajes, ni instalaciones de ninguna especie. 

Ninguna parte del establo seri usada como habitaci6n de personas para dormir, ni 
para ningtin otro fin dom^ico. 

El establo tampoco se hallari en comunicacidn con habitaciones ni piezas de fines 
dom^sticos, ni con caballerizas u otras habitaciones de animales. 

Art. 136. Los excrementos de los animales serin depositados a distancia de cien 
metres por lo menos del establo, en direcci6n contraria a los vientos predominantes 
y en condidones de impedir en lo posible el desarrollo y acumulacidn de las moscas 
y la producci6n de males olores. 

Art. 137. El terrene que rodea el establo eetari nivelado de tal mode que no se 
acimiulen en ^1 aguas superficiales y seri mantenido limpio, seco y libre de residues, 
basuras, trastos viejos o cualesquiwa otros inconvenientes. 



PUBLIC HEALTH AND MBDIOINB. 155 

Delante de las puertas habrd un vered6n de cuatro metroe de fondo y dos metros 
mia ancho que la paerta correspondiente, por lo menoe, conBtruMo de material 861ido» 
liBo e impenneable. 

En un radio de cien metros del establo no habr& aguas estancadas, pantanos, ba- 
rriales, sumideros o depMtos de eeti^rcol, ni porquerizas. 

Art. 138. No habrd letrinas a distancia menor de veinte metros del establo. 

Todas las letrinas del establecimiento ser^n cerradas, de material, con revestimi- 
ento interior impermeable hasta dos metros de altura, prot^das contra el acceso 
de las moscas, con los asientos provistos de tapa y con servicio de agua corriente» 
Siempre estardn limpias, en condiciones higi^nicas. 

4. LIMPIEZA DE LAS VACAS PRODVCTOBA8 DK LECHE DS PRIMSBA CAUDAD CSRTIFICADA. 

Art. 139. Todo el establecimiento productor de leche de primera calidad certifi* 
cada estard dispuesto y mantenido de tal modo que las vacas se expongan lo menoe 
posible a ensuciarse. 

Art. 140. Cuando se use cama para los animales, ellas serim de paja de cereales o de 
paste, Umpios, sin tierra o polvo, ni mohos, ni mal olor. Se prohibe utilizar con tales 
fines paja u otras materias usadas en camas de personas o en embalajes o en cosaa 
anilogas. 

Art. 141. Las vacas estardn siempre limpias, sin caspa, ni barro, ni esti^rcol pega- 
doe a su piel. Se les podrd pasar la mano por encima sin ensuci^rsela. 

£1 pelo de los ijares, del vientre alrededor de la ubre, de la ubre, del muslo y parte 
superior de la piema y el de la cola ser^ mantenidos cortos. 

Las vacas ser&n completa y prolijamente limpiadas a cepillo una vez al dia. Las 
partes sucias de esti^rcol, barro, etc., que no puedan ser limpiadas a seco, se lavarto 
con agua y jab6n. 

Art. 142. Para la limpieza a seco y lavado de las vacas mantenidas continuamente 
a campo se tendrd un tinglado especial, con piso impermeable, drenaje adecuado y 
provision de agua corriente. 

En cuanto al emplazamiento de ese tinglado y su orientaci6n y 8ituaci6n reepecto 
de otroe lugares, instalacionee o locales, su mantenimiento, limpieza y usos, deberin 
satififacerse las condiciones de un establo, en la medida que le sean aplicablee. Estari 
ubicado y dis puesto de tal modo que el viento no pueda llevar hada otro^ locales 
(lecherla, etc.) los pelos y el polvo que se desprendan de los animales al limpiarlos. 
Podrd estar pr6ximo al local de ordefto, pero no en directa comunicaci6n con ^1. 

Cuando se tengan las vacas en establos, su limpieza podrd hacerse en ellos; pero 
se considerard en mejoree condiciones higi^nicas el establecimiento que, teniendo 
establo, disponga tambi^n de un local especial para ese objeto, anexo a aqu61. 

5. ORDEl^O DE LA LECHE DE PRIMERA CALIDAD CSRTIFICADA. 

Art. 143. Esta operaci6n se efectuard con el miximum de limpieza que sea dado 
y de manera que la leche se contamine lo menos posible con microbios del exterior- 

Art. 144. Se hard en el establo o en un local especialmente destinado a ese objeto 
Este tUtimo existird siempre en el establecimiento y en 61 deberi efectuarse siempre 
el ordefio, si las vacas son continuamente mantenidas a campo (si no hay establo). 

El local de ordefio serd muy abundantemente ventilado, seco y con mucha luz. En 
cuanto a emplazamiento, estado y mantenimiento del terrene circundante, ubicaci6n 
respecto de otras instalacionee, orientacidn, naturaleza del piso, paredes y cielo-raso, 
temperatura interior, servicio de agua, drenaje, conservaci6n, limpieza, defensa con- 
tra las mocas, usos, etc., deberd llenar las condiciones indicadas para el establo, en la 
medida que le sean aplicables, con la salvedad de que la ventilaci6n y la luz tendrdn 
que ser por lo menos el triple que las del establo. Sus dimensiones estarin en rela- 
ci6n con el n(imero de vacas que se ordefien a la vez y serdn tales que permitan la ope- 



156 PBOGEEDINGS SECOND PAK AMEBIOAN SCIEKTIFIO G0NGBES8. 

raci6n del ordefio con holgura. En 61 habr& un servicio para lavaree las manoe como 
el indicado en el artfculo 132. 

£l Ber& ocupado por las vacas (inicamente en el momento en que van a ser orde- 
fiadas. En seguida serd limpiado a fondo. 

Habiendo buen tiempo, bub puertaa, ventanaa y ventiladores eetar&n aiempre 
abiertos durante el dia. 

En 61 no deberd hacerse la limpieza general de los animales. 

Art. 145. Eb indispensable que las vacas pennanezcan tranquilas durante el ordeilo. 
A este efecto tendrdn que ser animales perfectamente mansos y babituadoe a la opera- 
ci6n y se evitard durante ella todo lo que pueda excitarloe. 

Art. 146.- Las vacas que en el momento del ordefio se ballen mojadas, por haber 
estado expuestas a la lluvia o por otras causas, serdn perfectamente cscurridas antes 
de comenzar la operaci6n, de tal modo que de su piel no pueda desprenderse ninguna 
gota Ifquida. Esa preparaci6n del animal se hard en el local de limpieza (articulo 
142) 0, si 68te no existe, en el establo. 

Art. 147. Antes del ordefio se evitard todo lo que pueda ocasionar levantamiento 
de polvo y desprendimiento de malos olores. 

Las limpiezas generales del establo, la distribuci6n de las comidas o forrajes y ^ 
cambio y removido de las camas se efectuardn inmediatamente deepu^ de terminar 
un ordefto. 

La remoci6n de excrementos, las limpiezas pardales de las canaletas de los mismos, 
etc., no se hardn tampoco durante la bora que precede a aquella operaci6n. 

La limpieza general de las vacas, cuando se haga dentro del establo, serd efectoada 
tambi^n en seguida de terminar un ordefio. 

Si se trata de animi^es continuamente mantenidos a campo, su limpieza general se 
hard inmediatamente antes de comenzar un ordefio, evitando en lo posible los lavados 
extensos de las partes superiores y posterioree del cuerpo, que se dejardn para despu^s 
de^l. 

En todos los cases, cuando sea de eetricta necesidad lavar esas partes antes del 
ordefio, deberdn escurrirse bien las regiones mojadas de manera que mientras ae 
efecttia el mismo no puedan desprenderse gotas de Hquido capaces de llegar a las 
manos del ordefiador, la ubre, las tetas o el redpiente donde se recoge la leche. En 
una pal^bra, no se ordefiard ninguna vaca cuya piel est^ tan mojada que de ella pue- 
dan caer gotas de Hquido. 

Antes de comenzar a ordefiar en el establo, se abrirdn puertas y ventanas, a fin de 
que el aire se renueve y se evactien los males olores. 

Art. 148. Las vacas serdn inmovilizadas durante el ordefio. Sus colas estardn 
sujetas. 

Art. 149. Inmediatamente antes de ordefiar cada vaca, se le limpiard la ubre, 
las tetas y las partes limftrofes. 

Esta limpieza se hard, sea sacando por lo pronto las grueeas porciones de suciedad, 
lavando despu^ con agua tibia (a temperatura mds o menos igual a la del cuerpo del 
animal) y, finalmente, frotando y secando bien con un lienzo o toalla; sea frotando pri- 
mero con un pafio seco o Ugeramente hdmedo y en seguida con otro, seco o apenas 
engrasado. Los trapes, lienzos o toallas serdn blancos, de tela suave, lavables y limpios, 
debiendo a este dltimo efecto haber una buena provisidn, para que puedan cambiarse 
a menudo. La materia grasa que se use serd pura y en buen estado de conservacida 
(no rancia), incapaz de irritar la piel. 

Serd preferible que de esa limpieza se encargue espedalmente una persona, para 
que el ordefiador pueda operar inmediatamente con sus manos limpias. 

En case de volver a ensuciaise durante el ordefio las partes indicadas, antes de prose- 
guir habrd que limpiarlas otra vez. 

Art. 150. El ordefiador Uevard durante el ordefio sobre-pantalones, blusa laiga o 
delantal de mangas cortas, bien cerrados, y gorro que contenga y recubra los cabeUos, 



PUBLIO HEALTH AND MEDIOIKB. 157 

feodo de tela bl«nca y lavable y en perfecto estado de limpieza. 8erd preferible que 
en lugar de biiisa y sobre-pantalones separados use una combinaci6n de una sola piessa 
que comprende las dos cosas y especial para esos fines. 

Para cada ordefiador habri siempre diflpomble, ademils del que lleven puesto, tres 
juegos de la ropa susodlcha, perfectamente limpios. 

Art. 151. El ordeiLador cumplird su tarea con las manos y antebrazos descubiertoe 
y perfectamente limpios. 

Antes de qpipezar a ordefiar se lavard manos y antebrazos con agua tibia, jab6n y 
eepillo, operaci6n que repetiri antes de ordeilar cada vaca, y a(in durante el ordefio 
de cada una, si se le ensucian entonces. 

Art. 152. El banquillo del ordefiadcM* ser& de fidl limpieza y estard limpio siempre. 

El ordefiador lo llevari sujeto a su cuerpo, a fin de no tener que tocarlo con sub manos 
durante el ordefio. 

Abt. 153. Durante el ordefio, el operador evitari tocar con las manos el cuerpo de 
la vaca, salvo sus tetas ya lunpias, a fin de no ensucitoelas o contaminirselas. Tnk 
tar6 de mantener el animal en posicidn conveniente sin tocarlo con las manos. 

Art. 154. £1 ordefio se hard a seco (tetas y ubre de la vaca y manos del operador 
eecas durante toda la operaci6n). 

Se prohibe ezpresamente ponerse saliva en las manos, o mojteelas o mojar las tetaa 
oon la misma leche de la vaca. Quien haga esto incurrird en multa de den pesos, sin 
perjuicio de exigir, si se estima conveniente, que sea eliminado del personal del esta- 
blecimiento. 

Abt. 155. Los tres primeros chorros de leche de cada teta ser&n recogidos aparte y 
no s^in utilizados en ninguna forma para el consume de las peraonas. 

Art. 156. Los recipientes en que se ordefie la leche eetar&n perfectamente limpios 
y esterilizadoe a seco. 

Su boca no tendr& nunca mis de veinte centfmetros de diimetro. Se preferirin loe 
recipientes con embudo y filtro de algod6n o con tapa y muy pequefia abertura para 
la entrada de la leche. 

Abt. 157. La leche que se haya ensuciado con esti^rcol o en otra forma cualquiera 
no se mezclar& con la leche limpia ni se contar& como leche de primera calidad ceiv 
tificada. 

Abt. 158. En seguida de ordefiada la leche se echari en un recipiente colector, a 
tiav^ de un filtro que le serviri de tapa. 

La leche se retirar& prontamente dd establo, para evitar en lo posible que se con- 
famine y que tome el olor de los animales o del esti^rcol. A estos fines, serd preferible 
lener el redpiente colector fuera dd establo, en un lugar limpio y protegido del polvo 
y de las moscas. 

Del establo, o del lugar donde se halle d recipiente colector, la leche ser& pasada 
inmediata y directamente a la lecherfa. A ^sta no deberin entrar los ordefiadores 
que traigan la leche. 

Sn todo el transcurso desde el ordefio hasta su llegada a la lecherfa, el producto seri 
protegido contra las causas de contaminad6n. 

6. LSCHXmtA T rREFARACl6N DE LA LSCHX DK PBIMKBA CALIDAD CEBTlftCADA. 

Art. 159. En todo cstablecimiento productor de leche de primera calidad certifi- 
cada habri una lecherfa, o sea un local a propMto, donde se manipule y prepare la 
leche para la venta. Ella conssBtiii por lo menos en dos piezas construidas totalmente 
de material (obra de Mbrica), una destinada a la limpieza y esterilizad6n de envases, 
redpientes, Utiles, etc., y la otra a la mezda, filtrado, enfriamiento, conservaddn y 
envase de la leche. 

Art. 160. La lecherfa estari pr6xima al establo, pero no en comunicaddn con d. 

En cuanto a su emplazamiento, orientaci6n, ubicaci6n re8i)ecto de otras instala* 
denes, locales o lugares y estado y mantenimiento del terrene drcundante, habrd que 
Uenar las condidones indicadas para d establo, en lo que le sean aplicables. 



158 PBOGEEDINGS 8E00ND PAN AMEBIGAN SOIBNTIFIC C0KGBB88. 

Ser6 amplia, bien ventilada, soca, fresca, con abundante luz natiml, de ttdl 
limpiesa y desinfeccidn y completamente coimtniida de mamposterfo. Todo sa 
interior estari recubierto de revestiniiento de material (obra de ttbrica), liso, 
impermeable^ bianco y lavable. Los dnguloe de las paredes entie sf y con ei piso y 
cielo-raso ser&n redondeados. Satisfoii, por lo dem^, todas las condiciones eetableddas 
en lo0 artfculos 63, 64 y 65, en cuanto le sean aplicables. 

No se hallMrd en comunicaci6n directa jon habitadones de personas. 

Oada 8ubdiyiBi6n de la misma estari provista del equipo y Mementos n^cesanos pant 
lo8 fines a que se destina. 

En ella no se introdudii ni manipular& otra leche m&B que la de {Hrimera caHdad 
certificada, ni se introduciid ni tendri nada que no sea necesario para tiatar esta 
leche. 

Abt. 161. En seg:uida de venir la leche del establo, se mezclard, se filtraii nueva- 
mente, se enlriaiA a dies grades o menos y se envasari en lia botellas en que seriL 
entregada al coneunudor, que ser&n inmediatamente cerradas y selladas en la fonna 
en que debe redbirlas. 

Deede entonces, la leche serd mantenida continuamente a diez grades de temperatnra 
o menos. 

Art. 162. No de mezclar& la leche de distintos ordefios, aunque ^toe sean del 
mismo dia, debiendo venderse aparte la de cada uno. 

Art. 163. La leche envasada y lista para la venta ser^ tratada en forma que loe 
envases no se ensucien exteriormente. Las botellas o redpientes estar^n perfecta- 
mente limpios al entregarlos al consumidor. 

Art. 164. Todos loe recipientes usados en el ordefio, recolecci6n, filtraci<5n, mezda, 
enfiiamiento, medida y envase de la leche, aef como los filtros, serdn de chapa de 
hierro o acero sin costura y estafiados en capa gruesa. Los refrigeradores, m^quinas 
de envasar, etc., ser^ del mismo material en las partes que entren en contacto 
con la leche. 

Recipientes y todos los Utiles y maquinaria serin de fidl limpieza y deBiniecci6n 
y se hallaiin siempre en buen estado de conservaci6n. Se consideiari que no lo 
estin, cuando por sus condiciones la limpieza y desinfecddn no puedan hacerse 
{4cilmente. 

Art. 165. Los redpientes, utensilios y mdquinas de que se trata en el precedente 
artfculo serdn mantenidos siempre en perfecto estado de limpieza. 

En seguida de usarios ser&n limpiados en la forma indicada en el articulo 26. 

Los filtros, tolas, pafios, toallas, etc., usados en el ordefio y para el secado de titiles 
y redpientes que se hallen en contacto con la leche, despu^ de bien lavados y some- 
tidos a la ebullid6n, serdn esterilizados a seco a 120° de temperatura por lo menos. 

Despu^ de lavados y limpios, los dtiles y redpientes hasta de sesenta litres de 
capaddad que outran en contacto con la leche, ser&n esterilizados de igual manera. 

Todos los dtUes, mitquinas y redpientes de mayor tamafio, despu^ de limpiados 
en la forma ya indicada, ser&n esterilizados con agua hirviente o a chorro de va^ 
bajo presi6n y despu^ secados con trapes esterilizados. 

Todo lo mencionado en el presente artfculo, despu^ de esterilizado, seri resguardado 
de contaminadones hasta el memento de usarlo nuevamente. 

Art. 166. Durante el trabajo, las personas ocupadas en la lecheria vestirin panta- 
lones sobre-pantalones, saco cerrado y largo o delantal y gorro, todo bianco, lavable 
y limpio. Oada persona deberi estar provista por lo menos de tres mudas de esa ropa. 

Mientras est^n ocupadas, esas personas tendrin sus manos y antebrazoe descubiertos 
y perfectamente limpios. 

7. ABBO T SSTADO SANTTABIO DE LAS PSB80NAB QUI UlTZ *V IJOI|l tJ I BN LA PBODVOaON DB LBCHB DB 

rSniBBA CALIDAD CBBTIflCADA. 

Art. 167. Esas personas serdn aseadas y observardn en todo la mayor limpieza 
posible. 



PUBUO HEALTH AND MBDIOIKB. 159 

La adiiiinuitraci6n samtaiia podii exigir que las que no BatiBfagan estas condicioneB 
eean excluidas del establecimiento. 

Art. 168. Eetaiin libies de enfermedadee contagioeas que puedan transmitine 
por la leche y de las que se mencionan en ek artfculo 99. 

Antes de entarar a fwrnar parte del personal del establecimiento, tendr&n que pro- 
veerse de un certificado de reviBaci6n m^ca expedido por la administracidn sanitaria. 
Ese certificado se renovar& cada seis meses. 

La inobse^^acia de estas disposiciones ser6 penada con multa de cien pesos, sin 
peijuicio de prohibirse la introducddn y venta de la leche en la ciudad mientxas 
ella no sea cumplida. 

Art. 169. No estaiin en contacto con otras personas afectadas de enfermedades 
contagiosas de las indicadas en el articulo precedente. 

Los que lo lia3ran estado no deber&n intervenir en las faenas que les conrespondan, 
hasta despu^ de ser autorizadas por la administraci^n sanitaria. 

La infiacci6n de este articulo dar& lugar a las medidas indicadas en el articulo 
precedente. 

Art. 170. El propietario est& obligado a avisar a la admmistraci6n sanitaria de 
todo case de enfermedad que se produzca en su establecimiento o entre las personas 
del mismo, acompafiando un certificado m^co en que conste la enfermedad de 
que se trata, si el enlermo no puede presentarse a ella para ser examinado. 

La inobservanda de esta di8po8ici6n S6r6 penada con multa de doscientoe pesos, 
si la enfermedad no es contagiosa, y con la prohibici45n definitiva de introdudr y 
vender la lecde en la Capital, en case de tratarse de alguna de las enlennedades con- 
tagiosas indicadas en ek articulo 168. 

S. TlQILAirCIA 8AHRABIA DE LOS S8TABL1CIMIENT08 PBODVCTOaSS DE LBCHX DB nUMXBA CAUDAD 

CBBnnCADA T BSTllCULOB PAKA LOS IflSMOS. 

Art. 171. Un veterinaiio inspects inspeccionarA dichos establecimientos por lo 
menos una vez por mes. 

La administraci(Sn sanitaria podxi disponer que tales inspecdones se repitan cuantas 
voces lo estime conveniente o necesario. 

El veterinario, ademis de los animales, inspeccionaWl el campo, los edificlos e 
instaladones, los forrajes, las aguas, las miquinas, envases y, en general, todo lo que 
haya que tener en cuenta en la producci6n de leche higi^nica, y vigilari asimismo 
el aseo y estado sanitario de las personas y los procedimientos usados en esa pro4ucci6n. 

Podrd recoger muestras de aguas, leche, forrajes, etc., cuantes veces lo estime 
necesario o conveniente. 

Los gastos de viaje, hospedaje y comida del veterinario en las inspecdones ser&n 
coeteados por los propietarios de los establecimientos. En case de negativa a abonar 
estos gastos en la forma y plazos que fije la administracidn sanitaria, ^sta podii prohibir 
la introducci6n y venta de la leche en la Capital. 

Art. 172. A los establecimientos que no llenen las condiciones prescritas en esta 
ordenanza en cuanto a instalaciones e implementos no se les permitiri introducir 
ni vender en la Capital leche de primera csdidad certificada. 

En cuanto a su estado y funcionamiento, el inspector ela8ificar& por un sistema de 
puntos que fiijard la admLaistraci6n sanitaria, y por separado, todos y cada uno de los 
elementos que deben tenerse en conaideraci6n al producir leche higi6nica. Esa 
clasificaci6n se hard en cada visita o inspecci6n del establecimiento y de ella se entregard 
siempre una copia al interesado. 

Se consideraii en condiciones deficientes el establecimiento cuyos puntos parciales 
no sumen en total el 85 por clento por lo menos del total mdximo fijado por la admi- 
nistraci6n sanitaria. 

Laclasificaci6n de defidente serd seguidade un aviso al interesado, para que trate de 
salvar las imperfecciones existentes. Un mes despu^ de la primera cla8ificaci6n de 



160 PROCEEDINGS SECOND PAN AMEBICAN SCIENTTPIO C0NQBE8S. 

deficiente se procederd a una nueva inspecci6n y clasificacidn, y, si el resultado de 
^9ta 68 el mismo, no se pennitird la introduccidn y venta de la leche respectiva en el 
mnnicipio. 

A los estableclmientos cuya claaificacl6n total no pase del 75 por ciento se les i»t>- 
hibird InmediatameDte esa introducci6n y venta. 

Art. 173. Los interesados podrdn poner en las etiquetas de los en vases, en loo 
lugares de venta, en los avisos en que ofrezcan su producto, etc., las claslficaciones 
obtenidas por stis estableclmientos, asf como las proporciones de gordura y de microbios 
de la leche que venden. Pero siempre que lo hagan, serdn las dltimas clasificaciones 
obtenidas a esos respectos de la administraci6n sanitaria las que deberdn bacer coostar. 

La adnilnistraci6n sanitaria podrd publlcar las clasificaciones obtenidas por loo 
estableclmientos y sus productos, a fin de que el pdblico sepa cuilee son los 
mejores. 

Aniudmente la administracidn sanitaria discernird un premio, consistente en mil 
pesos m. n. y un diploma, al establecimiento que haya conseguldo mds altas claslfica- 
clones eii cl afto y cuya leche durante el mismo plazo haya sido de mejor calidad. 
Para estr* se tomard en consideracidn las duce planillas de clasificaci6n mds alta de 
cada establecimiento y el resultado de los exdmenes de por lo menos doce muestraa 
de leche de cada uno, tomadas mds o menos al mismo tiempo en todos ellos. No se 
tendrdn en cuenta las planillas de claalficacidn correspondientes a inspecciones pedidas 
por los interesados ni los exdmenes de leche solicitados por ellos. Se considerard 
leche de mejor calidad la que supere en mayor grade las condiciones establecldas 
en el artfculo 2. Este premio no empezard a discemirse hasta despu^ de pasado un 
afio de existir por lo menos dos estableclmientos productores de leche de primera 
calidad certificada. 

Art. 174. Las condiciones enimciadas en este capftulo en cuanto a los establecl- 
mientos implementos y procedimientos de lecherla son las mini mas que deben cum- 
pllrse. Pero los interesados podrdu apartarse de ellas, siempre que sea para mejorarlaa 
superarlas del pimto de vista higi^nico, sin afectar los procedimientos de contralor 
sanitario, y previa aprobaci6n de la administraci6n sanitaria, quien decidird sin apela- 

ci6n sobre el cardcter de los cambios o innovaciones propuestos. 

CAPfnTLO X. TAMBOS URBAN08. 

Art. 175. Los tambos que se establezcan en la capital despu^s del dfa de promul- 
gaci6n de la presente ordenanza estardn constituidoa cuando menos, por el establo, 
el local de manipulacionee, un local de despacho que satisfaga las condiciones espe* 
cificadas en el Capftulo VI, el dep6sito de forrajes y un "paddock" para el ejercicio 
de las vacas y estardn provistos de un dep6sito adecuado para el esti^rcol. 

Art. 176. El establo serd todo de mamposterfa y hierro. No x>odrd haber en H 
otras obras de madera mds que las puertas y ventanas. 

Estard provisto de cielo-raso de acero esmaltado o de mamposterfa, liso y de color 
daro. £n sus partes mds bajas, ^ste se hallard a una altura de 5 metroe sobre el piso 
por lo menos. 

En todo lo demds (construcci6n, disposicidn y naturaleza materialee del edificio 
y de sus instalaciones interiores, ventilaci6n, humedad, temperatura, mantenimiento, 
limpieza, servicio de agua, etc.) habrd que satisfacer en cuanto a este establo las con- 
diciones enundadas en los artfculos 122 a 137. 

Art. 177. El local de manipulaciones o lecherfa podrd estar en comumcaci6n con 
e) puesto de venta por intermedio de una puerta que se abrird s61o para pasar y provista 
de mecanismo de cierre automdtico, pero no deberd estarlo con el establo, ni con habita- 
ciones, ni con el dep6sito de forrajes. En todo lo demds, la lecherfa responderd a 
las condiciones enunciadas en los artfculos 159 a 166 y en los en ellos mencionadoe. 

Art. 178. El dep^sito de forrajes serd todo de mamposterfa, interior y exteriormente 
revocado y de acuerdo en todo lo demds con lo estableddo en el artfculo 119. 



PUBLIO HEALTH AND MEDICINE. 161 

Abt. 179. El "paddock" o corral de ejerdcio de las vacas seri al aire libre, tendr& 
por lo menos 10 metros de di^etro en cualquier sentido, estard provisto de piso blando 
y con drenaje y rodeado de cerco de superfide lisa y redondeada, todo de f&cil limpieza. 

8us partes de madera eetar&n pintadas de bianco. £1 blanqueo se renovard toda 
vez que se halle en mal estado. Si es con cal, se repetiri por lo menos cada seis meses. 

Art. 180. El dep6sito de esti^rcol serd de mamposterla, recubierto interior y 
exteriormente de espesa capa de cemento impermeable o de material an&logo y 
tendr& tapa metdlica, cano de ventilaci6n y buen drenaje. 

Art. 181. Todo el terrene libre de edificios que ocupe el tambo, ezceptuado el 
'' paddock, '^ estard recubierto de piso s61ido, impermeablOi bien drenado y liso, esto 
tiltimo hasta donde lo permita la estabilidad de la marcha de los animalee. 

Art. 182. A distanda de quince metros del establo y de la lecherfa no habri ester- 
coleros, letrinas, depiSsitos de residues, gallineros, caballerizas, etc., ni nada que d^ 
males olores o atraiga moscas en abundancia. 

Art. 183. Las vacas permanecer&n sueltas en el "paddock '* de ejercicio por lo menos 
tres horas diarias, salvo que el mal tiempo no lo permita. 

Art. 184. En cuanto al estado sanitario de las vacas, su alimentad6n y ordefio, 
aseo y estado sanitario de las personas, mantenimiento y limpieza del establecimiento 
y de los animales, manipulaciones de la leche y, en general, en cuanto a todo aquello 
para lo cual no se hayan fijado condiciones especiales en este capitulo, los tambos 
urbanos Uenar^ todas las estableddas al respecto para los establecimientos produc- 
tores de leche de primera calidad certificada, en lo que le sean aplicables. 

Art. 185. Los tambos que se abran al pdblico despu^ de la promulgacidn de la 
presente ordenanza se considerar&n como de primera categorla y deberdn Uevar en el 
irente el siguiente letrero, en grandes caracteres de molde: "Tambo de primera cate- 
gorla." 

S61o esos tambos podr&n llevar este letrero. 

Despu^s de dos meses de abierto el primero de esos tambos, todos los otros, estableci- 
dos antes de la promulgad6n de esta ordenanza, deber&n llevar en su frente, en el lugar 
m&a visible y en grandes caracteres de molde, el siguiente letrero: "Tambo de segunda 
categorla. " 

Art. 186. Todo tambo de los existentes antes de la promulgad6n de la presente 
ordenanza, que despu^ se reconstruya, amplle o cambie de duefio, serd considerado 
como establecimiento nuevo, y regir&n para €i las prescripciones de este capitulo, 
lelativas a los que se estabiezcan despu^ de dicha promulgaci6n. 

Art. 187. Los tambos modelos munidpales arreglar&n los precios de sus productoi 
en forma que no puedan competjr con los de los tambos de primera categorla. 

capItulo zi. vigilancia del comercio db lechb. 

Art. 188. La aplicad6n de esta ordenanza y, en general, todo lo relative a la vigi* 
lancia sanitaria del comerdo de leche y de sus derivados, estard a caigo de la Oficina 
Contralor de la Leche de la Administrad6n Sanitaria. 

Art. 189. Los productores o tamberos que envlan leche de primera calidad a la 
capital permitirdn que los empleados de la susodicha oficina recojan muestras de 
leche en el mismo tambo rural, en las estaciones ferroviarias de embarque o en cual- 
quier otra parte, fuera y dentro del municipio, asl como de las aguas usadas en sus 
establecimientos, y prestardn a esos empleados toda su cooperaci6n, a fin de que la 
recolecci6n pueda hacerse en la forma y con las garantlas necesarias para deecartar 
cualquier error o fraude y sin molestias personales injustificadas. Let falta de co- 
operaci6n en este sentido serd considerada como una negativa a permitir la recolec- 
ci6n de las muestras. 

Iguales obligaciones tienen las empresas, establecimientos o personas que envfen 
leche de primera calidad a la capital, procedente de distintos tambos o establed- 
mlentos productores, corriendo por cuenta de ellos el asegurarse de que estos 61timofl 



162 PB00EEDING8 SECOND PAK AMBBICAK 80IBKTIFI0 OONGBESS. 

cumplan la obligacidn de permitir la recolecci6n de las muestraa en sub tambos o en 
el trayecto de ^stos a la faictorfa o lugar de recibo de la leche por dichas empresas. 

Loe inspectores municipales podr&n presentane sin previo aviso a tomar las mues- 
tras, de modo que los interesados debc^in disponer lo necesario a fin de que atin en 
flu ausencia ellos puedan cumpllr su misi6n. 

Abt. 190. Los gastos de fenocarril, coche, hoqpedaje y comida que tengan que 
hacer los empleados encaigados de recoger las muestras indicadas en el articulo 
precedente ser&n abonados por los tamberos o producU»es, si ^stos envian diiecta- 
mente o por su cuenta la leche a la capital, o por las otras empresas o personas mencio- 
nadas en el mismo articulo, en case de ser ^stas las que remitan la leche. 

En ningtin case, los tamberos o productores tendr4n que abonar por tales conceptos 
m&B de 250 pesos anuales, si sus eetabledmientos se hallan a 100 kil<knetros o menoe 
de la capital, o m&B de 350 pesos, si ^stos se hallan a m&B de 100 ldl6metros de la ca- 
pital, ni las empresas o las personas que envien leche de varies productores tendrin 
que abonar anualmente m&s de esas sumas multiplicadas por el ntunero de produc- 
tores de qulenes recojan la leche. £1 exceso 8er& costeado por la municipalidad. 

Esos gastos ser&n abonados despu^ de cada intervenci6n o viaje de loe empleados 
municipales, en la forma y plazos que fije la admim8tiaci6n sanitaria. 

La adminiBtraci6n sanitaria dispondhl que se recojan muestras de leche fuera del 
municipio s61o cuando sea estrictamente necesario para efectuar an^Uisis compani- 
tivos con muestras de las mismas leches tomadas antes o despu^ en la capital y tn^ 
tar& de que los gastos que deban costear los producU»es o remitentes se reduzcan at 
minimum posible. Las muestras de agua se tomar&n con ocasi6n de la recolecci6n 
de las de leche. 

Las in&acciones de este articulo o del precedente ser&n seguidas de la prohibici6n 
de introducir leche a la capital, so pena de decomisarla a su arribo, a menos que loe 
interesados abonen una multa de 100 a 500 pesos, segdn la gravedad del caso. A la 
tercera infracci6n del articulo 189, se prohibiri definitivamente la introducci6n y 
venta en el municipio de leche de primera calidad procedente del establecimiento 
respective. 

Art. 191. Los propietarioe de lecherfas o bus representantes permitir6n en cual- 
quier memento la inspeccidn de sus establecimientos por los empleados de la ad- 
cniniBtraci6n sanitaria, que podrin inspeccionar todos los compartimientos o sec- 
ciones del establecimiento y todo lo que se halle dentro de los mismos, asf como re- 
visar los certificados mMicos del propietario y de todo el personal, y a quienes debe- 
Hn prestar la cooperaci6n necesaria para que puedan desempefiarse en la forma que 
m&B convenga para evitar errores o fraudes y sin sufrir molestias personales injusti- 
ficadas. La fadta de cooperaci6n en este sentido se considenu:i como una negativa 
a permitir la inspeccidn. 

Las mismas obligaciones, tiene toda persona que se dediqueal comerciode ledierfa 
o que venda leche, en cuanto al local de que se trata en el capitulo V, las empresas 
o firmas que se dediquen a la pasteurizaci6n o higienizaci6n de la leche o a cualquier 
otra operaci6n con ella o sus derivados, en cuanto a bus respectivos establecimientos , 
y los lecheros ambulantes, en lo que se refiere a bus vehiculoe en circulaci6n o en 
depdsito. 

Art. 192. Toda persona, empresa, sociedad o fiima que intervenga en cualquier 
forma en el comercio de leche dentro de la Capital, asi como bus empleadoB, permitiiin 
que en cualquier memento y en cualquier parte los empleados de la administraci6n 
sanitaria examinen la leche que reciban, tengan o lleven y tomen muestras de la 
misma y de tantos recipientes como lo consideren conveniente, sin exigir retribuci6n 
alguna, y les prestardn la cooperaci6n indicada en el articulo 189, cuya &dta serd 
considerada como una negativa. 

Las infracciones de este articulo y las del precedente tendr6n las mismas penas 
que las del articulo 8. £1 establecimiento serd clausurado en cada caso o no se per- 



PUBUO HEALTH AND MEDIOINE. 168 

mitM la circulaci6n del vehfculo, ri se trata de ^ete, haata que el intereeado deponga 
eu opodcidn o resistencia. 

Art. 193. La administracidn sanitaria podi& eetablecer servicioe de vigilancia per- 
manentee en laa usinas, f&bricas, etc., cuyos productos de lecherfa se introduzcan 
o vendan en el municipio para consumo. 

Eee servido serd coeteado por las empresas cuando sns usinas o f&bricas se hallen 
fnera del municipio. En eete case las empreaas estarto tambito obligadas a dar 
alojamiento conveniente a loe empleadoe de la admini8traci6n sanitaria. 

Cuando ^sta lo juzgue conveniente, segtin la importancia de loe establecimientos 
mencionadoe en este artf culo, podri exigir que se habilite en ellos un local para labo- 
ratorio, provisto de los elementoe necesarios para el an^isis qufmico y bacteriol6g;ico 
de la leche y sua derivados. 

Art. 194. Las mueetras de leche de que se trata en los artfculos 189 y 192 ser&n 
dobles y se lacrar&n y sellar&n en presencia de los interesados o sus representantes. 

Oada una llevar& una etiqueta con todos los datos necesarios para individualizarlas. 

Si el interesado lo pide, se le entregari una tercera mueetra igual a las dos primeras, 
envasada y preparada en iguales condicionee. 

En s^:uida se levantar& un acta por duplicado, en que consten todas las circuns- 
tancias y detalles necesarios para precisar el acto, y que serd firmada por el inspector 
y el intereeado. En case de negarse a firmar ^te tUtimo, se dejard constancia de 
ello en el acta y se hard firmar ^ta por un testigo. Una de las actas se entregar& al 
interesado. 

Una de las dos primeras mueetras eeri analizada lo mis r&pidamente posible en la 
ofidna contralor de la leche y la otra serd convenientemente conservada, para el 
caeo en que el interesado promueva un peritaje contradictorio. 

CAPfTULO Xn. PERMI808. 

Art. 195. Nadie podr6 vender leche en la capital sin previo penniso de la adminis- 
traci6n sanitaria, bajo pena de cien pesos de multa, dausura inmediata del estable- 
dmiento respective, detenddn de los carros de reparto que se hallen en circulaci6n 
y comiso de la leche consjgnada al responaable, o que ^te tenga o intente vender. 

Las personas que so propongan vender leche en la capital deber&n presentar una 
solidtud de penniso a la admini8trad6n sanitaria, en un formulario especial que 
^ta les proveer&, en que consten su nombre y apdlido, su edad, nacionalidad y 
domicilio, la ubicad6n de su establecimiento, el ntimero de litros de leche que venden 
diariamente, la calidad de la misma seglin las dispoeicionee de esta ordenanaa, su 
procedenda y las horas en que la redbe, y el nombre, apellido, nadonalidad y edad 
de cada una de las personas que tenga empleadas en su negodo, y en que se compro- 
meta a respetar y a cumplir las prescripdonee de la preeente ordenanaa en las partes 
que le atafien. Adem^, el intereeado acompafiari a su solidtud su cMula de identi- 
dad, expedida por la polida de la capital, y con un retrato, un retrato suyo de perfil, 
suelto y de 6 por 5 centimetroe y los certificados mMicos de la administrad6n sani- 
taria para 4\ y cada uno de sus empleados. 

El retrato suelto quedar& archivado en la administraddn sanitaria, juntamente 
oon loe datos realtivos al causante. 

La persona que adquiere un negodo cualquiera de lecherla est4 obligada a cumplir 
todas las disposiciones de eete artfculo, aun cuando el que se lo venda ya las haya 
cumplido. 

Desde que entre a regir la presente ordenanza, toda persona dedicada al comercio 
de lecherfa en el munidpio estari provista del penniso aqul indicado. 

Art. 196. Todo cambio de domicilio o de ubicad^ de lot establedmientoB aeri 
comunicado antidpadamente a la Adminiatraddn Sanitaria. 

Loe cambioe del personal onpleado en el negodo se comunicarim inmediatamente 
a la misma, dando los nombres y apellidos de loe onpleados saHentes y de los que 
entren a reemplazarlos y acompafiando los certificados m^cos de estos tdtimos. 

6843e— 17— VOL X 12 



164 PBOOEEDINGS SECOND PAN AMEBIOAN 60IENTIFI0 C0N0BE6S. 

Todas estas comunicadones se har^ por eecrito. 

Art. 197. No podri habilltarae o tisarae ningdn carro de reparto de leche dentro 
de la capital que no se halle aprobado y registrado en la adminiatracidn sanitaria, s 
cuyo efecto los interesados presentar^ con antlcipaci6n a la misma la solicitud 
correspondiente. 

No 86 aprobardn ni registrardn los carros mientras las peraonas o empresas por cuenta 
de quienes se hard el reparto no est^ provistas del permiso establecido en el articulo 
195. 

Si la administraci6n sanitaria lo estima conveniente, podrd esdgir que los cairos 
Ueven £ija en un lugar visible, en vez del ntimoro de registro pintado o a la vez que 
^ste, una chapa con dicho ntimero, que ella entregard a los interesados mediante^el 
pago de Bu costo y que tendr& el valor de un certificado de registro. 

Art. 198. Dentro del mtmicipio, nadie podrd ser repartidor ambulante de leche, 
por cuenta propia o por la de otros, sin previo permiso de la administraci6n sanitaria, 
bajo pena de 100 pesos de multa, comiso de la leche y detenci6n del carro por cuenta 
y rieego del interesado (art 91) hasta que la multa sea abonada y aqu61 se provea del 
permiso correspondiente. 

A tal efecto, toda persona que se proponga repartir leche a domicilio presentard anti- 
dpadamente una solicitud de permiso a la administracidn sanitaria, en el formulaiio 
que ^sta le proveerd, en que constar^ todos los datos que debe Uevar la libreta de 
que se trata en el artfculo 97 y en que ella se comprometeri a respetar y a cumplir las 
prescripciones de la presente ordenanza en las partes que le atafien. Adem^, acom- 
pafiar& a su solicitud una cMula de identidad como la indicada en el artfculo 195, 
dos retratos sueltos como los alll tambi^n indicados, uno para ser pegado en dicha 
libreta y otro para quedar archivado en la administraci6n sanitaria, y un certificado 
m^co extendido jKjr la ofidna respectiva de esta dltima. 

La adminlstraci6n sanitaria extender^ el permiso en la libreta mendonada. 

En cuanto entre a r^gir esta ordenanza, todos los lecheros o repartidores ambulantes, 
deber^ estar provistos del permiso aquf eetableddo. 

Arj. 199. Todo product(»r o lechero que se proponga introdudr o remitir leche al 
mnnidpio debe solidtar antidpadamente permiso a la administraddn sanitaria, en 
un formulaiio especial que Ma le proveeri. En su solidtud dari su nombre y apeUido 
o la firma comercial del negodo, su edad, nadonalidad, dcnnidlio, ubicad6n del tambo, 
tannine medio de vacas que ordefle diariamente, raza de las mismas, tdrmino medio 
de producci6n de leche por cabeza, horas a que ordefle las vacas, superfide de campo 
en hectdreas que ocui>a con su tambo, superfide al&d&ida o con otros f orrajes artifidales, 
superfide de campo con pastosnatuiales, dir&siel campoesde supropiedad o lo tiodeen 
aniendo, dando en este dltimo case el nombre del propietario, dedarard el nombre de la 
estaddn ferroviaria de embarque de la leche, las horas en que embaica en ellas el pro- 
ducto de cada ordefio, el nombre de la estaddn mds pr6xima a su tambo o por donde sea 
mds f dcil el acceso de personas a su establedmiento. Al mismo tiempo se comprometeri 
a respetar y a cumplir en las partes que le atafien las disposidones de la presente 
ordenanza. A su solidtud acompafiard una c6dula de identidad, con retrato, ezp^ 
dida por la policla del lugar donde tenga su tambo, en que deberd constar su pro* 
feei6n, y un retrato suelto de perfil y de 5 por 5 centfmetros por lo menos. Este 
retrato quedard archivado en la administrad^ sanitaria. El permiso que se expida 
al tambero Uevard el ndmero de su registro en la adminiBtrad6n sanituia. 

8i la leche que se ha de remitir a la capital es de primera calidad, tambi^ habri 
que acompafiar a la solidtud una o varias muestras de las aguas usadas en el estable- 
dmiento, recogidas y transportadas en la forma que indique la administraddn sani- 
taria, y una descripd6n del establedmiento y de los procedimientos aplicados en el 
mismo. 

Si se trata de leche de primera calidad certificada, ademds de todo lo indicado en 
los dos pfoafos precedentes y de los que deba exigir la administraddn sanitaria de 



PUBLIC HEALTH AND MEDICINE. 166 

acuerdo con lo establecido en el Capf tulo IX, deberd acompatiarBe un piano del estable- 
eimiento y de sua edificios e instalaciones. 

Los permisos de los establecimientoe que remitan leche de primera calldad certifi- 
cada o leche de primera calidad ser^ renovadoe anualmente. 

En cuanto entre a regir esta ordenanza, todos loe remitentes de leche a la capital 
deberdn eetar provistos del permiso aqni establecido. 

Art. 200. Las f&bricas, udnas, etc., de lecherfa no podr^ funcionar dentro del 
mnnicipio ni vender sus productos sin previo permiso de la administraci6n sanitaria, 
que solicitar&n anticipadamente de la misma, dando los siguientes datos: nombre de 
la firma o empresa, ubicaci6n del establecimiento, capaddad productiva del mismo 
y cantidad de leche con que empezard a funcionar, clase de productos que ha de 
preparar o con que ha de operar u operaciones a que ha de someter la leche y forma 
en que ha de vender sus productos (si por intermediaries o directamente al consumi- 
dor, etc.) y acompafLando una descripci6n del establecimiento y de las maquinarias 
y sistemas aplicados, ilustrada con pianos. 

Las que se hallen fuera de la capital tampoco podr&n introducir bus productos sin 
eee permiso previo. Estas deber^ presentar para conseguirlo una solicitud igual a 
las otras, pero que contendrd adem^ los siguientes datos: distanda del estableci- 
miento a la estaci6n de embarque de los productos, ntimero de tamberos o productores 
de quienes recibird la leche, efectivo total de vacas productoras de la misma y forma 
en que ha de transportar sus productos a la capital. 

Unas y otras, en su solicitud de permiso se comprometerdn a respetar y a cumpiir 
las disposidones de la presente ordenanza en las partes que les atafien. 

Al entrar en vigencia esta ordenanza, las fdbricas instaladaa dentro o fuera del 
municipio, que introduzcan o vendan bus productos en el mismo, deberdn estar 
provistas de nuevos permisos, de acuerdo con lo estableddo en este artfculo. 

AsT. 201. Para introducir o vender en el munidpio, para el consume, leches que 
hayan sufrido preparadones o transformadones especiales, tales como leches esteri- 
lizadas, matemizadas, kefir, koumis, yogurt, etc., deberd tenerse previamente un 
permiso especial de la administrad6n sanitaria. 

Abt. 202. Desde la promulgad6n de la presente ordenanza, antes de abrirse un 
tambo nuevo en la capital, o de proseguir fundonando, despu^ de reconstrufdo, 
ampliado o haber cambiado de duefio, alguno de los existentes, deberd solidtarse 
permiso de la administraci6n sanitaria, en un formulario especial y con los requisitoe 
indicados en el artfculo 195 y para los establedmientos productores de leche de 
primera calidad certificada, en cuanto sean aplicables al caso. 

Abt. 203. La administraci6n sanitaria podrd exigir ademis a toda persona, firma, 
empresa o compafifa cuyos productos de lecherfa se introduzcan o vendan para el 
oonsumo en el munidpio, o que intervenga en cualquier forma en el comercio de 
leche y sus derivados destinadoe al consume en el mismo, cuantos datos o requisites 
■ean necesarios para a8^;urar el cumplimiento de esta ordenanza, comprendida 
la presentaddn de tftulos de propiedad, contratos de sodedad o arrendamiento, 
redbos de alquiler, etc. 

AsT. 204. La adminiBtrad6n sanitaria podrd prohibir temporariamente la intro- 
ducd6n de leche al munidpio procedente de establedmientos o regiones donde 
exista alguna epidemia o epizootia que constituya ima amenaza para la salud de los 
consumidores del producto. 

AsT. 205. La Administrad6n sanitaria podrd seflalar o fijar los lugares por donde 
deber&n ser introduddos la leche y sus derivados destinados al consume en la capital. 

Abt. 206, incise 1. No se otorgard ningtin permiso sin cerciorarse primero de si el 
eolidtante tiene en las condidones establecidas en esta ordenanza todos los elementos 
necesarios para el comerdo o trabajo a que se va a dedicar. 

Indso 2. La ledie que llegue sJ mimidpio de establedmientos o remitentes sin 
pefiniso o a los cuales se les haya retirado 6Bte temporaria o definitivamente, caer& 
en comiso, en cualquier parte donde se encuentre. " 



166 PROCEEDINGS SECOND PAN AMERICAN SOIENTIPIO CONGRESS. 

Inciso 3. La repetici6n de las infraccionee o faltas bo coii8iderar& siempre como 
circunstancia agravante. 

Inciso 4. A los que se nieguen abiertamente a dar cumplimiento a cualquiera de lae 
dispodciones de la presente ordenanza, se les retiiar&n los permisoe correepondientee 
y se les clausurar&n los establedmientoe, si se hallan dentro del municipio. 

CAPfTULO Xra. IN8TRU0CIONB8, CONSULTAS Y ANXlISIS GRATXTITOS. 

Art. 207. La admini8traci6n sanitaria preparar&, hard imprimir y di8tribuir& gra- 
tuitamente a los interesados instrucciones sobre la manera de produdr leche higi6- 
nica y de tratarla hasta el momento de ser consumida, atenderi en la misma forma 
cualquier consulta que se le formule respecto de esas cuestiones y asesorard sobre el 
terreno a quienes lo soliciten y abonen todos los gastos del t6cnico que a ese efecto se 
comisione. 

Analizari tambi6n gratuitamente toda muestra de leche que se le envfe, asf como 
de las aguas empleadas en la alimentaci6n de los animales de lecheria o en la limpieza 
de recipientes y utensilios usados en la misma industaia, siempre que ellas sean toma- 
das y remitidas en las condiciones que ella indique, a cuyo efecto los interesados 
deber&n dirigirse primero a ella, por escrito o verbalmente, pidiendo instrucciones. 

Todos estos servicioe ser&n prestados a las personas del gremio de lecheria que 
tengan sus establecimientos en la capital, a las que los tengan fuera de la misma 
y dentro del radio de aprovisionamiento de la ciudad y, en general, a todas aquellas 
que puedan contarse entre bus posibles proveedores. 

Art. 208. A las personas que por cualquier motive no puedan hacerlo por s( mismas 
y que lo soliciten, se les redactardn en la Ofidna de Contralor de la leche los docu- 
mentos eecritos que deban presentar al dirigirse a ella en cualquier sentido. 

CAPItULO XIV. DI8P08ICI0NB8 TRAN8ITORIA8. 

Art. 209. Las partes de esta ordenanza relativas a la leche de primera calidad 
certificada, a la leche de primera calidad y a los tambos urbanos entrar&n a regir 
desde la fecha de su promulgaci6n. Todo lo dem^ a los dos afioi de la fecha de su 
promulgaci6n. 

Art. 210. £1 D. E. reglamentard la presente ordenanza. 

Art. 211. Der6ganse todas las disposiciones que se opongan a la misma. 

The Chairman. These papers really constitute what might be 
called a symposium, and may be discussed as such at this time. 
I will therefore ask if any one here desires to make any remarks 
in regard to the papers that have been read. 

Dr. Sedgwick. Mr. Chairman, there are one or two small points in 
the way of addition that it seems to me might be made. In the first 
place, it has not been pointed out that by changing values we can 
add materially to some of our food supplies. It has lately been 
noted in the newspapers that in New York horseflesh is being 
recommended, or at least allowed for sale — a very proper procedure, 
as it seems to me, and I personally look forward to the time when 
a good many animals not now eaten will be regarded as good food. 

Another point, it seems to me, is very illuminating, and that is 
in confirmation of Dr. Laspiur's statement that transportation has 
done so much for us that it may be said to have conquered famines. 
I had occasion some years ago to write for a youths' journal a paper 
on the conquest of famine, and I was very much struck with the 



PUBLIC HEALTH AND MEDICINE. 167 

fact that since we have good transportation the important civilized 
and accessible portions of the world have had no famine. Of course, 
we all remember the terrible famines in Ireland in 1846-7, or 
1848, or thereabouts, and as far as I know that period was the last 
period of terrible famine along the Atlantic or Pacific coasts, barring, 
perhaps, certain places in China and Japan. I suppose that if in 
1847 they had had the means of transportation which we have 
to-day — certainly if they had had the means of cold storage, can- 
ning, and all that has come up since our Civil War — the awful mor- 
tality of Ireland would never have happened. So that this pro- 
cedure of canning and cold storage and other methods of food 
preservation, added to transportation, have, for the time being at 
any rate, brought about a condition which we may well call the 
conquest of famine. On the other hand, that man would be foolish 
who did not give heed to the predictions of Sir William Crook or to 
those of Malthus, and keep his eye well to windward, watching for 
improvements and betterments of the food supply. Famines still 
occur, but they do not happen when a charitable public is able to 
send food. It was not able to send food in 1847 to Ireland; it would 
be able to send it to-day and send it in great abundance. Those 
are very small points, but the paper is so interesting I could not 
refrain from adding them. 

The Chairman. Does any one wish to speak on this very inter- 
esting subject? If not, the other paper on the program will be 
read by title, as the writer is not present. 



VULGARIZAaON CIENTlFICA— HIGIENE BUCAL. 

Por JULIO L. CATONI. 
Buenoi AireSy Argentina. 

C(mtribuci6n al dtfundimiento de conocimientot HiiUi. Aunque es diffdl com- 
parar entre s( la distinta importanda de lo8 diferentes 6iganos del cuerpo, pueeto 
que cada uno de ellos ee necesario a la economfa y sa falta produce una perturbaci6ii 
en 8U actividad regular, Bin embaigo bien puede dedne que la boca ea el 6igano 
m^ 6til del cueipo, pues a ella estdn encomendadas muy nobles fundoneo. En 
ella se encuentran loa dientee que tienen, a su ves, importanda grande, pues sig- 
nifican caai todo para la digestidn y constituyen una parte muy esendal de la cara 
como est^tica. Bien se sabe qu^ encantos pueden dar a una fisonomfa que sea hasta 
repuMva, una hermosa dentadura, como se observa tambi^ el caso contrario. Sin 
entrar a enumerar los varios 6iganos que entran en la formad6n de la boca dar^ un 
ligero repaso sobre los fen6menos objetos de esta cavidad. La masticad6n, la insaU- 
vad6n y la gustad6n se efectdan integralmente en la boca y son la prim^a fas de 
la digestidn con la cual est&n en reladdn directa. La masdcaddn produce la tri- 
toraddn de los alimentos que son de este modo mezclados m^ ttdlmente a la saliva 
y * los otros jugos digesdvos. Las primeras modificadones que sufren los alimentos 
en su constituddn qufmica y que tienen pcnr c<msecuenda rendir los aaimilables 



168 PBOOEEDINGS SECOND PAN AMERICAN SCIENTIFIO CONGBESS. 

son debidos a la acci6n de la saliva, Ifquido segregado por las gUndulas difeientes 
que existen en la boca. En la Umacidn desempefia tambi^n un papel importante 
aunque el verdadero productor de la voz ee la laringe; la faringe y la boca constituyen 
un tubo adidonal que no toma parte en la emisi6n de los sonidos que vienen direc- 
tamente de la laringe, pero sirve a darles articulaci6n. Loe fendmenos de masd- 
caci6n que acabo de mencionar y que ae efecttian con la boca y los dientee son la 
primera faz de la digestidn. Ahora bien, ya conoddos a grandes raegos el objeto 
y fin de la boca debemos suponer que estando en buenas condiciones debe Uenar 
su cometido en forma ventajosa para el organismo, siendo por lo tanto dtil y aprove- 
chable para el estdmago e intestine el bolo alimenticio recibido, los cuales podr&n 
asimilar con facilidad el alimento bien preparado aprovechdndolo en su caai totalidad. 

En el cumplimiento de estas operaciones entra el valioso concurso de los dientes, 
factor importante; justo es pues que me dedique a elloe, verdadero objeto de mi artl- 
culo y que demuestre la gran importancia de su buena conservacidn por medio de las 
reglas higi^nicas tan sencillas, las cuales a su vez redundan en beneficio directo de la 
cavidad bucal a la cual pertenecen. El nifio nace sin dientes; cuando su naturaleza 
adquiere alguna consistencia, que es a los 7 meses mis o menos, comienza a efectuarse 
en 61, la erupci6n de los primeros dientes, los cuales en los sucesivos, contintian haciendo 
su aparicidn hasta los dos afios, y algunas veceshastadespu^dela^poca en que el nifio 
ya es apto para alimentarse por sus propios medios ; la primera dentadura del nifio que ee 
temporaria, consta de veinte dientes y muelitas, ntimero suficiente para llenar el 
espacio reducido de la boca in&uitil. Con esa dentadura provisoria el nifio tiene que 
hacer frente en la edad de loe continuos cambios, a la gran tarea de la alimentaci6n, 
pues en esa edad todoe los 6rganos se desarrollan y exigen del cuerpo gran reserva de 
elementos constitutivos, esos dientes desempefian tambi^n un gran papel, el de la 
formacidn de los dientes permanentes. Es evidente que como fendmeno fisioldgico 
la dentici6n participa de ese orden y concierto con que la naturaleza reviste todas sus 
manifestadones y que el nuevo ser no tiene necesidad de masticar, no se completa su 
aparato dentarlo. Hasta tanto el desarrollo lo exija, no de^gastaii el diente perma- 
nente al temporario para expulsarlo y sustituirlo. El nuevo germen no solo tiene por 
objeto el triturar los alimentos como parecerfa a primera vista, sine que tiene tambi^n 
el de guard&r el sitio a su sucesor; el diente sustituto que en el fondo del maxilar se 
desarrolla socava a su predecesor por las ralces, las cuales cabalgando y aprisionando la 
corona del nuevo germen le marcan la senda que invariablemente debe recorrer, al fin 
de cuyo dclo el diente de leche ha perdido por complete su rafz por cuyo motivo ae 
engendra en el publico la falsa idea de que los dientes de los nifios no tienen raiz. 
Cualquier anomalfa de la denticidn temporal se trasmitird de una manera mis o menos 
pronunciada a los dientes definitivos o viceversa, una primera dentid6n normal es 
seguida de otra normal tambi^n, pues muy raras vecee esa tiene por consecuenda 
anomalfas de la dentadura definitiva. Esta regla fisioldgica con que se realiza la 
evoluddn dentaria, tiene numerosas excepdones, unas debidas a enfermedades intra 
o extrauterinas, y la mayor parte de las voces, a la extracci6n prematura de los dientes 
de leche. 

En eetos casos la mala posiddn dentaria es la consecuenda mis frecuente y lament 
table, puesto que el que extrae la muela extemporineamente es el ocasionador de on 
verdadero desorden en la boca. Al extraer un diente temporal, antes de su cafda, 
se deja amplitud al sucesor para que tome cualquier direcd6n, puesto que se le quitan 
las gulas seguras que le hubieran conduddo por camino recto a su justo lugar. Quiere 
decir que es a todo trance indispensable la cQn8ervad6n de los dientes de leche en el 
nifio, puesto que su extracd6n no s61o perjudica a su masticad6n, sino a los dientes 
permanentes en su po6id6n, evitando asi a voces su erupd6n, por destruirse o arrastrar 
el germen con ella. 

Despu^ de los seis afios hacen su aparid6n las primeras grandes muelas Uamadas 
por este motivo los molares de seis afios, efectuindose casi simultineamente el cambio 



PUBUO HEALTH AND MEDICINE. 169 

de lo8 dientes incisivos, ee dsta una edad crftica, pues la infancia entra en la edad 
eecolar, edad que a la vez ee 6poca de los grandee desgastee og&nicos exigidoe tanto por 
el desarrollo como por las fatigas de las tareas eecolares, que aunque proporcionadas a 
la edad , no dejan de hacerse sentir en el organismo infantil . En eete perfodo la infancia 
necesita del concuieo de todos sua 6rganoe nutritivos para hacer frente a los procesos de 
trans!ormaci6n, como asi a sua mdltiples enemigos. Hasta loe 12 afios contindan 
los cambioe dentarios, 6poca en que puede decirse es ya definitiva y estable la situa- 
ci6n de los dientes, salvo pequefias modificaciones complementarias de crecimiento 
como del maxilar, que hasta la salida del tercer molar o del juicio sufre alguna pequeff 
modificaci6n. Este molar hace erupci6n entre loe 18 y 25 afios salvo raras voces qw 
sale antes a causa de haber sufiido la boca extracciones tempranas del primer o segund' 
molar. 

Ahora ya conocidos someramente los procesos de la anatomia dentaria, debo explicar 
que no es suficiente tener dientes en la boca para poder masticar, sino que a eeos dien- 
tes, cuyo valor es inestimable, se les debe cuidar con esmero para que la utilidad que 
presten sea maxima y no minima, y para ello voy a describir todos los efectos posibles 
de producirse en una boca descuidada, pudiendo aceptarse deede luego que la mayorfa 
de los descritos existen en alto porcentaje en el mundo. 

Los hombres de ciencia, actives higiemstas, nobles de coraz6n, anhelosos de difundir 
ensefianzas provechoeas entre el pueblo con objeto de hacer obtener mayor facilidad 
en la vida y mayor aprovechamiento de las energfas humanas, evitando con ello los 
entorpecimientos que ocasionan las enfermedades y propendiendo con elloe al mejora- 
miento de nuestro estado social, aconaejan sabiamente reglas sobre diferentes r^- 
menes de vida y alimentaci6n; pero qu6 provecho puede sacar de esas ensefianzas el 
que las lea, ai antes que esas nociones debe poseer las elementales, o aea conocer los 
medios para poder llevar a cabo con buen 6xito y en buenas condicionee aqu^llas, 
comenzando por poseer una boca idealmente limpia y dientes (ntegramente sanosT 
La base de la buena alimentaci6n estnba sencillamente en eso. 

La limpieza de la boca del aer humane debe practicarae deade aus primeroa dfaa, 
68 una provechosa prictica de las madree limpiar las encfas y lengtdtas de sus hijos 
con una gasa limpia, hervida y humedecida en agua hervida tambi^n, con objeto de 
deeembarazarle de las aglomeraciones saburrosas que se forman en los nifioa, eapecial- 
mente deapu^ de laa horaa de repoao: ieea pr^tica evita que el p&rvulo ingiera eaaa 
concredonee nocivaa airvi^ndole a la v^z de t6nico a la mucoaa gingival, sobre todo 
cuando comienzan a brotar loa primeroa dientea, evitando aaf laa inflamadonee y la 
mayor parte de loa accidentee de la dentici6n, debidoa, caai siempre, a falta de higiene. 
Cudntaa madrea no conocen laa bocaa de aua hijitoa aino hasta que ae lea ha llamado 
la atenci6n aobre la aalida del primer diente, el cual aiempre ee redbido como un 
acontecimiento; al rev^ de otraa madrea que ae deaviven por verlea dientes a aua 
hijoB y, anheloaaa de que eao suceda, consultan a amigaa y vecinaa qu^ medioa aon mia 
eficacea para favorecer la aalida de loa dientea, no faltando comedidaa que aconaejen 
pocionea y jarabes de dudosa eficacia, caai aiempre mal aanoa y otraa, menoa teme- 
rariaa aconaejan hacer chupar al nene dientes de loa animalee, collares de Ambar y 
colgar al cuello de la criatura amuletos de las espedes m^ variadas? En el siglo de 
hoy deberfan desaparecer esas ignorancias. 

Desde que los dientes se van colocando en sus respectivoa lugaree aon ya acreedorea 
de la limpieza mAs minudosa la cual ae hard con el concurao de cepilloa fabricados 
exprofeso para nifios con objeto de desembarazar loe interstidos de los dientes y la 
boca de los residues alimentidoe. Estas limpiezas deben hacerae con espedalidad 
en la noche antes de acostarlos. 

Suponiendo que los nifios han de pennanecer 8 o 10 horas durante el snefio con la 
boca en complete repose e inmovilidad, encontr&ndose 6sta llena de reeiduos de los 
alimentos ingeridos durante el dla, tienen que produdrae fermentadones y deecom- 
poaidonea altamente favoreddaa por un ambiente htlmedo y tibio. Eataa altera- 



170 PBOOEEDINGS SEOOITD PAK AMBBICAN SCIEKTIFIC 00NGBB88. 

donee del contenido bucal son casi siempre de caricter icido, quedando estacionadas 
en f onna de papillae, en el cuello de loe dientes, vestfbulo de la boca y superficie de la 
lengua acumuUndose, noche tras noche. hasta formar verdaderos cdlculos, enemigos 
de las encias a las cuales desalojan de los dientes imitdndola en alto grado y dando lugar 
a la apaiicidn de inflamaciones de di versa Indole; favorecen la acidez constante de la 
saliva pudiendo esta acidez penetrar en la primera grieta del eemalte de los dientes 
dando origen a la f ormaci6n de la cane o picadura del diente, la cual arrastra al mismo 
fin a SUB compaiieras, determinando en poco tlempo la p^rdida o inutilidad cad total 
de esos 6rganoB. 

La boca, en ese estado, puede decirae que ya es albergue de una regular cantidad 
de microbios, los que estdn en acecho de cualquier oportunidad para hacer de las 
Buyas; debido a las caries comienza la inflamaci6n de las glindulas, que no es otra 
cosa que la infiltraci6n s^ptica de microbios en esos drganos, originando esto un 
peligro muy grande, pues ellos se ven debilitados en su poder ofensivo contra loe 
g^rmenee nocivos, y quedan completamente impocdbilitados, en su poder defensivo 
dejando en el mayor desamparo a las mucosas bucalea y el organismo. Estas miBmae 
gl&ndulas, al inflamaree, pueden comprimir el conducto auditivo, impidiendo la en- 
trada del aire a 61, originando por consecuencia diversos trastomos en los ofdos; pueden 
dar lugar tambi^n a la formaci6n de vegetaciones adenoideas conocidas por la mayor 
parte del pdblico ilustrado, tan peligrosas, pues impiden al nifio respirar por la naiiz, 
obUg&ndolo a respirar mdebidamente por la boca; la nariz no es s61o un adorno, 
tiene por objeto atender la respiraci6n, filtrando los g^rmenes nocivos y calentando 
el aire antes de que llegue a nuestros pulmones; en cambio la respiraci6n bucal la 
priva de esos beneficios, esas mismas vegetaciones, sobre todo las nasales, debido a 
su expansi6n, modifican y comprimen los huesos de la nariz, estrechando de tal modo 
los canales que dan paso al aire que luego el calibre permanente de dichos huesos es 
insuficiente para dejar pasar el aire necesario, dando al nifio un aspecto corporal 
raquitico e impidiendo su expansi6n tor^ca debida. 

Estos son algunos de los peligros locales de la boca; ahora veamos los peligroe de 
la mala nutricidn. Ante todo, un nifio con dientes cariados no puede masticar bien, 
puee 8US dolores y la lalta de integridad de aqu^llos no se lo permiten; los alimentoe 
que ingeriri, en esas condiciones, aparte de estar mal masticados iiixt mezclados con 
lo8 residues nauseabundos que contiene su boca, cuellos de sus dientes y encias in- 
fectando el alimento y neutralizando la acci6n de los jugos gistricos, ese nifio tiene 
que tener forzosamente, una merma enorme'debido a eea forma anormal de nutrirse 
y en lugar de abastecer a su organismo de elementos constitutivos, lo obliga a de- 
vorar los que tiene, creando una falta de equilibrio orgdnico, originario de un estado 
an^mico y raquitico, quedando ese organismo predispuesto en cualquier memento a 
sucumbir a la acci6n de loe mtUtiples enemigos que lo acecban. 

La falta de ese equilibrio lentamente acaba por poner triste al nifio, priv^doee 
de eea al^rfa tan natural en la infancia; loe doloree acaban por initarle los nervioe sen- 
sorioe volvi^dolo irritable y poco acceeible, ddndole la anemia, debida a la infecci6n 
de Bu sangre un aspecto enfermizo; perdiendo el brillo de sus ojoe y presentando un 
aepecto p^lido tan desagradable y tan poco caracterlstico de la nifiez, la cual siempre 
ee y debe ser un exponente de robustez y lozania. 

Puede adquirirse en eee peUgroeo periodo cualquiera de las terriblee enfermedades 
que azotan la infancia, como son la difteria, fiebre tifoidea, fiebres g^tricas, etc., 
cuyo resultado 16gico ee el empeoramiento de las condiciones orgdnicas, hallindoee 
por consecuencia ese cuerpo mis inhabilitado para lucbar contra la devastaci6n, 
Es entonces que la terrible tuberculosis tiene oportunidad eepl^ndida para aduefiaiee 
de eee organismo, no se neceeita para ello mde que un leve reefrfo, que degenerari 
en una congeeti6n pulmonar, la que si no es atacada a tiempo se eztiende ocasionando 
los verdaderos estntgoe de una pulmonia infeccioea muy grave de por sf, y que si 
llega a curar ipobres pulmonesi, quedan casi siempre convertidos en el palacio mds 
apto para vivienda y asilo seguro de los bacilos de Koch, loe que formar&n sus colonias 



PUBLIC HEALTH AND MEDICINE. 171 

ain impedimentos de ningdn g^nero, devorando en poco tiempo ese pobre organiBmo 
y% cafii indtil por todos Iob achaques y accidentes sufridos, exponiendo con tal hecho 
el inmerecido y triste final de una juventud que era toda una promesa para el future. 

Muchos de los padres que lean eetas Uneas no habr&n llegado a suponer que la 
responaabilidad moral que tienen sobre sub hijoe se extienda hasta estoe Ifmites. 
Sin embargo es asi. 

En Europa civilizada existen y fimcionan en todas las ciudades y pueblos cuerpos 
m^coB escolares bien organizados, donde la boca ee objeto de preferente atenci6n 
y estd encomendada al cuidado exclusivo de profesionalee peritoe, que no tienen 
otra misi6n que prodigar a loe que necesitan esos cuidados especiales, se ocupan tarn- 
bi^ de dar peri6dicamente conferencias a loe nifios sobre la gran impcnrtancia del 
cuidado higi^nico de la boca y dientes, inculc&ndoles conocimientos y m^JTimas 
suficientemente poderosos i>ara que esos hombres de mafiana se preocupen realmente 
de cuidar una cosa para ellos ignorada y de gran trascendencia en su vida. 

Aquf y en regiones andlogas, desgraciadamente, no ban llegado todavla los bene- 
ficios de esas titiles instituciones y parte de esa enorme labor esta encomendada al 
medico, que en medio de su atareamiento diario, donde se ve obligado a ejercer todoe 
los ramos de la medicina y cirugfa, no le queda materialmente tiempo dedicarse a esa 
especialidad de la higiene y s61o lo bace en cases necesarios donde su preeencia ea 
exigida, limitindose cad siempre a enviar al paciente al dentista mejor especiaUzado. 
Efl entonces donde el dentista tiene oportunidad de hacer ver, por medio del case 
piictico, al paciente o a sus padres, el estrago y las consecuencias de la falta de hi- 
giene. Momentineamente ^tos aparentan dar importancia a la cosa bajo el peso 
de las circunstancias, pero como esos consejos cayeron al azar en un memento acci- 
dental los olvidan con facilidad; en cambio, si ese nifio hubiera tenido nociones y 
sus padres hubieran sabido que la higiene de la boca tiene importancia trascendental 
en el sostenimiento y con8ervaci6n de la vida habrlan dado mds importancia al acci- 
dente sufrido y hubieran tratado de evitarlo en lo sucesivo. Entonces el dnico mode 
de conseguir algo en pro de estas ensefianzas es comenzar a dictar por medio de la 
prensa local tan empefiosa y decidida en la obra educativa, una cdtedra de higiene 
haciendo conocer el objeto de determinados 6rganos, consecuencias distintas e inevi- 
tables de la falta de limpieza y cuidado de dichos 6rganos y medio para evitar su des- 
perfecto y alteramiento propendiendo con ellos a su verdadera conservaci6n. 

En resumen definir^ en pocas palabras todos los medios y cuidados necesarios para 
la buena conservaci6n de los dientes, evitando oon ello y por consecuencia el altera* 
miento de loe dem^ diganos anexos. 

Como he dicho, repito, desde la m^ tiema edad se debe vigilar la lunpieza de la 
cavidad bucal, cuando los dientes ya ban hecho su aparicidn y durante todo el trans- 
curso de la vida. Esa limpieza debe efectuarse dos veccs por dfa a la mafiana al 
levantarse y a la noche antes de acostarse, a fin de que el ambiente de esa boca, sea lo 
m&B est^ril posible; un cepillo de forma y dureza especial seri el encaigado de efec- 
tuarla con la ayuda de determinados agentes bajo forma de polvos de cualidades de- 
finidas, y que el m^ indicado a prescribirlas es el Dentista, despu^ de previo examen 
de la boca del interesado. Si a pesar de esos cuidados se nota dolor o alguna pequefia, 
cariadura a veces imposible de evitar, se debe acuir sin p^rdida de tiempo al Dentista 
a objeto de curarla y taparla, lo mismo si se nota que los dientes salen en mala po6ici6n 
o torcidos y las mandibulas estan proyectadas hada adentro o hacia afuera, se debe con- 
sultar igualmente al odontdlogo. 

La boca a pesar de esos cuidados, que no siempre serin efectuados con la debida 
energia y esmero, acumula sarro y dep<5sitos llamados ddculos. Igualmente se debe 
acudir una' vez por afio a los buenos oficios del Dentista para que liberte a los dientes 
y encias de esos temibles enemigos. 

En fin, para tenninar, la boca debe ser objeto de la mds constante atencidn en cual- 
quier persona y durante todos los perfodos de la vida, pues en todos esos perfodos es 
igualmente dtil; pero donde tiene mayor importancia la buena conservacito de la 



172 PB0CEEDIN08 SEGOKD PAK AMEBIOAK 8CIBNTIFI0 OOKGBESS. 

denfadura es en la inEancia, vuelvo a repetirlo, dn cansarme, por ser ella la esperanca 
de un pueblo y por repreeentar el futuro evolucioniata de una raza y el perfecciona^ 
miento de la generaci6n que anhelamoe todos. 

La no observanda de la higiene buco-dentaria detennina todas y muchas mis alte- 
racionee que las deecritas, trayendo como consecuencia trastoraos de efectoe terribles. 
en la nifiez, con su inevitable corolario de depre8i6n mental. Es por lo tanto neceeario 
hacer un llamado a los padres de familia sobre la activa vigilancia que deben ejercer en 
eee sentido sobre bus hijoe, constituyendo, su indiferencia e impa^dbilidad al conocer 
todos eeos peligros, la Banci6n social de un crimen de lesa humanidad. 

Oreo haber usado de medioe suficientee, dentro de mi inutilidad literaria, y sin la 
facilidad y claridad que lo habrfa hecho un hombro de letras, para demostrar y hacer 
resaltar la imperiosa necesidad de aplicarse en la higiene bucal. Si algo consiguiera 
con dsto, tendrfa la sati8facci6n de haber side dtil, con mi modesto y pequefio aporta- 
mjento de nociones concemicntee a mi profesidn, a muchoe que quiz&s hubiesen re- 
■ultado perjudicadoe con su desconocimiento. 

Through the courtesy of the writer there was presented to the con- 
gress at this session a copy of the following printed book: 

Higiene dentaria del nifio, por Carlos P. Berra, Dentista del ^'Cuerpo 
M6dico Escolar.'' Cabaut y Cfa, editores, Buenos Aires, 10J6. 

Adjourned at 4.30 o'clock. 



JOINT SESSION OF SUBSECTION D OF SECTION VDI AND 

SUBSECTION 4 OF SECTION V. 

New Ebbitt Hotel, 
Tuesday morning^ January 4, 1916. 

Ghairman, J. D. Gatewood, 

The session was called to order at 9.15 o'clock by the chairman. 
Papers presented: 

Disposal of refuse. Papers by George A. Soper and William T. 

Sedgwick. 
Collection and disposal of municipal refuse. Papers by J. T. 

Fetherston, Morris Enowles/ and J. W. Paxton^ 

The Chairman. The first paper, on a most interesting subject, '' Dis- 
posal of refuse/' is by Dr. George A. Soper, president of the Metro- 
politan Sewage Commission, New York City. Dr. Soper will please 
oome forward and read his paper. 

AVAILABLE METHODS FOR THE SANFTARY DISPOSAL OF REFUSE. 

By GEORGE A. SOPER, 
ConniUing Sanitary Engineer^ New York, 

The intended scope of this paper was indicated in the preliminary program of this 
meeting as follows: 

VI. Dis^sal of refine, — Under this topic there is a wide range of topics to be con* 
■idered, viz, (1) sewage disposal, (2^ garbage, (3) ashes, (4) night soil, (5) stable 
manure, (6) trade wastes, (7) miscellaneous refuse of the household, and (8) street 
cleanings. The collection, transportation and ultimate disposal of liiese classes of 
refuse will be considered, and incidentally the purity of nvers wad other bodies of 
water. 

When it is considered how small a topic may profitably engage one's attention, 
and how various and complicated are the chemical, physical, biological, sociological, 
political, economic, engineering, and administrative questions with ndiich the present 
subject is involved, the magnitude of the undertaking which has been assigned to the 
author of this paper will become apparent. No attempt at thoroughness could be war* 
ranted within dimensions smaller than a series of volumes. Nor would such an effort 
be pertinent before the members of this congress had been given an opportunity to 
relate their experience and opinions. All that will be attempted is an outline of some 
of the main bearings of the subject as related, particularly to methods, the expecta- 
tion being that the contributions of others will supply many details of present interest. 

. 1 Paper printed tn ToL VI of tlM ProoMdings of the Beooiid Pan American Soian^ 

173 



174 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONGRESS. 

The tenn ' * refuse " is here used to cover broadly all liquid and solid waste substances 
produced in the houses and streets of cities, towns, and villages under ordinary condi- 
tions of occupancy. 

Refuse is divisible for consideration into two general classes: I. Solid refuse, and 
II. Sewage. This division leaves something to be desired on the score of precision,, 
but it is impossible to be scientifically accurate in the use of terms in dealing with 
the disposal of refuse, for there is no universal agreement among sanitarians with 
respect to them. 

Sewage, which is the material customarily carried from its points of origin in under- 
ground pipes and drains, usually by means of a flow of water, can be finally disposed of 
in definite and effective ways. The means which are available for the collection 
have reached a point of perfection which leaves little to be desired. The processes 
which are available for final disposition have received a great deal of study in the 
laboratory and on a practical scale with the result that a large amount of infonnation 
exists concerning the principles which must be followed in order to insure successful 
results. Sewerage and sewage disposal, therefore, represent a rather high state of 
development considered either as a science or as an art. 

The disposal of solid refuse, on the other hand, has not yet emerged &om that primi- 
tive state of development in which the experimental generally exceeds the certain re- 
sult. Centuries older than the subject of sewage disposal, the current methods of 
to-day are not very far advanced over the methods which were in force in the time 
of Moses. Considering the fact that the sanitary disposal of refuse has materially 
affected the comfort and welfare of human beings ever since men ceased to live an 
uncivilized and nomadic existence, it would appear that the methods now available 
for the removal and final disposal of all classes of solid refuse should be well worked 
out and thoroughly understood. The truth is, however, that modem civilization 
has but recently come to recognize the importance of the subject and been able ta 
focus the scientific attention upon it which is necessary in order that well-developed 
methods may be evolved. 

I. THE DISPOSAL OF SOLID REFUSE. 

While the sewage of a city is removed from the houses and streets where it is pro- 
duced without the average inhabitant seeing or knowing even the routes which it 
follows, the opposite is the fact with regard to the disposal of the solid wastes. The 
garbage, ashes, papers, stable manure, and other solids are stored on the premises until 
they become no longer tolerable, then placed with their receptacles in the highway, 
from which they are collected in a noisy, dusty, odorous manner, hauled in foul and 
leaky wagons, often for long distances, through the city, and finally dumped at places 
which are offensive in the extreme. This is not the best practice, but it is the usual 
one; there is hardly a city to be found which is not guilty of some or all of the offenses 
named. It is unpleasant to mention these conditions, but it is necessary to recognize 
them, if more correct and suitable procedures are to be devised. 

There is need of improvement in the manner of collecting the solid wastes and of 
disposing of them. The first is laigely a matter of administration, the second chiefly 
a question of plant. If the wastes can be gathered properly to suitable points for dis- 
posal, it will be within the range of scientific e£fort to dispose of them without danger 
or offense. If the collections can not be made suitably, it will be hopeless to attempt 
to cope with the problem. 

Suitable collections mean, first, appropriate receptacles and a correct use of them 
by the householder. This is always a difficult thing to accomplish. It is natural te 
throw refuse away carelessly and think no more about it. This course has been made 
practicable so far as sewage is concerned , by the invention of the water carriage system,, 
but there is nothing comparable with the sewerage system which can be used for the 
solid wastes. The ashes, papers, floor sweepings, old cloths, bottles, cans, boxes^ 



FUBUO HEALTH AKD MEDIOINE. 175 

and kitchen garbage must be put into receptacles, and these must be taken out of the 
house and emptied from time to time. Proper receptacles and a proper use of them 
constitute the first essential for the householder. 

The duty of the municipality begins soon aftw the waates are produced. It extends 
into the houses. The municipality should insist upon the kind of receptacle to be 
provided and what kinds of materials may and may not be put into them. There 
should be r^ulations specifying where and when the receptacles should be placed to 
&cilitate their removal and emptying. 

In some well sanitated cities the solid wastes are collected together in mixed con- 
dition; in others the householder is required to keep the ashes separate from the 
kitchen swill and from the papers and other materials. The regulations in respect to 
thii matter should depend upon the way in which the wastes are to be disposed of. 
It has not been found that any appreciable hardship is imposed upon householders by 
such requirements. Separations at the house were first required in New York by the 
late Col. Waring many years ago, and are still infosted on in that dty with it« 5,500,000 
inhabitants. The householders can be made to do a great deal of work which will 
6ici1itate the disposal of the solid wastes if they are treated Mrly, and it is desirable 
that this fact be made use of to the full. Experience shows that it L> desirable and 
feasible to insist that the house receptacles shall be placed for collection in situations 
which are accessible to the men who are chaiged with the duty of emptying them, and 
they are to be placed there on those days and at those times when the collectors are 
able to make their rounds. Compliance in these directions will be the more effective 
if there ir no que^ion as to the authority demanding it, and confidence that the collec- 
tors will dn their part. There must be real authority and the public must be treated 
fairly. 

One of the secrets of success in all branches of municipal refuse disposal lies in the 
mutual help which can be given by the public and by the dty officers. No cleaning 
department, however effldent it may be, can keep a dty clean if it does not receive 
the intelligent help of the dtizens. The health department, the police, and the clean- 
ing force should work together with mutual confidence and understanding. In no 
blanch of dty work is cooperation so necessary as here. 

Contract and day labor. — ^The collection and disposal of solid refuse are sometimes 
done by contract and sometimes by a force in the regular employ of the munidpality. 
In many cases the collections are made by the dty and the collected materials turned 
over to a private firm for final disposition. Carts and wagons, too, often of unsuitable 
form, are used in dther event; their main faults are that they are too high, too heavy, 
and too open. There is a good field for the employment of American ingenuity in the 
perfection of carts and wagons for the collection of solid refuse. 

Traction is usually effected by horses, and this seems to be the cheapest plan, 
except when the vehicle can be operated for unusually long periods of time, or is 
employed on long hauls, in which event motors are the more economical. The partic- 
ular type of wagon or cart to employ depends a good deal upon the material to be car- 
ried and the topography of the district. Whatever their design, the vehicles should 
be iBOgOf low, covered, and tight. 

Carts have been designed for household receptacles so as to carry off the refuse in 
the containers in which it was first put, empty receptacles being left in their stead. 
Tha« is the objection to this practice that it is seldom feasible to thoroughly cleanse 
the containers, and no one wants to receive a receptacle which has previously been 
used in a house where sickness has occiured. Wagons are sometimes provided with 
covers and a mechanical device for emptying the receptacle without causing the 
dust and odors to escape. This appears to be a practicable scheme and has much to 
recommend it. But it is to be noted that such vehicles generally require the house- 
holder to employ a special form of receptacle. Perhaps some will regard thii as an 
advantage, for it does away with the use of such unsuitable receptacles as boxes, bas- 



176 PBOOEEDINOS SECOND PAN AMEBIOAN SCIENTIFIC C0NGBES8. 

kets, and worn out cooking utendb, which, in spite of considerable pressure, are to be 
found in use in nearly all cities, to some extent, at the present time. The standard 
receptacle for garbage and for mixed garbage and ashes, in American cities is a gal* 
vanized iron can with a tight-fitting cover. 

Collections should be made at regular intervals, and the days of collection should 
be scrupulously kept. The frequency of collection for garbage, when kept separate 
from ashes, should be not lees than twice or three times per week, according to the 
season of year and climate. A somewhat longer period is permissible when the aahee 
and garbage are mixed. 

Final disposition, — ^The most conmion methods of final disposition for household 
refuse are diunping, burning, and hog feeding. 

In spite of the fact that the feeding of hogs with the garbage of cities is widely prac- 
ticed, it can not be said to be wholly satisfactory. The idea of turning useless swill into 
valuable pork has attractions for the economist, but it can not be accomplished on a 
laige scale in a way that is satisfactory to the sanitarian, judging by the efforts which 
have been made so far. A few years ago it was undertaken by a Prussian city, and 
although the scheme was carried out with characteristic German thoroughness, the 
plan was eventually given up. It was impossible to keep the hogs healthy and their 
quarters clean. Hog feeding is lees objectionable when practiced on a small scale. 

Notwithstanding its bad reputation, the dumping of household refuse on land 
when properly carried on has a great deal to recommend it. All dumping is not bad 
dumping, by any means. It may be said to be good or bad according to the place 
where the material is dumped and what is done with the deposits. Left to itself, a 
refuse dump may be one of the most objectionable nuisances to be found in the vicin- 
ity of a city. Properly cared for it may not be objectionable at all. Garbage alone 
can not, of course, be suitably disposed of in this manner, but garbage and ashes in 
mixed condition may be dumped, or ashes alone, or garbage, ashes, and rubbish. 

It is a mistake to suppose that land whose level has been raised by deposits of refuse 
is a menace to health or unsuitable for any use. There are few cities of considerable 
aise parts of which have not been filled in and built upon without evil consequences. 
In some of our great cities very large tracts have been recovered in this way and parks 
have sometimes been made of the districts so reclaimed. 

Dumps should be drained to start with and leveled and covered with earth as the 
work of dumping progresses. If the process of filling is carried on in accordance with 
correct engineering and sanitary principles, it will not be objectionable. 

Garbage can be composted to advantage, a fact which is much less generally under^ 
stood in America than in Europe. The compost heaps need not be especially offensive 
nor located where the material is likely to cause complaint; the resulting material is 
likely to be of considerable value as fertilizer. Unfermented garbage is of little 
service as a manure. 

Reduction and burning. — One of the most approved processes for the conversion of 
garbage into a useful commodity is known as reduction. Essentially this method 
extracts the grease by means of heat or gasoline, leaving a by-product which can be 
used as a basis for manure. There are some large plants which dispose of garbage by 
reduction; in fact, this method seems less suited to small cities and towns than to 
large places. Usually the works are owned and operated by a corporation which takes 
the city's garbage and disposes of it for a term of years upon the payment of a sum of 
money by the municipality. 

Burning, or, as it is sometimes called, incineration, is generally r^arded as one of 
the best, if not the very best, and most frequently applicable processes for the final 
disposition of household wastes. It has the advantage, so far as sanitary considera- 
tions are concerned, that it utterly destroys whatever it deals with. Further, burning 
is capable of dealing with garbage, ashes, and rubbish, so that, unlike reduction, the 
entire problem of disposing of these three classes of refuse is solved at one stroke. 
Finally, the heat produced by the flames can be turned to profitable account in the 



PUBUO HEALTH AND MEDICINE. 177 

production of steam and electric power and light. The furnaces which are suitable 
lor this work may be of a size to accommodate the wastes of almost any municipality. 
For good results they must be skillfully designed and operated. In Europe, particu- 
larly in England and Germany, there are excellent examples of refuse destructors, as 
they are properly termed. 

Utilization finds an encouraging field in the disposal of rubbish, for here are con- 
tained the metals, bottles, pieces of cloth, and other materials which, when separated 
from the mass in which they are cast away and brought together in quantities, have a 
market value. It is feasible and often desirable for the authority which is charged 
with the duty of disposing of rubbish to have it overhauled with the object of recov- 
ering the salable ingredients. In this direction, as in some others, useful lessons may 
be learned from the practices of private scavengers. 

Private scavenging. — In practically all cities of the United States there aie men who 
make a living by taking away for disposal the wastes of butcher shops, restaurants, 
and the garbage and ashes of private dwellings. Where there is no central scavenging 
force operating at the expense of the city, and this applies to hundreds of small cities 
and villages in the United States, the employment of private scavengers affords the 
only means which the householders have for getting rid of their solid refuse. Some- 
times the scavengers operate under licenses issued by the health authorities; some* 
times such permission is not required. 

The operations of private scavengers are various and seldom sanitary, except in 
large cities. Depending upon the value of the material which is taken away, the 
scavenger either receives a sum of money for his services or gives a small amount. 
The work of collection is often done badly, and the system has many disadvantages, 
but the commercial aspect of the subject is developed in some cases to a surprisingly 
high state of perfection. The garbage is usually fed to hogs; the ashes are dumped; 
the rubbish is overhauled; and the salable materials are carefully collected into piles 
and stored until enough of each class has accumulated to be marketed to advantage, 
when it is shipped away. 

The tendency of the times is to insist upon more frequent collections of solid house 
refuse, a better disposition of it, and a more centralized control of the whole subject. 
The future seems likely to see improvements in the operations available for collection 
and disposal in small communities as well as in large ones. There is certain to be a 
better recognition of the need of devoting intelligent care to the whole subject, and 
in view of the remarkable amount of attention which is being given all other branches 
of sanitary work, it seems not too much to expect that the collection and disposal 
of the solid refuse of municipalities will emerge from the neglected state in which 
it exists and take its place among other well organized mimidpal enterprises. 

Encouragement for expecting improvement is found in the popularity which has 
recently attended the periodical cleaning up of cities of all sizes in the United States. 
In these ''clean ups," as they are called, special days are set aside for the thorough 
cleaning of houses, yards, shops, alleys, and streets. They are not intended to be 
substitutes for the routine cleaning which is desirable, but are supplementary to it. 
Prizes are given for the best individual work, and school children are enlisted to act 
as inspectors and, it must be confessed, as educators. The campaigns carried on in 
this way have been full of practical value, for if they have laid what to some would 
appear to be unwise emphasis upon an occasional cleaning instead of upon the con* 
tinuous care which a city should have, they have aroused the interest of many persons 
who could not have been persuaded to follow the better course at once. A thorough 
cleaning once a year is better than no cleaning at all, and in some cases, probably in 
many, the good b^:iiming has been followed by sustained and productive efforts. 

Night ioil, — The removal of night soil is generally carried on by a force quite inde* 
pendent of other refuse collecting agencies. Sometimes this work is done by a health 



178 PBOOESDINGS SECOND PAN AMEBIOAN BOISKTIFIO 00NGBB88. 

department, but usually by small contractors licensed by tlie city and operating 
under more or less careful regulation. The material is removed from the privies and 
cesspools either by shoveling or pumping. Sometimes the work is done by so-called 
odwless excavating apparatus, if the quantity and consistency permit of it. It is 
customary to clean cesspools and privies when they become so full as to necessitate 
empt3dng, although some municipalitiee provide that they shall be cleaned out 
periodically, as once a year, for example. In some English cities, in France, and in 
many warm countries where the water carriage system of sewerage is not used, special 
receptacles and collecting wagons are employed and the excrement is taken away at 
frequent intervals. 

As generally done in the United States, the removal of night soil is costly, imperfect, 
and hi bom satisfactory from a sanitary standpoint. But with careful supervision it 
can be carried on with relatively little objection. Barrels and wagons can be made 
tight and kept clean, the night soil can be excavated without destroying the shrubbery 
or other property and the material can be finally disposed of by applying it to land. 
In the cleaning of over 1,000 privies under the direction of the author of this paper 
there were no complaints from property holders, no illness among the workmen and 
the material was disposed of, countlDg all expenses from the privy to the field at 
about 1 cent per gallon. The material was buried in shallow trenches dug by a 
plough and at once covered. 

The disposal of excrement, in such condition as is likely to be met with in cities 
and towns which are unprovided with sewerage sjrstems, is an important field for 
discussion, since the methods to be followed apply practically to all villages and 
towns and to some extent to most cities. Theoretically the material is highly dan- 
gerous, containing, as it often does, the germs of many infectious diseases. Practi- 
cally it does not appear to be so. 

The disposition of night soil offers opportimity for the utilization of the nitrogen 
and other manurial ingredients of feces which in sewage is highly diluted with water, 
yet science shows that its value as a fertilizer is not so high-as many persons suppose. 
The custom of the inhabitants of China and some other countries in hoarding their 
excrement for the purposes of agriculture is thought by some to mean only that these 
people are very thrifty. Commercial companies which have been organized to turn 
human excrement into fertilizers for the market have never been successful for long. 

The trend of recent effort in the disposal of excrement is toward better-built privies 
and cesspools and stricter board of health control over the subject and the construction 
of sewerage systems wherever practicable. It is recognized that flies and other insects 
must not have access to the material, and that the danger that food and drink may 
become contaminated by it must be reduced to the lowest terms. Properly managed 
privies and cesspools may, in certain cases, afford the best means of solving the excre- 
ment problem. Sewerage systems are not always either feasible or desirable. 

Strut cleaning. — ^Turning now to the subject of street cleaning, another division 
of our general topic, we find certain standard practices and on the whole a much better 
stage of development. But even here there is considerable diversity of procedure 
in the efforts made in different cities for the accomplishment of the same object. 
It must not be overlooked, however, that the work to be done in cleaning a pavement 
is not always the same. Different conditions of traffic and of pavement produce 
different effects. A degree of cleanness which is suitable for one part of a city may 
not be appropriate at all for another. The best-cared for sections are usually those 
which are most difficult to keep clean. The most neglected parts of cities are the 
outlying districts. These often appear to be utterly forgotten by the street cleaning 
authorities. 

In no case should there be imsightly litter, nor the excrement of animals, except 
for brief periods of time. Dust should be prevented as far as it reasonably can be. 



PUBUO HEALTH Ain> KBDIOIKB. 179 

Not that the duet is dangerous so much as because it is disagreeable. Dust is, moie- 
over, costly for householders to remove from their homes and injurious to fobrics and 
other things. 

The trend of modem practice is distinctly toward the prevention of dust, which 
means the collection of this material either in its familiar dry ionn or as mud, which it 
becomes when it is wet. The future to judge by the efforts which are now being made 
will witness more distinct improvements in this direction than in any other. Machines, 
as yet of doubtful efficiency, may be developed to operate on the vacuum principle 
to pick up street dirt and store it in a suitable receptacle until it can be finally dis- 
posed of. 

Hand and machine work. — There are two geneial ways of cleaning streets whidi 
demand consideration here: hand and machine work. Handwcnrk is the more mobile 
and effective method and is to be preferred where the pavement is poor or the work 
difficult for other reasons or the beet results are desired. Machine work is to be pre- 
ferred on the score of economy and speed. 

Under handwork is to be mentioned the prompt picking up of litter, including 
papers, fruit skins, and haree droppings, which, if sdlowed to remain on the pavement, 
would invite to a fiuther dirtying of the street and would become ground up and so 
made more difficult to remove. The labor of this sort which is entailed in most 
American cities is very large — ^it is unnecessarily large. A great deal of the dirt in 
our city streets can and should be prevented by the police enforcements of suitable 
ordinances. No one should be allowed to throw papers, house sweepings, ashes, or 
other refuse into the streets. It is forbidden in Grerman cities and it should be equally 
unlawful elsewhere. 

With the best of care some littering is unavoidable and this beet can be taken care 
of by what is known as the orderly, or patrol, or block sytem. In this system men 
or boys are required to patrol certain districts and pick up the laige articles of refuse 
and place them in suitable receptacles for final removal and disposition. In the 
United States the receptacles are generally jute or canvas bags conveniently hung 
on two-wheeled hand carts, or barrel-shaped cans carried in a similar vehicle. When 
a receptacle is full it is exchanged for an empty one, the full receptacle being tem- 
porsrily placed where it can be seen and picked up by men with carts especially 
assigned to that duty. A weak 2>oint in this system is the temporary storage. 
The receptacle may be left too long and in too conspicuous a place. Sometimes 
the material is not contained in a receptacle, but is simply piled up near the gutter; 
under such circumstances it is very likely to get scattered about by passing yehides 
and by winds. 

Sweeping, — ^Tbe proper function of sweeping is to clean pavements of the finely 
ground dirt, which is dust when dry and mud when wet. It may be removed in either 
condition, but from the sanitary standpoint it should never be dealt with by a process 
which raises the dust into the air. Brooms of special design and of standard f(»rm are 
are usually employed, irrespective of the kind of pavement or the character or amount 
of dirt to be removed from it. There is room for considerable improvement here. 

To prevent the raising of dust when sweeping, it is often customary to sprinkle the 
pavements; this is usuaUy done by means of a horse-drawn watering cart. Qood 
judgment is required in order to apply the right amount of water, for if too little is 
used the material is not sufficiently moistened and some of the dust rises into the 
atmosphene; and if too much is employed, the material is reduced to a condition of 
plaster which the broom smears over the payment. At best, hand sweeping is expen- 
sive, far the hhcx is arduous and the area which a wivkman can properly care far is 
relatively small. 

The material which is swept up is commonly stored on the pavement in pUee until 
it can be removed to the place of final disposal in carts. This practice is apparently 
unavoidable. It is least objectionable when the dirt is collected prconptly. When 

684S6— 17— VOL X 18 



180 PB00EEDINQ8 BECOND PAN AMERICAN 80IENTIFI0 C0NGBE88. 

the piles are allowed to remain long, a considerable amount of the dirt may become 
scattered upon the pavements again by the wind and movements of vehicles. 

A substitute for hand sweeping lies in the use of the revolving broom attached to a 
suitable frame and drawn by one or more horses. Many cities use the horse broom 
and it may be said to be a standard piece of apparatus. It should always be preceded 
by a sprinkling wagon when the material to be removed is not already damp. It 
could be used to great advantage during and inunediately after rain, but it seldom 
make^ its appearance under such circumstances. In some cities where there is a great 
deal of work to be done, horse brooms travel in gangs, the broom being so adjusted 
as to throw the dirt to one side, each broom taking it up where the other left it and 
carrying it nearer and nearer to the side of the street, until it reaches the gutter. 
Here the dirt is shoveled into piles to be collected into carts for final disposition. 

Flushing. — The most recent advance in street cleaning lies in the use of a stream 
of water to cleanse the pavements. The object is to secure a greater degree of clean- 
ness than is possible with broom work. This method is commonly called flushing, 
but it is not merely flushing. When properly done, the stream sweeps as well as 
flushes the material away. Before the water is applied, the material to be removed 
should be thoroughly lubricated to remove its adhesiveness toward the pavement. 
This is beet done by means of sprinkling wagons which thoroughly wet the pavements 
before the water is used to carry the material to the gutters. 

Street flushing is sometimes done by means of a fire hose and sometimes with 
wagons which carry a supply of water and direct it downward under pressure upon the 
pavements. Under favorable circumstances, good results can be obtained by either 
method, but where the pavements are irregular, very dirty or the smallest quantity 
of water must be used or the cleanest results obtained, no automatic apparatus can 
take the place of intelligent and experienced hand workers. 

It Ib often feasible and desirable to scrub or scrape the pavements with brooms 
or rubber squegees. These tools may be used in the hand or operated mechanically. 
An automatic scraper which is equipped with rubber placed spirally upon a hori- 
zontal drum has been found to be one of the most serviceable jneces of equipment for 
this service. Like flushing, it was first used extensively in Europe. 

It is perhaps unnecessary to point out that in selecting the method to employ in 
any case, the choice should depend not alone upon the results which are obtainable 
elsewhere, but under the particular conditions with which one has to deal. Before 
any system of water cleansing or sweeping is decided on as the best for any case, it will 
be desirable to consider it in all its local aspects. Experiments and tests of appli- 
ances and methods may be exceedingly helpful. 

Combinations of apparatus have been invented for sweeping, sprinkling, picking 
up dust and carting it away, and very laige pieces of apparatus have been built to 
clean streets on the vacuum principle. There are many difliculties in the way of 
successful machines of these types and it does not appear that they have all been 
overcome. One of the main obstacles is the irregularity in the surface of the pave- 
ment, another is the variety in the consistency of the dirt to be removed. In time, 
perhaps, such automatic apparatus will largely supersede hand work, but that time 
has not yet arrived, except in some cities where the conditions are decidedly favorable. 

Final disposition of street dirt. — ^As to the disposition which can be made of street 
dirt, it is well to consider that the main object should be to get rid of the material 
in a sanitary way, and attempts to extract the manurial values present should be a 
secondary consideration. 

The manurial value of street sweepings is less than it would be if the material did 
not lie our in the wet and air and become mixed with useless dust. The fresh horse 
droppings have the most value, and it is often more economical not to attempt to use 
them tlum to gather them with the idea of putting them to practical use. When 
horse droppings are collected promptly and removed, the pavements are to that 



PUBLIC HEALTH AND MEDICINIL 181 

extent protected from objectionable littering, but this work should be done for the 
sake of cleanness, rather than for profit. Sometimes street sweepings are placed in 
piles and allowed to ferment like compost. This is an admirable procedure wheu 
the opportunities are favorable to it, but the resulting compound is not of much value^ 

Snow, — The removal of snow is one of the most costly and unsatisfactory branches 
of street cleaning for the reascm that the amount of work involved, if large areas of 
pavement are cleared, is very large and its occurrence uncertain and irregular. Most 
cities do little to clear away snow except upon the main highways, and there are 
few, indeed, where even this result is accomplished to the general satisfaction. For 
the most part cities allow the snow to lie upon the pavements until warmer weather 
occurs, when the compacted mass is picked and broken and the natural melting 
facilitated. 

Like the disposal of refuse generally, the removal of snow involves three processes : 
1, Collection; 2, cartimg; and 3, final disposition. For collection the main reliance 
is hand labor, shovelSy and sometimes when the snow is compact and frozen, picks 
being the tools most often employed. 

It is customary to shovel the snow into piles located at convenient distances apart 
at the center or sides of the carriageways. Carts and wagons of the largest capacity 
available are then driven alongside and the snow is shoveled into them. The carts 
are hauled to dumping places which should be as accessible as possible, rivers, parks, 
and empty lots often being utilized. 

Recent improvements in snow removal have been made by the employment of 
plows to assist in the collection and in the use of sewers as the place of final diBposi- 
tion. It has been found that large sewers are capable of carrying off a great dcAl of 
snow without injury to them, provided little else than snow is put into them. Fol- 
lowing European custom, great improvement has been made in perfecting the organi* 
sation necessary to handle the snow. The largest item of expense being in the Labor 
employed, and this labor being necessarily of the poorest sort, an improvement in 
the organization of the directing force of permanent employees which helps to direct 
the auxiliary laborers, makes for efficiency and economy. 

In future the work of removing snow is likely to see considerable improvement in 
the organization of the workers, in the use of the sewers and in the apparatus designed 
to supplement the large amount of hand labor which must always be the chief reliance. 
The use of salt to melt the snow and the employment of streams of flushing water to 
carry the snow into the gutters and sewers appear to offer some promise in those 
situations wherein the cold is not excessive and the water is available at no great 
expense. 

n. 8BWAGK DISPOSAL. 

According to statistical information, it appears that most of the cities of the United 
States are provided with sewers, to some extent, at least, but have no means of getting 
rid of their sewage, except by discharging it into a natural body of water in the vicinity. 
As sewers first came into use for the means which they afforded for carrying away 
lain water from the streets, so they are likely to be built in the small and growing 
municipality for the same purpose to-day. There is, perhaps, little objection to be 
raised against the discharge of surface water to the rivers, but when house sewage and 
the drainage of factories are added, grave consequences may, and often do, follow. 
These consequences are of two general kinds — danger of disease and risk of nuisance. 
The nuisance may be an offense to the sense of sight or smell. The danger of disease 
is usually through the pollution of drinking water; but it must not be forgotten that 
a nuisance may have a prejudicial effect upon health, so that the line separating the 
two clases of objectionable consequences just drawn, should not be regarded as a very 

sharp one. 

ExUnt of treatment required. — ^Many sanitarians have contended that the proper 
function of sewage disposal works was to i^event nuisance only, and that the proper 



182 PBOGEEDINGS SBOOND PAN AMBBIOAN SODSKTIFIO CONGRESS. 

way to protect a community from polluted riven and otlier natural bodies ctf water, 
was to avoid the use of the unpurified water for drinking purposes. Their contention 
has been that the streams were natural sewers and should be utilized as such; that it 
was cheaper to purify the drinking water supplies than to keep all natural bodies of 
water clean enough for domestic uses without purification. It has been argued that 
the only practicable way to deal with the problem of utilising the rivers and lakes for 
sewage disposal and water supply is to let the sewage into them and regard all water 
obtained from surface sources as polluted and requiring to be filtered or otherwise 
rendered suitably piure. 

This is the status of the subject in the United States to-day. 

Sewage should be discharged only in such quantity and in such places as will not 
produce a nuisance and add unreasonably to the difficulty and cost of purifying the 
water for such purposes as it may be required to serve. Neariy all drinking water 
supplies, unless from underground sources, must be regarded as probably unsafe unless 
artificially purified. This point of view should be kept in mind in considering the 
methods which are available for the treatment of sewage. By treatment is meant 
partial purification. 

Exhaustive experiments as well as experience in Europe and America have yielded 
a great deal of information concerning the methods which can be successfully employed 
for the purpose of relieving sewage of its offensive ingredients, and there is little doubt 
but that marked progress will continue to be made in this important field for some 
time to come. 

Objects which can be accompl'ished, — Few sanitary subjects are so complicated or 
require so varied a knowledge of science for their mastery as sewage disposal; but 
once the principles of the art are understood, it will be possible to proceed with con- 
siderable confidence to the construction of the necessary works. The most successful 
works are those in which the proper principles are best applied to the local conditions; 
no single process of sewage disposal exists which is capable of dealing satishictorily 
with all cases. Sewage varies in composition and is not of the same volume or quality 
in different cities or different sewers in one city, or at different times of day in a 
given sewer. The state of the weather, the season of the year, the character of the 
district with respect to residence and business occupancy, the nationality and habits 
of the population and other conditions all affect the quality and quantity produced. 
Standard methods of treatment exist, but they apply only to standard conditions. 
The success of a system of sewage treatment depends upon the completeness with 
which it is suited to the particular situation to be dealt with. To many persons the 
repetition of this fact may seem unnecessary, and yet it is to its continual neglect 
thAt most of the failures in the works which have been built are attributable. 

The best methods for the treatment of sewage have for their immediate objects the 
removal of the grit and other relatively large and solid matters, the destruction or 
abstraction of the very finely divided colloidal and other semisolid substances, and 
the oxidation of the remaining liquids. 

The processes may be said to be mechanical and biological and chemical, according 
to the principles upon which they operate. The mechanical methods aim to remove 
the relatively large solids and some of the colloids. The biological undertake to 
destroy the peculiar molecular structure of the colloids which are not removed mechan- 
ically and to carry on the oxidizing processes. The chemical procedures aid the 
mechanical and biological effects and sterilize the sewage when that extreme measure 
is attempted. No one of these processes is capable of adequately treating a sewage 
except where a partial and imperfect effect is desired. It is usual to employ two or 
more, each to do a certain share toward the general result desired. 

MSCHANICAL PROCESSES. 

a. Screens and grit chambers. — Mechanical methods include grit chambers, which 
are essentially enlaigements of the sewer as it enters the disposal plant. As the 



PUBLIC HEALTH AND MEDIOINE. 183 

sewage flows into the chamber the velocity of the ctnrent is retarded and this slowing 
causes the solid matters to settle out. Facilities are provided in the form, often, of 
dredging machinery, for removing the grit from the bottom. 

In connection with the grit badns, there are generally coarse screens composed of 
heavy bars placed an inch or more apart, for the purpose of intercepting large floating 
substances. * 

Fine screens are sometimes used to take out of the sewage the solid matters which 
are not heavy enou^ to sink readily in the grit chambers. If not removed, these 
solids become more and more comminuted and add materially to the difficulty with 
which the more refined processes of treatment can be carried on. The fineness of 
these screens and the ingenuity with whidi they are constructed, are among the 
most recent advances which have been made in the whole art of sewage treatment. 
The beet screens are so constructed as to present always a free and clean surface to 
the sewage stream. This result^is accomplished by means of machinery whidi car- 
ries the screening surface dowly up out of the sewage and there cleanses it before 
the screen automatically revolves back for a new load of soMd matters. 

Fine screens have reached their highest development in Germany. England, 
which leads the workl in nearly all other blanches of sewage treatment, possesBes but 
few examples of fine screens. The Crermany screens are standard for Grermany ; nearly 
every laige city is provided with them in some form. The forms are various; it is 
possible to find one to suit almost any requirsment. The difficulty is to know which 
is the best for the particularly case in hand, and Just what to expect of it under Ameri- 
can conditions. Again, being of oompUcated construction, it would seem necessary to 
employ a conaidenble amount of skill to operate one successfully. But this objec- 
tion is rather a general one and can not be escaped in sewage disposal. No process 
is capable of good woric without good attention. 

Between the complicated fine screens of the Germans and the conmion bar screens 
which are a necessury featinv of all works lies a large variety of screens of varying 
degrees of efficiency. Their function is to collect such relatively large substances 
as leaves, matches, cloths, paper refuse, and whatever else will gather upon them. 
Screens of these kinds are often employed and are generally inefficient, being poorly 
provided with cleaning arrangements and too coarse to gather much material. 

The screenings are disposed of in different wajrs, according to their amount, and the 
natural aptitude of the people to turn .such material to account. In Germany the 
screenings are often used as manure, sometimes they are burnt. In all cases they 
are exceedingly offensive, and diould not be stored or handled any more than is 
absolutely necessary. 

h. Settling banm. — Settling basins are regarded as one of the most useful, as they 
are one of the most frequently met with devices used for the treatment of sewage. 
They are of various types and perform various functions, although their chief useful- 
ness has, until recently, been considered to lie in the removal of solids which will 
subside if given a chance to do so. 

In its simplest form a settling basin is a tank of such size as to permit the sewage 
to flow slowly through it in about three or four hours. The bottom slopes gradually 
toward a large outlet pipe which is used when the solid matters are cleaned out. An 
inlet and an outlet for the sewage are provided at opposite ends of the tanks near the 
surfeice of the liquid. The solids are deposited as the pewage flows through the basin 
or is allowed to stand quiescent in it, according to the method by 'vdiich the operation 
is conducted. Sometimes chemicals, such, for example, as lime and iron, are applied 
to the sewage to increase and hasten the settlement; this method is termed chemical 
precipitation. It is not so much used now as formerly. 

Improvements have been made in the settling basin just described until its (Higinal 
functions, as well as its appearance, to-day are scarcdy recognizable. Among the 
most interesting and importaa t of these changes were those which were brou g^t about 



184 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONGRESS. 

by the discovery that if sewage was kept in a settling tank for a period of eight hours 
or more it would putrefy and much of the solid matters which gathered upon the 
bottom would become liquid, thereby lessening the frequency with which the tank 
would have to be emptied of its sewage and the accumulations at the bottom removed. 
This new process was thought capable of affording a nearly complete solution of the 
sewage problem, for it promised to do away with the troublesome question of disposing 
of the settlings. A settling basin operating upon the principle just indicated was 
called a septic tank. At first the limitations of the septic tank were not recognized. 
To-day it is probable that no engineer would build a septic tank for large works, even 
in connection with other devices, except under unusual circumstances. 

The latest development in settling basins is the Emscher tank, the invention of 
Karl Imhof , of the Emscher drainage district of Germany. The Imhof tank possesses 
two notable features: First, great depth and a pointed bottom, which causes the 
depositing solids to settle toward an outlet pipe, from which they can be withdrawn 
without emptying the tank of its sewage. Second, a trap through which the solids 
settle to a bottom compartment and from which they can not escai>e to the flowing 
sewage above. The sewage passes Xhrough the tank too rapidly to become foul, as it 
does in the old septic tank, but the solids imprisoned in the trap remain long enough 
to undergo a complete fermentation with a result which is truly remarkable. Whoreas 
the accumulations at the bottom of an ordinary ^ttling tank consist of a very watwy 
mud which can be dried only with great difficulty, the material drawn from the lower 
part of the ImhoC tank quickly parts with its water on standing. It can then be burnt 
or used for filling low lying land. Immense volumes of inoffensive gas are produced 
in the process, and the solids taken out are relatively small in volume and practically 
inodorous. Hundreds of new tanks have been built on this principle within the last 
few years, and many sewage works formerly employing plain sedimentation or septic 
tanks have been constructed on the Imhof principle. 

Processes of oxidation. — When sewage has been deprived of its settleable solids by 
sedimentation of some kind or the solid matters have been removed as far as possible 
by screening, it is still capable of produdng offensive odors in rivers and other natural 
bodies of water unless the diluting power of the latter is large, and for this reason some 
further process of treatment frequently becomes necessary. The odors are due to 
putrefaction, or, in oiher words, bacterial fermentation in the absence of oxygen. 
Experience has shown that in the presence of a proper supply of oxygen, objection- 
able odors will not be produced. The organic matters which are a characteristic of 
sewage become oxidized and so converted into mineral compounds which are inoffen- 
sive and incapable of becoming so. 

It has been found practicable to cause the oxidizing changes to take place in arti- 
ficially prepared beds of broken stone or other solid media through which the sewage 
is allowed to pass very slowly with an abundant supply of atmospheric air. Some- 
times the beds are contained in water-tight basins and the sewage is allowed to flow 
into them, remain in contact with the stone for a period of two hours or so, and then 
drawn off; in this case the device is called a contact bed. More often the beds are 
built upon an impervious floor without containing sides. The sewage is sprinkled 
over the top of the stones and allowed to drain slowly through to the bottom; in this 
case the beds are known as sprinkling filters or percolating filters. Both contact beds 
and sprinkling filters are capable of doing excellent work, but the latter are by far 
the more effective for a given amount of land. Large works on each principle exist 
and have proved effective even in cold climates. 

The oxidation, like the putrefaction of sewage, is brought about by the activities 
of special types of bacteria, and it is by providing the suitable conditions for their life 
processes that the desired results are secured. When suitable conditions for the par- 
ticular kind of bacterial action desired are not provided, the whole process fails. 
Thus, oxidizing beds are able to ti^e care of a definite amount of sewage stuff per acre 



PUBUO HEALTH AKD MEDIOINB. 185 

and will handle no more. If more be added, or the supply of atmospheric oxygen be. 
diminished, the bed becomes sick and the improvement in the sewage stops. 

The latest advance in sewage-disposal practice has been accomplished by doing 
away with the stone beds and giving the oxidizing bacteria their proper supply of 
oxygen directly by pumping air through the sewage. This process can apparently 
be carried on in tanks like the old-fashioned settling tanks, if necessary. Experi- 
ments made at the famous sewage testing station at Lawrence, Mass., at Milwaukee, 
Wis., Manchester, England, and elsewhere, give promise of a substantial advance in 
the efficiency, reliability, and economy with which sewage can be treated in this 
general way. 

UtUizatian of the manunal value of sewage.— There was a time when it was thought 
that the manurial value of sewage should serve as an incentive for the employment of 
this kind of municipal waste as fertilizer. Economists solemnly warned the public 
that millions of tons of nitrogen were being wantonly thrown into the watercourses 
when the world's supply of guano was showing signs of depletion. It was claimed 
that the heedless pursuit of this policy was certain to result disastrously in course of 
time. The sewage should be returned to the soil. 

Under mistaken ideas of conservancy attempts were made to apply sewage to agri- 
culture, and these efforts were persisted in in England until the subject was thoroug^y 
tried out. There are now some laige farms using sewage, not only in England, but on 
the Continent of Eiurope. But it is no exaggeration to say that there is hardly a city 
which would not willingly give up its sewage farms for more modem and intensive 
methods of disposal if it could do so without sacrificing the money which is invested 
in the existing works. Sewage fanning affords a good way to get rid of sewage pro- 
vkling the climate, soil, and agricultural conditions are favorable; but it can rarely be 
recommended unless the water, aside from the manurial ingredients, is needed for the 
crops. 

Such fertilizing value as sewage contains is difficult to turn to practical account. For 
one thing, the useful materials are too highly diluted; sewage, as ordinarily produced 
by the cities of the United States, is about 998 parts water to but two parts of solids, 
and of these two parts, only one-half is organic matter. Ordinarily, land does not 
require, nor can it take, a great deal of water at all times, and yet the sewage must be 
gotten rid of at times of rain and frost and in the unproductive period. Furthermore, 
It has been abundantly shown by competent agricultural chemists, that such fertilizing 
values as are present are not, for the most part, in available form for plant food. 

The most promising way in which sewage matters can be utilized for the manuring 
of crops is in the form of a dry powder produced from the sludge of settling basins. 
Filter presses and other drying apparatus can be employed to get rid of the water, but 
the undertaking is expensive. Some fertilizer is made in this way; the amoiint is not 
laige. Up to the present time it has cost too much to sepsurate the useful materials 
from the water. The subject, in spite of the interest which has been taken in it for 
more than a generation, still lacks practical development. 

Sludge.— In most sewage-disposal works a great deal of mud or sludge, as it is called, 
is produced, and the final disposition of this material offers many difficulties. Some 
cities carry it to sea and dump it from steam vessels constructed for the purpose; 
others discharge it into lagoons where it lies, an unsightly and malodorous mass, for 
long periods of time until the forces of luiture eventually consume it. In order to 
avoid the insanitary conditions which sewage produces when discharged upon land, it 
is often ploughed into the soil. In Germany centrifugal machines are used to express 
a part of the moisture, after which the sludge is further dried by heat and burned. 
There are plants in England and America where the material is passed through filter 
presses and then dumped upon low-lying land. 

Recently it has been found that sludge will ferment, if kept stirred up and mixed in 
cotain ways with fresh and stale matoial, and after this change takes place the water 



186 PBOOEEDINOS SSCOKO PAK AMBBIOAN ddEKTIFIO 00NGBE88. 

will easily drain away. This is the secret of the Imhof tank — ^the Dickson and activated 
sludge processes and other methods more or less resemble them. 

In some cases where the sewage is particularly rich in useful ingredients, special 
pfoceases are employed to recover the useful materials. Thus, grease can profitably 
be recovered in certain cases. We are here approaching the field of the industrial 
chemist. Corporations which think that their wastes contain valuable substances 
which it is shrewd business policy to recover, are often compelled to employ chemical 
ability to work out the best system of utilisation. 

Various trades produce peculiarly offensive liquid discharges, as, for example, gas 
making, paper making, leather tanning, wool scouring, and brewing . Much experience 
has been gained, particularly in England, in utilizing Industrial wastes, or at least, in 
ridding them of their offensive character, and the steps which diould be taken in dis- 
posing of them are still the subjecft of continuous study. Speaking broadly, the undei^ 
lying principles for the disposal of trade wastes are much like those which have been 
described in this paper for the disposal of municipal wastes. Screening, filtering, set* 
tling, precipitating by means of chemicals, biological treatment, application to land, 
filter pressing, dumping, burning, and dischaige into natural bodies of water are all 
practiced. 

LiUrattare.'^The literature of the subject of waste disposal is laige and scattered 
through the textbooks and journals of various sciences and jvofesrions. There is no 
comprehensive work which deals adequately with all branches of the subject. The 
richest literature is that of sewage disposal; the poorest is that which relates to the 
aoHd wastes. England and Germany have been the greatest contributors, although 
America is conceded to have prdduced much of incalculable value. 

A feature of American effort has been the making of exhaustive investigations and 
the publication of coirespondiDgly elaborate reports concerning the disposal of the 
aewage of particular cities. Of special interest are the reports ^ddch deal with the 
sewage of New York, Chicago, Philadelphia, Boston, Baltimore, Worcester, Cohunbos, 
Itilwaukee, Plttdburgfa, Gloversville, and Cleveland. The researches of the Lawrence 
Experiment Station of the Massachusetts State Board of Health into the dierposal of 
sewage and the purification of water are classic. 

In England the reports of the Royal Commission on Sewage Disposal, which was ap- 
pointed in 1898 and continued until 1915, easily overshadow all other work of this 
character in the scope and practical aspects of the subjects dealt with. Many English 
cities have also issued reports of the utmost value with respect to their sewage diq)osal 
problems; as, for example, London, Birmingham, Manchester, Leeds, Sheffield, Salftupd, 
and Bradford. The reports of the EngUsh rivers boards are interesting and instruc- 
tive. The reports of the Rivers Pollution Commission, the Health of Towns Commis- 
sion, and similar bodies are regarded as having laid the foundation for much of the best 
work which has been done in all countries in the disposal of sewage. In G^ermany the 
reports of the Imperial Sewage and Water Testing Station, whose headquarters are in 
Berlin, and the reports of the cities of B^^n, Frankfort, Hamburg, Dresden, Cologne, 
and many smaller places are among the most useful by way of reference. 

Wiih regard to the disposal of solid wastes, intersting information may be found in 
reports issued by the cities of Boston, New York, Philadelphia, Chicago, Baltim<n*e, 
Milwaukee, and Cleveland. 

The periodical literature is far too large to mention in detail. The student should 
consult the proceedings of engineering societies and chemical associations especially^ 
and give careful attention to tiie engineering trade papers for descriptions of the most 
recent developments in sewage and solid waste disposal. Best of all, in order to get 
a comprehensive knowledge of the subject, will be a tour of inspection of some of 
the great cities where disposal works are hi operation and where opportunity may 
be given to meet the splendidly trained and intelligent men under whom, in many 
cases, the ^Bsposal works have been constructed and to whose intelligent efforts 
further progress is to be looked for. 



FUBUO HIALXH AJTD KEDIGDrB. 187 

The Chairman. We have papers on this same subject by Prof. 
1/^Uiam T. Sedgwick, of the Massachusetts Institute of Technologyi 
and Mr. J. T. Fetherston, commissioner of street cleaning. New York 
CStj. I shall now call for their papers. 



DISPOSAL OF BEFUSE. 

By WILLIAM T. SEDOWIGK, 
MoitaehuieUi IiuUluU of Technology. 

We are all creatures of fashion, followers of fttshion in sanitation as well as other 
ihatters, but I am inclined to think that the pendulum has swung too ht. We can not 
say in sanitary matters, as we may in the law, '' De minimis curat non lex. '' The law 
does look after the least things in sanitation, and will forever look after the least things, 
because as we go along we are getting the big things looked out tar and have to attend 
to the little things. At any rate, cleanliness will always be the mother of sanitation 
and hygiene; and in dealing with these wastes, sewage, garbage, street dirt, and all 
the rest, we are dealing with fundamentals of cleanliness, and if we ever take the 
standpoint, as some people are taking to-day, rashly and without thinking, that boards 
of health have nothing to do with such thii^ as garbage disposal and the diEfposal of 
street dust and the like, because they at the moment have so much more to do with 
infection and epidemics, then we shall make a very serious mistake, and boards of 
health will find themselves by and by having a certain amount of disease from sources 
which they had overlooked. The sanitary chain is no stronger than its weakest 
link, and we have got to pay attention to aO these things. 

Now, Dr. Soper began with night soil, and the proper disposal of night soil is a very 
•erious matter. If it is put on cidtivated fields for lettuce and cabbage and the like 
to grow upon, if men track it on their boots, or chickens carry it on their feet to open 
wells, then it becomes a serious sanitary menace. In rural sanitation the disposal of 
night soil is. the i»incipal problem. In the public health service here, Dr. 
Lumsden is showing some wonderful results that he has accomplished in rural sanita- 
tion in several of the counties of West Virginia and Maryland and Indiana and 
Kansas — marvellous reductions of typhoid fever, laigely by attention to the proper 
disposal of night soil. 

While in a laige and engineering way, the board of health may be said to have very 
little to do with the disposal of ni^t soil, to take very little interest in it in some 
cases, in other cases it is going to be the principal work of the future. The invention 
and the stimulation of the use of sanitary privies is one of the most important subjects 
of the time. There is one at the hygienic laboratory now, a model sanitary privy, 
which everybody who is interested in rural sanitation or in tropical sanitation, where 
the privy is wanting or too rare, should get acquainted with. It is a most interesting 
development. 

Again, touching on a matter which is not always thought of, there is the sanitary 
disposal of sewage on steamboats and railroads. The sanitary disposal of the waste 
from these sources is sometimes a serious matter. For instance, when steamers leave 
the Chicago River and go out near the intake of the Chicago water supply, great excur- 
sion steamers laden with thousands of people, and the discharges from the closets go 
into the lake near the intake, it can not help being a serious thing. Just how serious 
the scattered disposal from a moving train is or is not, no one knows; but, as you know, 
closets are still locked upon trains in certain parts of the country passing over certain 
watersheds, and while that is a barbarous method and in some respects absolutely to 
be disapproved of, it is better than none. From the standpoint of personal hygiene. 



188 PBOCEEDINOS SECOND PAN AMBKEOAN BClEMTliflO OONGBESS. 

from the standpoint of efficiency, it is all wrong; but it is better than allowing the 
excreta to go into a public water supply over which a train may be passing. Within 
my own knowledge, I have known of two instances in which human excrement from 
passing railway trains was found right in a public water supply and not for from the 
intake. 

The question of stable manure is an important one because of its connection with 
vault building and flies, and the health officer of Brookline, a town in which I have 
been living for some time, is proposed to take municipal charge of this matter and have 
municipal disposal for a more satlBfactoiy sanitary treatment and control of the vault 
nuisance. 

I can confirm, and heartily confirm, Dr. Sopor's statement of the inefficiency of 
many street "squeegees." They simply pass over the dirt, allowing it to dry and 
blow about. I have had my mouth partially filled with pulverized horse dung and 
other refuse for so many years that I hope I am Immune, but it is not pleasant* 
Boston, for instance, in a windy time, has an atmosphere of pulverized horse dung 
and other dirt, although these "squeegees '' are used there very frequently. Anyone 
who has seen the street washing in Munich and then watched it in any of oiu* American 
cities has noticed the difference; there it is efficient, here it is generally very 
inefficient. And let me say that I heartily second Dr. Soper^s suggestion that we 
hear from oiu* Central and South American friends in regard to their sanitary 
efforts in these various directions, for we need to know more about their ways 
than we do. 

When we come to garbage, we have again a variety of connections between sanita- 
tion and engineering. From the moment the garbage leaves the kitchen until it is 
either destroyed by burning or by reduction or by hogs or something else, it is a 
nuisance and a certain source of danger; probably not a source anywhere near ae 
important as sewage or some other things, but still important. The handling of 
garbage, for example, from tenement-house districts in which a variety of diseases 
may be existent, is liable to infect the handlers; and even if no infectious disease is 
carried by it the nuisance which arises from the carting of the garbage through the 
streets by those that generally do it is unpleasant and needless except under our 
system — apparently it is necessary there. 

Then, the garbage pail in the back yard, or the garbage can, is a source of trouble. 
Dogs and cats and rats by day and by night scatter things about, and if the rat prob- 
lem is a serious one, as it always should be regarded, then the garbage can is a most 
important sanitary appliance. I have often smiled when I have observed that the 
able and highly trained officials of the United States Public Health Service have 
sometimes descended from their lofty level to invent and approve garbage cans. 
The modem medical man is so far descended from ^culaptus that he is now inventing 
and approving garbage cans; and I rejoice in this fact, for it shows that he is getting 
right down to mother earth and doing fundamental things. When, however, he goes 
further and invents a new word, "deratization,'' the philologists may have occasion 
to quarrel with him but I certainly shall not. The vermin that gather around the 
garbage paU and make the back of the house a nuisance are not only objectionable 
from a sanitary point of view, but in time of plague become very dangerous; un- 
pleasant always, dangerous occasionally, and yet back doors are neglected in your 
house and in my house. As a rule we do not pay much attention to the back door, 
however much we pay to the front. 

As to the sanitary aspects of garbage reduction and incineration and the like, so 
long as no public nuisance is produced, I see on objection to any of these, excepting 
the hog disposal method. It has been found that hogs in municipal piggeries are 
often very tuberculous, and that is, of course, a serious matter. Moreover, piggeries 
for the disposal of public refuse are almost always public nuisances, because the 
hog is not a sweet-smelling animal under any circumstances. Municipal piggeries 



PUBUG HEALTH AND MEDICIKE. 189 

have been proposed, but I do not think that the idea will bear serious consideration 
because of its nuisance features. 

Garbage-reduction plants are often a nuisance, because of the odors they produce, 
and public comfort must go with public safety. The interpretation of public we^hie, 
which brings sanitation close together with comfort, is too often overlooked. 

In this connection, and in connection with sewage and its sanitary aspects which 
are so well known to us all, I want to say there is one thing in this country which is, 
at any rate, fearfully neglected, and that is the establishment of public-comfort 
stations. In an address at Rochester two on three months ago I remarked that the 
most flagrant failure in American sanitation to-day is the ahnoet universal lack of 
public convenience or comfort stations in American cities or towns. Now, this is a 
sanitary matter connected with the disposal of personal sewage and it is bringing the 
thing down to the very bottom. The stranger within the gates of most American 
communitieB seeks in vaia for any public sanitary conveniences. If he is well dressed 
he must be refenred to hotels or other semipublic buildings; if poorly dressed, to 
saloons or railroad stations or other semiprivate or public-service stations. In sending 
out my abstract to the authorities of the Rochester meeting I wrote, as I have just 
raid, '' the most flagrant failure; " but I was in despair to find on arriving that it had 
been sent out to the press all over the country as '* the most fragrant failure," and 
I am afraid that that was quite as correct as the other, because one of my students 
came to me the other day and said, " Professor, I thought that Boston was a leader in 
sanitary matters, but if there is a worse smelling place than that comfort statkni down 
on the Common I would have to go for to find it." 

It turned out a little later, on investigation by Dr. Wilbiur, of the New York State 
Board of Health, that in Madison Square, New York, through which, as you know, 
tens of thousands of people pass every day there is no public comfort-station . They had 
one about a year ago, but it was so filthy that they decided to close it up. That, I 
think, bears out what I have been saying, that the most flagrant failiure in American 
sanitation to-day is this matter of the failure to provide public-comfort stations, and 
I may say here, by way of parentheses, that Dr. Wilbur was so much stirred up by this 
discovery of his in New York, as well as by my remarks, that he has established 
a league for the enforcement of the common decencies of Life, which is to be known 
as the "Public Comfort League." This is one of the most remarkable things that 
I ever heard of, for the constitution provides that there shall be no officers, rules, 
regulations, annual meetings, or dues. Any person may become a member at any 
time, at any place, by helping along, etc. You see what an admirable thing this is, 
such a league as we have always been looking for, having no meetings, no officers, 
no dues. 

Now, banning with the disposal of personal sewage in comfort stations and else- 
where, we come to these methods of which Dr. Soper has spoken so well and of which 
Mr. Featherston will have much to say, no doubt, although his subject is more par- 
ticularly the garbage and the street work. We do not need to dwell on the need 
of the disposal of sewage. That has been proved too often by epidemics and in sanitary 
science. I may say that at a sanitary laboratory, of which I am director, we have been 
experimenting on a method for the treatment of sewage by sulphurous acid, with 
recovery from the sludge of grease, and to oiur surprise have found it much better 
than we had supposed, so I think I may say here, and I think it will interest all the 
sewerage people as being somewhat new, that there is a possibility— I can not say 
any more than that — that a process not too costly and perhaps even slightly remun- 
erative may be devised in the near future, by which domestic sewage and certain 
trade wastes may be treated by sulphur, in this case preferably sulphurous acid, 
causing a precipitation of a sludge rich in grease, rich for sewage. Fnmi that the 
supernatant liquid can flow off, practically sterile and reasonably clear, so that it 
may be poured into a harbor or lake or stream with little sanitary dang^. The proc- 



190 PBOCEEDINGS SECOND PAN AMEBICAN SCIENTIFIC CONGRESS. 

en, then, involvet the extnctioa of & specially precipitated shidge for the grease 
which it has, and at the moment it looks as if the process might he successful. I do 
not want to say much about it, because we are always wary about these new processes 
and we have had so many failures that we do not want to risk anoth^, but careful 
and repeated experiments which have lately been made in the little laboratory, of 
which I have had the direction, upon Boston sewage and on a reasonable scale have 
led us to the point where we want to make experiments on a large scale and intend 
to do it if we possibly can. 

Anything which would thus sterilize the greater part of the liquid of sewage and 
then leave us to deal with a sludge economically valuable would be a very 
great boon. We may not have reached this, but we are certainly woridng in that 
direction. 

So, from the sanitary point of view, I want, first, in the way of recapitulation, to 
protest against the current idea in some sanitary, and more particularly medical, 
circles and boards of health that these questions of sewage disposal and garbage dis- 
posal and street cleaning and the rest are not sanitary questions, that they are not to 
be regarded within the natural purview of boards of health. That is a temporary 
fashion which must pass. I have explained the reason for it. The law of sanitation 
must take account even of the least things and of the most remote things dealing with 
the public health, and we must give attention to the sanitary aspects of garbage dis- 
posal, of street cleaning, of sewage disposal, and of all the other branches of waste dis- 
posal . Of course if we could bum everything up economically, or even at a small loss, 
it would be well to do so, provided it could be done without producing a nuisance, 
but at present in most cities that does not seem to be practicable. On the other hand, 
principles of conservation make us wish to get what we can out of these wastes. If a 
ton of garbage will keep 75 hogs a day and turn them into food for man, that is a very 
taking proposition on the face of it, and that is said to be the case; but if the keeping of 
the hogs produces a public nuisance and exposes a lot of people associated with the 
hogs and with the garbage to the contracting of infectious diseases, then it is a great 
deal better to bum the stuff up and get rid of it even at a loss. We must never lose 
Bight of the sanitary side of the case, although it is the engineering dde tiiat is always 
put first because of the economies of the problem. 



COLLECTION AND DISPOSAL OF MUNICIPAL REFUSE. 

By J. T. FETHERSTON, 
Commissioner of Street Cleaning of City of New York. 

The topics discussed in this paper will be restricted to the consideration of (1) the 
quantity, quality, and seasonal variations of household wastes and street sweepings, 
and (2) the cost of collecting and disposing of these classes of refuse. 

Household refuse consists of ashes from furnaces or heating appliances, garbage or 
oigamc wastes resulting from the preparation or use of foodstuffs, and rubbish or arti- 
cles from households not comjnrised under the terms ashes or garbage . Street sweepings 
consist of miscellaneous mata-ials removed from public thoroug^aies. 

For any particular municipality there is one most suitable, sanitary, and economical 
method for the collection and disposal of refuse, and any approach toward a satisfac- 
tory solution of refuse handling can only be attained by a detailed study of all local 
conditions bearing on the problem. Scientific data on the subject until recent years 
have been, and even to-day are, genially unsatisfacttny. For any city it is almost 
hopeless to expect a satisfactory solution of the collection and disposal question unless 



FUBUO HBALIH AND MEDIOIKE. 



191 



the amount, character, and variationB of refuse materials are definitely known for a 
period or cycle of at least one year. With such data the next step usually is to secure 
information from and study the practice of other cities, and the results therein secured. 
In all cases sanitary efficiency should receive primary attention, and cost or expense 
should receive secondary consideration. More often than not these items are con- 
sidered in reverse order. 

The collection and disposal of refuse from a sanitary standpoint involves to a greater 
degree the comfcHrt and omvenience of dtisens rather than the actual health aspects 
of the community, though it is true that garbage affords a breeding place for flies; 
dust from ashes affects the respiratory organs, while rubbish may contain discarded 
materials from the sick room, carrying pathogenic organisms. 

From the cost standpoint it is apparent that the enormous volume of waste produced 
in municipalities and the great cost of collection and disposal of refuse should be more 
forcibly brou^t to the attention of citizens generally. There are in the United States 
184 cities of over 30,000 population, aggregating 27,316,000 people. The expenditures 
for the collection and disposal of household refuse approximate 50 cents per capita 
per annum. Thus the total expenditure of 113,658,000 per year gives a clue to the cost 
of work in the larger cities of the United States. 

Local conditions, such as the character of inhabitants, geographical location, and 
and the nature and amount of food, fuel, and accessories necessary for urban dwellers, 
determine to a great extent the volume of refuse produced per capita per annum. 
Statistics from six cities in the United States and one in Canada show an average 
production of 1,361 cubic yards of housdidd refuse per 1,000 of population per year. 
(See table No. 1.) 

Comparing the foregoing statistics with similar information secured from cities on the 
continent of Europe, it is shown in Table No. 2 that American cities produce about 
2.7 times more househ<4d refuse per capita per year than fcHreign cities. (See Table 
No. 2.) 

The foregoing tables indicate the necessity for discriminating in methods of refuse 
collection and disposal on the basis of the volume of materials produced, not consider- 
ing at all the nature or variations in the materials themselves. 

For the purpose of secunng a comparison by weight of refuse in foreign and American 
cities Tables Nos. 3 and 4 have been compiled, and here also American cities are shown 
to produce about twice the amount of material discarded in foreign cities. Thediffer- 
mce between weight and volume, comparing foreign with American cities, is undoubt- 
edly due to the greater amount and lower weight of rubbish discarded in American 
households. 

Tablb I. — Household refuse, volume per annum, seven Am>er%can cities, 19 IS, 



New York: Uanhattui, Brookljm, 

Broix 

Washineton, D.C 

Boston, Mass , 

Trr^nt'^. Ontark), OaoadA 

New Orleans. la , 

Baltimire, Md , 

PhiJadelphki, Pa 



Avefage. 



Populatloii. 



ft, 118, 383 
353, 2»7 
72»,072 
475,575 
373,000 
558,485 

1,650,000 



Number 

ofool- 

lectors. 



Refuse 
collected 
per year. 



1,878 
240 
056 
361 
180 
197 
600 



7,429,858 
440,368 
066,570 
845,908 
500,688 
647,951 

2,004,000 



Popula- 
tk>nper 
collector. 


Refuse 
per col- 
lector per 
annum. 




Cu.ydi. 


2,725 


3,956 


1,472 


1,834 


1,111 


1,458 


1,248 


2,220 


2,072 


8,831 


2,835 


3,288 


2,760 


3,340 


2,030 


2,704 



Cubic 
yards of 

refuse 
per 1,000 
popula- 
non per 
annum. 



1,462 
1,244 
1,311 
1,780 
1,366 
1,160 
1,214 

1,361 



192 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONGRESS. 
Table 2. — Household refuse^ volume per annum j seven European citiei, 1912. 



Hamburg. . 
Nomberg.. 

Cologne 

Dusseldorf. 
Bannen.... 

Berlin. 

Paris 



Average. 



Population. 



976,000 
360,000 
516,000 
380,000 
150,000 
2,090,000 
2,846,966 



Nomber 

ofool- 

leotors. 



lU 
70 

150 
28 

400 

750 



Refuse 
collected 
per year. 



Popular 
tionper 
collector. 



414,011 

125,931 

232,824 

175,272 

52,320 

1,700,400 

1,974,130 



3,243 
7,371 
2,533 
5,883 
5,225 
3,796 



3,752 



Refuse 
per col- 
lector per 
annum. 



Cu,fi», 



1,135 
3,326 
1,168 
1,860 
4,251 
2,632 



2,397 



Cubic 
yards of 

refuse 
per 1,000 
popola- 
non per 
annum. 



J24.2 
349lS 
45L2 
461.2 
348.8 
813. ft 
693.4 



606.2 



Tablb 3. — Household refuse, per capita per annum, by weight, 10 European cUie$, 1912^ 



Hamburg 

Numberg 

Cologne 

Dusseldorf. 

Barmen 

Berlin 

Paris 

Finsbury Borough, London. 

Manchester 

Sheffield 



Average, 



Popula- 



'opuJi 
tion. 



026,000 

360,000 

516,000 

380,000 

150,000 

2,090,000 

2,846,986 

87,923 

731,677 

471,662 



Tons 

mixed 

household 

refuse per 

annum.1 



248,406 

75,558 

139,604 

105,163 

31,392 

1,020,200 

1,006,806 

20,403 

168,245 

121,103 



Pounds 

refuse 

per 

capita. 

per 
annum. 



50» 

41» 
541 
553 
418 
976 
707 
45» 
461 
5U 



5S0.ft 



t Weight of mixed household refuse assumed to be 1,200 pounds per cubic yard. 
Tablb 4. — Household re/use, pounds per capita per annum. 





Pounds per capita per annum. 






Gar- 
bage. 


Ashes. 


Rub- 
bush. 


Total. 


Remarks. 


New York: 

Brooklyn . . 

Bronx 

Philadelphia... 

Boston 

Milwaukee 

BulTalo 


217 
145 
119 
109 
235 
220 
137 


1,327 
496 
708 
1,112 
1,529 
476 
560 


108 
88 
51 
72 
43 
193 
120 


1,652 
729 

878 

1,293 

1,807 

880 

817 


New York Commission on Street Cleaning, 1907. 

Do. 

Do. 
Municipal Journal. Nov. 11, 1915. 
X. H. Goodnough (computed.) 
Rudolph Hering, 1907. 
Municipal Journal, Nov. 11, 1915. 


Average.. 


169 


887 


169 


1,152 





PUBLIC HBAUTH AKD MBDIOHrE. 





L«l([tho 
itreeU. 


■tnaU. 


Slmst 


rardspave- 


t,^ 


tfOa. 

StI 


I s 

flO 

i; s 


13, «n 

•SS! 


■**« 




»:« 






■S! 


SS 






to 




131 




13. a 










X.H 









Tablk No. 6. — Street HBeepmgi r 





Loirthof 
Mceeti. 


Armor 

itnets. 


Strut 
«wwptan, 


street 




3t 

S 

71 


1 31 

9 m 
a 87 

« 3S 

7 M 
« M 
11 45 


C^t^nrb 


"■"■■sit 




13! 

iS 

331 

SM 


1 






».I0 











































Table No. 7. — Monthly vanation, in percentage*, ofgarhage produeed antvaallf. 





ffir 


"Sir- 


Ckwfai- 


sgt 


& 


DatiXJit. 


Chfaxwo. 


miDd. 




Ptttnl. 

il 
■lis 

8.10 

T.n 


PtlttM. 

il 

0.70 

il 

13.31 

1 


Ptrcnt. 
0:30 

1 

ii-n 

1 .10 

1 


7 10 

il 

11.70 

1 


"1 
ll 

11 


'Ti 
11 

10.40 

!i 


S.30 

3.60 

IS 

10. W 
1330 


''"Tl 



















































194 PB0CEEDIN08 SBCOVD FAJS AMBBIOAV 80IBKTIFI0 C0KQBB8S. 

Tablb No. 8. — Monthly voriaHonf in percmtaget, o/oihet and rubbiMh produced an- 
nually. 



• 


Cleve- 
land, 
Ohio 
(State 
Board of 
Health). 


Cindn- 

iiati.Ohlo 

(State 

Board of 

Health). 


Mil- 
waukee 
(Herlng). 


Boston 
(Good- 
noogh). 


otmS- 

mood 

(Fether^ 

ftoo). 


JanoaiT .....^..r..-TTr- 


Peretnt, 
11.44 
7.97 
11.51 
9.56 
8.72 
8.36 
7.19 
7.66 
6.35 
7.39 
8.36 
5.50 


Percent. 

12.45 

11.46 

12.98 

8.17 

6.88 

6. OB 

6.62 

5.28 

6.82 

6.19 

7.12 

18.35 


Percent. 

12.46 

10.81 

11.68 

7.16 

8.86 

6.27 

4.88 

5.89 

6.38 

6.47 

9.16 

11.64 


PereenL 

10.80 

10.62 

10.47 

9.94 

8.77 

6.76 

6.09 

6.36 

6.26 

7.13 

7.86 

9.46 


Percent. 
10.6 


Fehruary 


9.6 


ifawsh..'^.!.!.... 


11.8 


AdtU 


10.7 


M^::::::::::::::::::;:::::::: :.::: 


10.9 


June 


6.1 


July 


4.7 


Aamflt T . . . r , r , . r . r . - - T T -, - 


4.6 


BeptetDDeT. ■•••••.•.•••.••..•......••••....«...•..... 


4.7 


October 


6.2 


NoveiDDef • ••.••••••..•.•••............••.......... T. 


8.4 


December 


9.7 







Table No. 9. — Monthly variation, in pereentage$, o/rubbiih produced anniMUy. 





Buffalo. 


Rochee- 
ter. 


Pitts- 
burgh. 


New 
York. 


January ..............r ■, 


Percent. 
8.62 
6.43 
7.78 
9.79 
11.97 
ia38 
7.69 
7.24 
7.30 
8.96 
6.54 
7.31 


Percent. 
8.50 
7.58 
8.06 
&78 
a90 
8.00 
9.35 
&67 
7.99 
8.94 
7.49 
7.75 


Percent. 
8.27 
5.83 
7.92 
9.44 
ia92 
9.63 
8.26 
7.84 
7.57 
9.48 
8.38 
6.49 


Percent. 
6.43 


Ffibmary 


6.28 


I'urch ' V - '. '. 


7.54 


April 


&26 


Ilay 


&81 


Jime T ,.,.-..,,,- T r r , r , r ,. T r 


8L6S 


July 


&94 


An?u8t 


a64 


September , 


9.68 


October 


9.80 


November 


a77 


December 


7.83 







One feature shown in Table No. 4, compared with the preceding table, is the separa- 
tion of refuse into three classes as generally practiced in American cities, while in 
foreign municipalities as a rule all wastes are placed in one receptacle. Here, again, 
there is a dew as to the trend of practice regarding the collection and disposal of 
wastes. Foreign cities with small amounts of materials have practically standardized 
their methods and have adopted a combined collection and disposal of refuse, while 
American cities require the separation of refuse into three classes and disposal of each 
kind separately. Attention may be called to the variation in garbage production 
among tiie borou^ of New York Oity, as indicating the necessity for studying even 
subdivisions of a city for the purpose of determining the most suitable methods 
adapted to localities within the municipality. 

It is not enough to provide general data as to the total volume or weigjit of refuse 
produced per unit of population or per year when considering the adoption of any 
method of refuse collection and disposal. The peaks and valleys of refuse production 
require determination. In American cities climate has the greatest influence in 
this regard, particularly in the production of garbage and ashes. Gcmaidering only 
American cities. Table No. 7, shows the monthly variations in the amount of garbage 
produced annually, and indicates generally an increase of approximately 50 i>er cent 
by volume during the summer season over normal production, with a slightly less per- 
centage below the normal during the winter period. The same condition is approx- 
imately true among cities in the northern part of the United States for ashes and 



FUBLIO HBALTH A2n> MENOINB. 



195 



rubbish collected together, as riiown in Table No. 8. Rubbish separately collected 
has less seasonal variations on the whole than garbage or adies, as indicated in Table 
No. 9. 

These variations in the quantity of material produced at different periods of the 
year require careful consideration in the design of plant and equipment necessary 
for the economical operation of a collection and disposal system. 

In addition to the amounts and seasonal variations of the various classes of waste, 
scientific methods of disposal d^;»end upon the mechanical and chemical properties 
of the materials to be treated. Table No. 10 presents data relating to the mechanical 
analysis of mixed household refuse, composed of fine ash or material passing through 
a three-eighths inch mesh screen; coal and dnders, or unbumed or partially burned 
coal; rubbish or generally combustible refuse; garbage (oiganic waste); and metals, 
^asB, crockery, etc. 

In foreign cities generally the amount of fine ash is greater than that shown in the 
analysis of mixed refuse in one of the borough of the city of New York, where tests 
were carried on for a niunber of years, and, surprising as it may seem, the amount 
of coal and dnders wasted is apparentiy less in New York City than in foreign cities, 
while the amount of rubbish produced is decidedly greater, except in Melbourne, 
Australia. It is interesting to note the relatively small proportion of garbage pro- 
duced in Cterman cities, and the larger amounts in Great Britain and New York. 
The variation in the metals, ^ass, and crockery discarded is hard to explain. 

The system of refuse collection depends upon the metiiod of disposal adopted. 
In foreign cities with few exceptions household refuse is collected in a mixed condi- 
tion, while in tiie United States garbage is generally separated from other dasses 
of waste, and disposed of either by incineration or by the so-called reduction method. 

Where combined cdlections are in vogue great progress has been made in elimi- 
nating nuisances due to the escape of dust and odon while transferring refuse from 
the householders' cans to the wagon body. This is particularly true in the German 
dties, where a standard type of receptacle f<»r holding wastes, having an attadied 
cover, iB so designed that it acts in conjunction with a loading device on the vdude 
whereby the transfer is made without allowing the material to oone into contact 
with the air or to be scattered about the ndg^bochood. In Great Britain and the 
United States not mudi progress has been made in collecting refuse so as to eliminate 
odors and dust, but there has been a widespread public demand for improvements 
of this diaracter. 

Tablb 10. — Medumiieai ono^ftet cfimxtdhxnmkM r^itm. 



Fine 

ash. 



Coal and 
cinders. 



bish. 



Qar- 
l)age. 



orookery, 
etc 



Autborlty. 



Berlin, Oermany 

Potsdam, Qenuany 

Cliarlottenberg, Qermany 

Kiel, Germany 

Frankfort, Oemiany 

St<dce Newington, England 

Ktaigs Norton. England 

Prahran, Australia 

Melbourne, Australia 

CUnon, Boroogh of Rkflunoid, N. Y. .. 
West New Breton, Borough of Ricb- 
mond, N. Y. 



Percent. 
46.73 
60.96 
30.58 
fia25 
49.25 



g 



.23 
42.81 
3L1 
34.7 



PereenL 
2S.77 
18.61 
37.00 
30.63 
43.14 
42.93 
46.4 
48.06 
20.66 
19.6 
28.6 



Percent. 

6.18 

2.28 

5.06 

2.21 

1.13 

16.4 

0.3 

9.26 

1L87 

10.80 

7.1 



Per cent. 

20.0 

&25 

4.86 

LOS 

.58 

34.43 

39.60 

17.67 

14.31 

8L10 

24.90 



Per cent, 
3.32 
ia87 
14.49 
6.88 
6i69 
7.36 
6.2 
3.87 
4.76 
7.6 
4.8 



68436—17— VOL x- 



i Inehided In ooal, einder. 
14 



Dr. Dfiir. 

Da 

Da 

Do. 

Da 
Leask. 

Da 
Calder. 

Da 
Fethenm. 

Da 



196 PB00BEDINQ8 SECOND PAN AMBBIOAK SOISNTIFIO 00KGBE88. 



Table No. 11.— 22^^ ditpomd in the United Statu. 



Matflrial and nMtbod of difpoMl. 



Oarbage: 

Redofliioo.. 

Incineratkm. 

Feeding pigi 

LandflU:... 

Dumping at 
Rnbblsh: 

Incineration 

Reclaniatioo and fills 

Landfills 

Dumping at sea 

Reolunation, fills, and incineration 
Ashes: 

Landfills 

Incineration 

Dumping at 
Street sweepings; 

Landfills... 

Fertilizer... 

Dumping at 



Number 

of cities 

using 

this 

method. 



95 

41 

11 

7 

2 

33 
3 
6 
3 
1 

11 
7 
3 

17 
3 
4 



Total 
population 

oidties 
using this 

method. 



16,093,000 

3,618,500 

1,960,000 

633,000 

905,000 

4.178,000 

2,035,000 

672,000 

730,000 

4,600,000 

8,093,000 

1,321,000 

765,000 

9,747,000 

645,000 

1,506,000 



Motor-driven collection vehiclee have replaced horses in a number of foreign cities, 
and it is claimed that the cost of collection by this method is less than that by horse* 
drawn vehicles. In the United States, however, the horse, with cart ox wagon covered 
or partly covered, still remain the standard types of i^paratos for collecting refuse. 

Practically every city uses some portions of refuse for land fills, and smaller cities 
use this method almost entirely until a point is reached where the cost of hauling 
to land fills exceeds the cost of disposal within the city limits, where the short haul 
ofibets the increased cost of disposal by a scientific process. Table No. 11 summarizea 
the methods of refuse disposal practiced in cities having over 30,000 population 
in the United States. In cities of over 100,000 population a separate collection 
of garbage and reclamation of grease and tankage ox fertilizer base is apparently 
the most popular practice, mainly from the standpoint of economy. Twenty-six 
cities, aggregating over 15,000,000 people, diq>ose of garbage by the reduction sys- 
tem, while 41 municipalities with about one-quarter the population incinerate the 
garbage. Feeding garbage to pigs, using it as land fills, or dumping it at sea is prao* 
ticed in 20 of the larger cities in this country. Rubbish generally is either incin- 
erated or placed on land fills. Ashes, in the majority of cities, are placed on land 
fills. Incineration of various classes of refuse, except street sweepings, is practiced 
generally among small cities and towns and is adaptable to all classes of waste, while 
reduction can only be applied to the treatment of garbage. Either system may be 
made sanitary in effect by proper design and efficient operation of the disposal works. 

Garbage, when separated from other classes of waste and treated by the reduction 
process, provides two by-products: (1) Grease, varying from 3 to 8 per cent by weight 
of the original material, depending upon the location of the city and the character 
of the population. This grease is worth from 3 to 5 cents a pound and is used mainly 
for soap making. (2) Tankage or fibrous residue, after extracting grease and mois- 
ture, averages from 12 to 15 per cent by weight of the original material and contains 
fertilizing elements of value (|6 to |10 per ton) for various classes of crops. Net 
revenues from the treatment of garbage indicate the possibility of obtaining a profit 
at the plant varying from 75 cents to $1. 50 per ton of garbage treated, depending upon 
the process used and the efficiency of the organization and management of the works. 

Garbage-reduction works are genmully located in sparsely settled sections, and 
as most of the plants are operated by private companies for commercial reasons, 
no greater attempt is made to eliminate odors than necessity demands. As a 
result, such plants have been frequent offenders on account of nuisances created. 



FUBUO HEALTH AKD MBDICIKB. 



197 



though with proper design and management this drawback can be entirely eliminated 
or minimized to a point where the odors are not objectionable. 

Probably the most sanitary method of refuse disposal is by incineration, as naturally 
all classes of waste contain some portions of combustible matter. Two methods of 
incineration are practiced in this country and abroad — (1) incineration of mixed 
household refuse, where all wastes are collected together and burned by the aid 
of forced draft at high temperature; (2) incineration of garbage alone or with portions 
of rubbish or ashes. By-products from high-temperature incinerators consLst of 
steam power and clinker. Considerable information is available as to the heat values 
of the various classes of refuse, so that plants may be designed with some degree 
of knowledge concerning the proportions of the furnace required and the tempera- 
tures necessary to prevent the escape of noxious gases. The tables which follow 
summarize the available tests and the calorific values of various claBses of household 
refuse in this country. For comparison with foreign cities, Table No. 17 is intro- 
duced. It is interesting to note in this latter table that the incineration of mixed 
refuse in German cities deals with a material high in ash, low in moisture, and gen- 
erally lower in calorific value when compared with similar materials in New York 
City, though the conditions are reversed in San Francisco. 

Table No. 12. — Analyses of garbage. 



CincinDati, Ohio 

deretend, Ohio 

Columbus, Ohio 

Dayton, Ohio 

Boro^h of Manhattan, 

ICilwaiilree, Wis. 

Borough of lianhattan, 



Ether 
extract 
(grease). 



Percent. 
4.02 

8.85 

8.96 

8.88 

6.70 

8.77 
6.00 



Phos- 
phorie 
add. 



Percent. 
0.29 

.24 

.22 

.19 

.50 

X31 
L84 




nii 



Percent. 
0.04 

.64 

.59 

.51 

.94 

L61 
L76 



Potash. 



Peret. 
a28 

.30 

.25 

.20 

.37 



LOl 



Authority and remarks. 



Ohio State Board of Health re- 
port, 10 samples. 

Ohio State Board of Health re- 
port, 28 samples. 

Ohio State Board of Health re- 
port, 31 samples. 

Ohio State Board of Health re- 
port. 30 samples. 

Lederle Laboratory, 4 samples. 

R. E. W. Somers. 1 sample. 
Otto H. Klein, 4 samples. 



Table No. 13. — Heat values of garbage. 





Mois- 
ture. 


Ash. 


Com- 
bustible. 


B. t. u. per pound. 






Origfaial 
sample. 


Dry 
sample. 


Authority. 


Cindnnati, Ohio 

Cleveland, Ohio 

Columbus, Ohio. 

Dayton. Ohio 


Peret. 
76.7 

75.6 

76w4 

8a6 

74.4 

77.66 

78.5 
75.0 
82.3 

78.00 
73.26 

47.66 

07.0 

71.4 


Peret. 
3.66 

3.20 

3.30 

X57 

2.72 

8.15 

2.95 
3.50 
2.47 

13.614 
5.14 

26.35 

4.49 

3.72 


Percent. 
19.70 

21.16 

20.27 

1&82 

22.88 

19.20 

18.60 
20.91 
15.23 

8.386 
21.60 

25.99 

28.51 

24.88 


2,000 

2,057 

1,994 

1,712 

2,304 

1,832 

1,925 
2,100 
1,413 


8,553 
8,459 
8,448 
8,776 


Ohio State Board of Health re- 
port. 10 samples. H 

Ohio State Board of Health re- 
port. 28 samples. ^ 

Ohio state Board of Health re- 
port, 31 samples. 1 

Ohio State Board of Health re- 




Dort, 30 samples. 
OdIo State Board of Health re- 


KmiYfl^ld, Ohio 




port, 4 samples. 
Ohio State Board of Health re- 


Marion, Ohio 




port, 2 samples. 
Do. 


Steuben rllJe. Ohio 




Do. 


ZanesviUe. Ohio. 




Ohio State Board of Health re- 


llUwaukee.Wis 

BorouKh of Richmond, 

N. Y. 

Toronto, Canada 

Boroosh of Manhattan, 
bol 


4,522 
8,351 

4,914 

8,723 


port, 3 samples. 
R. E. w . Somers, 1 sample. 


2,233 
2,572 


B. F. Welton, 25 samples. 

Works Department Laboratory, 
45per cent rubbish, 4 sampka. 
D. C. Johnson, 3 samples. 


2,507 


Klein, 1910, 4 samples. 









198 PROCEEDINGS SEOOSTD PAK IMBBIOAN BCIENTIFIO G0NQBB8S. 

Table No. l4.-^Heat vdUi^i o/itreei »w€9pmg$. 





Mois- 
ture. 


Ash. 


CJom- 
busUbto. 


B.tu. 

pound 
(original 
sample.) 


Authority. 


Cfnclnill^tf 


Peret. 
43.0 

29.0 


Peret. 
42.30 

48.8 

82.1 

41.64 

36.69 
67.73 


Percent. 
13.9 

22.2 

17.9 

66.61 

36^86 

4L02 


1,446 
2,133 
1,680 


Ohio State Board of Health report, 6 


Clft vftland ............. , 


samples. 
Ohio State Board of Health report, 3 


Dayton 


samples. 
Ohio Dtate Board of Health report, 1 


Do 


2.86 

S7.46 
L36 


sample. 
New York Commission on Street 


3,666 
3,730 


Cleaning, 1907, 4 samples. 
KMn. 1910. 4 sw^pieA- 


BorooRh of Richmond, 
N. Y., dry manure. 


Lederie LaboratofT, 1906, 2 samples. 



Tablis No. 15. — Heat valuet of rubbish. 





Mois- 
ture. 


AOl 


Com- 
bustible. 


B. to. per pound. 






sample. 


samiH** 


Authority. 


Borough of Richmond, 
N. Y., West New 
Brighton. 

Toronto, Canada 

Borough of Manhattan, 

Borough of Richmond, 
N. YV;cUfton. 


PereL 

6.78 

33.02 

11.50 

6.3 


PereL 
13.87 

7.82 
7.59 
11.6 


Percent. 
80.36 

50.16 
8a 91 
83.3 


6»833 

6,449 
6,701 
6,636 


7,351 

8,136 
7,673 
7,063 


B. F. Welton, 16 samples. 

Works Department Laboratory, 

Toronto, 3 samples. 
D. C. Johnson, 4 samples. 

A. B. HiU, 13 samples. 



Tabls No. 16. — Eeai value$ of ashes and componmU ofajikes. 



Cincinnati. 



Cleveland., 



Dayton.. 



Chicago. 



Do 

Borough of Rich- 
mond. West New 
Brighion. 
Do 



Borough of Manhat- 
tan. 

Boroujdi of Rieh- 
mond. Clifton. 
Do 



Description. 



Ashes. 



.do. 



.do. 



Fine ash. 



Cinders 

Coal and cinders. 



Mois- 
ture. 



Fine ash 

Coal and cinders. 

Fine ash 



Peret. 
7.8 



14.1 
19i3 
L92 



1.16 
1.34 



1.20 
7.65 
3.8 
L9 



Ash. 



PerH. 
61.70 



63.9 
69.3 
77.76 



63.0 
39.93 



77.40 
3L83 
33.3 
7&6 



Com- 
busti- 
ble. 



Peret. 
3a6 



32.0 
21.6 
3a 33 



45.84 
6a 73 



21.40 
6a 63 
73.0 
36.6 



B.t.u.per 
pound. 



Origi- 
nal 
sample. 



3,087 
1,815 
1,680 
3,167 



6,941 
8,396 



3,846 

9,310 

10,946 

3,119 



Dry 
sample. 



Authority. 



3,348 
3,113 



8,610 
3,880 



11,360 
3,180 



Ohio State Board of 
Health report, 7 
samples. 

Ohio State Board of 
Health report, 6 
samples. 

Ohio State Board of 
Health report, 
samples. 

Bureau of Streets, 
Chicago, 30 sam- 
ples. 
Do. 

B. F. Welton, 96 
samples. 

B. F. Welton, 1 sam- 
ple. 

Otto H. Klein, 4 ssm- 
ples. 

A. E. HUl, 13 
pies. 
Do. 



PUBUO HEALTH AND MEDIOIHB. 
Tablb No. n.— JlmtwUue* of mixed n/we. 





'-~-"--""'"-^"""- 








AriL 


tun. 




a 


AuttOrtty. 




bon. 


Hrdn>- 


Callu- 


ToUl 
bdrtlUa. 






6&7S 
10. (t 
UH 
MM 

■a. to 

H-TS 
SbM 

11. « 

M.87 
U 


un 

3t.l3 
10.08 

10.11 
KLIO 
■.IT 

a.K 

13.96 

S!' 


ILIA 
<L00 
10. BS 

i&«e 

XU 
II.(B 
».» 
30.31 


an 

.00 

.01 
.3> 
■M 

.30 
.43 
.« 


3.U 

8.10 

4.7S 
T.M 
LJ3 
3.73 

1.18 
J.H 
3.M 


1173 
17.10 
U.B 
10.00 
19.08 

n.si 

J0.01 

33. S7 
M.B 

34.9 


1,(31 
t,03B 

1,877 
1,115 

i,»a 

3,981 

i,m 
i,m 
*,m 

1,873 
41141 

4,174 

1,410 






»■"£: D, 




»m'"" 






















WlMbadao. 










B T wetton. 








'ffi.ffiSSS: 











Tabli No. is. — Chewtieai eompotilion of mixed houseluild refute. 





ss: 


■ran. 


Hydro- Nltro- 


Bul- 


0.y- 


Adi. 


K^.. 


ci(tt^^.y..B«RKicb 

8«n^£>,0U 


19.74 


3&«8 
13.10 


Ptrtl. 
1.30 
L70 


.50 


PffCl. 


'li 

8. SI 


17.x 


A. E. Hill, 11 Min- 

CompuM, IWlher- 
■ton. 



Tablb No. 10. — Cost o/eotUeHon and ditpotal ofhouMKold refuMt. 





Poputati™. 


Amount 


'iS* 


Vl»h. n««i>h I.»»ln 


S7,«3B 

sss 


ill 
























tmburs 









200 PBOGEEDINOS BEOOKD PAN AMEBIOAK SOIEKTIllO C0KQBB88. 



Table No. 20. — Co»t of eolUcHon and disposal of household refuu. 



Washingtoii, D. C... 

Newark. N.J 

CftmbrkiKe. Mass 

Chicai;o,lu 

Buffalo, N.Y 

New Orleans, La 

Loubvllle, ICjr 

R ichmond , va 

Spokane, wash 

Galveston, T«x 

Manchester, N. H 

Salt Lake (%, Utah 

Harrlsbure, Pa 

Kansas Citv, Mo 

Augusta, (Hk 



Popula- 
tion. 



353,000 

395,000 

110,000 

,142,000 

415,000 

334,500 

232,000 

115,000 

99,000 

37,000 

69,000 

87,330 

61,000 

241,767 

41,000 



Amount 
expended. 



$158,550 

190,605 

65,000 

1,231,065 

272,075 

169,635 

93,606 

54,62S 

50,036 

90,604 

22,534 

39,416 

26,520 

51,724 

14,968 



Per optta 
cost per 
annum. 



90.450 
.484 
.501 
.574 
.655 
.507 
.421 
.470 
.606 
.557 
.327 
.451 
.434 
.214 
.366 



Authority and remarks. 



Year, 19U. 

Do. 

Do. 
Bureau of Census, year 1900. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 



Further information concerning the chemical composition of mixed household 
refuse is provided in Table No. 18 for one borough in New York City, also San Fran- 
cisco, Cal., where differences in the composition are again apparent, especially in the 
amount of moisture, carbon, and ash. It is evident from the statistics herein pre- 
sented on incineration that the success of this method will depend to a Isif^ degree 
upon the preliminary investigations covering the heat values and chemical compo- 
sitions of the waste in conjunctiotn with the amount of material to be dealt with in any 
locality. Effective organization of the force employed and efficient management 
of the disposal works are essential in any type of plant in order to eliminate nuisances 

The amount of street sweepings or cleanings removed from pavements in any 
municipality depends almost entirely upon local uses of the public thoroughfares. 
Only a general clue can be given as to the volume of street sweepings removed per unit 
of pavement per year. Statistics on this subject are not always satisfactory, but two 
tables have been compiled, one covering eight foreign cities, compared with eight 
American cities. Abroad about 29.6 cubic yards of material are removed per 1,000 
square yards of pavement per year, while statistics for American cities show the 
removal of only 24.9 cubic yards. To one familiar with the use and abuse of streets 
in this country and in foreign cities, it would seem as if the figures should be reversed, 
and it is interesting to note that one of the cleanestcities in the world, Berlin, accounts 
for the greatest amount of material, 50.7 cubic yards removed per year from the unit 
of pavement area. 

Two cost tables are presented on this subject, No. 19 covering the collection and 
disposal in seven foreign cities, and No. 20 containing similar information for 16 
American cities. The average cost for the American cities is approximately 48 cents 
per capita per annum, as against 45 cents per capita per annum in foreign cities, where 
wages generally are less than half the standard rates in the United States. Apparently 
the refuse collectors in the United States are harder worked men than the foreign 
collectors. 

The statistics herein presented summarize on a broad basis the best available data 
on the subject and are presented in concise form in the hope that those interested may 
find them of value. 

BIBUOQRAPHY. 

Report of Commission on Street Cleaning and Waste Disposal, New York City, 1907, 
by H. de B. Parsons, Samuel Whinery, Rudolph Bering. 

Report of a Study of the Collection and Disposal of City Wastes in Ohio, 1910. Ohio 
State Board of Health. 

Report on Garbage Disposal for the City of Milwaukee, Dec, 1907, by Dr. Rudolph 
Bering. 



FUBUO HSALTH AVD IfXDIOINB. 201 



Report en the OoUeetiaii and DmpoBil of Rehiae for the City of Chicago, 1914, by 
I. S. Oabom and J. T. Fethenton. 

Report of the Second Special CommiBsion to Inveatigate the Collection and Disposal 
of Refuse, City of Boston, 1910. 

Report <m Refuse Collection and Diqixwd for City of Albany, 1908, by Wallace 
Greenalch. 

Report to President of Borough of Richnumd, 1906, Test of West New Brixton 
Destructor, by J. T. Fetherston. 

Report to President of B<Ht>ug^ of Richmond, 1914, Summary of Results of Refuse 
Disposal at West New Brighton and Clifton Plants, J. T. Fetherston. 

Report of the Bureau of Streets Investigation, Chicago, 1913. 

Report for year 1914, Department of Street Cleaning, New York City, by J. T. 
Fetherston, Commissioner. 

Specifications for Garbage Disposal System, San Francisco, 1910, Marsden Manson, 
City Engineer. 

Specifications for Refuse Indneratiog Plant, Toronto, 1914, by I. S. Osbom, En- 
gineer. 

Specification for Clifton Destructor, 1910, J. T. Fethenton, Engineer. 

The Collection and Disposal of Municipal Wastes, X. H. Goodnoug^ (Journal ci the 
Association of Engineering Societies, Vol. XL, 1906). 

Municipal Refuse Disposal: An Investigation, by J. T. Fetherston, Transactions 
Am. Soc. C. E., Vol. XL. 1908). 

Some Notes on Municipal Cleaning and Refuse Destruction, by J. T. Fetherston, 
Proceedings of Municipal Engineers, N. Y. City. 

Final Disposition of City Refuse by Mixed Recuse Destruction, etc., by J. T. Fether- 
ston, Journal of the Slociety of Chemical Industry, 1908. , 

HaQsmQU in Strassenkehricht, by Dr. Clemens DOrr. 

Die Strassenreinigung in Den Deutschen Stftdten, by Dr. Ing. Franz Medner. 

Elektrizit&t Aus Kehricht, by Etienne de Fodor. 

Genmml Statistics of Cities, 1909, published by Bureau of Coisus, 1914. 

American Society of Municipal Improvement8--Statistics. 

Municipal Journal. 

Engineering News. 

Engineering Record. 

The Chairman. The papers to be presented at this session have 
been completed. It is especially desirable to have some formal 
debate on the subject, in view of the importance of the subject itself 
and the importance of the papers presented. 

Dr. GuTFEBAS. As reference has been made by some of the gentle- 
men to the tropical cities and the request has been made directly 
that information be given with r^ard to what is being done there, 
I think it my duty to inform you on that point, although we are all 
devoting our time to learning all that we can about it. 

In the last two years a system of separate disposal of sewage has 
been completed in Habana. The discharging place for this sewage 
of this large city could not be a more favorable one. The sewage 
of Habana is discharged by a separate system into the Oulf Stream. 
The same may be said with regard to the garbage and street and 
house refuse. Nothing could be more favorable than this. Still, 
undoubtedly; the mani^ement of this city refuse, the handling of it 



202 PBOCEEDINOS SOOOKD PAN AMBBIOAN SOIEKTIFIO 00NGBE8S. 

in the city, the carrying of it to the lighters that go out to the sea to 
dump it into the Gulf Stream, i3 a disagreeable process at least, and 
perhaps accompanied with^ some danger. Therefore we have tried to 
introduce a system of incineration and we have had a large plant 
built for the purpose of doing away with the carrying out to sea. I 
must say that this plant, although it is completed, has not yet been 
used, because it is supposed to be expensive. I imagine that this 
means that the other system of dumping into the Gulf Stream is 
not so bad a one as was thought since we are not willing to go to a 
little more expense in putting into operation the already compiled 
incineration plant. It may be true, as one of the gentlemen said, 
that these plants must be perfectly built and conducted. Probably 
our trials with the plant have shown that it was not properly built 
and that perhaps we were not very sure that we were going to handle 
it in a satisfactory manner. 

As one of the g^itlemen has said, when you have a system of 
sewage disposal in large cities you also have in the same city other 
systems. This means that we have still in Habana cesspools, espe- 
cially the outlying districts. But certainly the introduction in the 
last three or four years of this enormous system of sewage disposal 
in the city of Habana ought to have made a striking difference in the 
amount of typhoid fever in the city. I am afraid it has not, and that 
has surprised me greatly. It is one of those subjects difficult to 
accoimt for. Our typhoid-fever rate at Habana is rather high; not as 
high as in some American cities, but higher than in others. We do not 
believe that this is due to our water supply. The manner of distri- 
bution of typhoid and the character of the water are very strongly 
against the idea that it is a water-borne disease; but at any rate this 
very radical change in the disposal of sewage, the doing away with 
an enormous niunber of cesspools in the city of Habana, has not had 
any influence upon the nimiber of cases of typhoid. In fact, typhoid 
has rather increased slightly in the last three years since this sewage 
system is in operation. We believe that our typhoid fever is a 
contact disease and that the distribution of it in the city of Habana 
is due to contact. 

I was very much interested in the remarks that were made as to 
whether garbage disposal was a sanitary question. Of course it may 
become suddenly a sanitary question of intense importance, as it 
does, for instance, when plague appears in a city. Disposal of gar- 
bage may be considered almost one of the principal sanitary questions 
before a city. At a time of plague the disposal of garbage so that rats 
can not get at it and the utilization of that disposal as a means of 
doing away with rats by removing the food supplied to them are of 
the most extreme importance. 



PUBUO HEALTH AKD HEDICnTE. 208 

Of C011IB6 I have been speaking of a large city, a rich city, as 
Habana is. When we come to the disposal of sewage and garbage 
in the rural districts, it is quite different. The human excreta are 
▼ery commonly thrown upon the surface in the rural districts of 
Oaba, yet we do not have much hookworm th^re. Cuba is very far 
from presenting the same situation that Porto Rico does with r^ard 
to the numb^ of cases of hookworm. It is not a national problem 
with us. llie garbage, etc., of houses is usually disposed of by 
dumping. 

Dr. AoRAMONTB. Perhaps I might be allowed to furnish a Kttle 
additional information to Dr. Guiteras' remarks. This question of 
sewage and r^use disposal in Habana is in the hands of two dif- 
ferent departments — the sanitary department and the department 
of public works. The department of public works has charge 
of the disposal of sewage refuse and garbage from houses, while 
the sanitary in a way supervises how this garbage is collected, etc. 
We have a national health organization, as you probably know. 
The head is the secretary of public health, a member of our cabinet. 
This national organization takes in every city and every munici- 
pality in the Republic of Cuba. Habana is only different from the 
other cities in having a special service in that direction. The ques- 
tion of public health can not be separated from the sanitary question 
in its engineering or medical aspects. We have sanitary ordinances 
which are applied to all the cities, all the mimicipalities in the island 
of Cuba, and they must all obey these ordinances. The ordinances 
refer to the disposal of garbage or its collection from houses, etc., 
providing the means under which the work shall be done, and, by 
the way, 'insist that it should always be collected in metal pails 
or barrels. The garbage is also indirectly under supervision of the 
sanitary department, while the street cleaning is in the hands of the 
department of public works in Habana. In the smaller cities of 
the island it is under the chaise of the sanitary officers. 

In Habana the care of the streets is divided into two parts. One 
is really the street cleaning and the other is the collection of manure 
from the streets. This is in the hands of private individuals, who 
utilize the manure for fertilizing purposes, and who also collect the 
manure from the large stables, public hack stables, etc., and sell 
it to tobacco planters in the eastern part of the island mainly, lliey 
coUect it in huge piles, ferment it, and then carry it into the interior. 
The manure from the private stables, of course, is carted off separ- 
ately from the garbage and house refuse. 

As I said, it ia difficult to conceive how the medical question can 
be separated from the engineering or the question of sanitation. We 
have a particular condition in Cuba that is unlike, of course, the con- 



204 PB0CBEDIKQ6 BBOOKD PAK AMBBIOAK SOIBKTIFIO 00KGBBS8. 

dition in large countrieB. We have no inland waterways. Therefore 
the question of poUution of streams does not exist with us. The water 
employed for drinking purposes in large cities is not surface water, 
it is spring water; therefore the contamination of water supplies 
from streams and trains does not concern us. Trade wastes engage 
the attention of the sanitary department particularly lately with 
r^ard to the immense amoimt of waste produced in the distilleriee 
of the large plantations, which throw their waste into the small 
streams, as we have no large rivers. But these small rivers have 
fish and the waste kills the fish, and sometimes a very unpleasant 
condition arises. This question is now being attended to. I believe 
Dr. Guiteras knows better than I do about this. The idea is to have 
these wastes go to a reservoir of some kind, remain there for a con- 
siderable period of time until they are self-purified, and then dumped 

into these rivers, when they would do less harm. 

Dr. Kebleb. I was interested in some of the remarks made by Dr. 

Sedgwick, particularly that feature referring to the inhalation of 

street filth. Most of the material that is dropped on the streets or 

sidewalks is dried, and during a vdndy day is, of course, wafted into 

our faces, our nostrils, and our mouths. I have frequently wondered 

why we forbade spitting on the sidewalk and in a way invited spitting 

on the street. To my mind, there is not very much difference. 

As a matter of fact, the material dries as rapidly in the street as on 

the sidewalk. It is considered a matter of inconvenience, possibly, 

but I personally have never been able to see why such a distinct 

element has been made of that particular feature. 

The Chatbman. As there is apparently no further business, the 

chair will annoimce this session adjourned. 

Adjourned at 11.26 o'clock. 



GENERAL SESSION OF SECTION YIIL 

New Ebbitt HoteLi 
Ttiesday afternoon, January 4$ 1916, 

Chairman, Sam. L. Rogers. 

The session was called to order at 2 o'dock by the chairman. 

The Chairman. The program opens with a contribution by Dr. 
E2dwin O. Jordan, department of hygiene and bacteriology, University 
of Chicago, Chicago, 111., Dr. Jordan has requested Dr. Ransdell to 
kindly read his paper. 

THE PURIFICATION OF WATER SUPPLIES. 

By EDWIN O. JORDAN, 
Chairman Department of Hygiene and Bacteriology , Univernty o/ Chicago. 

DiflcuflBion of water purification in this paper is limited to the hygienic aspects of 
the subject. Clarification of a muddy water, removal of an excess of iron, softening 
of a hard water are all ends desirable in themselves, but they are not purification in the 
sense in which that term is here considered. Removal of turbidity may be economic- 
aUy and esthetically important; installation of a municipal water-softening plant may 
be demanded by considerations of convenience and economy, but softening and 
clarification of water are never matters primarily concerning public health. If a 
eommunity desires and can afford to pay for a clear or a soft water, it can get it. The 
degree of expense in this direction that is justified in comparison with oth^ needs 
is a question to be determined by each community, bearing in mind that the demands 
of the modem city are many and urgent, and remembering that in but few instances 
are funds available to carry out aU the measures of improvement that appeal to differ- 
ent groups. 

Most citizens would agree in principle, if not in practice, that the sanitary purity 
or direct relation of a water supply to health is by far its most important feature. 
Consideration of purification of water may therefore be here consistently restricted 
to the methods of rendering a contaminated or potentiaUy dangerous supply safe for 
use. 

WHT PURIFICATION » NBCBSaARY. 

The present necessity for water purification in civilized countries is in the main a 
consequence of two Victors: First, the greatly increased demand for water under 
modem conditions of life; second, the increasing density of population on most parts 
of the earth's surftu^e. It is becoming more and more difficult to draw for a water 
supply of any size upon a body of surface water that is uncontaminated or at all 
events not liable to occasional or accidental pollution; as is well known infectious 
material discharged by a single human being is sufficient to poison many gallons of 

206 



206 PROCEEDINGS SECOND PAN AMERICAN SCIENTIPIO CONGRESS. 

water and to cause hundreds of cases of disease. It is difficult also to obtain the 
volume of water sufficient for a large and rapidly growing community. Many of the 
smaller towns and villages in the United States rely on deep wells as a source of sup- 
ply, and from a sanitary point of view such waters are usually excellent. In many 
r^ons, however, the amount of available underground water is limited and if a large 
amount of water is required by a municipality, surface waters more or less exposed to 
pollution must be taken. Where surface waters are resorted to, the need for purifying 
them is so plain in some cases that there can be no question of its imperativeness, as 
with the Merrimack River used by the city of Lawrence, Mass. ; the Hudson River, 
used by the city of Albany, and the Schuylkill River, drawn on by Philadelphia. 
In these cities simple inspection of the water source is sufficient to show that the 
river water used as a source of supply is contaminated with fresh sewage and in an 
untreated condition is grosBly unfit for drinking purposes. Water purification in 
these cities has been followed by a marked diminution in the amount of certain dis- 



On the other hand, the need for purification of a surface water supply is not always 
so obviously urgent to the untrained judgment, and detailed observation of disease 
prevalence and of the bacterial character of a water is necessary before general agree- 
ment on the desirability of purification is reached. This has been the water supply 
history of some cities on the Great Lakes. The city of Cleveland hesitated for several 
years before undertaking the construction of a filter. Detroit and Buffalo have been 
rather recently convinced of the desirability of protecting their water supplies by 
chlorination. 

Still other large cities are so fortunately situated in respect to surface water sup- 
plies that artificiBkl purification for the time being is not considered necessary. These 
are practically all in localities where the water e^ed levied on is owned or controlled 
by the municipality, and wheate long storage of impounded wators in natural or arti- 
ficial reservoirs can be trusted to effect a natural purification. New York and Boston 
are well-known examples of cities depending on protected and stored surface water. 

THB DBVBLOPMBNT OF WATBR PURIFICATION. 

Public water supplies, although not unconmion in the early history of southern 
Ehirope, were practically unknown in the Middle Ages, and the large modem water 
supply s3rBtems have been developed for the most part in the last 70 years. Stor- 
age of water was undoubtedly practiced in antiquity, but was not consciously 
retorted to as a means of purification, and the first deliberate attempt at purification 
of water on a laige scale seems to have been less than 100 years ago, when, in 1829, a 
slow sand fiHer was built by one of the London water companies. Even in fhia 
instance the immediate end in view was clarification of a muddy water, and it wb» 
not until the connection between drinking water and disease beotune manifest some 
20 yean later that the filtration of the whole London water supply was more definitely 
undertaken as a hygienic measure. Purification of public water supplies became 
general in England and on the Continent of Europe two or three decades earlier than 
in this country, owing perhaps to the greater density of population in many regions 
and to the glaring evidences of pollution in many streams serving as water sources. 
European cities that delayed or boggled water purification often suffered severely 
from water-borne diseases, as did the wealthy Glerman city of Hamburg in the cholera 
epidemic of 1892-93. 

In the United States, as in Europe, development of public waterworks has taken 
place almost wholly since 1850, and the introduction of methods of purification is 
yet more recent. A beginning in water purification had been made at Poughkeepsie, 
N. Y., and elsewhere before 1890, but progress has been much more rapid since that 
date, owing in large part to the impetus given to the study of water purification by the 
investigations*of the State Board of Health of Massachusetts. These investigations^ 



PX7BU0 HBALTH AND BfEDICINB. 



207 



begun in 1887, were soon followed by tbe conftnMtion of a modem sand filter plant 
At Lawrence, Maes. (1893), and the striking sucoeas et this filter in reducing tyi^md 
lever aerred as an object lesson to the whole country. 

It was calculated by Hazen that in 1900, 6.3 per emit of the urban population of 
the country (towns ol over 2, §00 population) were supplied with filtered water, while 
in 1911, according to G. A. Johnson, this proportioa had arisen to over 20 per cent. 
The following table that I have compiled from the information given in the McGraw 
Waterworks Directory and from other sources of information shows the present condi- 
tion in the larger cities of the United States. 

Tablb I. — CharaeUr of water supplies in cUies of the United States with over 10,000 

population in 1915, 



Wells and springs 

Riven aod streams. . . . 
Impounding reservoirs. 

Wells and rivers 

Unknown , 



Total. 



Treated. 



Number 
of cities. 



28 
141 

ao 
» 

15 



3S2 



Popula- 
tion. 



3,491,810 

10,780,M7 

1,993,035 

5,408,300 

571,566 



21,818,164 



Untreated. 



Unknown. 



Number i Popula- 
of cities. 



76 
23 
19 



147 



>0pu]8 

tfon. 



3,215,168 
1,068,418 
5,360,524 
1,880,813 
93,801 



10,516,718 



Number 
ofdties. 



08 
35 
19 
16 
7 
83 



163 



PO 



opula- 

tlOD. 



1,705,500 
608,423 
843,536 
464,000 
458,813 
516,378 



4,645,288 



It will be noted that while over 60 per cent of the total city population of the 
United States is at present supplied with water treated by some method of purifica- 
tion, the actual proportion of the population supplied with hygienically sale water is 
ht greater. The water from deep wells and from storage reservoirs is unquestionably 
in laige part of excellent quality, even if not subjected to artificial purification. It 
is fair to assume that 30,000,000 out of the 36,500,000 people living in cities with over 
10,000 population are now provided with water initially pure or more or less effectively 
purified. Taking into consideration smaller towns and villages, it seems likely that 
at least 50 per cent of the total populati<m of the United States is to-day supplied 
with water of a high degree of purity. 

Hasen estimated that in 1904 water of a more or less unsatisfactory quality was 
supplied to approximately 52 per cent of the urban population of the United States 
in cities of more than 25,000 inhabitants; at present^ 1915, this statement, as to as 
•anitary quality is concerned, would hardly hold true for more than 20 per cent. 



MODERN MBTHOD8 OF PUBIFICATION. 

(a) Storage, — ^A high degree of natural purification of water can be effected by 
storage. When the water of small streams is impounded in a reservoir instead of 
being pumped directly into water mains important changes occur. Suspended mat- 
ter in part sinkB to the bottom and the water becomes clearer, the color of the water is 
usually lessened owing to bleaching by the sunlight, and the total number of bac- 
teria in the water is materially diminished. Most impcvtant of all, any diseaee- 
pTodudng bacteria that may have found their way into the tributary streams tend to 
perish during the sojourn of the water in the reservmr. A cardinal factor in bringing 
about the death of pathogenic bacteria in water is time. So far as is known, disease 
germs introduced into water never multiply under natural conditions, but progrea- 
sirely and rather rapidly die off. The longer a water can be stored, therefore, either 
in an artificial reservoir <« in a natural lake or pond with protected shores, the less 
liable it is to harbor disease germs. This principle of storage, based on the hi|^ 
mortality of typhoid bacilli and allied bacteria suspended in water, is being utilised 



208 PROCEEDIKOS SECOND PAK AKKRTCAN SCIENTIFIC CONGRESS. 

apparoitly with high succeas in the treatment of many large svabnoe water supplies. 
New York and Boston, as already mentioned, are relying mainly on this method (o 
insure the purity of their sui^lies. The safety of the London supply is thought (o 
depend very largely upon storage. Adequate storage is often all that is needed. In 
cities where other methods of purification are employed, preliminary storage is highly 
advantageous rince it reduces the hurden upon filters and in other ways fodHtateB 
the application of special purifying treatment. 

(6) Slow Mtnd fiUen.— The use of beds of sand carefully superimposed on gravel in 
water-tight basins and through which water flows by gravity was probably the first 
method employed for water purification (London, 1829) on a large scale. The earlier 
European filtration plants were all of this type. In this country slow suid filters 
have been installed at Albany, N. Y.; Pittsburgh, Pa.; Washington, D. C; Philadel- 
phia, and other cities. Through such filters water may be commonly passed at a 
rate of 3,000,000 gallons daily per acre of filtering surface, and if the water treated is 
not very tiirbid or badly polluted, a rate of 6,000,000 gallons or more daily may be 
permissible. It is important that the speed at which the water passes through the 
sand shall not vary suddenly or in different parts of the filter, and ingenious devices 
for regulating the flow are in use in order to maintain a uniform rate of filtration. 
Disturbance of the filtering surface by ice also impairs the eflldency of the operation 
and in some instances has been followed by outbreaks of disease. 

One of the principal elements of expense in the operation of slow sand filters is the 
necessity for removing and eventually cleaning and replacing the thin upper layer 
of sand which becomes clogged in operation. The frequency with which the sand 
surface must be scraped and renewed depends largely upon the amount of suspended 
matter in the water treated and upon the rate of operation. The use of ample pre- 
liminary settling basins or storage reservoirs will lessen the operating cost, as well 
as introduce an element of safety. Taking into consideration the interest on the 
capital invested in construction and other proper capital charges, together with the 
cost of maintenance, the average cost of purifying water by slow sand filters is about 
$8 per 1,000,000 gallons under present conditions in this country. On the basis of a 
daily per capita water consumption of 125 gallons this involves an annual cost of 
about 36 cents per capita. 

(c) Rapid sand filtration, — Slow sand filters are not adapted for use in many parts 
of the United States because the amount and fineness of the suspended matter in many 
American rivers leads to premature clogging of the sand and a total obstruction of 
operation. A somewhat different type of filter known as the mechanical or rapid 
filter has proved to have marked advantages in dealing with very muddy water, 
such as is found in the Ohio and Mississippi Rivers. If a turbid water is first treated 
with some coagulating chemical, such as sulphate of aluminum or sulphate of iron, 
it can be passed through sand at a much higher rate than is possible with the untreated 
water. The development of rapid filtration with the use of a coagulant has been 
largely a matter of American invention, and in its beginning depended to a great 
extent on the use of patented processes and mechanical devices protected by patent 
The expiration of some of these patents has opened the road for a wider appUcatioD 
of this method and has been followed by important developments. Experiments 
at Louisville and Cincinnati have established the applicability of the coagulating 
process to large volumes of water, and at present rapid sand filters are in operation 
at Cincinnati, Ohio, Minneapolis, Minn., St. Louis, Mo., an^ many smaller cities. 
Suitable automatic devices for controlling the application of the coagulating chemi- 
cal are indispensable, since any material excess or deficiency of the coagulant is fatal 
to successful or economical operation. Many of the earlier installations of rapid 
filters by private firms were not properly supervised, and in some cases the original 
plant was improperly constructed or allowed to deteriorate so that the whole process 
for a time fell into a measure of disrepute. 



PUBUO HEALTH AND HEDIOIKS. 209 

The cost of ooDstruction of rapid mnd filten is much kiB than that of Bkrw mod 
fihen, but the cost of operation is greater. Beckoning all charges, the total cost per 
miihon gallons of water purified averages distinctly less (about |6 pw million gallons) 
by the rapid than by the slow process. 

(d) OermicUkd treatment. — AlthousJi ui the course of years a great variety of chem- 
ical substances have been proposed for the disinfection or partial sterilization of water 
supplies, only a few of these have won any extended practical application. The 
use of osone for water sterilization possesses certain theoretical advantages. Several 
small plants using ozone have been operated in European countries, but in practice 
the relatively high expense of generating the ozone and bringing it in intimate con- 
tact with the water to be treated has so far proved an obstacle to the utilization of 
this mode of treatment for large supplies. It is possible that the availability of cheap 
electric power for generating ozone combined with othw fiivorable tectors may, under 
•ome conditions, render ozonization desirable. The development of cheapw ger- 
micidal processes, however, has diecked, permanently perhaps, the general intro- 
duction of ozonization. 

The objection of high cost obtains also with respect to the use of ultra-violet rays. 
These rays, which are conveniently generated by specially constructed lamps, have 
a hig^ germicidal power, and quickly destroy bacteria in clear water. Experimen- 
tally ultra-violet stailization has very desirable qualities, but thus far, owing to the 
expense of operation and to the necessity for a preliminary clarification of v^ry tur- 
bid waters, it has not been used in this country for large soJe installations. 

The use of calcium hypochlorite, ''chloride of lime," or "bleaching powder'' has 
for some years past quite overshadowed other methods of germicidal treatment. 
Variations in the character of the water and in the composition <A the conmierdal 
bleaching powder affect the amount that it is necessary to add to secure germicidal 
efficiency, but in general the quantity of the powder used ranges from about 5 to 15 
pounds for each million gallons of water treated. The cost of bleaching powder under 
normal conditions has been leas than 2 cents a pound; including the cost of appH- 
calion hypochlorite treatment costs not more than one-tenth as mudi as filtration. 
The action of the hypochlorite is similar to that of ozone and depends on the 
strongly oxidizing powers of the hypochlorous acid that is formed when the bleadi* 
ing powder is added to wat«r. 

The advantages of the hypochlorite treatment are the cheapness, harmlessness, 
ease, and speed with whidi it may be employed. The diief objection is the liability 
to the production of disagreeable tastes or odors whidi its use entails. Chlorine gaa 
itself has a distinctly unpleasant odor even in small quantities, and the action of the 
h}rpoch)orite on certain organic matters present in water also generates disagreeable 
tastes and smells. Complaints on this score in communities where hypochloritt 
treatment of the water is practiced are especially common in cold weather. Waters 
differ in respect to their tendency to develop objectionable odors, and in practical 
operation some waters are very troublesome. An important improvement in the field 
of water disinfection has been the substitution of liquefied chlorine gas (*' liquid 
chlorine ") for calcium hypochlorite. The gas, which is generated by the electrolyaia 
of brine, is dried, cooled, and comi^essed, and is then marketed in liquid form in 
portable cylinders under pressure. The advantages claimed for the use of the gaa 
indude superior economy and simplidty in regulation. Liability to cause unpleasant 
odors is said to be much less by this mode of treatment. Overdosing, however, may 
occur both with liquid chlorine and bleaching powder. 

Rssm/ra ov water PUBmcATiON. 

When a polluted water that serves ad a source of munidpal supply is treated by 
slow sand filtration the most conspicuous immediate change in the health of the 



210 PB0CEEDINQ3 SECOIH) PAN AMBBIOAK SCIENTIFIC CONQBESS. 



community is a drop in the typhoid death rate. This has been demonstrated re- 
peatedly in European citiet, as in Hambui;g» for example, and in many American 
cities. In Lawrence, Albany, Pittebiugfa, and Philadelphia, Blow sand filtration of 
% hi^y polluted river water has been followed by a reduction in the reported typhoid 
mortality to one-third or even one-fourth of that formerly prevailing. A deciease 
in water-caused in^t mortality has also been noted.^ It is yet unknown to what 
extent the connection between in^t m<»rtallty and sewage polluted water supplies 
is due to infection with the typhoid bacillus. In some instances, though not in all, 
the so-called Mills-Beincke phenomenon has been observed, namely, a decline in 
the general death rate minus the tyj^oid component, and in the reported deaths 
from certain other diseases, such as tuberculosis and pneumonia, not onmmmily 
regarded as water borne.' 

There is no doubt that some deaths from typhoid infection both in infants and 
adults have been and still are reported under some other designation. I have elsa- 
where ' called attention to the decrease in reported deaths from ''malaria" in Albany, 
N. Y., following the installation of a sand filter. It is unquestionably true that in 
other cities some of the deaths in the past reported as due to "malaria*' or ''typho- 
malaria*' should have been properly classed with those from typhoid fever. Mis- 
taken diagnosb may explain to s(Hne degree such decline in general death rates as 
can not be refierred directly to the diminution in deaths epecifically attributed to 
typhoid fever. Thus, in St. Louis, a correqxmdenoe can be noted in some years 
between the number of r^>orted deaths from typhoid lever and the reported deaths 
from "malarial fever." 

Tabls 2.— Dsfitlkt reported in 8i. Lotitt. 



Year. 


Typhoid 


inotttoi 


Year. 


Typhoid 


IbJirUl 
fefrar. 


1800 


140 
105 
441 


216 


1818 


171 


184 


1891 


1804 


179 


1M2. 











In mote northern cities, where for various reasons the diagnosis of death from 
"malaria" is less likely to be made, the same correspondence can yet be noticed 
under certsin conditions. 

Tablb ^.—Deathi reported in Chicago, 1891, 



Month. 

i 

Janottrj 

yebrusrr 

March 



T ypho id 



87 
61 
71 



MilMiA. 



7 



16 



Ifontti. 



ApilL 
May. 

Tune. 



Typhoid 



188 
406 
167 



Matarls. 



18 

as 

7 



There seems no escape from the conclusion that at least some — probably a large 
proportion— H>f the deaths recorded as due to "malarial fever" in these cities were 
in reality caused by typhoid infection. 

It has further been shown by Dublin * from a study of insurance records that the 
normal expected mortality is doubled among typhoid convalescents during the first 
two years after their recovery from the disease. In his statistics tuberculosis, dis- 
eases of the heart and kidneys, and pneumonia were prominent among the causes 
of death in a limited number of typhoid patients subsequent to recovery. If this 

t Moliai^lln, R«priat Irom Pnblto HMlth Baports, No. H, lOlB, Wanhlnfton, D. C. 
< Sedgwick and MacNutt, Jour. Infect. ]>ia., 1010, 7, p. 480. 

* Transactions, Amar. Soc off CiyO Engineers, Inter. Eng. Congress, 1006, 54, D, p. 306. 
« Amer. Tour, off Pub. Health, 1016^ N. 8. h, p. SO. 



PUBUO HEALTH AHD MBDIdKB. ' 211 



conehision proves generally valid, there must alwaye be expected eome leeBening of 
ihe general mortality in additk>n to that due to the typhoid component, and perhi^ 
in some cases a measnn^le diminution in the death rate irom tuberculosis and 
other diseases accompanying a decrease in typhoid fever due to water purification. 
In a word, certain individuals appear to be so affected by the typhoid infection that, 
although surviviz^ for a time, they die within two years from tuberculosis or cardiac 
lesions. To what extent the Mills-Reincke phenomenon and Hasen's theorem 
are explicable on this basis is a matter for further investigation to determine. 

Granting that many deaths from typhoid fever and its sequelae are prevented by 
alow sand filtration, the question may be raised as to what degree of safety is attained 
by this method, whether absolute or limited. The necessity of care in operation is 
w^ known. Bacterial and other observations clearly show that dangerous bacteria 
may pass through the sand, if there is any '* accident'' to the filter or any '* disturb- 
ance" of its normal action. The epidemics of cholera at Altona, Germany, and 
typhoid fever at Lawrence, Mass., illustrate the way in which the formation of ice 
can intoiere with the safe operation of a filter. 

While the harm from such unusual intwruption of mnmal filter action is sufficiently 
demonstrated, it is not so easy to measure the degree of danger existing under more 
ordinary conditions. Reliance on bacterial averages of effluents may be misplaced, 
since a low average may be reached ev^i if occasional breaks occur in a long series 
of low numbers. Should typhoid bacilli pass through a filter during one hour 
in 24, or for one day in the year, absolute protection is plainly not afforded. 
While the data for a final judgment on this point do not exist, it must be admitted 
that there is some evidence that the attempts to treat a highly polluted raw water, 
place at times too great a burden on the filter. Intestinal bacteria of the B, coli 
type may appear in the effluent in such cases in numbers thought by some observers 
to indicate danger.' 

Among the recent attempts to establish standards for safe drinking water may be 
noted the report of the commission appointed by the United States Treasury Depart- 
ment to consider standards for water supplied to the public by common carriers 
engaged in interstate commerce.^ The commission reported as follows: "(1) The 
total number of bacteria developing on standard agar plates, incubated 24 hours at 
37^ C, shall not exceed 100 per cubic centimeter; (2) not more than one out of five 
10 cubic centimeter portions of any sample examined shall show the presence of 
organisms of the B, coli group." A study of the records of filtration plants shows 
that in some instances the application of such a standard would lead at times to the 
condemnation of filter effluents. It has been suggested that the standard proposed 
is too severe for general municipal water supplies,' and perhaps this is a just criticism, 
but in any case it is clear that the maigin of safety in some filtration plants is not 
very great. 

Tlie results of rapid or mechanical filtration are essentially similar to those of slow 
sand filtration. Tlie percentage bacterial removal reaches practically the same 
height as in the slow sand filter, and a marked decline in typhoid fever has been 
observed in many cities following the introduction of rapid filters. In Cincinnati, 
Ohio, Columbus, Ohio, Paterson, N. J., and other cities, the typhoid death rate has 
sunk to low figures after rapid filters were installed. The necessity for careful and 
unremitting supervision of operation is quite as great in the case of rapid filters as 
with the slow sand type. The safety of the mechanical filter effluent is no more cer- 
tain or absolute than that of slow sand filters. 

Excellent results as regards bacterial efficiency and security from typhoid infection 
are achieved by bleaching powder and by liquid chlorin treatment. The chief 

1 McLaagtalin: Reprint, Pabtic Hoftlth R6ports,No. 204, Jan. 26, 1914. 

> BaoUriological Standard for Drinking Water, Reprint, 232, U. 8. Public Health Reports, 1914. 

* Fnller: Jour. Franklin Institute, July, 1915, p. 42. 

68436— IT—VOL x 15 



212 PR0CBEDIN6S SECOND PAN AMBBICAN 8GIEKTIFI0 C0NQBB88. 



difficulty experienced in this mode of water purification lies in the cloee approxi- 
mation for many waters of the limit of germicidal efficiency and the limit of inoffensive- 
ness. If unpleasant odors are produced by the chemical, the maintenance of an 
adequate bactericidal strength often proves difficult in the tece of complaints from 
hundreds of water consumers. The city of Cleveland is thought to have suffered 
excessively from typhoid in 1913 in consequence of a decrease in the dosage of hypo- 
chlorite.^ Temporary cessation of the hypochlorite or reduction to an amount inade- 
quately germicidal may sometimes be followed by a definite typhoid epidemic, as in 
the outbreak investigated by the writer at Quincy, 111., in 1913.' 

A remarkable reduction of typhoid has been observed in some cases to acc<Hnpany 
the hypochlorite treatment. The experience of Milwaukee is in point. 

Tablk 4. — DeathBfrom typhoid per 100,000 population^ Milwaukee, Wis,* 

1906-1910 (average) 27 

1911 (hypochlorite used intermittently) 19 

1912 (hypochlorite used continuously after September, 1912) 25 

1913 (hypochlorite used continuously after September, 1912) 11 

1914 (hypochlorite used continuously after September, 1912) S 

1915 (estimated, liquid chlorin treatment begun Mar. 31, 1915) 5 

Other similar instances are on record in which a marked typhoid decrease has been 
chiefly attributable to chlorin treatment of the public water supply. In such cases 
it is interesting to note that although clarification is not effected by the chlorin treat- 
ment, the sanitary success seems at least as great as when filtratbn is practiced. 

One noteworthy development of the chlorin treatment has been its application 
either to the raw water or to the effluents of slow sand and rapid filters. Hypochlorite 
dosage of the water applied to filters or of the filter effluents has in bet become an almost 
universal procedure. (See Table 5.) It does not yet appear that this practice is 
accompanied by any measurable decline in typhoid fever in cities previously served 
by a modem well-operated filter. 

Tablk b,— Methods of toater purifieatUm in ciUei of the United Statee with over 10,000 

population. 



Population 



- 


Slow aand flltratton. 


Rapid saod iUtntion. 


Chlorin 


• 


With 
(dilorin. 


Without 
chlorin. 


With 
chlorin. 


Without 
chlorin. 


treatnMot 
alone. 


Citi«8 


13 
2,886,233 


19 
1,073,200 


105 
7,343,087 


46 
8,835,980 


67 




5,793,419 





THB OUTLOOK. 

A few probable developments in water purificatbn in the United States can be fore- 
cast. It seems likely that the public demand for a clear, as well as a purified water 
will increase and that sand filtration of the mechanical type will become more genial. 
It is also probable that the increase in pollution of suribce waters consequent upon 
growing density of population will tend to overburden filter plants and that If the 
raw water can not be protected, chlorinatbn will be resorted to as an adjunct to 
filtration. In the near future practically all surface waters not adequately purified 
by protected stcnrage will be treated by some purifying process. Already approxi- 
mately 80 per cent of the population of cities of over 10,000 inhabitants and over 50 

I Collins and Pflrklns, Cleveland Med. Joor., 1914, 13, p. 786. 

s Jour. Infect. Die., 1913, 13, p. 16. 

> Prom Information kindly tarnished me by Dr. Q. C. Ruhland, health oommisBloiMr, Milwaukee. 



PUBLIC HEALTH AND BCBDIOIKB. 213 

per cent of the total population of the country are supplied with purified surfoce 
wvter or from ground water sourcee for the most part of excellent sanitary quality. 
At the i»e0ent rate of progress water-borne disease in the cities and larger towns of 
this country ' will within 10 years be relatively rare. 

The Chairmax. If I am not mistaken it is the rule in this section to 
grant a limited time to the discussion of any paper under consideration. 

Col. HoFF. I move that the discussion be postponed until after the 
reading of other papers of a similar character. 

Seconded and approved. 

The Chairman. The next contribution is by Prof. E. M. Chamot, of 
the laboratory of sanitary chemistry, Cornell University, Ithaca, N. Y. 
I think the secretary has had a communication within the last few 
minutes from Dr. Chamot. 

Secretary Whttmore. This letter is from Ithaca, N. Y., dated 
January 4, 1916: 

An attack of rheumatism and neuritis will prevent my attendance at the congress, 
and therefore the reading of my paper on Tuesday afternoon. £. M . Chamot. 

The Chaibman. We are sorry that the doctor is not present. His 
paper will go into the proceedings if there is no objection. Hearing 
none, it is so ordered. 



THE APPUCABILITY OF MICROSCOPIC METHODS TO THE STUDY OF 

WATER-SUPPLY PROBLEMS. 

By E. M. CHAMOT, 
Froftnor of Chemical Mkro9Copy and SanUary Chemistry ^ Cornell University, 

The great desideratum in all inveetigations involving the quality of a water supply or 
the efficacy of a system of water purification is that the results of the tests or analyses 
shall be avaUable in the shortest possible time. It is therefore no exaggeration to say 
that the most serious problem which confronts the water analyst and water works 
official is that of obtaining information concerning the quality of a water in question 
before such water can have reached the service pipes and have been used by the con- 
sumer. That our present methods are in the great majority of cases too slow and hence 
inadequate will be gainsaid by but few analysts and sanitarians, for year by year the 
increasing number of water purification plants of the rapid American type which are 
seldom properly operated forces upon our attention the fact that in the majority of 
these plants the true quality of the filter effluents can not be known until some hours 
after the water has been drunk by the public, since in most of these plants the rates 
of filtration are very high and the capacity of clear wells or distributing reservoirs 
relatively small. 

Granting that it is intelligent supervision of the plant and not analytical control 
which is of the greatest value and all important, we are forced to recognize that the 
knowledge gained by the analyses must be regarded as documentary evidence avail- 
able for reference and study, to guide in the future operation of the plant, and to serve 
as proof, in the event of controversy, of the quality of the water at the time the sample 
was taken. 



> Joar. AiiMr. Med. Assoc., 1915, 64, p. 1322. 



214 PBOGBEDIKGS SECOND PAH AMERIOAN 8CIENTIFI0 00KQBB88, 

Since it is esBential in all bacteriological methods that time be allowed for the growth 
and development of bacterial colonies it is unlikely that any culture medium can be 
discovered containing materials which will so stimulate and accelerate growth as to ma- 
terially reduce the time which must now elapse before we are able to obtain the results 
we need in order to pass intelligently upon the waters in question. But if we are wil- 
ing to recognize the quite obvious fact that essentially that which we are striving for 
is always in reality an opinion as to quality and not very accurate numerical results, 
then we may hope to add to the present accepted standard methods, supplementary 
tests yielding approximate results, easily and very rapidly obtainable. The develop- 
ment of such methods will enable the analyst to make many examinations of filter 
effluents in the course of a day. On the other hand very frequent platings of effluents 
from a number of filter beds is a task requiring too much time, labor and expense to be 
generally practicable. Few water purification plants indeed are financially able to 
perform the number of daily examinations of water that good management and oidi- 
nary common sense require. It follows, therefcnre, that there is but one system of very 
rapid bacterial enumeration which we may hope to successfully develop and this is a 
direct count by means of the microscope of the bacteria present. Al though a numbtf of 
such direct microscope count methods have already been proposed they have attracted 
little attention and have never received the study and trial as applied to routine work 
which they deserve and to which they are entitled. Most of these direct microscope 
count methods are modifications of the Hesse suggestion or that of MQller. In the 
Hesse * method the bacteria are concentrated by filtration through a bacteria proof 
filter, while in the Mtlller ' method sei>aration of the bacteria is accomplished by the 
centrifuge. A portion "of the concentrate corresponding to a known volume of the 
original sample is then spread upon an object slide, fixed, stained, and examined. By 
means of a coordinate rule eyepiece micrometer adjusted to cover a known area of the 
preparation the stained bacteria are counted and from these counts the total number of 
bacteria per cubic centimeter can be calculated. 

These methods are capable of yielding results bearing a very Mr approximation to 
the colony counts obtained on gelatine. The numerical figures are usually a little 
lower than the standard coimt, being from 90 to 98 per cent of the latter. It is not 
my intention to here discuss the details of these microscopic methods nor to burden 
you with a recital of modifications and improvements. It is my wish to point out 
that methods exist which will enable us to obtain an idea as to the number of bacteria 
present, with little labor and expense and a total expenditure of time of not over an 
hour. In actual practice, after a little feimiliarity with the technique, we may obtain 
a count of the bacteria present in from 30 to 45 minutes, corresponding to 94 to 95 per 
cent of the counts we will obtain on gelatine at the end of 48 hours. 

We have here, therefore, even granting its inaccuracies, a means at our command 
of very rapidly estimating the number of bacteria present in a sample of water with 
little labor and no disagreeable after-cleaning of dishes and apparatus and no appro- 
ciable waste of material. We can also by means of microscopic methods, make 
very frequent tests of filter effluents in rapid American system plants and obtain an 
idea of what the filters are doing, and this before the water can have reached am- 
sumers, a matter of prime importance when dealing with questionable efficiencies 
due to so-called air-bound filters, filters overtaxed to take care of some sudden emec- 
gency, filters whoso normal run has been greatly shortened through clogging by the 
sudden development of some organism, or filters in which the upper or effective part 
of the filter bed has ruptured through sudden changes of head and loss-of-head. All 
of these conditions are apt to arise in any and every plant. The quality of the filter 
effluents is then immediately in question. If the number of bacteria in an effluent 
rapidly increases and the raw water is a contaminated one, it is only a matter of a short 

» Hesse. Ztschr. f. Hyg. u. Infekt.-Krankh., 69, 522; 70, 310. 
• Mttller, An*, f. Hyg., 75, 189; 82, 57. 



PUBUO HEALTH AKD MEDICINE. 215 

time before this effluent will contain objectionable species of bacteria. It is rare 
indeed that oiganisms of the B. ooli group are jMresent in numbers in a raw water of 
low count and still rarer in filter effluents from properly washed and operated filters, 
unless these effluents run relatively high in bacteria. To this rule, however, there 
are exceptions. One interesting and very unusual case of this sort has come under 
the speaker's personal experience. A new unstripped reservoir, formerly employed 
tt9 pasture land, was flooded in the spring, then followed a serious drought during the 
summer months. During the latter part of the summer the water in the reservoir 
became very low and stagnant. The coimts on gelatine at 20^ and on agar at 38** 
became substantially identical, averaging 200 colonies per cc. with practically every 
colony one of the B, coli group. Filter efflents gave from 10 to 30 colonies per cc. 
on gelatine at 20^ at the end of 48 hours, yet with this low count it appeared that from 
10 to 20 of these were to be ascribed to the B, coli group. A direct microscopic count 
in such a case would give information of little value. 

No doubt many other less striking unusual cases could be cited, yet they are unusual, 
and it will be found that in the vast majority of days in the year where questions 
involving the doubtful efficiencies of filters arise, direct microscopic counts will yield 
all the information necessary for the guidance of the plant superintendent. Were 
such methods studied, developed, and adopted in practice, the public would be 
insured a water of a much better quality. It seems to me, therefore, that we can not 
afford to longer ignore the practicability of such control methods. 

There is also another valuable application of the method of direct microscopic 
bacterial count which is worthy of note and trial. A daily problem of the water 
analyst is that of deciding upon the dilution of a given water under examination 
which will yield him plates with not over 200 colonies developing per cubic centimeter 
at the end of 48 hours. If he is in doubt, several dilutions must be made, involving 
a loss of time, labor, and culture media. A direct microscopic count gives informa- 
tion with little loss of time and labor which may be utilized to good advantage in sub- 
sequent plating, while at the same time an excellent idea of the bacterial quality of 
the water is also obtained. 

The one most serious drawback to direct microscopic counts undoubtedly lies in 
the little evidence diagnostic of species which it affords. We need in all cases not 
only an enumeration of the bacteria present but also information as to their species or 
groups. It may be possible that the method can in the near future be improved so 
as to afford at least a slight diagnostic value over and above the information yielded 
by the morphology of the organisms seen, but it is doubtful whether this phase can 
be developed to any satisfactory degree. In spite of these drawbacks, the water 
analyst should be willing to recognize the fad that direct microscopic counts are 
invaluable in the majority of everyday water problems. 

There is only one type of water where such an examination is obviously of no value 
and this is in the analysis of * 'sterilized'' or ''disinfected" waters. Here we meet 
with the question of not how many bacteria are present in the water, but how many 
are living. Direct microscopic counts give us only the bacteria present — Hving or 
dead cells are alike counted. Plating methods give us only the count of those living 
and developing at the end of a given period of incubation. Both methods together 
carried over a long period of time should yield data of inestimable value. Nor is it 
beyond the range of possibility that staining methods are discoverable which will 
differentiate between living and dead cells. 

'fhe term "microscopic examination of water" has become through usage so closely 
associated with biologic, limonologic, or planktonic studies that its broader field 
of usefulness and sanitary applications have been almost lost sight of and generally 
neglected in America, and our standard methods for the examination of water (ail 
to contain a single statement or suggestion as to the microscopic examinations, save 
for searching for odor and taste-fHXKlucing organisms. 



216 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONGRESS. 

The study of water sediments, of suspended mattere, the association of certain species 
observed in large numbers with that of a suitable environment necessarj- for their 
development, which environment is of an insanitary character; the presence of forms 
of life in a water which should be absent and could not possibly exist were that par- 
ticular source free from pollution, are matters which no modem water analyst can 
afford to ignore. Many times a microscopic examination will solve a difficult problem. 
Permit me by way of illustration to briefly cite several cases of the kind of application 
we may make of microscopic sediment examination. 

A smiill stream flowing through the grounds of a large corporation developed r!uring 
cue summer months a foul odor. In order to abate the nuifiance it became ne^ essary 
to find the cause of the trouble. A number of drains from laboratories, shoy>B, and 
houses discharged into the stream . Qhemical and bacteriological analyses eliminated 
one by one these drain lines as the direct cause of the nuisance. Samples of the water 
of the stream taken above these drains gave on chemical analysif evidence of grosB 
pollution^ while the bacteriological examination showed the presence of fecal and 
intestinal organisms. The analyst held that the water was receiving sewage. This 
was denied upon the basis that the sediment in the stream was not of the character 
and color mot with in small brooks which are sewage polluted to an extent of giving 
off foul odors, and moreover the presence of feral and intestinal organisms was to be 
cx]>ected, since a large stock farm was located upon the drainage area of the stream 
les ' than a mile above the point of sampling. It should be explained here that the 
bro )k flowed through a relatively long line of tile imder a roadway sidewalk and 
fillod-in ground and the samples were taken at the lower end of this culvert. The 
waier analyst insisted, however, that the cause was sewage and that search should 
be matle for a broken sewer line or an overflowing cesspool. Another factor entered 
in the problem in that the stream water varied greatly in character at different times 
of day, seenrng to indicate an intermittent sewage discharge. The matter rested 
here through the winter and spring, but the next summer the odor became unbearably 
f(>ul. Analyses showed a greater amount of contamination than before and again of 
marked variation in amount. Microscopic examination was resorted to with most 
excellent results. It was possible to demonstrate that the stream carried at times 
relatively large amoimts of wood pulp and that this wood pulp was of the character 
of that of the toilet paper employed in the water-closets of the corporation, and further 
that the appearance of this disintegrated tissue paper coincided with the periods of 
maximum odors. This was evidence of a character not to be ignored. The sewer 
line was traced, found to cross the culvert tile above referred to. and excavated. 
The culvert tile were found to be cracked, the sewer tile above sunken on each side 
where it crossed the stream tile, opening up the sewer-tile hubs. Fine material was 
percolating through the loose soil and entering the little stream. 

Here we have a very striking example of the value of microscopic examination in 
aiding in locating the exact cause of the nuisance in a water known to be grossly pol- 
luted and fiuther of pointing out the remedies which should be applied to abate a 
nuisance. As a matter of fact, the microscopic examination alone gave all the infor- 
mation necessary, and had it been applied in the first summer it would have solved 
the problem witliout recourse .to either chemical or bacteriological analyses. 

Similarly in the case of drinking water, ofttimes both chemical and bacteriological 
examinations prove a water to be unfit for household use, yet the cause of the trouble 
is obscure or indeterminate. In the majority of such cases the microscope will usually 
supply the missing links in the chain of evidence. An excellent example is afforded 
in a problem arising in the case of a drilled veil. The facts were these: Two old 
people died under circumstances pointing to the water of their well as the cause. 
The small farm was purchased by a city contractor and the house and its siuroundings 
cleaned and repaired. The well, 95 feet deep, drilled in the rock and cased for some 
60 feet, received special attention. A huge slab of concrete, 10 fort square and 2 feet 



PUBUO HSALTH AND BCEDIOIKB. 217 

thick was cast about the well casing, a small catch basin with tile drain for leading 
ofif the water was provided to prevent water pumped from the well from flowing upon 
the soil in the vicinity of the well rasing and seeping back into the well. Having 
thofi improved the property and protected the well, two years later the new proprietor 
requested an analysis of the water. This analysis need not be given in detail; both 
chemically and bacteriologically the water was bad and the microscopic examination 
of the sediment pumped from the well disclosed a remarkable state of affairs, in that 
fragments of all sorts of ordinary articles of food and household debris could readily 
be detected and identified. These included cereal and potato starches, cooked and 
raw; muscle fibers; fragments of human hair and those of domestic animals, cotton, 
wool, and Hnen fibers dyed and undyed, such as would be found in the sweepings 
from carpets and floors; in other words, all the material normally to be foimd in dish- 
waters and laundry and household wastes. 

It was obvious that dishwaters and slops had penetrated into the well, but no evi- 
dence as to just how this had taken place was obtainable for some time. The cesspool 
into which dish and laundry waters were being dlschaiged was water-tight and so 
situated as to preclude any possibility of this source of contamination. The nearest 
neighboring farmhouse was over 3 miles away. Floor sweepings were being burned. 
The surface of the ground round about the well and the house afforded no possibilities 
of surface waters entering the well. There existed no visible drains. It was there- 
fore surmised that the pollution must date back to the time before the improvements 
w^re made and that there must have been some drain line from the kitchen sink past 
the well . Upon investigation this supposition was found to be correct. There formerly 
did exist a subsoil wooden trough passing close by the well, but the manner in which 
the water of the well became befouled was not that anticipated, namely, a break 
in the trough and a leaky well casing, but proved to be due to a joint in the shale 
rock forming the precipitous bluff of a lake. The abandoned drain dischaiged over 
the edge of this bluff about 122 feet high. The dirty water stnick a ledge upon the 
rocky wall some 70 feet down from the top. This ledge was formed at a joint in the 
stiuta and the inclination of the strata was such (so far as could be observed) as to allow 
a percolation of water to a level just below that of the water table of the well. By dig- 
tnng into the joint a short distance material was found of the same sort as that forming 
tho sediment in the well water. Inasmuch as two years had elapsed since the waste- 
water drain had been abandoned and the well had been pumped dry on many occa- 
sions, it was evident that the polluting material had completely filled the joint and 
would render the well water unsafe for an indefinite period. The more the well was 
pimiped the more the putrefying material could enter. 

It iB further worthy of comment that the water of this well was long regarded as a 
sulphur water because of its hydrogen sulphide odor. The milky turbidity was be- 
lieved to be precipitated sulphur. The water being very cold, and high in dissolved 
gases, it was much sought after in the neighborhood as a mineral water, and its power- 
ful cathartic effect was ascribed to purgative salts in solution. This is one of the 
only moderately deep-seated waters, cold and with an odor of hydrogen sulphide 
which the speaker has yet met with where the sulphiureted water derived its odor 
and taste from putrefying material. 

This case has been gone into at length because it is an exceptionally good example 
of the value of microscopic examination of sediments. It is to be especially noted 
that the microscopic examination not only solved the problem of the exact nature of 
the polluting material but eventually led to the discovery of its source and demon- 
strated that the weU water must be indefinitely abandoned. We must not foiget 
that a properly conducted water examination should give answers to three questions: 
(1) Is the water fit for household use; (2) if unfit,what is the trouble?;(3) how can it 
be permanently improved? To these three a fourth sometimes arises: WiU the water 
probably continue to remain good or bad? 



218 PROGBEDIirGB 8BC0VD PAV AMEBKUK 60IBVTIFI0 CONQBESS. 

In the same cUm but of a dififerent type fall thoae cases of microscopic ezaminataoii 
of sediments and 8uq;>ended matteis disclosing finely divided wood palp &t»i chain 
pumps having wooden pump tubes, or an emulsion of oOy droplets, etc., from pumps 
lubricated with an excess of oils and greases. Such waters yield high oxygen con- 
sumed and high loss-on-lgnition, with the total solid residues usually blackening on 
ignition but all other chemically determined constituents low and usually low bac- 
teria. The microscopic examination here serves to elucidate the cause of these hi^ 
results and renders the interpretation of the entire analysis simple and certain. 
Without the microscopic examination the analyst is apt to be sorely puzsled. 

Time forbids giving other examples althou^ a large number might be cited. Yet 
it is remarkable how seldom the water analyst has recourse to this most valuable aid 
to assist him in forming an opinion as to the character of a water in question and as 
to the means for improving its quality. 

The examination of sediment and suspended matters in waters lor the possible 
presence of animal parasites is also too often neglected as a matter of routine work; in 
at least two instances the speaker has found the ova of the common iMpewixm in spring 
waters submitted to him for analysis. It is true that these are but two instances in 
some twenty-odd years of experience as a water analyst, yet similar examples are apt 
to arise at any time, and if we are to really serve our clients, we must be prepared to 
adopt every and all means at our disposal. 

That branch of microscopic examination devoted to the detection of the specific 
cause of bad odors and tastes in impounded waters is too well known and too g«i- 
erally employed and the necessity for its practice too firmly established to necessitate 
any consideration by me; but the study of the plankton causing rapid clogging of 
filters in rapid American systems is receiving altogether too little attention by 
analysts in chaige of filter installations. It is not uncommon to have the period of 
ssrvice between filter washings cut down fuUy 95 per cent in the course of two or 
three days, due to the sudden multiplication of organisms of one species or another, 
thus forcing the purification plant to its capacity and not infrequently rendering 
its operation almost impossible. A knowledge of the species causing the clogging is 
imperative in order that the trouble may be intelligently fought. Even less atten- 
tion is being paid to the influence of certain oiganisms in loosening the sand beds 
or at least in some way lowering efficiencies. There seem to be good reasons for 
believing that some of the lowering of efficiencies due to the pocketing of air within 
the filter beds may be due directly or indirectly to the action of organisms — directly 
when the oiganisn efifects a liberation of gases in the water, indirectly when through 
their action in forcing sand grains away from one another they form a space where 
air eventually accumulates. If there are a large number of such pockets formed, the 
available filter area may be greatly reduced and the filter finally taxed beyond its 
capacity, its loss-of-head rapidly increased, and finally the pocketed air rising loosens 
the bed and we have an airbound filter bed. Actually in practice, however, we fre- 
quently encounter what amounts substantially to airbound filters without the air 
rising as in typical cases, for the air clings tenaciously to certain sand grains which are 
coated with a film of sudi a nature as to hold the air. In such an event the filter may 
not "break," but its bacterial efficiency falls. 

In our purification plants we have paid considerable attention to the effective size 
of the sand and its coefficient of uniformity, but we have absolutely ignored the ques* 
tion of the adsorptive powers of sands of different scurts for the coagulants we are to 
employ in the specific waters to be treated. Usually a newly constructed filter bed 
does not yield as high an efficiency as after it has been in use tot a longer or shorter 
period, or until it has become "seasoned" or "ripened,'' as it is sometimes stated. 
It is the commonly accepted theory that the bed becomes efficient as soon as the sand 
grains acquire a thin coating of coagulant or a thin film of protoplasmlike material. 
This surrounding envelope is held by such grains of sand by virtue of their adsorptive 



PUBUC HEALTH AND MEDICINE. 219 

power for the particular kind of colloidal matter iMreaent, and it is probably largely 
by reason of the adsorptive power of the colloidal matter for the materials which we 
wish to remove that we obtain the efficient filtration we meet with in practice. It 
seems reasonable in the light of the recent develc^ments of colloidal chemistry to 
regard the mechanical sand analysis expressed in terms of effective size and uniformity 
coefficient as giving us information only of the rates of flow we may expect through beds 
of the unclogged (uncoated) sand bed, but the purification efficiency of the bed must 
be measured laigely by the adsorptive power of the sand for the colloidal matter and 
its ability to retain this adsorptive property. If we take 'sand from seasoned filter 
beds and examine it wet under the microscope just as it is, or treated with an aniline 
dye (congo red or benzo orange for basic aluminum sulphate treated waters), we will 
find a relatively large number of sand grains with no colloidal coating whatever, or 
with colloidal patches instead of coatings, and we will further find that the relative 
proportion of coated and uncoated grains is quite different in sands of different sorts. 
We need, therefore, to investigate sands with respect to their adsorptive powers. 
There is little question that the differences in efficiencies of different filter plants is 
a matter largely of adsorption of colloids and the power of the sand grains to tenaciously 
hold these adsorbed colloids in waters containing substance which through their 
chemical action might cause the colloidal envelopes to loosen and disintegrate. 

It is safe to conclude that the sanitary engineer in writing his specifications for 
sand beds ought to be able to include details looking toward the use of a filter material 
of high adsorptive power. Were he in possession of this knowledge, much progress 
could be made, and in the opinion of the speaker we would meet i^ith fewer plants 
of doubtful efficiencies. 

Much interesting information as to the actual condition of the sand in the filter is to 
be gained by periodic microscopic examination of sand before and after washing a 
filter and studying the sand just as it comes from the beds, staining it to render the 
film m<Nre easily recognized, and also through examinations of sand after treating it 
with dilute hydrochloric acid. In many waters it will be foimd that in addition to 
the colloidal coating a film or a conglomerate of fine crystals of calcium carbonate 
coats the sand grains, and this when no lime or soda ash has been applied to the water. 
It is not clear whether this lime coating is beneficial or objectionable, whether it 
tends to cause colloids to deposit or prevents their ads(»rption. A fertile and highly 
interesting field upon which considerable work should be done is here open to the 
investigator. In one filter plant with which the speaker is familiar this tendency of 
calcium carbonate to deposit upon sand and gravel has been at times so great as to 
rapidly lead to the formations of patches of conglomerate in the bed, rendering wash* 
ing of the filters inefficient and certain areas of the beds impermeable. 

Occasionally the chemist finds it important to ascertain the nature of the salts 
deposited during evaporation or heating. The usual method consists in performing 
a quantitative analysis of the solid residue and then computing the so-called hypo- 
thetical combinations. 

Few analysts appear to be aware of the ^t that a microscopic study of the properly 
obtained solid residue will in most cases not only enable him to identify most of the 
salts which hare separated but also to form a very good idea of their relative propor- 
tions with a certainty that is as surprising as it is simple and rapid. 

There is absolutely no question whatever that microscopic qualitative analysis 
methods are the simplest, most rapid, and most certain that are at present available 
for the detection in water of minute quantities of copper, lead, zinc, etc. For copper 
and zinc, volumes of from one drop to 10 c. c. are evaporated to dryness, moistened 
with dilute nitric acid, evaporated to dryness, taken up with a drop or two of distilled 
water, and a portion of this liquid tested upon an object slide with ammonium mercuric 
sulphocyanate. In the case of lead the water is treated exactly as above and the lead 
made evident by the usual inpLe nitrite reaction, using cesium chloride to hasten the 



:r20 PBOGEEDIKGB SECOND PAN AMERICAN SCIENTIFIC C0NQBE8S. 

fonning of the crystal phase. The crystaLi obtained in these cases are abundant, well 
formed, very characteristic » easily recognized, and not liable to any serious interf^- 
ences by other substances which may be present. 

With two microscopes available and a comparison eyepiece, quantitative colori- 
metric methods can be employed with minute quantities of water and yet with an 
accuracy comparing very favorably with our standard methods of water analysis. 
This ifl a matter of vital importance when the taking of very small samples of water 
only is practicable. 

In this sh<Hrt r^simi^ I have endeavored to point out that microscopic metliods are 
capable of a very broad application, permitting us to study not only organisms included 
in the general term of plankton but also enabling us to estimate the bacteria jxeeent 
with ease and rapidity, and to make qualitative or even quantitative analyses with 
an economy of time, material, and space not possible by any other method, and more 
important still, that the microscope intelligently employed yields inf(»rmation of a 
character of prime importance and inestimable value in the sanitary examination 
< f w^ter and even in the operation and design of water-filtration plants. 

Th<' (^H AIRMAN. Dr. Edward Bartow, director State Water Siirvey, 
rrl».aia, 111., is the next on the program. 



THE SIGNmCANCE OF CHEMISTRY IN WATER PURinCATION. 

By EDWARD BARTOW, 
Director StaU Water Survey, Urbana, III, 

When water purification is mentioned one thinks first of water for drinking pur- 
poses. It is a fact, however, that a very small percentage of the water furnished by 
a municipality to its citizens is used for drinking purposes. Water purification must 
include treatment of water for drinking purposes, for domestic uses, for the production 
of steam, and for manufacturing processes. The value of an abundant supply of pure 
water for all piuposes is becoming more generally realized, and many investigatc^s 
have been and are endeavoring to find the beet means for judging the quality of a 
water and for purifying water. The chemist, the bacteriologist and the biologist 
are all busy investigating these problems. 

The bacteriologist rightly considers that the presence or absence of diseaae-pooduc- 
ing bacteria is the only absolute means of judging whether a drinking water will cause 
disease. But the difficulties in determining absolutely the presence or absence of 
disease-producing bacteria and the uncertainty which negative results leave with 
regard to possible later access of pathogenic bacteria make it necessary to use some 
index other than the disease-producing bacteria themselves by which to judge the 
piurity of a drinking water. The bacteriologist has the nearest approach to a reliable 
index in the bacteria which acccnnpany pollution. Bacteria of the colon group are 
always present in sewage, and their presence or absence in a drinking water is very 
important since it implies the jnreeence or absence of pollution by sewage. There- 
fore, finding the colon bacillus, the bacteriologist would condemn the water. The 
biologist, finding organisms that impart an unpleasant taste or odor, would condemn 
a water. The sanitary inspector, from a survey of the territory surrounding the source 
of a water supply, finding imfavorable conditions, would condemn a water without 
further examination. The bacteriological, biological, and inspection approval of a 
water is not sufficient. Chemical approval in addition is necessary because of the 
possibility of unseen undergroimd contamination, because chemical tests reveal the 
previous history of a water and may indicate possible future contamination, because 
chemical tests determine the therapeutic character of a drinking water. 



PUBLIC HEALTH AND MEDICINE. 221 

Chemical tests are used to 4etennine the purity of water and to control the treat- 
ment. Chemicals are used in purification and disinfection of water supplies. 

When it was first realized that a polluted well water might spread infectious 
diseases chemical tests alone were relied upon by the water analyst. Because 
organic waste matter contains nitrogen as an important constituent, Wanklyn in 1868 
first suggested the determination of nitrogen as an index of the character of a water 
supply. He proposed the albuminoid ammonia test and while it has had consider- 
able criticism it has, nevertheless, served a good purpose. The albuminoid ammonia 
test and the determination of oxygen consuming capacity have given the best informa- 
tion concerning the character of a water supply, until the introduction of bacteriological 
ter^ts. For many years the sanitary examination of a drinking water consisted of 
purely chemical tests and included the determination of residue, chloride, oxygen 
consiuning capacity, free ammonia, albuminoid ammonia, hardness, dissolved gases 
and poisonous metals. Later, owing to the demand for a clearer water free from 
iron and manganese, determinations of alkalinity, carbondioxide, iron and manga- 
nese were added. 

When bacteriological tests are made, it is surprising to note the amount of chemistry 
used by the bacteriologist. Even in determining the number of bacteria, the acidity 
of the media must be accurately adjusted by chemical analyaiB. The determination 
of the colon bacillus, as stated before, the most reliable index of pollution, depends 
upon the chemical decomposition of sugars in media whose acidity is accurately 
adjusted. Other tests for the colon bacillus depend upon the chemical reaction 
toward litmus lactose agar or Endo's media. The formation of indol and its recogni- 
tion are chemical reactions used by the bacteriologist. 

At present in the analysis of drinking waters certain chemical tests may be said to 
supplement the bacteriological tests. These are the tests for organic matter. They 
include tests for ammonia, albuminoid, nitrite, and nitrate, nitrogen, and the oxygen 
consuming capacity. 

The inorganic constituents must not be overlooked. Some serve as an index of 
pollution, others have therapeutic significance. Chl(»ide furnishes an example of 
the usefulness of a chemical test as an index of pollution. It is always present in 
sewage, hence in regions where the amount of chloride present in normal waters 
varies with the distance from the sea coast an excess of chloride above the normal 
arouses suspicion. It must be remembered, however, that in other regions, especially 
r^ons which have been covered by the sea, the normal chloride of the water supplies 
is so high and its variation so great that it is impossible to use it as an index of pollu- 
tion. The chemical analysis of the inorganic soluble matter shows the therapeutic 
significance. Waters containing notable amounts of the sulfates of sodium, or mag- 
nesitun, or waters containing dis^jolved gases, especially hydrogen sulfide, will have 
a physiological action on those who drink them, especially on those who are not 
accustomed to them. Therefore, these waters containing large amounts of sulphates 
or hydrogen sulphide are valuable mineral waters. 

The chemical tests for the troublesome metals, iron and manganese, and the 
pQiBonous metals — copper, lead, and zinc, must not be overlooked. Copper, lead, 
and zinc are found in waters in mining regions and many waters will dissolve lead or 
zinc from pipes. The drinking of these waters will cause serious illnesses. Iron and 
manganese if present in sufficient quantity to be injurious are usually precipitated 
on contact with the air and give warning against the use of the water. 

To determine definitely the therapeutic value of a water acciuHte determinations 
of the chemical composition of the mineral content of waters are needed. These 
accurate determinations serve also to show the value for use in boilers, for manufac- 
turing purposes and for the determination of methods of water purification. The 
tests ordinarily made are for the positive ions, potassium, sodium, iron, aluminium, 
calciimii, magnesiimii, and for the negative ions, chloride, nitrate, sulfate, and car- 



222 PB0CESDIKQ8 8B00FD PAN AMERICAN 80IBKTIFI0 C0NQBE88. 

bonate. Sometimes rare ions such as bromide, iodide, lithium, and i^osphate are 
determined. For boiler use an excessive amount of calcium and magnesium will 
cause the formation of scale. Chloride or nitrate ions in excess will cause corrosion 
and sodiiun and potassium in excess will cause foaming. Many examples might be 
given of the injurious action of soluble compounds in water used for jnanuftu:taring. 
Suffice it to say, that compounds of iron and manganese by their color interfere with 
bleaching processes; calcium and magnesium increase the amount of soap required 
and form substances that can be with difficulty removed from ftibiics, thus interfering 
with laundry processes; calcium and magnesium when present in water used in 
preparing foods give an inferior product. 

Chemists have been working for years to improve methods of analysis and methods 
of purification. They have been working in cooperation on methods of analysis and 
individually on mediods of purification. In the United States committees have 
formulated standard methods of analysis. The first attempt to obtain uniform methods 
was made by the chemical division oi the American Association for the Advancement 
of Science, which presented a preliminary report at the meeting in Cleveland in 1886.' 
This committee gave standards for (1) free and albuminoid ammonia; (2) oxygen 
consuming capacity; (3) nitrites; (4) nitrates, and implied that readue, chloride, and 
hardness should also be determined but gave no specific directions for these tests. 
The American Public Health Association in 1894 took its first step toward the foimu- 
lation of standard methods.' The committee formed at that time made eevend 
progress reports and prepared recommendations for bacteriological examination of 
water. It was not until 1905 that they published the first report <m standard methods 
of water analysis, including both chemical and bacteriological methods. A revised 
report was published in 1912 and a second revision will appear during 1916. This 
published report on Standard Methods has done much to unify the chemical procediue 
in water laboratories and to promote interest in investigation of methods of analyses. 

Having by analjrsis found a water impure the next step is purification. The method 
ot purification depends upon the proposed use. Drinking water demands filtration to 
remove turbidity and bacteria when waters are turbid. Impure drinking waters, if 
clear, demand disinfection. Slow sand filters, imitating nature's process were first 
used to remove turbidity and bacteria. Owing to the expense oi installation, 
especially in America, the so-called mechanical filters have been substituted . Chemi- 
csds are necessary for the operation of mechanical filters. By means of chemicals a 
precipitate is formed, which in settling collects colloids and bacteria and permits the 
water to be filtered at nearly 40 times the rate possible when no chemicals are used. 
Aluminium sulfate (filter alum) iron sulfate, and lime separately or in combination, 
are the chemicals added. Aluminium sulfate reacts with the bicarbonates of calcium 
and magnesium in the water to form a precipitate of alimiinium hydroxide. Iron 
sulfate usually added with lime reacts with the bicarbonates of calcium and 
magnesium to form a precipitate of iron and magnesium hydroxides, and calcium 
carbonate. It is necessary to add sufficient lime to neutralize any free carbon dioxide 
present or set free by the iron sulfate. Lime reacts with magnesium salts forming 
a sufficient precipitate to allow filtration without aliuninium or iron sul^te or with 
a very little of either to counteract the excess of lime. Waters with an excessive 
turbidity like those in the Missismppi River Valley, can not be filtered practically by 
slow sand filtration and filtration with chemicals is used exclusively. 

Each year the public is demanding better water. Standards of purity are being 
raised. The United States Public Health Service, through a commission, has formu- 
lated standards for the purity of drinking water to be used on interstate carriers.' A 
glance at the literature of the last few years shows how investigators are endeavoring 

> The Journal of Analytical Chemistry, 3, 808 (1887). 

s Proceedings of the American Public Health Association, 20, 81 (18D4). 

> Public Health Reports, 39, 2959 (IVM). 



PUBUO HBALTH AND HEDIOINS. 223 

tft comply with the demand for better water. It is diflkult to conlorm to tlie improved 
Blandarda for drinking water without dianfection. 

For disinfection, ozone, ultraviolet rays, bleaching powder, liquid chlorine and lime 
ai6 uaed. Osone has beoi used quite extensively in Europe. Plants are in operation 
in Europe at Wiesbaden, Schierstein, Paderbom, Gosne, Ghartus, Nizza, Dinard, 
Sulina, Qinnekin,' St. Maur,' Chemnitz, Florence, Spezia, Genoa, Bndla, Paris,' 
Koenigsberg,* Petrograd* and other places. 

The plants which have been constructed in the United States * have not been very 
successful and it must be considered that the use of ozone in Ajserica is still in the 
experimental stage. 

Disinfection or sterilization with the ultraviolet ray was first proposed by Henri, 
Helbrunner, and Recklinghausen.^ Their pioneer work has been followed by many 
investigators. Plants are in operaticm in Europe at Luneville, St. Malo, and Rouen.* 
No large installations have been made in the United States but small installaiticms have 
been used with evident succeas. 

Bleaching i>owder (calcitun hypochlorite) was first used in 1908 at the Union Stock 
Yards in Chicago and at the Boonton Reswoir of the Jersey City supply. The process 
because of its cheapness is being widely used throughout the United States. In 1915 
Lon^ey ' reported that 240 water supplies were being treated with some disinfecting 
i^eot; about 80 per cent using bleaching powder and the remainder liquid chlorine. 

Within the last few years liquid chlorine has been made available and several forms 
of apparatus for adding liquid chlorine to water have been successful. It is much 
easier to handle the liquid chlorine or the gas from it than to handle the bleaching 
powder. This method will very soon replace the use of bleaching powder. 

Investigations by Houston ^^ in London have shown that the addition of lime before 
storage of water removes the bacteria almost completely. Sperry at Qrand Rapids 
and Hoover " at Columbus have shown that a slight excess of lime when used as a pre • 
dpitant removes the bacteria, serving as an excellent disinfectant. For the disin- 
fection of drinking water on a small scale potassium permanganate, bromine, iodine, 
and bleaching powder have been used. Tablets of bleaching powder with tablets of 
sodium thiosulfate to remove the excess of bleaching powder are quite satisfactory. 
In brief this is the summary of chemical methods of purifying drinking water. 

For purifying water for the production of steam and for manufacturing processes or 
"water softening,'' lime and soda, alone or in combination have been long used, 
lime is used for the removal of carbonates; soda for the removal of sulfates, nitrates 
and chlorides of calcium and magnesium. Soda may be replaced by other sodium 
salts BO that sodium silicate, sodium phosphate, sodium hydroxide, etc., are used in 
water softening and boiler compounds. 

A new method for softening water was suggested by Crans.^' It had been known 
that zeolites would soften water but since a sufficient quantity of the natural material 
could not be obtained Gans prepared an artificial zeolite by fusing kaolin, feldspar 
soda, and potash. This artificial zeolite called by the trade name ''permutit," has the 
power of removing calcium and magnesium from a hard water, delivering a water 

1 Ed Imbeax Wasser n. Abwasser, 7, 39. (1015.) 

• B. Spftulding Eng. Mag. 45, 726. (1913.) 

< Q. Brlwelii Qesondh lug. 36, 17. (1013.) 

< K. Kisskalt Oesumdh log. 38, 195. (1915.) 

• F. P. Mann Man. J., 82, 935. (1912.) 

• S. T. PoweU, J. Ind. Eng. Chem. 6, 050 (1914). M. W. Franklin, J. Ind. Eng. Chem. 6, 959 (1914). 3. 
T.PoweU, J. N. W. W. Assn. 29, 87 (1915). 

7 Ck>mpt. Rend, 155, 852. (1015.) 

• ReckUnhauseo* J. Am. W. W. Assn., 1, 565. (1914.) 
» Longley, J. Am. W. W. Assn., 2, 679 (1915), 

10 Hooston, 8th Research Report Metropolitan Water Board, 1912. J. Soc. Chom. Ind., 31, 508. (1012.) 
" Hoover, Eng. Record 68, 257. (1013.) Sperry, Mmi. Eng., 45, 343. (1014.) 
>< Oans, Chem. Review, Fett-Harc Ind., 16, 300 (1009). Chem. Ind., 32, 197. 



224 FK0CEE1>INGS SECOND PAN AMEBICAN SCIENTIFIC CONGRESS. 

with zero hardnees. The proceeB is well adapted to soften water for the textile indus- 
try, for laundries, etc. Only one municipal plant, at Hooten, England, has beeu 
built. As yet it seems too expensive for municipal water supplies but very probably 
efforts will be made to lessen construction costs so that it can be made available for 
munidpalitieB. 

The use of disinfectants and the invention of permutit are the most important 
recent improvements in water purification. Many other imiMrovements of minor im- 
portance but having practical value have been recently discovered. Copper sul&tte ' 
has been found to be an efficient algsecide and is widely used to remove al^ae growths 
from reservoirs. Alum has been made from sulfuric acid and bauxite' and without 
refining has been used at Columbus, Ohio, in water purification with a great reduction 
in the cost of purification. In Omaha * the efficiency of filter alum is said to be 
greatly increased by passing the solution of alum over iron filings before adding it to 
the water to be purified. Analyses of chemicals and their purchase under specifica- 
tions has increased the efficiency of water purification plants. 

A summary of this pap^ on Uie "Significance of chemistry in water purification" 
should answer the question often asked: What does water chemistry do? 

It assists in and supplements bacteriological tests. 

By determining the mineral content of a water; it shows the therapeutic character; 
it shows the presence or absence of troublesome metals, iron and manganese; it shows 
the presence or absence of poisonous metals, copper, lead, and sine. 

It controls purification. 

It formulates standards of purity and improves methods of purification. 

It makes filtration of turbid water possible. 

It softens water for many purposes. 

Finally, its fundamental purpose is to furnish and conserve pure water for all 
purposes. 

The Chairman. You have heard the papers on "Water Supply." 
I would like to ask Prof. Bartow if there are plants in this country 
that have the dual water supply, such as they have in some Euro- 
pean cities where there is drinking-water service and also commercial- 
water service. 

Dr. Bartow. Mr. Chairman, I am unable to answer that question. 
It is my understanding that in New York City they have along the 
water front hydrants through which they can pump water for fire 
protection. 

The CHAiBBfAN. I mean general, throughout the city. 

Dr. Bartow. I do not know of any such plant. 

Dr. Sedgwick. I have greatly enjoyed these papers, and I think 
that Prof. Bartow's survey of the situation as to both chemical and 
bacterial analysis is thoroughly admirable and very helpful. I re- 
member the time, however, when by chemical analysis highly pol- 
luted waters were allowed to be drunk, because we did not then have 
the notion of the bacterial content; when, for instance, the Merrimac 
River at LoweU, because it analyzed well chemically, was reputed 
to be good for drinking. Of course that is many years ago, but 
it was done at the hands of excellent chemists. It has greatly 

> ICooreand KeUerman, Bui. 64, Bureau of Plant Intl., U. S. Depl. -Vgrlctiltnre. 
« Hoovv^r, Eug. News, 72, 1239 (1914.) 
3 Jaoobson, Eng. Record, 71, 394 (1915). 



PUBLIC HEALTH AND MEDICINE. 225 

strengthened the bacterial side to be able to bring in or to secure the 
aid of the chemists, and I think the bacterial side in its turn has done 
something for the chemists. Certainly no bacteriologist or biologist 
would ever claim that his science is anything more than the chemistry 
and physics of living matter, and biologists and bacteriologists always 
rejoice to hear of the progress which is being made in chemistry. 
We know what the water survey of Illinois has done to help us in 
these various directions. 

One point in Prof. Jordan's paper interested me very much, and 
that was his dealing with the so-called Mills-Reincke phenomenon 
when that was emphasized some years ago and Hazen's theorem was 
formulated. Some of you may not know what these things were, 
but the gist of them was this, that for every death from typhoid 
fever saved by the purification of the water supply, two or three 
deaths from other diseases were likewise saved, and this numerical 
relation was named Hazen's theorem. That was submitted with a 
good deal of diffidence by the authors, who said that it seemed to be 
accounted for by one of two things: Either there were some oigan- 
isms capable of carrying diseases in water which were not at that 
time recognized as thus capable (tubercidosis, for example), or eke 
that the vital resistance of people was affected unfavorably by pol- 
luted water. Neither explanation seemed then wholly satisfactory, 
but the former has some support to-day. In the meantime various 
critics of the findings have arisen, notably Dr. Chapin, the admirable 
authority at Providence, who, however, is always skeptical of every- 
thing that is not strictly proved, and the hardly less weU-known Dr. 
Houston in chaige of the London water supply. There appeared, 
however, in January last — I think it was — the paper by Dr. Dublin, 
which was referred to by Prof. Jordan, in which the experience of an 
insurance company with typhoid convalescents was recx)rded with 
respect to their susceptibility to other diseases, and while the paper 
can hardly, perhaps, be considered as final or conclusive, it was very 
interesting as far as it went, for it said, as Dr. Jordan stated, that 
typhoid recoveries seem to be, so to speak, comparatively temporary, 
dying of other diseases before very long, or at least before others in 
the same group who had not had typhoid. Col. Woodruff, the 
author of 'Tropical Life," who has studied the effects of tropical life 
on the white man, was also very much interested in this matter, and 
he had figures which seemed to him to show that people having had 
typhoid were more than ordinarily susceptible to tuberculosis, etc* 

Dr. George A. Sopbb. With respect to the amount of protection 
afforded — ^referring to the fact stated by Prof. Jordan that about 80 
per cent of the population of this country is supplied with pure 
water — I think we should not come to the conclusion that the pro* 
tection against typhoid is quite as great as the figure 80 per cent 



226 PROCEEDINGS SECOVD PAN AMERICAN SCIENTIFIC OONQRESS. 

would indicate. We must know more of the 20 per cent of the 
unprotected and the means by which they may communicate the 
disease. 

The introduction of a pure water supply does not always reduce 
the typhoid rate so much as is expected. We have an instance in 
the city of Washington, where the introduction of an improvement 
in the existing water supply was expected to practically eliminate 
typhoid fever. Very much to our surprise there was littlei if any, 
reduction in typhoid. 

Throughout several cities apparently somewhat similar surprises 
have resulted, and we must, I believe, recognize that diseases which 
we have formerly been taught to regard as transmitted chiefly if not 
exclusively, through water are also transmitted through other vehicles. 
It has witiiin the last few years come to be regarded in England that 
contact infection, for example, in typhoid fever plays a predominant, 
if not exclusive, r61e in producing high death rates from typhoid fever. 

We should consider these matters chiefly from the standpoint of 
the latest information which investigators can give. Such work as 
the United States PubUc Health Service has done in Washington 
should by all means be reinforced, indorsed, and the proof supple- 
mented, so that no doubt shall remain as to the means by which 
these so-called water-borne diseases are to be controlled. 

Dr. KoBER. It may be of interest to the advocates of the water- 
borne theory of typhoid fever that the history of Washington shows 
clearly that when we had local pump supply and polluted water 
supply from the Potomac River there was an ever-increasing rate 
from year to year. In 1889 to 1890 we had a typhoid rate of 104 per 
100,000 of population. It was during that year that I dared to 
assert that the typhoid (eveir epidemic at Cumberland, Md., would 
react upon our typhoid fever rate. My suspicion that typhoid fever 
germs discharged with sewage into the Potomac River at Cumberland, 
a distance of 134 miles away, might infect consumers of Washington 
was confirmed by studying the effects of the Cumberland epidemic 
upon the prevalence of the disease in Washington. The records of 
the Health Office show that during this epidemic from December, 
1889, to April, 1890, the deaths from typhoid fover amounted to 74 
as compared with 42 for the corresponding months of the previous 
year. Indeed we had almost double the number of typhoid deaths 
during these months than for any similar perioH either before or 
since this epidemic. It was the fact of caUing attention to this 
coincident event, and also simultaneously the demonstration made by 
Dr. Theobald Smith that turbid water always contained a large num- 
ber of colon baciUi, that actually aroused an interest in the typhoid 
fever situation and the purification of the water. Steps were taken 
to increase the storage facihties of the water supply of Washington, 



PUBUO HEALTH AND MEDICINE. 227 

X)^rmitting of longer sedimentation; city pumps and box priyies were 
gradually abandoned and with these improvements there was a 
decided reduction from year to year in the prevalence of typhoid fever. 

One of the great factors before filtration was actually adopted was 
the installation of a reservoir which permitted longer storage for our 
water; and everyone familiar with the subject knows that sedimenta- 
tion alone will eliminate about 87 per cent of bacteria. So that we 
really had a marked decrease in typhoid fever before the actual com- 
pletion of the filtration plant, but for the information of the last 
speaker I will say that it is a very different thing to compare a 
typhoid-fever rate of 104 per 100,000 of population in 1890 and one 
of about 15, which we have at the present time. I feel no hesi- 
tation in declaring that over 50 per cent of all the typhoid-fever cases 
in this city before the completion of the system of water purification 
were water borne, and this in spite of the fact that I was a pioneer 
on the subject of milk-borne typhoid and also the first man on record 
in this country to direct attention in 1895 to the agency of flies in 
the transmission of typhoid fever. Those who are interested in the 
subject will find a very excellent chart prepared by me in Rosenau's 
recent book on hygiene, in which the very important rdle which pol- 
luted waters play in the transmission of typhoid fever Ls conclusively 
demonstrated. 

Dr. Bartow. Prof. Sedgwick has spoken of the water which was 
formerly allowed to be used because of its supposed purity after 
chemical tests were made. I want to tell of one which was con- 
demned because of the chemical tests, although it was bacteriologi- 
cally pure. The central part of Illinois was once covered by glaciers. 
The water is drawn from depths of 150 to 200 feet from gravel stratum 
that contain a large amount of nitrogenous organic matter. 

The waters are imfit for drinking purposes, and water from our 
wells has been condemned by one of our best Illinois authorities on 
the groimd that the free elements were too high, whereas when we 
analyzed this water bacteriologically it was practically sterile. 

With regard to the reduction of typhoid fever by the introduction 
of water supply, one of the greatest steps in this direction has been 
the introduction of a filter plant at Niagara Falls. The typhoid rate 
in that city used to be 160 to 170 per 100,000. After the introduc- 
tion of that plant, the typhoid rate dropped, I think, to 15, or some- 
thing like that, and one can hardly conceive what improvement 
that meant in the conditions all over the country, as so many people 
visit Niagara Falls. 

The Chaikman. If there is no further discussion of the papers we 
have heard, the next on the program is that of Dr. Allan J. McLaugh- 
Kn, United States Public Health Service, on the subject of " The 
control of Asiatic cholera along int'emational trade routes.'' 

6843e— 17— VOL X 16 



228 PBOOEEDINOS SECOND PAN AMERICAN 8CIBNTIFI0 G0NQRB88. 

THE CONTROL OF ASUTIC 0HOLER4 ON INTERNATIONAL TRADE 

ROUTES. 

By ALLAN J! McLAUGHLIN, 
DhiUd 8tate$ Public EeaUh Service, Commitiionir of Hecdtk, MaeaadhueiU. 

General principles of control of Atdatic cholera on international trade routes are 
the same for overland travel as for travel by sea. These principles demand the 
restriction of travel to certain definite routes which pass, at the frontier or on the sea 
coast, through well-equipped modem quarantine plants. 

LAND ROUTBS. 

An international trade route overland may involve several kinds of transportation, 
and the character of the transportation is a matter of vital importance in the spread 
of Asiatic cholera. Asiatic cholera spreads as &st as man can travel, so that it can 
not spread as fast along a caravan route as along an international railroad line. 

THB ESTABLISHMENT OP FRONTIER QUARANTINE STATIOITS. 

When a country is menaced by Asiatic cholera on its land frontier, whether the 
routes over this frontier are caravan routes, ordinary roads, or railway lines, passage 
of the frrontier must be prevented, except at certain specified quarantine stations. 
In the interests of commerce and passenger traffic, these stations should be established 
on all important points through which passenger or freight traffic ordinarily crosses 
the frontier. 

These quarantine stations or detention camps on a frontier should not be essen- 
tially different from the r^^ular maritime quarantine stations which are used to pro- 
tect against Asiatic cholera carried along sea routes, and for that reason the same type 
of quarantine station will serve for either land or wat^ quarantine. 

WATER ROUTES. 

Lanes of ocean travel are almost as definite as roads for land travel, and great steam- 
ship lines run on a schedule with the regularity of railway trains. These great steam- 
ship companies use regular terminals in the large seaports, and their control is no 
more difficult than that of regular train traffic on land. There are in addition tramp 
steamers and sailing vessds. These present less difficulty than irregular traffic across 
a land frontier. Similarly, water routes by river or canal ai^ controlled by a quaran- 
tine station at the frontier. 

Just as in the case of land frontiers, the seaboard of a country may be closed except 
certain specified ports, provided with proper quarantine stations, through which all 
traffic must pass. In the interest of commerce this list of open ports should include 
all important ports, and as many smaller ports at which quarantine stations can be 
maintained at a cost commensurate with the importance of the port. 

THE ESSENTIALS OF SUCCESSFUL QUARANTINB. 

The essentials of successful quarantine are the same on land and sea, and include: 

1. Accurate information and delimitation of the infected territory. 

2. Efficient frudlities and personnel for inspection at the seaports or points on 
frontiers where important roads or water routes cross the frontier. 

3. Modem quarantine stations. 

It is not possible within the limits of this paper to discuss all the details of these 
essentials. I will omit discussion concerning the very interesting and sometimes 
devious methods by which information is secured, and of the problematical value 



PUBLIC HEALTH AND MEDICINE. 229 

of 60-called official information. I shall be obliged also, because of lack of space, to 
omit detailed description of what constitutes an efficient equipment and personnel 
of an inspection service, and of a modem quarantine station. 

I should like to accentuate the necessity of giving the menaced country the benefit 
of the doubt in attempting to delimit the infected zone in a neighboring country, 
and to bring out certain important changes of technique and procedure in the handling 
of an Asiatic cholera quarantine. 

DBLDCrTATION OF INFBCTBD TBRSFTORY. 

The delimitation of infected territory is of the utmost importance, but it is often 
extaremely difficult to secure accurate information of the exacta rea which may be 
dMsed as infected. It is a very dangerous procedure to assume that certain portions 
of a country are cholera free, unless a representative of the menaced nation is on the 
•pot, whose investigations are unhampered, and whose reports are uncensored. In 
1905, for example, it was claimed that n<Hrthem Russia was free from Asiatic cholera, 
while southern Russia was infected. The writer was on duty in Hamburg, Germany, 
at the time and recommended that all Russia be considered infected, in view of the 
fact that all trains crossing the German border must pass through infected territory 
either in Poland or the valley of the Vistula, and that owing to internal disturbances 
in Russia, the Russians themselves were unable to delimit accurately the infected area. 
This was the attitude of the German Imperial Health Office, and the United States 
sustained its representative, ordering that all Russians be detained in quarantine 
under observation in German ports, before embarking for United States ports. 

On the other hand, in Germany, because of unhamper(>d investigation and ready 
access to accurate information, and also the uncensored us 3 of the cable, it was possible 
to delimit the infected area and to rpmove restrictions from a huge part of the empire. 
While the importance of exact delimitation in avoiding undue restriction can not be 
overestimated, it is nevertheless wise to err on the side of safety, and a country menaced 
by Asiatic cholera is justified in imposing its quarantine restrictions upon suspected, 
ae well as infected, territory. 

PERIOD OF DBTBNTION IN QUARANTINE. 

Formerly cholera quarantine detention was at least five days, and this period of five 
days under observation was considered a sufficient guaranty for safe discharge from 
quarantine, provided no signs of illness developed. In the Philippines, in 1908 and 
1909, the writer, as a requirement for disduuge of contacts from quarantine, substi- 
luted a negative examination of the intestinal discharges for the ordinary five-day 
detention period. 

In October, 1910, the writer recommended to the Suigeon (General that the intestinal 
dischaiges of all arrivals at United States ports from territory infected of suspected of 
being infected with Asiatic cholera, should be examined bacteriologically, and that 
discharge from quarantine be made only after a negative result of the stools examina- 
tion. On July 19, 1911, the Secretaiy of the Treasury promulgated a regulation 
providing for this additional safeguard. 

The demonstration of carriers who discharged vibrios In their stools for weeks, and 
even months, showed that no mere arbitrary detention alone could prevent their 
passage through quarantine. 

Rapid methods of technique and an efficient system of collecting samples and 
handling the specimens make it possible for each bacteriologist to examine 100 to 
ISO stools per day. 

This important advance in our methods of Asiatic cholera quarantine not only gives 
us an additional safeguard in preventing the entrance of vibrio carriers, but makes 
ponible the shortening of the period of detention from five days to two or three days. 



230 PROCEKDINGS SECOND PAN AMXJEUGAX SCIENTIFIC CONGRESS. 

TECHNIQUE OF BACTEBIOLOGIC BXAMINATIOV OP STOOLS ON A TiARQB SCALE AT 

QUARANTIME STATIONS. 

In conBidering the problem of a fvioob examiiuttion on a large scale, two facton must 
be given tbeir proper weight: 

1. Proper protection of the public. 

2. Minimum restriction of commerce consistent with No. 1. 

If we could take unlimited time in the matter we would use every procedure known 
for the detection of the cholera vibrio, and would probably detain the suspects in 
quarantine many days or weeks, but as quarantine officers, we are charged by law wiih 
carrying out the quarantine fsguktienB, and especially instructed to carry them out 
with the minimum restriction of commerce. This no osssitatas the elimination ol 
hanging drop or other dow technical procedurss, dioleim red rsactions, use olgehUiAe 
media, and many other tests whidi are inteiesting, but not necessary for eholeta 
diagnosis and only serve to increase the time of the examination. 

SECURING THE SPBCDfEN. 

The specimen is best secured by the administraticm of a saline, and magnesinm 
tjulphate serves very well. It is best administered on an empty stomach about 6 a. m. 
Suspects with diarrhea and children may be exempted, and a good specimen may be 
obt^ned from these by passing a laige catheter or rectal tube with several ''eyes*' 
<'ut in the upper end . In withdrawing the tube the "eye " scrapes mucus off the lining 
of the bowel and furnishes a very good specimen. The use of swabs is not recom- 
mended, as a good specimen is diffictilt to obtain if the suspect is constipated. The 
Hwab has a great deal of the material scraped off by the tight sphincters and further 
may cause considerable pain and injury, especially when hemorrhoids are present. 
Dr. Serrati, the Italian royal commissioner at New York, suggested that the swabs be 
ahuathed in glass tubes. The tube protects the swab in passing the sphincters and is 
also lees painful in passing. 

DISPOSAL OF THE STOOLS AFTER PLANTING. 

The specimen should be passed in a paper sanitary cuspidor or similar receptacle 
which is cheap and may be burned. After planting in peptone the stool and con- 
tainer is dropped in a flour barrel. When the barrel is full or the samples all taken 
the cover is placed and the barrel with its contents burned. 

The specimens are planted in peptone by means of sterile pieces of wood (an ordi- 
nary wooden tongue depressor split in three serves very well) . This obviates the neces- 
sity of sterilizing a platinum loop or other metal instrument and saves much time. 
After planting, the stick is destroyed with the specimen in the barrel. 

PLANTING AND RBCORDINO THE SPBCDIENS. 

The suspects are divided into groups of 150 to 200, each group designated by differ- 
ent-colored tags. The plants are made on a table convenient to the latrines. The 
specimens are brought to the bacteriologists at the tables by the male suspects them- 
selves, under the supervision of orderlies or male nurses. The specimois from the 
women and children are taken by trained female nurses and brought to the tables. 
At each table there is, besides the bacteriologist, a clerk, who records the name of the 
suspect in a book and gives him a number in consecutive order. This number goes 
on the suspect's colored tag and also on the peptone tube, which has been inoculated. 
The amount of material for each peptone tube should be about equal to two or three 
large loops. After inoculation the tubes should not be agitated, ^id agitation should 
be avoided until the smears are made after incubation. 

INOXJBATION. 

The best temperature for incubation is from 35^ to 37^ 0., and the tubes should be 
incubated about six hours. If it is not possible to examine before eight hours, soeond 
peptone subculturea should be made. 



I^UBUO HEALTH AND MEDICINE. 231 

UAKTHQ SM8AR0 AND 0TAININO. 

To make a satiBfactory smear from a peptone culture is not easy. Four or five large 
loops from tiie surface (but avoiding the pellicle) are placed in the center of a clean 
alidey and without much spreading dried slowly and fixed by heat. This gives more 
concentration and more organisms in a field than if one drop was spread upon a slide. 
The stain should be carbol-fuchsin 1 part diluted by the addition of 9 parts of water. ^ 
Stain about one minute, wash carefully, and examine. It is convenient to have the 
numbers cut on the slides with a diamond, numbering the slides consecutively, in 
lots of 50, as the peptcme cultures come in in racks of 50. The slides corresponding 
to the numbers on the tubes were selected and used. 

BXAMm ATIONS OV TAB 0MEA1W. 

This is the most important step in the teclmic. If carelessly done, the whole 
examination is valueless. If properly done, SO to 90 per cent of the specimens may 
be rejected without plating. The observer must search, using a mechanical stage, 
kom 25 to 50 fields, and if he finds no suspicious curved organisms, the specimen is 
marked * 'negative. ^* If he finds curved organisms, a subculture in peptone and plates 
aie made. To be able to do this requires acute vision, and a knowledge of vibrios and 
other curved forms. The observer at first finds curved organisms in nearly every speci- 
men, but after plating these out he finds that many are not vibrios at all. At first 
the beginner will plate out about four-fifths of his specimens. After training and the 
csperience gained by studying his plates, ho will not find it necessary to plate more 
than 10 per cent. The differentiation of what seem to be curved organisms and vibrios 
ean only be learned by actual experience, and safety at first lies in plating all the 
4««btful ones. 

PLATB8. 

The |>l»te8 dumld be ordinary nutrient agar (2 to 3 per cent) neutral to phenol- 
fhthalein, the attrlace dried an hour in the thermostat at 37® 0., or one may use plates 
more than 24 hours old. The plates should be examined after about 16 hours. 

AGGLUTINATION TESTS. 

The colonies which have the charactenstict of the cholera colonies may be fished 
direct to drops of 1 to 200 specific cholera serum on a clean glass slide, carefully mark- 
ing tile colony on the piste. Or a smear may be made from the colony, stained, and 
eamnined. In any event, the colony, if a vibrio, must be fished to an agar slant grown 
18 hours and a quantitative agglutination made, using a serum of a titer of at least 
1:4000 in dilutions ranging from 1:50 to 1:1000. Dilution 1:1000 should be positive 
beyond question after one hour in the incubator at 37® 0.; 1:200 should give an in- 
stantaneous agglutination. The agglutination test should be controlled by test with 
a known cholera vibrio and with dilutions of normal serum and salt solution. 

The rapid test on the slide with an instantaneous reaction in a dilution of 1:200 may 
be c<»npleted by drying, fixing, and staining the clumps in situ. Under a low power 
the clumps will show very well, and the higher-power lenses will show the character- 
istic morphology. 

mPBOVBMBNT IN MBDIA. 

One other advance in our methods of handling Asiatic cholera suspects has been 
made by Qoldbeiger,* which promises to increase our efficiency in detecting Asiatic 
cholera carriers when making stool examinations on a large scale. 

There has been no great change in the bacteriologic methods of Asiatic' cholera 
diagnosis in the past 10 years, and these methods are based upon the procedure of 
tile German Imperial Heftlth Office. 

• Ooldberger, Joseph, Some ww cholera selective media. Hygienic Laboratory, Bulletin No. M, Wash- 
i]«ton. 1914. 



232 PBOGEEDINGS SECOND PAN AMEBIOAN BdENTIFIC C0NQRE88. 

As a time-saving measure, test tubes are used instead of large flasks for the peptone 
solution. This necessitates that the amount of feces added to the tube must be small, 
and if the vibrios are very scarce a carrier might be recorded as negative. Large 
flasks and many platings are impracticable on a large scale where the daily examina- 
tions may run in thousands. Goldberger's media permits the planting of relatively 
laige quantities of feces, using the same convenient size of test tubes. 

Goldberger suggests two enriching solutions, an alkaline egg peptone and an alkaline 
meat infusion peptone. The cholera vibrio grews well in both solutions, though less 
luxuriantly than in ordinary cholera peptone. The multiplication of the ordinary 
fecal bacteria is markedly restrained, especially the colon bacillus. Goldbeiger'a 
work shows that in his media the vibrios, if present even in small numbers, will 
increase and not be oveigrown, even after 72 hours. Goldberger's media was de* 
vised after a careful study and test of the various selective media suggested by 
Dieudonn6, Newfeld and Woithe, Esch, Pilon, Crenderopoulo and Panayotatoa, 
Krumwiede, Pratt and Grund, Hoffmann and Kutscher, Moldavan, and others. 

The addition of Goldberger's media to our equipment should make the passage of an 
Aaatic cholera carrier through our quarantines still more imlikely. It is true that 
this media has not yet been tested in actual field work, but the laboratory tests suggest 
that it is the most valauble addition to our cholera technique which has been made in 
recent years. 

CONCLUSIONS. 

1. The spread of Asiatic cholera in international traffic is largely a question of tiie 
travel of cholera carriers. 

2. Frank cases of cholera present no difllculty in diagnosis, can not travel fast or ter 
without detection, and consequently should be considered a lesser menace by the 
quarantine officer than the carrier without symptoms. 

3. An arbitrary period of detention in days is not a sufficient safeguard per.se but 
should cmly serve as an opportunity for detecting cholera in the intestinal contenta 
of the suspects. 

4. Model quarantine stations upon all trade routes by land or sea, where they cross 
the frontier or at their seaport terminals, are a necessity, and in times of danger all 
travel from infected territory should be restricted to routes thus equipped and con- 
trolled. 

5. The most important feature of a model quarantine staticm should be the laboratory 
equipped to examine and report on not less than 100 stools per day for each 
bacteriologist. 

The Chaibman. Dr. C.-E. A. Wiuslow, Yale Univei-sity, New 
Haven, Conn., will now present a paper on '* Fresh air and ventilation 
in the light of modem research.^' 



FRESH AIR AND VENTILATION IN THE UGHT OF MODERN RESEARCH 

By C.-E. A. WINSLOW. 

Anna M. R. fMuder Professor of Public Healthy Yale Medical School^ and chairman. 

New York State Commission on Ventilation. 

The problems of ventilation might at first sight appear to be of so universal a nature 
as to have but little place in the program of a conference laigely devoted to the com- 
parative problems of tho different countries on our hemisphere. Normal air has 
indeed the same percentage chemical composition wherever we may sample it. 



PUBUO HBALTH AND MEDICIKB. 233 

JUtltode, however, strikingly affects physiological reactions by its influence on par- 
tial pressure; and the extension of our conception of air conditioning to include a 
consideration of the physical effects of the atmoq>here upon the body brings the whole 
question of tomperature and humidity and climate within its scope. 

The evil effects of bad air conditions are obvious and clearly recognized. In a 
crowded, ill-ventilated room we experience a feeling of dullness, deepiness, and under 
more extreme conditions perhaps nausea, and even faintness; and there are several 
classic instances in which conditions of the atmosphere have become so extreme as to 
result fatally. The most famous of these examples is the Black Hole of Calcutta, 
which Prof. Lee, of Columbia University, has described in the following sentences: 

On one of the hottest of the hot nights of British India, a little more than 150 years 
ago, Siraj-Uddaula, a youthful merciless ruler of Bengal, caused to be confined within 
a small cell in Fort William 146 Englishmen whom he had that day captured in a siege 
of the city of Calcutta. The room was large enough to house comfortably but two 
persons. Its heavy door was bolted; its walls were pierced by two windows barred 
with iron, through which little air could enter. The night slowly passed away, and 
with the advent of the morning death had come to all but a score of the luckless com- 
panv. A survivor has left an account of horrible happening within the dun(<eon, of 
terrible strugglings of a steaming mass of sentient human bodies for the insufficient air. 
Within a few minutes after entrance every man was bathed in a wet perspiration and 
was searohing for wavs to escape from the stifling heat. Clothing was soon stripped off. 
Breathing became difficult. «rhere were vain onslaughts on the windows: there were 
vain efforts to force the door. Thirst grew intolerable, and there were ravings for the 
water which the guards passed in between the bars, not from feelings of mercy, but 
only to witness in ghoulish glee the added struggles for impossible relief. Ungovern- 
able confusion and turmoil and riot soon reigned. Men became delirious. If any 
found sufficient room to fall to the floor, it was only to fall to their deatii, for they were 
trampled upon, crushed, and buried beneath the fiercely desperate wave of frenzied 
humanity above. The strougest sought death, some by ]>raying for the hastening of 
the end ; some by heaping insults upon the guards to try to induce them to shoot. But 
all efforts for relief were in vain, until at last bodily and mental agony was followed by 
stupor. This tragedy of the Black Hole of Calcutta will ever remain as the most 
drastic demonstratioin in human history of the bondage of man to the air that surrounds 
him* 

On the other hand, the beneficial effects of good air are equally susceptible of demon- 
stration. Dr. Edwud Trudeau, who died November 15 last, went to Sarsnac in 1878 
as a hopeless victim of consumption. All his friends were filled with horror at the idea 
of his going practically alone to die, as they believed, in the Adirondack wilderness, 
in a little town consisting of little more than a sawmill and half a doeen cabins, 42 
miles from a railroad. Dr. Trudeau did not die during the winter of 1873, but grew 
very much better; and some 10 years later, as a result of his experience, he founded 
the Adirondack Oottage Sanatorium, which in its primitive form consisted of a single 
house in which, with great difficulty, he persuaded two consumptive patients to live. 
That was the beginning of the demonstration in this country of the fresh-air treatment 
of tuberculosis, which Brehmer and others had introduced on the other side of the 
water. To4ay we are going through a reaction against the more extreme applications 
of very cold air to sick people and to intots; but the general value of fresh air, if not 
too cold, and except in certain diseases, has been amply demonstrated. 

What are the factors to which these evil effects of bad air and these boieficial effects 
of good air are due? 

The air is inade up of 78.1 per cent nitrogen, 20.9 per cent oxygen, and 0.9 per cent 
aigon, with 0.03 per cent cari)on dioxide, and traces of other gases. It usually contains, 
in addition to these gaseous elements, a certain amount of finely divided solid matter 
in the form of dust particles. Analyses made undor my direction during the past 
summer have shown this dust to be present to the amount of something less than one- 
tenth gram per million liters of air, or 5,000 dust particles per liter, in the air of New 
York City on a clear day. At the other extreme we found 22 .2 grams per million liters, 
or 250,000 dust particles per liter, in a mattress factory, and still luger weights in a 




234 PBOGEKDINOS SECOND PAK AMBRIGAN 8CIEKTIFI0 C0KQRE88. 

starch foctory. BacterUarapresentinofdinaryairtotlieBtimbOTof 1 to4p6rlit«r>- 
in very small numbera as a rule. 

Five different changes take place in this normal atmosphere when human beings 
occupy a confined space. 

1. The oxygen is reduced by respiration. Tigerstedt estimates the amount of oxy- 
gen absorbed by a man ci average weight at rest as 764 grams, or 634 Uters per 24 hours. 

2. The carbon dioxide is increased by the same process. The oxygen consumption 
cited above with a respiratory quotioit of 0.80 would equal 840 grams, or 427 litecs 
per 24 hours. 

3. There is given off into the air a greater or less amount of oiganic matter, which 
is perceived by us as odors--material given off not from the lungs to any extent but 
from the mouth, from the teeth, ddn, and clothing. 

4. The temperature of the air is raised by the heat given off in the process of metab- 
olism. The number of calories produced in 24 hours corresponding to the oxygen 
consumption ol 634 liters cited above would be 2,563.2 cabries. About four-fiftha of 
this, say 2,000 calories, is given off from the sidn. Ludc and his associates have 
recently diown that the heat production bears a direct and close rehition to the super- 
ficial area of the body and amounts for a resting individual to 953 calories in 24 hours 
per square meter of body surface (corresponding to an oxygen consumption of 108 
liters per square meter ol body surface). # 

5. The humidity of the air is increased by the moisture given eff in the breath and 
from the skin . The amount of moisture evaporated has been estimated as in the neigh- 
boBlioodofl,400grams in 24 hours Turanian at rest. All of these values may be greatly 
increased by active exertion, and the amount of water given off in particular iatadi- 
oally altered by the heat and humidity of the sunroonding atmosphere. 

In seeking among these various changes for the cause of the physiological effects 
of vitiated air it was perhaps natural that the mind should turn to lack of oxygen as 
of prime importance. When a mouse is confined under a bell jar, it dies from oxygen 
i9tarvation, and it was at first aasmned that the same thing happens to a less degiee 
in a badly ventilated room. As a matter of fact men do sometimes die from iMk 
of oxygen in ckgged sewer manholes (althoui^ poisoning by carbon monoxide is 
dten at fault in such cases) or in the low parts of mines. 

In such rooms as are ordinarily used for human occupancy, however, the changes 
in oxygen and carbon dioxide, even with the worst ventilation, are found to be com- 
parativ^y slight. The oocygen may fall from 21 per cent to 20 per cent^ and the 
carbon dioxide may rise from 0.03 to one-half per cent; greater changes than this are 
not observed even in the most crowded and worst ventilated room on account of the 
leakage through walls and ceiling and cracks of all aorta. These values are very te 
from the vahies which are found to produce harmful physiokgical effects. In 
mines the oxy;gen is often deliberatdy kept down to 17 per cent or less in the hope 
of avoiding the dust expkoione that are likely to follow in freely ventilated mines 
during cold weather. 

Some of the most interestiDg work along this Une has been that in regard to the phe- 
nomena of mountain sickness. My colleague. Prof. Hendersonf with the English 
I^ysioIogistB Douglas and Haldane, made a most important series of studies of thi» 
kind on Pikes Peak two or three years ago. On Pikes Peak the partial pressure of 
Cfsjg&n present corresponds to about 13 per cent at ordinary atmosph^c pressitfe. 
Under these omditions there are distinct symptoms of mountain sickness, blueness of 
lips and face, loss of appetite, nausea and vomiting, intestinal disturbances, headache, 
fainting, periodic breathing, and great difficulty in getting breath on exertion. But 
even here, with only 13 per cent of oxygen, after a few days the symptoms b^gan to 
lessen, and after a few weeks of acclimatisation the extreme conditions disappeared, 
although periodic breathing was still occaskmally observed, and lips became blue on 
vigorous exertion. The investigators found that at least three th^igs had happened 



PUBLIC HEALTH AND MBDICINE. 236 

in this adaptation. In the first place the cells liDin^ the alveoli of the lungs had 
acquired the power of secreting oxygen one way and carbon dioxide the other more 
vigorously for the same gaseous pressure than they would under (vrdinary conditions. 
In the second place the alkalinity of the blood had changed so as to stimulate the 
respiratory center with a less amount of carbon dioxide. And finally the hemoglobin 
had increased so as to supply the tissues more readily with the needed oxygen. 

Many people live active and vigorous lives under such conditions as this. In the 
great city of Potosi, in the Andes, for instance, the partial pressure of oxygen is very 
close to that at Pikes Peak, and many famous health resorts at an altitude of 5,000 feet 
have a lower partial pressure of oxjrgen than obtains in the most crowded room. 

Much the same thing is true in respect to carbon dioxide . Carbon dioxide may reach 
one-half per cent in badly ventilated rooms. In certain parts of many breweries it is 
maintained between one-half and 2 per cent without serious effects. The only result 
of a concentration of 2 per cent of carbon dioxide is an automatic 50 per cent increase 
in depth of breathing such as occurs with moderate exercise. Only when ssdi an 
excess of carbonic dioxide is combined with vigorous exercise is discomfort experienced . 
By observations on conditions in various industries, and at yarious altitudes, and by 
detailed physiological experiments of many observen, it has been shown quite con- 
chisively that oxygen may fall as low as at least 17 per cent and carbon dioxide may 
rise as high as 1 per cent without harmful jdiysiological effects. 

We must therefore ttim to some other cause than changes in carbon dioxide and oxy- 
gen to account for the sensation of discomfort in badly ventilated rooms. This fact 
has been recognized for, many years. Von Pettenkoler in the sixties worked the 
problem out broadly, althou^ without the detail which is now available. Hygienists 
turned next to the coganic matter, a subject much harder to study. It was simple 
to try out various percentages of carbon dioxide and oxygen, but with ofganic matter 
of a hypothetical nature the opportunity for m3r8tic imaginings was mudi greater. 

The conception of subtle organic poisons in the air is probably due to Brown-S^quard 
mcH« than to any one else — Brown-S^uard, notable among biologists because he had 
three or four entirely erroneous opinions on important points which he ampported by 
brilliant and apparently convincing experiments, and which it took decades to dis- 
prove. He believed that he could demonstrate the presence of organic poisons by 
condensing the material from the breath of animals and injecting it into other animals, 
which died as a result. It was later shown that they would have died in exactly the 
same way if the same amount of pure water at the same temperature had been injected . 
Then he placed animals in jars and allowed them to breathe the air breathed by other 
animals, once more with fatal results. These experiments were harder to control, 
but it was finally shown that the animals died from excessive carbon dioxide or from 
the chilling effect of excessive moisture. Many others have repeated these experi- 
ments excluding such factors, and all of them have obtained unif<»mly n^^tive 
results. 

The series of investigations conducted by Prof. Roeenau, of Harvard, about five 
yean ago approached this questicm in a somewhat different way. If a minute amount 
of some foreign protein substance is injected into an animal, after a certain time the 
animal will become highly sensitive to that particular protein and will die in a few 
minutes from a second injection, with characteristic symptoms. This anaphylactic 
reaction is a test for the specificity of proteins. Rosenau attempted to use this method 
for the detection of very minute quantities of oiganic substances, and he believed that 
he had demonstrated that there were such substances present in the expired air. He 
collected, for example, the matter expired in the breath of a dog and injected it iuto a 
guinea pig, and later injected dog-blood serum into the guinea pig, when, as he 
believed, the guinea pig died with symptoms of anaphylactic shock, which would indi- 
cate that there was a specific protein substance given off in the breath, althou^ of 
course not necessarily an intrinsically poisonous one. These experiments have now, 



236 PROCEEDINGS SECOND PAN AMSBICAN SCIENTIFIO C0KGBE88. 

however, been repeated by three other observers, by Leonard Hill in England and 
by Weismann and Lucas in New York City, the latter of whom worked under my 
direction. All three entirely failed to confirm Rosenau's experiments. 

There has been one series of investigations carried out during the past year by the 
New York State Commission on Ventilation, which again reopens this question in a 
different form. We have been carrying on rather extensive experiments for the past 
three years, to which I shall refer in more detail later on, in which human subjects 
were exposed to known air conditions and a wide variety of physiological and 
psychological observations made upon them. In the course of Uieee experiments 
we thought it would be interesting to see whether heat had any effect on appetite 
for food. We served our subjects in the experimental chamber with a standard 
luncheon, and we weighed the amount that they left on the plates afterwards so aa 
to see how much they had eaten. We did not find very striking results due to the 
heat, but we found what we had not expected, a marked effect of vitiated air aa 
compared with fresh air at the same temperature. We gave our subjects on certain 
days fresh outside pure air at low temperature; on other days fresh pure outside air 
raised to a high temperature; on other days we kept the same air in the room all 
day, allowing it to become chemically vitiated, but regulating its temperature. We 
found to our great surprise that comparing the fresh air and vitiated air days with 
the same temperature and humidity there was a distinct difference in the amount 
of food eaten. One series of experiments showed more food eaten on the stale air 
days, 4.9 per cent more for the whole squad of subjects; but this series had been 
stopped in the middle before calculating the results, because the religious prejudices of 
the subjects had entirely destroyed its value. We happened to come across a series 
of fast days, and these subjects were women who were very orthodox, and we found 
that ritual was governing the amount they ate, not air condition. The other four series 
which were completed show uniformly an excess of food eaten on fresh-air days, the 
excesses in the four series amounting to 4.4, 6.8, 8.6, and 13.6 per cent, respectively. 
There were from 71 to 160 meals served in each series, and we believe the results to 
be significant. We have tried to produce the same effect with fresh air containing 
carbon dioxide, without success. We have tried it with air containing artificial 
odors, without success. My personal hypothesis is that there is a psychological effect 
or reflex reaction to the body odor which had that subtle effect on Uie appetite. At 
any rate it stands as the one demonstrated effect of the chemical constituents of 
normally vitiated air. 

It was, I think, Hermann who in 1883 first pointed out that heat and moisture 
were probably the factors that produced the bad effects of bad air rather than its 
chemical composition, but most of the fundamental work on the subject was don^ in 
1905 or thereabouts by FlQgge and his pupils . These experiments have been repeated 
by Hill and Haldane in England, and by Benedict and others in this country, and 
all of the results have tended to show that Hermann was correct, and that the people 
in the Black Hole of Calcutta died, not of oxygen starvation, but of heat stroke. 

In these experiments the subjects when placed in carefully controlled closed 
chambers experienced the symptoms that one is accustomed to associate with badly 
ventilated rooms. If the subjects in these rooms were allowed to breathe outside 
air through a tube they were not relieved. If subjects outside were allowed to 
breathe the vitiated air through a tube, they did not experience discomfort. These 
two simple experiments appear to be entirely conclusive as to subjective symptoms. 
The feeling of uncomfortableness affected the men in the chamber, not the men 
outside the chamber, whatever air each group was breathing. It was the heat and 
moisture produced by their bodies which caused the feeling of discomfort, by its 
effect not on the lungs but on the skin. Benedict showed that a man could live for 
many days in a closed chamber without damage to his health and without having 
any idea that anything was wrong, with 1 to 2 per cent of carbon dioxide present, 
provided the chamber was cool and dry. 



PUBUO HEALTH AKD MEDICINE. 237 

Leonard Hill comments on his experimentB in England as follows: 

In one class of experiments we shut within the chamber seven or eight students 
for about half an hour and observed the effect of the confined atmosphere upon them. 
We kept them therein until tke CO, re»Ached 3 to 4 per cent, ana the oxygen had 
fallen to from 17 to 16 per cent. The ^et-bulb temperature rose meanwhile to about 
80** to 85** P. and the dry bulb a degree or two higher. The students went in chattinj^ 
and laughing, and by and b^ as me temperature rose they ceased to talk and their 
faces became flushed and moist. We have watched them trying to lif^it a cigarette 
(to relieve the monotony of the experiment) and puzzled by their matcnes going out, 
borrowing others, only m vain. They had not sensed the percentage of the diminu- 
tion of oxygen, whicn fell below 17. Their breathing was slightly deepened by the 
high percentage of CO3, but no headache occurred in any of them from the short 
exposure to from 3 to 4 per cent CO,. Their discomfort was relieved to an astonishing 
extent by putting on the electric fans placed in the roof. Whilst the air was kept 
stirred tie students were not affected by the oppressive atmosphere. They begged 
for the fans to be put on when they were cut on. The same old stale air contaimng 
3 to 4 per cent CO3 and 16 to 17 per cent Oj was whirled, but the movement of the 
air gave complete relief, because the air was 80** to 85** F. (wet bulb), while the air 
enmeshed in their clothes in contact with their skin was 98** to 99** F. (wet bulb). 
The whirling away of this stationary air cooled the body effectually, for air at 80** 
to 85** P. holds considerably more water vapor when heated up to from 98** to 99** P. 

In our experimental plant in New York we have been repeating these experiments 
in somewhat more detail as regards the special physiological reactions involved. 
Our observation room is 10 by 14 by 10 feet high, very carefully insulated as to walls 
and ceiling, entered by passages through three doors, and arranged so that we can 
control with a high degree of accuracy the temperature and humidity and air flow. 
We have placed in that chamber from four to eight subjects at a time, each squad of 
men or women being observed from four to eight hour? a day for a period of two to eight 
weeks. We foimd that chemically vitiated air of a comfortable temperature and 
humidity had no effects on any physiological or psychological reaction except on 
appetite. High temperature (86** with 80 per cent relative humidity) produced a 
slight but distinct elevation of the body temperature, an increase in reclining heart 
rate, an increase in the excess of standing over reclining heart rate, a very slight 
lowering of systolic blood pressure, and a marked fall in the Crampton value (a ratio 
between the change in heart rate and the change in blood pressure on passing from a 
reclining to a standing position). Broadly speaking a high Crampton value means 
that the vaso-motor system of the body adjusts itself easily to the work of standing up 
after lying down. 

Moderately high room temperature (75** with 50 per cent relative humidity) had 
the same effects, although of course in less d^^ree. Even the extreme room tempera- 
ture of 86^ with 80 per cent relative humidity combined with high carbon dioxide 
showed no effect on the respiratory rate, dead space in the lungs, chemical composi- 
tion of the blood, or the rate of heat production or digestion or metabolism or any 
other physiological reaction studied. 

We next went on to the question of the study of efficiency — ^the ability and desire 
to do mental and physical work. We found that even a temperature of 86** produced 
no effect on the power to do mental or physical work. .When subjects were working 
under pressure, accomplishing all they could in a brief period of time, they did Just 
as well under bad conditions as imder good conditions. We ought not to be surprised 
at this. It is our own experience; on a hot day in summer we play tennis or do a 
piece of absorbing intellectual work just as well as in colder weather. 

We had therefore to adopt other methods. Prof. Thomdike, of Columbia, devised 
tests in which the subjects were allowed to work or not work as they cho5>e, and 
were paid a small amount if they accomplished a certain quota of work, giving a 
slight but only a slight incentive, imitating the condition that exists in schools and in 
factories that are not on piecework. 

We obtained marked and striking differences from these option tests. The amount 
of physical work done when the subject had the choice of working or not dropped 



238 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONORE88. 

15 per cent at the 76° temperature as compared with the 68**, and dropped 37 per cent 
at 86"* as compared with eS"". 

We found no such effect on the optional tests for purely mental work. On the con> 
trary we found that the amount of mental multiplication done optionally was A.9 
per cent more at 75° than at 68°. I am inclined to think that this was perhaps due to 
the stimulus of the slight discomfort, and a desire to keep the mind off the outside 
conditions by working. As soon as we got to typewriting, involving again a modicum 
of physical work, 6.3 per cent more was done at 68° than at 75°. I think these experi- 
ments show that overheating has a serious and important effect on the actual output 
under normal working conditions. The results should be significant for the school 
trustee, and for the office manager and factory manager. They show definitely 
what has been generally assumed without any quantitative basis of proof, that there 
is a laige loss in efficiency due to overheating. 

Prof. Ellsworth Huntington, of Yale Univereity, carried out a year or two ago some 
extremely interesting experiments along this line on the effect of season upon mental 
and physical work — phjrsical work of operatives in Bridgeport and mental work of 
students at West Point and Annapolis. He showed that there was a distinct foiling 
off in the amount of work when the outdoor temperatures went above 65° or 70°. He 
found that there was a still more marked decrease when the temperature fell below 
40° to 50°. There was thus a period of maximum productivity in both factories and 
educational institutions in spring and fall, with a minimiun period in winter and 
another minimum in summer. Sudden diangee, on the other hand, in either direc- 
tion were stimulating. In Prof. Huntington's book on Civilization and Climate he 
connects these observations in a most interesting and suggestive way with the efficiency 
of mankind imder the various climates of the globe. 

A word should be said as to one other important effect of excessive temperature, 
its influence upon infant mortality. It might be supposed that the infant, having^ 
more surface to get rid of the heat in comparison with its bulk, would not suffer 
severely from heat, but this advantage is much more than overbalanced by the 
greater sensitiveness of its organization. The combined effect of artificial feeding 
and high atmospheric temperature is what causes the great loss of infant life from 
summer complaint. A young baby can usually live in cold weather even when 
fed with cow's milk; a baby can live through severe summer weather if it is fed at 
the breast. The combination is the deadly thing. 

Investigations in Berlin and elsewhere have shown that the infant mortality in 
summer is of two distinct types. In the first place, diuing early summer there are 
deaths among infants due to direct heat stroke, sudden short illnesses due, primarily 
to the effect of heat, but occurring almost exclusively among infants artificially fed. 
Later the babies die from summer complaint, from long drawn out diarrhea, in which 
the milk plays a somewhat laiger part, but in which the lowering of the vital resistance 
by heat is an integral factor. 

I look forward to the day when there will be not only artificially cooled hospital 
rooms for babies, but cool day and ni^t nurseries in the crowded tenement districts 
where babies can be taken when a severe spell of weather sets in. There is verj-- 
little question that such a provision is quite as important, if not more important^ 
than the provision of warm habitations in winter. 

Finally, one other effect remains to be considered — ^the effect of atmospheric condi- 
tions on the membranes of the nose and throat. Benjamin Franklin said ^'that people 
who live in the forest, in open bams, or with open windows, do not catch cold, and 
that the disease called 'a cold' is generally caused by impure air, lack of exerdse,^ 
or from overeating." This general phenomenon is of course very familiar; yet there 
has been little exact scientific evidence on this point. This is a subject which the 
New York State Conmiission on Ventilation has been taking up during the past year 
in a series of experiments under the immediate direction of Dr. James Alexander 



PUBLIC HEALTH AND MEDICINE. 239 

Miller. With our experimental rooms we were able not only to expose the subject 
first to a hot condition and then to a cold condition, and vice versa, but by having 
them bend over in a somewhat uncomfortable posidon we could have the body in one 
room exposed to one atmosphere, and the head in another exposed to another atmos- 
phere. 

These experiments confurmed the conclusions of Hill and Muecke that in going from 
a hot room to a cold room the membranes of the nose become paler and less moist, 
while the inferior turbinates contract. 

Wo found, however, that when the change was too sharp, when the subject passed 
from a hot room into a cold room with a strong draft on the face, it frequently happened 
that while the redness of the meml^ranes decreased, the swelling and paleness did 
not deoreaae but often increased, so that the membranes were swollen and bathed 
with mucous secretion, but without an ample blood supply — an ideal condition for 
the cultivation of disease bacteria. Apparently this is the phenomenon which Hes 
at the base of ''catching cold " by going from a hot room into the cold air. 

We examined a number of workers who had lived under skbnormal conditions- 
furnace men, exposed to hot dry air; laundrymen, exposed to hot, moist air; and 
truckmen and teamsters, exposed to severe outdoor-air conditions. We found abnor- 
mal reactions among these subjects in much greater degree; and these occupational 
groups showed much more chronic nasal disease than did the student subjects. About 
3 per cent of the students had chronic diseases of the nasal passages, 19 per cent of the 
outdoor workers, 35 per cent of the furnace men, and 46 per cent of the laundrymen. 
Both the experimental work and this statistical work on the various occupational 
groups pointed to the very serious effects of hot, dry air upon the mucous membranes, 
and particularly the danger of passing from such a condition into chill outdoor air. 

These are the things we know, or think we know, sibout air. We hear a great deal 
about other subtle and mysterious effects, about "canned air,'' and the bad effects of 
bringing in air through ventilating ducts instead of through windows. I have never 
had any great sympathy with this phrase or with the idea that anything harmful 
necessarily happened to air because it went through galvanised-iron ducts instead of 
coming through a window frame. Its temperature and humidity may be altered. 
Those are things which we know about and can measure. Whether there is any other 
factor at work, I do not know. Our own observers on the conmiission staff are con- 
stantly reporting to us that window-ventilated rooms seem fresher than those ven- 
tilated by mechanical-ventilating systems. I suspect, however, that these differ- 
ences, when more carefully analyzed, will be found to be due either to odors or to 
variatiims in temperature or humidity or to the factor of air movement. 

Air movement is one of the most important elements in the problem, since it largely 
controls the temperature and moistiu^ effects upon the human body. The body is 
surrounded, as Prof . Sedgwick has expressed it, by an ''aerial blanket'' of hot, moist 
air. Wind breaks up this hot, moist envelope and drives it away, reducing the tem- 
perature of the body to that of the surrounding air. Leonard Hill has given us a 
useful instrument for measuring these effects. This apparatus consists simply of two 
thermometers graduated from 86^ to 110'', one a dry bulb, the other an ordinary wet 
bulb, which is chilled by the evaporation fnnn a doth surrounding it. These ther- 
mometers are first heated until they rise to about 110^, and the time taken to fall 
from 100'* to 90" is noted. This measures the combined effect of three factors, the 
temperature of the outside air, the humidity of the outside air, and the air move- 
ment; and it measures these three factors very much as they affect our own body. 
I have been making observations with this instnmient during the past summer. The 
limits of comfort set by Prof. Hill, and which I think are reasonably near the truth, 
are three minutes forthefall of the dry bulb and one minute for the wet bulb. In cme 
of my observations in a room before a fire when the temperature was 72", the dry bulb 
took 4 minutes 37 seconds to fall; the wet bulb 1 minute 18 seconds. On anoth^ day 



240 PBOCEEDINGS SECOND PAN AMBBIOAK 8CIENTIFI0 G0NGBE8& 

outside in a wind the thennometer was at 82^, yet it took only 3 minutes for tne dry 
bulb to fall and 42 seconds for the wet bulb. This ia why we feel so much more 
comf<»rtable out of doors in summer, with a high temperature, when there is a good 
wind, than we do in a closed room when the temperature gets a very little over 70^. 

On one exceedingly uncomfortable day in September in my laboratory in New 
York at a temperature of 79** it took 5 minutes 55 seconds for the dry bulb to fall, 
and 1 minute 35 seconds for the wet. We turned on the electric fan, and it took 1 
minute 58 seconds for the dry bulb to fall and 29 seconds for the wet bulb. This 
instrument gives at last an opportunity of measuring the effect of air movement, 
which m probably one of the most important things in determining our comfcnt. 

Prof. Henderson has uiged , in view of the similarity between the symptoms of moun- 
tain sickness and those produced by bad ventilation, that the temperature of the air 
may produce a hitherto unrecognized change in respiratory activity. The phenomena 
observed have however to do primarily, not with the lungs but with the vaso-motor 
system, which regulates the temperature of the body. Our bodies maintain their 
constant temperature of 98.6'' at the poles and at the Equator by an exceedingly 
delicate system of adjustments, which leads to the dilation of the blood vessels in the 
skin when the air is hot and their contraction when it is cold. Moderately excessive 
heat causes the expansion of the skin blood vessels and robs the brain and internal 
organs of blood. I suspect that the disinclination to do physical and mental work ia 
laigely due to deficient blood supply in the brain. Under a stimulus we may over- 
come this, but ordinarily when the blood is in the skin we are sleepy and dull, and in 
extreme cases toxic effects result, when the mechaniBm of the body is seriously de- 
ranged by the heat, as in the Black Hole of Calcutta and in the case of heat stroke of 
infants in summer. 

Extreme cold on the other hand also reduces efficiency as shown by Prof. Hunting- 
ton. It lowers the vitality and may form an important contributing factor in respira- 
tory and other diseases. 

Moderate cold exerts a tonic effect, training the blood vessels of the vaso-motor 
system so that they will respond promptly to external changes. This system needs 
to be exercised just as any oUier system of the body does, and the question of ventila- 
tion is tied up with the problems of clothing and of bathing. The judicious airing 
and clothing and bathing of the body so that the vaso-motor system may be protected 
from extremes but educated so that it will meet moderate changes of temperature, 
with success — ^these are among the most important tasks of personal hygiene. 

If the concessions drawn by Prof. Ellsworth Himtington in his striking book are 
confirmed by future study, countries whose natural climates do not conform to the 
ideal he has worked out may find it possible to produce and maintain on an extensive 
scale those artificial conditions of coolness and changeablenees which he finds nec- 
essary to stimulate the highest human efficiency. 

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Akad. d. ^^^ssensch., Mflnchen, II, 88. 
Pettenkofer, M. and Voit, G. 186i2-^. Untersuchungen liber die Respiration. Ann. 

d. Ghem. u. Pharm., Leipz. u. Heidelb., 2 suppl. dd., 52. 
Rosenau, M. J., and Amoss, H. L. 1911. Oiganic Matter in the Expired Breath, 

Jour, of Med. Research, XXV, 35. 



242 PBOCEEDINGS SECOND PAN AMBBICAN SCIENTIFIC C0NGBE8S. 

Weiaman, C. 1913. Bio-chemical Studies of Expired Air in Relation to Ventilation. 
Dissertation submitted to Faculty of Pure SddQce of Columbia University. 1913. 

Winslow, C.-E. A., and Palmer, G. T. 1915. The Effect upon Appetite of the Chem- 
ical Constituents of the Air of Occupied Booms. Proceeding, Society for Experi- 
mental Biology and Medicine, XII, 141. 

Winslow, C.-E. A., and Browne, W. W. 1914. The Microbic Content of Indoor and 
Outdoor Air. Monthly Weather Review, XLII, 452. 

Winslow, C.-E. A. 1915. Standards of Ventilation in the light of Recent Research. 
Science, N. S. XLI, 625. 

Dr. KoBEB. I wish to express my appreciation of the very scien- 
tific work presented by Dr. Winslow and to utter a word of caution 
against drawing practical deductions which might perhaps lead 
to harmful effects. I am a thorough behever in pure air such as 
nature provides in the average composition of the atmosphere. It is 
stated that in the question of ventilation, the temperature, move- 
ment, and amount of humidity in the air play the most important 
part. While this is true, I believe there are decided differences in the 
purity of the air of our habitations and workshops when compared with 
out-door air, especially in air of parks, seashore, mountains and in the 
open country. I think it can be shown that differences exist not only 
in the amount of carbon-dioxide and oxygen, but also in the organic 
and inorganic constituents, as demonstrated by the presence of dust 
and bacteria, which always go hand in hand. So, for example, Uffel- 
mann foimd that while the outer air contained only 250 germs per 
cubic meter, the air of his library contained 2,900, of his sitting room 
7,500, of his bedroom 12,500, and the air of a living room of a work- 
ingman's family as many as 31,000 germs. He also demonstrated 
that they increased after disturbing the dust of the rooms with 
feather dusters or by slamming the doors, showing that they actually 
cling to the dust. It does not follow that because laboratory ex- 
periments failed to demonstrate any bad effects from the presence of 
large volumes of carbon-dioxide and a corresponding deficiency of 
oxygen, habitual exposure to vitiated air is harmless. It is far 
better perhajfe to assume that every particle of impurities over and 
above the amount normally present, must of necessity influence the 
physico-chemical changes in respiration and, if continued for any 
length of time, health will be impaired. This belief is also in har- 
mony with nature's beautiful process in storing up the excess of 
carbon-dioxide in the form of carbon in growing vegetation. 

It will be difficult to account for the imdue prevalence of tubercu- 
losis among the North-American Indians except on the grounds that 
the change from the tepee with its copious ventilation, to bad housing 
conditions with insufficient ventilation has estabUshed a peculiar pre- 
disposition to the disease. It is the exf)erience of the old practitioners 
of the Southern States that during the days of slavery the Negro on 
the plantations enjoyed as good health as the average white people 



PUBUO HEALTH AKD BfEDICIHB. 248 

among whom they dwelt and that consumption was very uncommon 
among them. After their liberation these people had to find shelter 
as best they could in shacks and shanties wholly unfit for human 
habitations. Their tuberculosis rate was almost treble that of the 
white population in the city of Washington. This rate, which was 
690 per 100,000 of the colored population in 1878, has been reduced 
to 359 in 1914. 

When we condemned the buildings unfit for human habitations, 
they responded promptly to improved environments. Even hve- 
stock shows the baneful effects of impure air, for tuberculosis among 
the range cattle of the far west, which are practically without shelter, 
is comparatively rare, while it affects from 15 to 25 per cent of the 
dairy herds, which are housed but without sufficient regard to light 
and air. As a matter of fact, an abundance of pure air has been found 
a most important factor in the prevention and treatment of tubercu- 
losis, because it promotes the oxygenation of the blood, stimulates 
the appetite and nutrition and thereby increases the general resisting 
power of the system. 

Improved ventilation and increased air space have lessened every- 
where the death-rate, and it is chiefly by just such measures that 
the rate from consumption has been reduced, according to Sir Thomas 
Oliver from 7.82 to 2.5 per 1,000 in the British Army during the last 
60 years. The tuberculosis and pneumonia death rate in the United 
States Army has been reduced respectively from 0.95 and 0.48 in 1901 
to 0.49 and 0.28 in 1913, and similar gratifying reductions have been 
recorded in the United States Navy. It is to be presumed that then 
as now the recruits were selected with great care, and that the differ- 
ence is simply due to the fact that they were subjected to impure air, 
incident to limited air space and have responded to improved envi- 
ronments. 

The influence of overcrowding and bad air on diseases of the respira- 
tory organs, amounting at times to epidemics, was well illustrated on 
the Isthmus of Panama. By scattering the colored laborers from 
crowded dormitories into single huts or rooms with not less than 50 
feet of floor space for each individual. Gen. Gorgas reduced the 
pneumonia rate in a single year from 18.4 per 1,000 to 2 per 1,000. 

It is also well known that pneumonia is more prevalent among the 
cavalry troops than among other arms of the service. Cavalry 
barracks have always the characteristic odor of horses and stables 
about them and it is not improbable that apart from exposure to the 
inhalation of dust during the grooming process, a part of this dust is 
also carried to the quarters and contaminates the air. 

Personally I do not believe that the dangers of habitual exposure 
to impure air have ever been exaggerated and in my judgment no two 
factors have contributed so much to the reduction in mortaUty rates 

68436—17— VOL x 17 



244 PBOCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONGBESS. 

during the last 50 years than the improvement of the air we breathe 
and the water we drink. 

Lieut. Col. MuNSON. I want to thank Prof. Winslow for the 
extremely interesting paper he has given us. The subject, it seems 
to me, is one that has a side issue as well as a direct bearing on ven- 
tilation. I mean a climatological relation. To those who have been 
in the Tropics and in the Philippines there has lately come up the 
question of how long men should serve in the Tropics, and it has 
been decided by the War Department that probably two years 
would be sufficient. The question was considered pro and con as to 
whether physical deterioration did, or did not, occur among troops in 
a period less than that time. We know from the experiments which 
have been quoted to us here that a temperature such as we have in 
Manila means approximately a one-third decrease in the physical 
efficiency of people. 

We faiow that just for a summer day or a week or two of hot 
weather we can force ourselves to work, but there comes a time when 
the constant pressure of unfavorable environment tends to reduce 
our will power to a point where we do not work at the same degree 
of efficiency. It has always seemed to me that possibly the slug- 
gishness of the native, his unwillingness to work, which we looked 
upon with some contempt, was possibly due to the fact that he 
was more fit to Uve in that environment than the white man. The 
longer that we Uved there, the less we wished to do, the less physical 
effort we wished to make, mental or physical effort. At the outset, 
we could make this mental effort fairly easily, but there came a time 
when this was reduced, and we had what the Army knows as " Philip- 
pinitis," a mental apathy and a physical sluggishness. 

In these experiments of Prof. Winslow, in which he speaks of the 
psychological effect, I would rather be inclined to throw out the 
question of incentive, because the incentive is not the same to all. 
A dollar looks larger to one person than to another. One person 
will work harder for money than another. But the point is this, 
that np one willingly went along and did physical work. I should 
like to see what would happen if such experiments as Prof. Wins- 
low's were continued not for days or weeks, but for months, until 
one got what we find in the Tropics, a physical inertia, graduiJ, slow 
in coining, but ultimately arriving. 

In regard to indoor ventilation, one point seems to me to need 
emphasis. That is the point of proper humidifying of warm air. 
You will never find that worked out in anything but the most elabo- 
rately ventilated buildings. In Prof. Winslow's own town, which is 
my home, the people have no conception of it, and they overheat 
the houses at the same time they batten down the windows, pre- 
paratory to their annual six months' struggle with winter. 



PUBLIO HEALTH AND MEDIOIKE. 245 

Dr. GuiTERAS. I would like to say a few words in conneotion 
with the influence of heat, especially upon mental work. I am not 
convinced by these experiments. I have Uved one-half of my Uf e in 
a cold country and one-half of my life in a hot country, and I believe 
that as far as mental work is concerned, if you are entirely free from 
the prejudice that high temperatures make work impossible, you can 
do as much work in a hot climate as you can in a cold coimtry. I 
think we forget what has been done in the past, how great civiliza- 
tions in the past reached their height in hot climates. Even the 
people bom in cold coimtries, when they have been brought into the 
tropical zone, have been able to do most extraordinary work. I do 
not think that anything the Spaniards have done, for instance, in 
their own country or throughout Europe could equal the amount of 
work and energy displayed both physically and mentally in the con- 
quest of the Tropics in America. I think that there is a great deal 
of prejudice in education that makes us feel that we can not do work 
when a certain degree of temperature is arrived at. I have always 
maintained this and I have felt that I could do as much work in the 
Tropics as I could in a cold country. 

Prof. Sedgwick. It is not many years since we were all taught 
that the proper study in ventilation was the question of space. 
We must have so many cubic feet per capita, and it was figured out 
to be something like 400 cubic feet per capita. I have for some 
time referred in my classes to that as the per capita of fallacy, 
and the fact that Prof. Winslow has omitted all reference to it shows 
how dead it really is. Yet, if you pick up many books devoted to 
air and ventilation, you will find these figures still used, i. e., that aU 
you need to obtain good ventilation is 400 feet or 600 feet per 
capita. I always illustrate the fallacy of that to my students by 
saying that I would rather have my head inclosed in a box of 1 cubic 
foot per capita with a good breeze going through the box than to sit 
in the biggest room in the world where there was no motion of the 
air at all; that is, I would rather have 1 cubic foot per capita of good, 
fresh circulating air than any number of feet per capita of stagnant 
air. Prof. Winslow has rightly concluded, I beUeve, that the large 
part of this question is the question of stagnation — stagnant air. 

The Chairmak. If there are no further remarks I will call upon 
Dr. Winslow to close the discussion. 

Dr. Winslow. There are a few things I wish to take up. In the 
first place, Dr. Guiteras, as far as our experiments went, we found 
no diminution in the mental work, but rather the reverse. We foimd 
more mental activity as the temperature rose above 76°. We foimd 
a decrease in optional phjrsical work, but an increase in optional 
mental work. 



246 PBOOEEDIKGS SECOND PAN AMBBIOAN 8CIENTIFIG OONQBE88. 

I may say with regard to the point raised by another speaker that 
we had of course our subjects under the same conditions, so that I 
think conditions were fair, but we did not, of course, work them for 
long periods of time. Now Prof. Himtington's work on students at 
West Point and Annapolis in classes in mathematics showed a 
diminution imder high temperature, and these results show very 
strongly for a period of five years in the daily marks. Whether 
that is conclusive remains to be seen. 

As to the question of dryness, I have always felt personally that 
very dry air was bad. Many people say dry air makes them nervous 
and that they feel badly. All I can say is that our work has failed 
to show any effect whatever on the membranes of the nose and throat. 
The most extensive experiments on the effect of dry air in nervous- 
ness, interfering with very delicate reactions have been made by 
Prof. Thorndyke. These results so far are negative. I think we 
must regard the bad effects of dry air per ae, apart from heat, as 
unproved. 

Col. HoFF. Prof. Sedgwick seemed to be inclined to question the 
effects of air space, cubic feet, etc. Are you proposing to eliminate 
that point entirely? Are we to adopt no standard of air space? In 
the Army we demand a minimum of 600 cubic feet and 60 square 
feet of floor space, and in our hospitals we require a larger allowance. 
Are we to eliminate that entirely ? There is no doubt that movement 
of the air is an extremely desirable thing. For example, take the 
Caribbean Islands, where we have the trade winds the year through. 
I spent a couple of years in Porto Rico, and it did not seem to me 
that it was at all troublesome to do a great deal of hard work that 
had to be done down there at the time. On the other hand, in the 
Philippines, where wind is not blowing so constantly as it is in the 
Caribbean Sea, the situation seems to be somewhat different. 

Dr. WmsLOw. I think it is probably true that there is a lower hmit 
below which it is difficult to get motion of air without inconvenience. 
I am not sure that that l*foot box really would be comfortable with 
the amount of air going through it, but I think what Prof. Sedgwick 
meant was that our present per capita standard was based on a 
wrong conception of our needs. The result of the British commis- 
sion on factory ventilation was that there was no relation between 
the actual amoimt of air and the per capita space in the factory. 

The CHAmMAN. The following papers will be read by title before 
adjournment: 

Climatologia dos Campos do Jordfto S. Paulo, by Victor Godinho. 

Nouveau proc6d6 pour la transfusion du sang, par Louis Agote. 



FUBUO HEALTH AND MEDIOINE. 247 

CUMATOLOGU— CAMPOS DO JORDlO— S. PAULO. 

For VICTOR GODINHO, 
Dvtdor do Hospital de Isolamento de 8do Paulo. 

Ha dez annos que 00 Dree. Emilio Marcondee Ribas e Victor Godinho esforyam- 
06 por obter dos poderee publicofl do Estado de Sfto Paulo e do Govemo Federal do 
Brasil anxilios afim de constmir sanatorios para tuberculoeos e uma villa sanitaria 
para peesoas iracas, convalescentee, de repouso para oe individuos enfraqueddoa por 
qualquer causa, ou simplesmente veranistas. 

Em 1908 conseguiram do Gongresso do Estado a approva^So de uma lei que Ihee 
garantia uma subven^&o annual de Rs. 60:0001000 durante 20 annoe para construc^fto 
de sanatorios. Tratando entfto de estudar a climatologia das differentes localidades 
do Estado de Sfto Paulo, reconheceram que a situa^fto deeejada estava situada nos 
Campos do Joidfto a 1,640 metres de altitude, nas vizinhan^as da villa Jaguaribe. 
£ um lugar de clima privilegiado e gosando \k de grande fama em todo paiz, fama 
giangeada por innumeras curas alii conquistadas, deede longa data, por muitas centenas 
de tuberculosos. 

£ um clima de montanha, amenisado pela posi^So geographica, proxima da linha 
tropical, ao abrigo de ventos tempestuosos. 

A villa Jaguaribe fica a 22^ 44^ latitude sul e 45^ 35^ de longitude a oeste de Green- 
wich. PresB&o barometrica annual, 633.2 m. m., notando-se 164 dias por anno de 
dias claros. A temperatura media annual ^ de 13^ l^(centigTado), sendo os extremes 
absolutos — 7^ e 28^ 8^, havendo pois uma varia9&o annual de 35^ 8^. Nebulosidade 
media annual egual a 3.3 e humidade relativa variando de 61 a 95. 

"& pois um clima temperado situado em zona quente e modificado pela altitude 
e podpfto geographica. Quanto aos ventos temos uma taxa de 34 por cento de fre- 
quenda para as calmas, 27.4 por cento para os ventos seccos NE. e NW. e 16.7 por 
cento para os ventos humidos SW. e SE. 

Oonvenddos que os sanatorios para tuberculosos deviam ser construidos nesse clima 
ideal dos Campos do Jordfto, oe dois medicos tiveram de reconhecer tambem que 
a viagem era extremamente incommoda para aUi, predsando-se lugentemente cons- 
tihiir uma estrada de ferro que ligasse Pindamonhangaba a villa Jaguaribe. 

Por eesa razfto voltaram a solicitar ao Gongresso Estadoal favores para a construcgfio 
para a referida estrada e por eesa forma a concesrtU) primitiva para construcySo de 
sanatorios foi convertida em concessfio para a Estrada de Ferro dos Campos do Jcxxl&o. 
A sombra doe favores officiaes a estrada, que era primeiro passo para conquista de 
um tfto excellente clima e para a construc^fto posterior dos sanatorios, foi construida 
e vai ser encampada pelo Govemo do Estado, visto os embara^os da companhia cons- 
tructora em ultimar a obra. S6 folta adquirir o material rodante e electrificar a 
tracy&o, que o Govemo far&. Por emquanto o trafego provisorio fitz-se com machinas 
a vapor e automoveis de linha, apezar das rampas de 10 por cento na Serra da Manti- 
queira. 

A estrada come9a em Pindamonhangaba, quasi a meio caminho eatre Rio de Janeiro 
6 Sfto Paulo. A viagem na nova estrada- offerece pontes de vista deslumbrantes, mais 
belles do que o que se gosa na Serra do Mar atravessada pela Sfto Paulo Railway. 
A altitude 6 muito maior, 1,750 metres acima do nivel do mar, no ponto mais alto da 
Serra da Mantiqueira, horizonte muito mais vasto e os panoramas mais variados. 

Campos do J<HrdSo ^ uma regifto de campos naturaes em que sfto muito abundantes 
OS pinheiros {Araueana hraaUientii), Ha l& cerca de 2,000,000 de pinheiros de mais 
de 100 annos, prestando-se i expl(»a$&o da madeira e sem despir os mattes. Todos 
OS valles sfto cobertos de pinheiros, todos elles cercados de campos com excellentes 
paetagens para a creagfto de gado cavallar, bovine, ovino e suino. Estas creayOes 



248 PROCEEDINGS SECOND PAN AMEBIOAN SCIENTIFIC CONGRESS. 

teem sido ensaidas com muito sueceflso, mas s&o at^ agora pouco desenvolvidas por 
causa de difHculdade no traoBporte. 

A villa Jaguaribe desde muitos amios 6 procurada por tuberculoflos que na sua 
grande maioria \& encontraram a cura ou pelo menos uma melhcMA muito accentuada. 
No entanto, nfto ha ainda um sanatorio medelar e uma villa sanitaria, com todas aa 
regras da hygiene, como projectam construir 00 dois facultativos. 

Uma vez realisados esses projectos, a esta^ climaterica dos Campos do Jordfto esti 
destinada a attrahir concorrentes de todo Brazil e mesmo dos paizes vizinhos, 
especialmente Uruguay e a Argentina. 

Oa dois medicos fizeram contracto com a municipalidade de Sfto Bento do Sapucahy 
para construirem na villa Jaguaribe 100 casas e gozam dos segumtee favores: isen^&o 
de impostos para as 100 primeiras casas; luivilegio para abastecimiento de agua. 
luz e esgotos e para for^a electrica. A agua 6 abundante e purissima e as cachoeiras 
numerosas e de grande forga. Uma dellas produz uma for^a de 12»000 cavallos. 

A regiAo presta-se admiravelmente para cultura das fructas: magans, peras, pecegos, 
figos, etc. Muitas arvores fnictiferas est&o }& plantadas e dellas se tem colhido fructos 
abuntantes e deliciosos. 

Estd em discussfto no Congreeso Federal um projecto concedendo garantia de juros 
de 6 por cento ao anno sobre capital de Rs. 2,000:000$000 para construcg^o da villa 
sanitaria e sanatorios, isengio de impostos aduaneiros para o material de construc9^ 
e rouparia do sanatorio e das 100 primeiras casas. 

L'epende, por^m, da resolug^ do Congresso. escriptor deeta pequena com- 
muoica^ tem esperanga de dotar Brasil de uma excellente esta^ climaterica, 
procurada como fonte de sadde, de repouso ou simplesmente de recreio, e junto da qual . 
n^ distancia de 6 kilometres, serSU) construidos sanatorios modelos para tratamento 
doB tuberculoses. Elle 6 proprietario de 220 alqueiree de terra, que adquiriu pam 
03 estabelecimentos que projecta, garantindo assim come90 de execu90 do seu 
bonemerito emprehendimento. 



NOUVEAU PROCfiDfi POUR LA TRANSFUSION DU SANG. 

Par LOUIS AGOTE, 

Pro/essewr de Clinique MidicaU, Bueno$ Ayres, Argentina, 

La transfusion du sang, le recours pr^eux, au moyen duquel il est possible de 
sauver dee milliers de personnes, victimee d'h^morragies intenses, n'aipu dtre utilise 
pratiquement avec Tamplitude qu'on pouvait esp^rer de son indlscutable efficadt^; 
ceci est dQ» non seulement aux difficult^ d'une manipulation compliqu^ et seule- 
ment realisable par un chirurgien familiarise en chiruigie vaaculaire, mais aussi par 
les mortifications vraiment douloureuses souffertes par la personne donnant du sang. 
N^cessite de d^nuer la veine dans I'eepace suffisant afin de pouvoir faire la suture k 
la veine du malade, ce qui, en reality, constitue toute une operation chinirgicale. 
Ajoutez & tout cela, ce qui n'est pas depreciable, le danger imminent dee embolies 
dans le syst^me clrculatoire du malade, graves complications difficiles k eviter mal- 
gre toutes les precautions que Pon pourrait prendre. C'est ce h quoi Pon doit attri- 
buer les cas de mort dej^ observes. Comme si tout cela n'etait pas suffisant pour 
restreindre Pemploi de la transfusion parPanastomose arterio-veineuse, il faut compter 
encore la circonstance aggravante de ne pas savoir exactement la quantite du sang 
transfuse; ceci peut ne pas avoir d'importance pour celui qui le reyoit, mais beaucoup 



PUBLIC HEALTH AND MBQIOIKE. 249 

pour celui qui le doxme (on a observe dee caa de d^faillance, syncopea, mort, etc.): 1® 
danger de Pinfection dee blessures produites afin de dinner lea veines, ^vit^ par dee 
moyens parfaitement aseptiquee— par exemple, dans une salle d'op^tiona — cela 
n'arrive pas ailleurs et sp^alement dans lee hdpitaux de campagne, en cas de guerre 
oil la transfusion aurait un champ d'application vaste et efficace. 

Tons cee inconv^nients et d'autrea que nous vouloua taire afin de noua r6f6rer aeule- 
ment aux plus forta, experimental demidrement k Toccasion d'un easai de tranafuaion 
par lea proc6d^ recommand^ ap^alement par lea chirugienB de P Am^rique du Nord, 
noua ont induit & 6tudier dana Tinatitut mod^e de clinique m^dicale, Tint^reaaant 
probl^me afin de chercher aa aolution partielle ou totale, profond6ment convaincua 
que la r^aliaer actuellement conatitue un recoura vraiment exceptionnel. Noa efforts 
r^lis^a en collaboration du docteur Ig. Imaz Appathie, mMedn en chef dea labora- 
toirea de Tinatitut, ont donn6 dee r^aultata favorablea, permettant d'aaaurer que la 
tranafuaion du aang, c'eat-^ire I'injection de ce liquide provenant d'un aujet aain a 
un autre aujet malade, comme noua le conseillona, aperdu toua ceadangera, conatituant 
un proced^ clinique aimple d'une ex^ution facile et & la port^ de toua lea m6decina. 
II remplU alors lea conditUms exigSes par la clinique nUdioale, 

Sana vouloir raconter Thiatoire de noa travaux, eaaaia, fracaa et vadllationa, juaqu'it 
Parriv^ k un r^eultat d^finitif et satiafaiaant; sana vouloir diacuter aur lea diveraea 
queationa entrelac^ k ce probl^e intdreasant et qui aiirement ae pr^senteront auaai k 
Teaprit du lecteur, il nous suffit d'assurer qu'elles ont 6t6 ^tudi^es et r^eolues, adit 
par noa proprea travaux soit par d'autres observateurs. Nous nous limiterons k la 
description de notre proc^^, tel qu'il r^sulte de nos experiences concluantes, faites 
premi^rement sur des animaux et ensuite sur des hommes, pouvant assurer sa parfaite 
innocuite. 

Notre precede est celui de la transfusion immMiate/ en prenant du sang de la 
veine du pli du coude du donnant, recueilli dans tm recipient ou appareil dermoclyse, 
contenant une solution de citrate de neutre sonde au 25%, dans la proportion d*un 
gramme pour cent grammes de sang. Ce melange rend le sang incoagulable, sans 
qu'il perde ses qualit^s vitales. Comme le citrate neutre de soude est absolument 
inoffensif pour Foiganisme en quantites beaucoup plus grandes, on pent injecter ce 
mi'ilange au malade, avec toute facility, sans aucun danger, dans les veines de Pavant- 
bios au moyen du mdme appareil et comme n'importe quelle autre injection endo- 
veineuse. 

Cette merveilleuse propriety du sel de soude d'emp^cher la coagulation du sang, 
fait de la transfusion une operation tr^ simple, k la port6e de tout le monde, suppri- 
mant d6finitivement les dangers pr^sent^s jusqu'ici, gr&ce k ce recours d'un effet tr^ 
efficace. D'autre part, elle r^duit Tacquisition du sang a la simple piqiire d'lme 
aiguille en platine (le diam^tre interieur d*un millimetre est suffisant), suivant le 
m^me proc^eae la saign^e; personne ne verra d^inconvenients k donner une quantity 
determinee de sang, sans s'exposer k souffiir, durant des jours, des consequences 
comme nous le sommes de son innociute; la transfusion sous cette forme doit entrer 
dans la pratique courante de rasaistance medicale, dans les cas indiques et durant lea 
epoques de guerre comme actuellement elle constituera le recours suprdme pour 
combattre les grandes pertes de sang. 

On pourrait objector k notre precede Temploi du sang veineux au lieu de Tarteriel. 
Rappelons que Temploi de T anastomose arterio-veineuse n'a pas ete faite pour la 
qualite du sang, mais afin de pouvoir utiliser la forte pression arterielle, indispensable 
au moment d'une transfusion directe. 

Librea par conaequent de cette impoeition, noua pouvona utiliaer aans danger le 
aang veineux, d'autant plus lorsqu'il appartient k la circulation peripherique, mais 
toute objection reate nulle, noua laiaaant librea d' utiliaer la circonatance favorable de 
I'avoir k notre portee au moyen d'une aimple piq(ire. 

1 Nous avous fait la premi^ transfasicm le 14 de novembre de 1914. 



260 PBOOBEDIKQB SBOOKD PAH AMKRIOAy SOIBNTIFIO 00NGBB8S. 

Apr^ tout cela, le liquide injects, en p^n^trant dans la cixculation du malade va 
soufirir la mdme depuration pulnumaire que celle k laquelle il a M aoumiB dans 
Poiganiflme du malade; il s'oxygtee ainsi dans le r^pient comme dans le pounu>n. 
L'observation aurait sa raison d'dtre s'il s'agissait de sang pris dans une veine . . . 
d'une visc^ (du foie ou du rein). 

MANliRI DB PBOOiniE. 

L'op^tion n'offre aucune difficult^. On peut, k la rigueur, employer Tappareil de 
Potain ou n'importe quel autre semblable, utilise pour les injections endo-veineuses. 
Nous conseillons Pemploi d'un modMe construit par la maison Lutz y Schuls de 
cette capitale, d'aprds noe indications. L'appareil se compose d'un r^pient en 
verre gradu6 k deux tubes, avec ouverture relativement laige. On cherche que le 
sang tombe directement de la canule au r^pient dont le fond se termine en pointe, 
afin que le tube injecteur en verre arrive au niveau plus bas du liquide et permette 
ainsi d'utiliser, sans que Pair entre, la plus grande quantity de sang, dbrconstance 
tr^ importante lorsqu'il s*agit de cette mati^re. La branche la plus longue porte 
I'aiguille en pladne pour Tinjection, imie au moyen d'un tube en caoutchouc, d'un 
calibre int^eur plus ou moins ^gal k celui du tube en verre, et la plus courte de 
laquelle de diam^tre suflBsant afin de pouvoir le tenir en position verticale. 

Elu le donnant et qu'on est assure de sa parfaite sant^, en pratiquant toujours, si 
cela est possible, la reaction de Wassermann, refusant celui dont le r6sultat a ^t^ 
poeitif mtoie quand il s'agit d'un malaise sp6cifique en se rappelant des diversity 
des ipiroqiietes, avec see consequences pour le pronostic. On prendra le sang dans la 
veine du donnant, sans couper la pei^u, au moyen de TaiguiUe en platine, apr^ avoir 
lie le bras plus haut que le pli du coude, ou en incisant la veine par une incision 
comme dans n'importe quelle saign^e. On recueille le sang dans le recipient choisi 
dans lequel on depoeera prealablement trois grammes de la solution nommee plus 
haut, quantite suffisante pour trois cents gnunmes de sang, mdme lorsqu'on n'arrive 
pas k recueillir la dite quantite, puisque etant inofifensif pour Torgamsme, ce surplus 
n'a aucime importance. II est convenable d'agiter doucement I'appareil pendant 
que Ton recueille le sang, afin de fadliter le melange des deux liquides et d'eviter 
la coagulation dans les parties libres de son contact. Ceci fait, on I'injectera dans la 
veine du malade, suivant le procede ordinaire pour les injections dans lee veines, en 
prenant les precautions du cas. 

L'extraction de 300 grammes de sang chez un individu normalement robuste est 
f acilement tolerable. 

Afin d'eviter une syncope ou une simple defaillance on peut lui faire prealablement 
une enteroclyse de 300 grammes de serum. On peut ainsi injector apr^ avoir pratique 
Pextraction de la mdme quantite de la solution saline dans la veine dennant. L'ab- 
sorption du serum par le rectum est presque simultanee avec le sang, de mani^re 
que celui-Ui conserve en tout temps son equilibre circulatoire. 

Apr^ la transfusion on n' observe pas de temperature, ni rien de particulier. Nos 
affirmations ont ete faites aprds avoir analyse soigneusement les urines recueilliee de 
deux en deux heures, ce qui montre Tincorporation complete du sang injecte dans la 
masse sanguine du malade. Quant k Texamen du sang, celui-ci a demontre Paug* 
mentation dee elements figures et de I'hemoglobine, comme la tension sanguine et 
la reduction de la tachycardie. Consecutivement k ces signes retat general du malade 
est mieux. 

The Chairman. This completes the program of the afternoon, and 
the session is adjourned. 



SESSION OF SUBSECTION B OF SECTION Vin.> 

New Ebbitt Hotel, 
WednesdoA/ morning, Januafy 5, 1916. 

Chairman^ Sam L. Rooebs. 
General Topic: 

Pan Amexloan Theme: Firogrees of Vital StatiatieB in Pan Amexiean 
Countries. 

The session was called to order at 9 o'clock by the chaurman. 

TOOFOBMACION DE las ESTADlSnCAS DEMOGRlnCAS Y DE LA FECHA 
DE LEVANTAMIENTO DE LOS CENSOS DE POBLACION DE LOS PAlSES 
PANAMEiaCANOS. 

Por ALVARO COVARRUBUS ARLEGUI, 
Je/e de Section de la Ofiama Central de Estadisticaf de Chile. 

Introducci6n. 

En el presente trabajo no aparecer&n dfras que den a conocer demogr^camente los 
paiaes panamericanoB, ni trataremoe de demostrar la neceeidad de que cada uno de 
ellofl organice la eetadlstica del ramo; puee ya no ee dlscute que este servido fonna 
parte integrante de la admini0traci6n y que oL alguno no cuenta aun con 61, no ee 
porque ee deeconozca su importancia, sine x>or causae de otro orden que no ee del caeo 
analizar. 

Por lo tanto, el presente trabajo tiene por objeto proponer, en forma eepedal, la 
uniformaci6n de lae Eetadfsticae Demogr&ficae para bacerias comparablee entre d 
proponiendo a la yez, entre otras coeae, la reducci6n de lae mucbae materiae que boy 
comprende la demografia y que no eet^ claramente determinadae. 

Parte I. — Definicidn de la df!mograf\a, 

Etimoldgicamente la palabra demografia ee deriva de la griega Demoe, que significa 
pueblo y Graptein, deecribir; o sea, deecripci6n de loe puebloe. 

Se puede dedr que el creador de eeta palabra fu6 el doctor en dencias y eabio bot4- 
nico, Aquilee GuHlard, que la us6 por primera vez en el Congreeo de BrueelaB el afio 
de 1853, defini^dola de la siguiente manera: "Es la bistoria natural y social de la 
eepecie bumana" y en un sentido m^ reetringido: '' Es el conodmiento matem&tico 
de lae pobladonee, de sue movimientoe genendee, de su eetado ffsico, civil, inte- 
lectual y moral." 

Deede eea fecba, casi todoe loe eecritoree eobre eetadletica o denciae eocialee y lae 
pereonae dedicadae a esta clase de eetudioe la ban definido en eentidoe divereoe. 

E . Lavaeseur, en su libro sobre la pobladdn de Francia, la define : ' * £s la dencia de la 
pobladdn: ella estudia sue movimientoe y prindpalmente sue nacimientoe, matri- 
monioe, defundonee y su inmigrad6n; ella se esfuerza por llegar a conocer las leyes 
que los rigen. Ee la dencia de la vida bumana en eu eetado social." 

1 Then wss no steDOgraphio report of this session. 

251 



252 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIC CONGRESS. 

Ferraris dice: ^'Es la ciencia de la pobladdn." Meeadaglia: ''Es la cienda 
estadistica de la poblaci6n,'' y Benini: ''Es la ciencia cuantitativa de la poblaci6n/' 

Estas definiciones y muchas otras ban formado algunas sin autores conocidoe, por 
ejemplo: ^'Es la ciencia del hombre comdderado socialmente y en cuanto pueda ser 
expresada por medio de cifras num^ricas''; otra: ''Es el estudio y deecripci6n de loe 
pueblos, teniendo en cuenta la edad, profeei6n, domicilio, etc., de loe individuos." 

Las definiciones anteriores nos demuestran doe coeas: que eziste discon- 
formidad de apreciaciones y que, segtin las ^pocas, se restringen o ensanchan las 
materias que debe comprender la demograffa. 

Pabtb II. — Materias que camprendia la demografia. 

Por las definiciones anotadas se deduce que el campo de acci6n de la demografia 
es casi ilimitado; pnes abarca la mayorfa de las estadisticas que se relacionan con los 
hombres. Ella comprende la natalidad, nnpcialidad, mortalidad, inst2iicci6n, justicia, 
criminalidad, migraci6n, estaditicas morales, politicas, religiosas, etc. 

Sin entrar a profundizar cada una de estas materias, se ve que, aunqueligadas 
indirectamente entre si forman un bloque hetereog^eo de dificil amalgamacidn. 

Parts III. — SegregaMn de algunas materias que comprendia la demografia. 

En un prindpio no present6 mayores dificultades el estudio de la demografia en la 
forma amplia en. que fu6 concebida; pero el avance de las ciendas di6 a conocer 
que algunas de las materias comprendidas en ella, debian ser investigadas independi- 
entemente, para lo cual se necesitaban informadones distintas que para las demib. 

Estas nuevas investigadones trajeron como consecuenda la desmembrad6n de la 
demografia, y lentamente los Institutes de estadisticas publicaron trabajos espedales 
sobre muchas de ellas, dejando para ser tratadas en conjunto s61o aquellas cuyas 
informadones provenfan de una misma fuente. 

Parts IV. — Materias que debe comprender la demografia. 

Como se ve, en la desmembraci6n de que hablamos no ha intervenido directamente 
instituddn o persona algiina, 66I0 ha side originada por la fuerza de las drcunstandas. 

De aqui que en la actualidad no se sepa con exactitud las materias que legltimamente 
le corresponden; imponi^ndose pues la necesidad de eetablecerlo de una manera 
categ6rica. 

La prdctica que en este case ha representado la opini6n de la mayorla de los dem6- 
grafos, ha fijado ya casi definitivamente las materias que debe comprender y que son: 
los matrimonios, nacimientos, naddos-muertos y defundones. 

Existen tambi^n razones de otro orden que concuerdan con las fijadas por la pr&ctica 
y que omitimos anotarlas aqul para hacerlo en el capltulo siguiente. 

Xo contrariando lo establecido por la pr&ctica ninguna dispo8id6n, falta para darle 
fuerza l^;al un acuerdo intemacional. 

Por tanto se entenderd en lo sucesivo por demografia la ciencia que trata exclusiva- 
mente de los nacimientos, matrimonios, naddos-muertos, defundones y bus derivados. 

Como la palabra derivados encierra la mayorla de las informaciones, anotamos las 
que a nuestro juicio debe comprender: derivados de los matrimonios son los divcnrdos; 
de los nacidos-muertos, los fetos y abortos y de las defunciones, los suicidios. 

Posiblemente causard extrafieza que la migrad6n que estd Intimamente ligada con 
el aiunento de la poblacidn, haya side eliminada de la demografia; pero para obrar 
de esta manera nos hemes apoyado en el siguiente aigumento: 

Cuando los medios de locomoci6n no hablan alcanzado el desarroUo actual la migra- 
d6n, relativamente redudda, constitula 86I0 un hecho social secundario que podia ser 
tratado en conjunto con las dem^ materias demogrdficas. Pero actualmente las 
cosas ban variado en absoluto y la migrad6n constituye hoy dla un problema de vital 
importanda para algunos palses, pues de 61 depende en muchos casos, la prosperidad 
futura. 



PUBLIC HEALTH AND MEDICINE. 253 

For esta causa loe paiises de migracidn intensa hau separado las estadlsticas migra- 
torias de las demogrdj&cas, propiamente dichas, a tin de poder conocer a fondo los 
muchoe problemas que ella encieira. 

En consecuenda, creemoe que la demografia no debe comprender la migraci6n y 
que su programa debe eer sdlo el que anotamoe anteriormente. 

Parts V. — Conveniencia de adoptar una definici&n de la demografia. 

A pesar de existir innumerables deflniciones de la demograffa sin embargo, la 
mayorla de los autores estd de acuerdo en que no existe ninguna clara y preciaa. 

Recordando las muchas materias que encerraba se comprender& fdcllmente que 
las deflniciones no fueran rigurosamente exactas y que no expreearan su verdadero 
aignificado. 

Como lo hemes tratado de demoetrar, el progreso de las ciencias en general y 
el avance de los estudios sociales en particular, ha hecho que la demografia no com- 
prenda ya el gran ndmero de materias que abarcaba en su origen. 

De aqui que las definlciones existentes ademas de no ser concretas no expresen 
lo que es hoy la demografia. Por esta causa es necesario crear una definici6n.que 
revele con exactitud su verdadero significado. 

Estando ya los limites de ella perfectamente delineadoe no es dificil encontrar una 
definici6n concisa, clara y exacta y que concuerde con la etimologla de la palabra. 

Para esto hay que dejar establecido que los acontecimientos naturales mds impor- 
tantes de la hiunanidad son los nacimientos y las defunciones, puesto que constituyen 
el principle y el fin de la vida, y que todoe los demis hechos estdn subordinados a elloe. 

Hemes dicho que etimol6gicamente la palabra demografia significa de6cripci6n 
de los pueblos. Dejando establecido que los nacimientos y defunciones son sus 
acontecimientos m^ importantes, es natural que la descTipci6n de elloe se refiera a 
eetoe acontecimientos principalee y no a otros de menos importancia. 

(El fondo de esta argiunento lo hemes tomado tambi^n en consideraci6n para dejar 
reducida la demografia a las cuatro materias anotadas en el capitulo anterior.) 

De aqui que la detinici6n de la demografia tomando en cuenta su etimologla y las 
materias que comprende, serla: "descripci6n de los pueblos segtin sus principales 
acontecimientos naturales.'' 

A esta definici6n hay que agregarle algo para que abarque la nupcialidad, que por 
no ser creaci6n de la naturaleza, no es acontecimiento natural y por tanto estd eliminado 
de ella. 

Dada nuestra organizaci6n social, el matrimonio ha pasado a formar cad un aconte- 
cimiento natural (a i>e8ar de haber side creado por el hombre) pues, es el que legaliza 
la reproducci6n de la especie humana y el que constituye la feunilia, base del engran- 
decimiento de las nadones. 

Por tanto, la definici6n anterior podria quedar en la siguiente forma: "Enti^dese 
por demografia la ciencia que trata de la descripci6n de los pueblos s^;tin bus princi- 
pales acontecimientos naturales y legales, en cuanto a la nupdalidad se refiere.'' 

Parte VI. — Un'tfbrmidad de las eetadUticas demogrdficas panamericana$. 

Es un principio eetadfstico que todas las informaciones de una misma naturaleza, 
para que sean delddamente aprovechadas, deben ser uniformee. 

Consecuente con este principio, casi todos los Congresos de estadlsticas han tratado 
de uniformar las demograflas a fm de hacerlas comparables entre sf . En este sentido 
ee han aprobado diferentes acuerdoe; pero pocos han side los que se han Uevado a la 
pr^tica en la forma estricta en que se han aprobado. 

De estos acuerdo tal vez el adoptado por el mayor ntimero de paises panamericanos 
ha side el de la nomenclatura intemacional de causas de muerte, pero desgraciada- 
mente no ha side puesto en pr&ctica en la forma exacta en que fu6 aprobado. 

Revisando las publicaciones demogrdficas se \6 que unoa han adoptado sdlo la 
n6mina de causas de muerte; otros, la tabla de edades y por tiltimo, los hay, que han 



254 PBOOBEDnros beookd pan ambbioah bgibktifio ookobbss. 

ftdoptado ambaa coeaa, pero en forma tal, que con las edades no ae pueden fannu loa 
grandea gnipoa de que trata la miama nomendatora. 

Tot eata caoaa laa eatadfaticaa demog^rificaa pan americanaa no ae preatan a eatndioa 
comparatiToa. 

Eata dificultad para cefiirlaa a un miamo plan ae debe a delectoa de loa planea pro- 
pueetoa con eate objeto y a la forma como ban aido ai»obadoa, aogdn tiataremoa de 
demoatrarlo. 

El aervicio de eatadfatica demogrdficahaaido organizado en cadapafa en conlonnidad 
al regimen adminiatrativo y el aiatema de inveatigacidn y pnblicaddn, en reladdn a 
loe problemaa que deaean conocer. De aquf que cada uno tenga an aiatema piopio' 
y diferente de loa demda, aegt!in ae comprueba por laa reapectivaa publicadonea. Aaf , 
por ejemplo, mientraa un paia le da gran deaarrollo a nupcialidad, el otro apenaa 
la mendona y mientraa ^ate uaa la palabra var6n y bembra para determinar Ice 
aexoa, el otro emplea el de bombre o mujer o maacuUno y femenino, etc. 

Luego, el fracaso de la uniformacidn de las eatadfaticaa demogrdficaa ha provenido 
de que loe planes propueetos anulan los sistemas en uso, y como ^stoa ban aido creadoe 
aegtin laa necesidades propias de cada pafs, los nuevos aiatemaa no lea ban reportado 
utilidad mayor. 

En consecuencia, para Uegar a conaeguir que se uniformen las estadfatlcaa demo 
gr^caa de los pafses panameiicanoe es necesario que los acuerdos que en este sentido 
se aprueben no envuelvan, ni directa ni indirectamente, reforma alguna en las esta- 
(Ifsticas existentes, ni tampoco anulen o bagan cambiar loe procedimientos en uso. 

Por tanto, para llegar a este resultado y obtener ^xito en la pr4ctica respecto a la 
umformidad de ellas, proponemos la aprobad6n del siguiente acuerdo: 

''Los pafses panamericanos formar&n y publicardn bus estadfsticas demogr&ficas en 
la forma, fecba e idioma que lo estimen por conveniente; pero tendrto la obligaci6n 
de bacer figurar en un capftulo o folleto especial, laa informadonea demogr&ficaa en 
la forma e idioma acordado por el Congreeo. Eate capftulo o folleto ae tituladL " Infor- 
madonea demogr&ficas acordadas por el S^gundo Congreso Cientffico Panamericano." 

Respecto al idioma creemos que siendo d espafiol el de la mayorfa de loa pafses 
panamericanos deberd ser ^ste d que se adopte. 

Pabtb VII. — Dates gus Comprenderdn la$ Iriformaciones Demogr^ficM Poncrmmoanat. 

Habiendo dejado eatableddo que la uniformaddn propueata no se refiere en ningtin 
case a laa estadfstic&s demogr&ficas generales de cada pafs, sine a un capftulo especial 
de ellas, es necesario, por tanto, establecer con claridad los dates que el dtado capftulo 
o foUeto dd>e comprender y la forma como se publicardn. 

Estoa datoe deber^ aer de interna prindpal y general; pero, como para determinar 
ambaa condidonee se necedtan conocer loe problemas aodalea, econdmicoa, noao- 
Idgicoa, etc., de cada pafe; y, como eato aeria materia de un trabajo largo y prolijo y 
que ae preatarfa a apreciadonea err6neaa, noa concretaremoa a anotar nominatiyamente 
loe que a nueatro juido pueden aer dasificadoa como de interns prindpal de cada 
pafe y general para todos, badendo solo un Ugero andlisis de elloa e inaertando al final 
loa formularioa reepectivoe. 

P^ira obrar con orden anotaremoa primero los dates que se refieren a los matrimonies, 
despu^s los que se refieren a los nadmientos; en a^guida los de naddos-muertos y 
por tiltimo los de defundones. 

(a) matrimonios. 

N(!bnero total de matrimonies y proporddn pcM* mil habitantea. 

N(!bnero de matiimonioa daaificadoa aogdn el grade de parenteaco de loa contra- 
yentee y detalladoe en urbanoe y ruralea. (Formulario No. 1.) 

Ntimero de matrimonioe daaificadoa aegtin la nadonaUdad de loa contrayentee y 
detalladoa en urbanoe y ruralea. (Formulario No. 2.) 



PUBLIC HEALTH AND MEDICINE. 255 

(b) nagdobntos. 

Ntimero total de nadmientoe y proporddn por mil habitaiites. 

Ndmero de nacimientoe ciaaificados segtin la legitimidad y el sexo y detalladoe 
en urbanoB y rurales. (Fonnulario No. 3.) 

Ntimeio de nadmientos claaificadoB segiin la nadonalidad de loe padres y la legi- 
timidad y Bexo de loe naddoe, detallado en urbanos y runJes. (Fonnulario No. 4.) 

Ntimero de nadmientoe daaificadoe seg6n la clase de loe partes, detalladoe en 
nrbanoB y mralee. (Formnlario No. 6.) 

(O) NAdDOS ICUBBTOS. 

Se comprenderd en eete nibro todoe loe que la nomendatura intemadonal de caueas 
de muerte daeifica como talee y ademie loe abortoe, fetoe, etc. 

Ntimero de nacidoe muertoe daaificadoe segrhi la legitimidad y el eexo, detalladoe 
en urbanoe y rurales. (Fonnulario No. 6.) 

(d) DBVUNCIONB8. 

Ntimero de defundonee (deecontadoe loe naddoe muertoe) y properdin por mil 
babitantee. 

Ntimero de defundonee daeificadae por cauea, edad y eexo, detalladae en urbanae 
y mralee. (Formulario No. 7.) 

Ntimero de defundonee daeificadae SQgdn el eetado dvil y el sexo, detalladae en 
urbanae y mralee. (Formulario No. 8.) 

Ntimero de falleddoe menoree de un afio, dasificadoe por cauea, edad y sexo, detalla- 
doe en urbanoe y mralee. (Fonnukrio No. 9.) 

Ntimero de fiJleddoe menoree de un afio dasificadoe por cauea y agrapadoe por 
meeee. (Fonnulario No. 10.) 

Ntimero de btlleddoe menoree de un afio daaificadoe por edadee y agrapadoe por 
meeee del afio. (Formulario No. 11.) 

Los datoe que comprenderi el capitulo o folleto de estad£rtica demogr&fica Pan- 
americana, deber&n separarse los que se refieren a la parte urhana de loe de la parte 
tural. Far ejemplo, de los matrimonies se anotar&n independientemente los cele- 
brados en las dudades de los cdebrados en los campos, etc. Para determinar esta 
clasificaddn se emplear&n las abreviaturas (TJ) Urbane y (R) Rural. 

Esta 8eparad6n obedece a ]a necesidad de conocer la forma como se desarrollan en 
loe campoe y en las dudades los diferentes problemas sodales, nosol6gicos, etc., pues 
es sabido que mientras algunos acontecimientos son antiguos en las dudades, en los 
campoe no se conocen, o vice-yerea. 

Adem&i, la vida demogr&fica de las dudades tiene caracterieticas especiales y que 
si las informadones de ^stas van unidas con las de los campos, fale^anse mutuamente 
bad^dose impoeible su estudio. 

Respecto a la edad de loe falleddoe, la comiBi6n interaadonal encaigada de la 
revisi6n de la Nomendatura NoBol6gica Interaadonal reunida en Parfe en julio de 
1909, determin6 que la clasificadon de las edades debla bacerse tan detallada como 
sea poeible. Las razones que se dieron sobre el particular se encuentran en las 
actas de dicha comisi6n, por lo cual omitimoe anotarlas aquf . 

For esto las edades de los fallecidos se anotar&n sin formar grapes de afios, sine los 
afios continuando, esto es: Menores de un afio, de un afio, de dos afios, etc., agrapando 
sdlo los de den afios adelante. 

Biendo los estudios nosol^gicos de ci^tal importanda para la humanidad, estimo 
que se debe aportar a ellos el mayor ntimero de informadones poeible y mis, cuando 
se trata de paisee nuevos como los panamericanos que en este sentido tienen muchos 
puntos no reeueltos y aun desconoddos. 

Para reforzar nuestra opini6n anotamos la del Dr. norteame ricano, Carlos V. Cbapin . 
'*£1 registro de las eetadfsticas vitales es la base firme sobre la cual debe descansar 



256 PROCEEDINGS SECOND PAN AMEBICAN SCIENTTPIC CONGBESS. 

toda la estructura de la ciencia sanitaria pr&ctica, con el objeto de aprender las leyee 
de las enfennedades y buscar sns remedies. Se debe tener un conocimiento exacto 
del movimiento de la poblaci6n y de las causas de muerte.*' 

Partb VIII. — Vnijofrmaicidra de las fechas de lo$ cengoi generales de poblaci6n en lo9 

jxAsee panamericanoi. 

Casi sin ezcepci6n todas las materlas que fonnan la demografla tienen como base 
la poblaci6n y sus deducciones van encaminadas a conocer antecedentes o a explicar 
fen6menoB de la poolaci6n misma. Per esto se encuentran fntimamente ligadoe 
entre s( el censo y 1* demografia y es lo que nos ha inducido a tratarlo en estetrabajo. 

Todo lo propuesto es relativamente f&cil de llevar a la pr^tica, porque depende 
casi tinicamente de loe Consejos o de los Directores de Estadistica. 

No asi lo relatdvo a la fecha de los censos que, por lo que a Chile se refiere, esti 
reglamentado por una Ley de la Repdblica. 

Analizando este asunto con algdn detenimiento se ll^;a a la conclusi6n que presenta 
dificultades que no aparecen a primera yista. 

En primer lugar hay que tomar en consideraci6n la parte econ6mlca de la operacidn, 
que, con sus trabajos preliminares, escrutinios y publicaci6n demanda un desembolso 
pecuniario considerable. 

Otro factor es la situacidn de normalidad que se escoge para efectuar el censo, 
procur&ndose que no haya ningtin problema trascendental que agite la poblaci6n. 
Cierto es que algunas voces se efectda sin tomar en consideracidn ninguno de estos 
factores; pero solo por circunstancias especiales. 

Ahora bien, suponiendo que el congreso aprobara la uniformaci6n de las fechas de 
los censos, al llegar la 6poca fijada, habrla palses cuyo estado financiero no les permitirfa 
en ese memento, cumplir el compromiso; a otros o su situadon politica o social les 
harla imposible la ejucuci6n del trabajo, o habiendo levantado el censo poco tiempo 
antes de la fecha, llam^osla panamericana, no lo repetirlan, y por tiltimo, Chile 
tendrla el Congreso Nadonal que prestarle su i^robaci6n. 

Por estas causas y otras que serla laigo de numerar, la fijacidn uniforme de la fecha 
de los censos de poblaci6n, presenta grandes dificultades. 

Demostrados ya los principales inconvenientes que en la pr&ctica se presentarian y 
estando penetrado de su utilidad, considero que es indispensable encontrar la forma 
de solucionarlos. 

Como para esto se neceeita estudiar cada uno de estos inconvenientes a fin de poderlos 
remediar, estimo que la manera de llegar a un resultado es que el Congreso apruebe 
por el memento s61o la idea de la unifcnrmidad de la fecha de los censos, dejando el 
detalle o sea la forma concreta del asunto, a caigo de slguna instituci6n especial, la 
Oficina de la Uni6n Panamericana por ejemplo, paza que en el proximo congreso 
cientffico presente un proyecto con todos los antecedentes, incluso la opini6n de los 
gobiemos, respecto a la uniformacion de la fecha de los censos y a las informaciones 
que debe contener. 

Concretando la idea expresada en el ptoafo anterior, el acuerdo serfa el siguiente: 

£1 Congreso Panamericano aprueba la idea de la uniformaci6n de la fecha de los 
censos de poblaci6n y encarga al Institute de la Uni6n Panamericana presentar en el 
proximo congreso un proyecto complete sobre la materia. 

CONCLUSIONES. 

En vista de lo expuesto en los capitulos respectivos, el Segundo Congreso Cientffico 
Panamericano, aprueba las siguientes conclusiones: 

1^. Las estadisticas demogr4ficas panamericanas comprendedm dnicamente loe 
dates que se refieren a los matrimonies, nacimientos, nacidos — ^muertoe y defunciones. 
(Antecedentes Parte IV del texto.) 



PUBUC HEALTH AND MEDICINE. 



267 



2^. Se adopta la aigmente definicion panamericana de la demogiaffa. '^Entd^ndese 
por demografla la cienda que trata de la descripcidn de Iob pueblos segtin sus princi- 
pales acontecimientos natuialee y legatee, y en cuanto estos liltimos a la nupcialidad se 
refieren." (Antecedentes Parte V del texto.) 

3^. Los palses panamericanos fonnar&n su estadfstica demogi&fica en la fonna e 
idioma que lo estimen conveniente; pero tendr&n la obligaci6n de hacer figurar en un 
capftulo folleto especial las informaciones demogr&ficas en la forma e idioma acorda- 
dos por el Gongreso. Este capitulo se titulard ** Informadonee demogr&ficas acordadas 
por el Gongreso panamericano. (Antecedentes Parte YI del texto.) 

4^. Los datos que comfo^nderd el capftulo o folleto titulado informaciones demo- 
gr&ficas acordadas por el Segundo Gongreso Gientffico Panamericano ser&n las que se 
detallan en los formiilarios adjuntos. (Antecedentes Parte VII del texto.) 

6^. Se aprueba la idea de la uniformaci6n de las fecha de levantamiento de los 
censos de poblaci6n de los pafses panamericanos y se comisiona al Instituto de la 
XJni6n Panamericana para presentar en el pr6ximo Gongreso un proyecto complete 
sobre la materia. (Antecedentes Parte VIII.) 

Informaeioirus demogrdfieas apropuestas al Segundo Congreio Cieniifico Panamericano. 

MATRIM0NI08. 
FOBMITLABIO 1. 



Matrimoniofl aeg6n el grado de parentesoo. 



Sntro prlmo»tieniiaD08., 

Entre if o 7 sobrina 

Bntre tia 7 sobrlno 

Entre otios parlentes . . .. 
Entre penonas extniAas. 



Total. 



Nftmero de matrimonios. 



Urbana 

(enlae 

dada- 

dee). 



Roral 

(en los 

oampoe). 



Total 

(reoni- 

dos). 



FOBMYTLABIO S. 



Matrimonlos mgAn la naotonaHdad. 



Entre extrai^ieros... 

Entre nadonales. 

Entre esposos naotonatos j esposas extraqleras. 
Entre esposos extrai^eros 7 esposas nadonales. 



Total. 



Niimero de matrimonlos. 



Urbana 

(en las 

dada- 

des). 



Roral 

(en los 

campos). 



Total 
(reiini. 

dos). 



Edad media de los esposos 7 esposas: Parte orbana Partemral 



258 PB00BEDIN06 BBOOKD PAN ABCBBIOAN 80IBNTIFI0 00N0BE88. 



Infimnaeioniidemoipr^lfieaiapropuaUu CierU^fieo Panamerieano^ 

Gontin6a. 



NACDOENTOS. 
rOBinTLABIO 8. 





Ntkmeio de naddos. 


Legitliiiidad. 


Url>aDa. 


Rural. 


TotaL 




Vaacn- 
lino. 


Feme- 
nino. 


Total 


Masca- 
Uno. 


Feme- 
nino. 


Total. 


IfatDu- 
Udo. 


nino. 


TAcrfHmna . 


















TiArftiinofl 




































Total 






























i 





rORlCITLASIO 4. 



Legitlmidad legftn la naoio- 
nalidad de los padrea. 



Ambos padres nadonales: 

Le^timos 

negitimos 

Total 



Ambos padns extranjeros: 

Legttlmos 

Hegltiinoa 



Total. 



Padrea extraojaros madres 
nadonales: 

Legftimos 

negitimos 



Total. 



Padres nadonales. IDadres 
eKtran}eras: 

Legitimos 

negitimos 



Total. 



Otras: 

Legitimos. 
negitimos. 



Total. 



Nflmero de naddos. 



Urbana. 



Maseu- 
lino. 



Feme- 
nino. 



TotaL 



RuraL 



Itasou- 
lino. 



a f s 'ss^ 



Feme- 
nino. 



TotaL 



Total (remildoa). 



icaaeo- 
lino. 



a^ 



Fema- 
nino. 







PORMTTLARIO 6. 












Nflmero de naddos. 


Clase de partes. 


Urbana. 


Rural. Total (reunldos). 

! 




Mascu- 
Uno. 


Feme- 
nino. 


Total. 


Mascu- 
lino. 


Feme- 
nino. 


Total. 


Mascu- 
llno. 


Feme- 
nino. 


Simples 
















Dobles 








......... 










Triples 














......... 




Cti£ln]pka 




































Total 





































PUBLIC HEALTH AND MEDICINE. 



269 



Informacwn€8 (Umogr^eoB apropueitas alSegundo Congreio deniifico Panammcmuy— 

Contiii<ia. 



NACID08 MUEBT06. 



POBMULABIO •. 





Ntlmero de nacidos muertos. 


T^gitimidad. 


UrlMma. 


Bural. 


Total (mmfdos). 




Ifasou- 
lino. 


F61I16- 

nino. 


Total 


Ifosou- 
lino. 


Feme- 
Dino. 


Total. 


Masou- 
lino. 


Fema- 
nlno. 


LegftimoB 


















Ilegftimos 










• 


























Total 





































DEFUNCIONES. 

VOBMULABIO 7. 

[U— parte urbana. R— parte rural.] 





Edady sexo. 


Gansas demoerte 
(nomenolatnra 
intemaoional). 


If enoree de mi 
afto. 


De un afio. 


Dedos alios. 


Detresalioa. 


De coatro alios. 


• 


ICasoa- 

lino. 


Feme- 
nino. 


Uascn- 
lino. 


Feme- 
nlno. 


Masoa- 
lino. 


Feme- 
nino. 


MawQ- 
lino. 


Fem»- 
nlno. 


Maaoa- 
lino. 


Feme- 
nino. 


1. Fiebie ttfoi-fU.. 






















dea. ^R.. 













































2. Etc <g"' 








1 
















.: :....:::: 




• •■••••-i_-____ — 






3. Etc V^" 


. 




( 




i 












.. . .J. . .. 


i 












' 




■ 
















1 





Edad y sezo. 


Cansas de mnerte 
(nomanolatura 
intemaoiona]). 


Dednoo alios. 


Igoal alio per 

afio basta 99 

aftos. 


DelOOafios 
adelante. 


No dasiflcados. 


Total. 




Masca- 
lino. 


Feme- 
nino. 


Masoo- 

Uno. 


Feme- 
nino. 


KasoQ- 

lino. 


Feme- 
nino. 


Masca- 
lino. 


Feme- 
nino. 


Masca- 
lino. 


Feme- 
nino. 


1. Flebre tiM-fU.. 






















dea. iR.. 












































2. Etc <«*• 












































3. Etc |§** 












































*• E*c {ri: 













































68436— 17— VOL x- 



18 



260 PBOOEEDIKQS SECOND PAK AMEBIGAK 80IENTIFI0 OONOBEBS. 

TnfcffmtuicmM demogi^^fieaa apropuatM oZ 8egvmdo Congruo (XmtLJico Panamencano^ 

Gontinda. 

DBFTTNCIONES-Oontiinia. 

rOUTOLABIO a. 





Urbana. 


RnraL 


Total 


Bftttdo oMl do ke faUeeidos. 


Maaoa- 

Uno. 


Fama- 
nino. 


TotaL 


ICasca- 
lino. 


Fema- 
nino. 


TotaL 


Maaoa- 

lino. 


Fema- 
nino. 


BtMem 


















Casados 


















Vhidos 




































Bin MPMifloar 




































Total 



































MORTALIDAD DB MEN0RE8 DE UN AJ^O. 

FOBMTTLABIO 9. 

(U— parte urbana. R— parte mral.] 





Edadyaezo. ^ 


Cauflaa da mniirte 
(nomanolatora 
intemaeional). 


Ifenores de nn 
mea. 


Deunmes. 


Dedosmeses. 


Detresmeses. 


Decuatro 
meaes. 




Masca- 
lino. 


Feme- 
nino. 


liaaoa- Feme- 
lino, nino. 


Masoa- 

lino. 


Feme- 
nino. 


Mawo- 
lino. 


Feme- 
nino. 


Mawo- 
Uno. 


Feme- 
nino. 


1. Fiebre tiioi-ru.. 




















dea. IR.. 




















2. Tlfos ozante- V.. 






1 














mAtioo. R.. 






i 














3. Fiebre reoo- V. . 






1 




*■*•*••• 










mote. eta. R. . 






....... .|.... .... 




















1 
















Edadysaxo. 


Osamiif da nrnart^ (nonanoiatara 


Daeino 


Dmaaea. 


Igoalmeaames 
basta 12 meaea 
manoe on dia. 


No daaiflcados. 


Total. 


intemaniopal). 








Kaaon- 
lino. 


Feme- 
nino. 


Kaaon- 
lino. 


Fame- 
nino. 


Maaoo- 

lino. 


Feme- 
Dino. 


Masoa- 

lino. 


Fem^ 
nino. 


1. Flelm tifoidea /5-* 


















3. Tiftia ezantemitiai 
8. Flabre reoonante, 


, m- 


















R.. 
•to la- 












........ 




\R.. 




i 


1 









rOBM ULABTO 10. 





Meaea. 


Caoeas de moerte (nomenclatara intema- 
donal). 


Enero. 


Febfeco. 


Mano. 


Abril. 


Mayo. 


Igoal 

mesa 

mea 

baeta 

diciem- 

bre. 























































































PUBLIC HEALTH AND MEDICINE. 



261 



Informadona demogrdfietu apropuestas al Segundo CongreMO Cientifico Panamericano — 

Continda. 

MORTAUDAD DE MBN0RE8 DE UN AflO-Xontlnito. 

FOBMVLABIO 11. 









Meses. 






Edades. 


Enero. 


Febrero. 


Mano. 


Abril. 


Mayo. 


Igual 
mesa 

nun 

hasta 

dicJem- 

bre. 


Mffrwm d6 on fim. 










Dt 1 mee 












2me0e6 












3 nwMB... .. . 












4 Tnemii 












V 1I1Q90S. ............................... 








1 




De adelante mes a roes hasta 12 meses 


1 










f^ip clwrifloaci^n 














* 


(•■" 






Total 


1 








1 


> 

1 





INPORME SOBRE EL DESARROLLO DE LA ESTADlSTICA DEMOGRlFICA 

EN LA REPtBUCA DE EL SALVADOR, 

Por PEDRO S. FONSECA, 
Director General de Estadistica de El Salvador. 

ANTBGBDENTB8 HI8T6rIC08. 

Durante la doininaci6n espafiola, poco o ninguna ateiici6ii mereci6 el ramo de 
eetadistica; se excepttia el censo practicado en 1778, que di6 a conocer que las Pro- 
vindas de San Salvador y Sonsonate tenfan 146,684 habitantes. 

Despu^ de la Independencia, hubo algunoe indicioe de trabajos estadfsticoB, como 
loe ordenados en 1829, 1834 y 1837 sobre censo de poblaci6n y riqueza pdblica, los que 
se publicaron en el peri6dico oficial sin orden cronol6gico. Antes de la fundaci6n de 
un centro directivo, el trabajo m^ digno de consideraci6n es el efectuado por el Dr. 
Jos^ C. L6pez, en 1878, levantando un censo bastante aceptable. 

En 1881 se Iund6 la Direcci6n General de E8tadi8tica,su6pendida algunos alios 
despu^ y reconstituida formal mente en 1901. 

Han side Directores de Estadistica sucesivamente, los Sres. Marcos Alfaro, Esteban 
Castro, Rafael Reyes, Francisco E. Galindo, Ram6n Uriarte, JuliAn Escoto, Santiago 
I. Barberena y el infrascrito. Se han levantado censos en los siguientes afios: 1778, 
1878, 1882, 1888, 1892, 1896 y 1901. Algunoe de ellos se consideraron inaceptables y 
no se di6 a conocer su resultado. Es indispensable levantar un censo con plan cienti- 
fico y con recursos y tiempo suficiente para su preparaci6n. 

B8TADO ACTUAL. 

Deede 1901 se ha podido llevar sin intemipcidn la estadistica de nacimientos, 
matrimonies y defunciones. En 1911 se modificaron los modelos, procurando en 
cuanto es posible, seguir las pricticas intemadonales. Para indicar las causas de 
defiinci6n tropezamos con el inconveniente de que la roayoria de los que mueren es 
sin asistencia mMica, raz6n por la cual los diagn<56tico8 no deben aceptarse con rigo- 
rismo cientifico. En loe cuadros de nacimientos se hace constar: El sexo, condici6n 



262 PROOEEDIKGS BEGOKD PAK AMEBIOAK SCIENTIFIC CONGRESS. 



legal, nacionalidad del padre (cuando el nifio es l^timo y de la madre cuando es 
ilegltinio), cd es parte tinico o ii6, si naci6 vivo o muerto. 

En las defundones: Sexo, edad (se distribuye per perfodos), estado civil, ocupaddn. 
causa de defunddn (se agrupan conforme la cla8ificaci6n de Bertdllon), nadonalidad, 
si tuvo o no asistencia m6dica. 

En los matrimonios: Edad, estado dvil anterior, nadonalidad e instrucd6n de cada 
uno de los esposos. 

El circuito demogr&fico es el Departamento; agrupadoe todos los de la Reptiblica 
^stos se totalizan. 

La direcd6n examina parcialmente cada uno de los informes de los 252 pueblos 
de la Reptiblica, rectafica errores para formar el cuadro general del mes. 

Los resultados se publican en el Anuario Estadlstlco. 

He aquf un resumen del movimiento demogrifico en El Salvador, durante el 
perfodo de 1899 a 1914: 



Afios. 


Nadmicntos. 


DflAmdones. 


Matri- 
monios. 




Varones. 


Mujeres. 


Totales. 


Varones. 


Majeres. 


Totales. 


No. total. 


IHOO 


19.974 
21,612 
21,609 
20,788 
22,695 
22,978 
22,839 
21,731 
22,661 
24,396 
24,137 
23,846 
26,028 
25,408 
25,909 
26,374 


19,012 
20,340 
20,818 
20,217 
21,193 
21,581 
21,756 
21,093 
21,660 
23,256 
23,637 
23,021 
24,167 
24.601 
25,027 
26,485 


38,966 
41,952 
42,387 
41,005 
43,788 
44,664 
44,606 
42,824 
44,221 
47,661 
47,774 
46,866 
49,186 
49,999 
60,996 
61,859 


10,024 
9,229 
10,460 
11,456 
13,408 
11,624 
12,780 
12,384 
12,989 
12,644 
12,912 
18,886 
13.866 
12,788 
13,046 
13,046 


8,882 
8,286 
9,897 
10,907 
12,999 
11,061 
12,120 
11,606 
11,602 
12,147 
12,422 
13,467 
18,082 
12,137 
12,096 
12,367 


18,906 
17,464 
20,357 
22,363 
26,407 
22,685 
24,860 
24,080 
24,441 
24,091 
25,334 
27,353 
26.938 
24,926 
25,141 
25,413 


3,410 


I'JOO 


2,822 


imy 


3,774 


1W2 


3,402 


19:)3 


4,486 
4,483 


1 <>( ) 1 


1^05 


4.280 


lf;-V, 


3.67S 


19)7 


3,878 


1908 


4,137 


lf>0(« 


4,362 


1910 


4,287 


1911 


4,445 


1912 


4,481 


1013 


4,762 


1914 


4,018 








371,889 


366,763 


728,642 


196,831 


186,017 


381,348 


64,649 


Media 


23,243 


22,297 


45,640 


12,270 


11,563 


23,834 


4,084 







Mediante el cdlculo respective, se ha podido obtener el indice de natalidad, 
mortalidad y nupcialidad, de la manera siguiente: Nadmientos, por 1,000 habitantes, 
41.66; defunciones, por 1,000 habitantes, 21.00; matrimonios, por 1,000 habitantes, 
3.71. 

El estado dvil de los nacidos, por t^rmino medio es: Legitimes, 46.3 por ciento; 
ilegltimos, 53.7 por dento; total, 100. 

El TniJTimum de nadmientos se verifica en enero, y el minimum en junio. E 
maximum de defunciones se verifica en octubre, y el mfmlmum en febrero. 

El Oonsejo Superior de Salubridad, lleva estadlstica detallada de las causas de 
defundones. correspondientes a la Ciudad de San Salvador y a los puertoe. 

Adjournment. 



GENERAL SESSION OF SECTION Vm. 

New Ebbitt Hotel, 
Wednesdm/ morning^ Janwiry 6, 1916. 

Chairman, William C. Gobgas. 

The session was called to order at 9 o 'clock by the chairman. 

The Chairman. Dr. Weil, I think you are to start this program 
for us. 

ANAPHYLAXIS. 

By RICHARD WEIL, 
CwfUU UhivertUy, MedkaL ColUge, New York CUy. 

I have been asked, in the unavoidable abaence of Dr. Anderson, to speak on the 
development of the subject of anaphylaxis; that 's, to g:ive an historical oversight. I 
will attempt to sununarize the history of its development in as few words as possible 
and to indicate as far as I can the main problems which have presented themselves to 
the men who were active in the study of anaphylaxis at the various stages of its devel- 
opment. 

As you know, the entire literature of anaphylaxis does not go back more than 15 
years. It started with a series of observations made in different parts of the world, 
which curiously enough foreshadowed the various phases of development which the 
history of anaphylaxis has taken since that time. In the first place, there was the 
observation of Roeenau and Anderson, in 1906, which was also made independently 
by others, that guinea pigs which had been given a preliminary dose of foreign pro- 
tein responded to a subsequent dose of that foreign protein with severe and often 
fatal symptoms. That was the guinea pig phenomenon and represented the con- 
stitutional reaction of anaphylaxis. The first experiment of this t3rpe had been per- 
formed on dogs in 1902 by Richet. 

The second observation, made by Arthus in Lausanne, in Switzerland, involves the 
principle of the local reaction. He found that rabbits which had been given foreign 
protein, such as egg albumin or horse serum, over a period of days, subsequently 
responded to later injections with a peculiar, characteristic reaction at the site of injec- 
tion. They developed a severe local reaction, which might take the form of simple 
erythema, but might go on to abscess formation and necrosis. 

The third observation was the observation of Von Pirquet that human beings who 
had been vaccinated once responded to a second vaccination in an altogether different 
way, and that was the beginning of the observations that led Von Pirquet to interpret 
the various manifestations of the infectious diseases upon the basis of what he called 
allergy, which is a somewhat broader thing than what we call anaphylaxis. 

The very first problem which presented itself and which occupied the minds of 
investigators for a number of years was this: What is the character and what is the 
mechanism of the reaction? In specific terms is it an antibody reaction or is it not 
an antibody reaction? This recalls the violent i>olemic which occupied the earlier 

263 



264 PROCEEDINGS SECOND PAN AMERICAN SCIENTIFIO CONGRESa. 

yean and in which Gray and Southard, on the one hand, and Roeenau and Anderson, 
on the other, played the prominent parts. Gay and Southard, as you remember, 
believed that when a foreign protein, say horse serum, was injected into a guinea pig, 
that a certain part of it remained in the body and rendered it hypersusceptlble. 
They called this fraction anaphylactin, Rosenau and Anderson, on the other hand, 
were the first to maintain and defend successfully the theory that what we really had 
in anaphylaxis was nothing but an immune reaction. In other words, they showed 
that the injection of the foreign protein resulted in the production of antibodies in 
the guinea pig, and that the second Injection permitted an interaction between this 
newly formed antibody and the reintroduced antigen in the body of the animal. I 
need hardly remind you that this controversy raged for two or three years. It was 
definitely settled not only through the work of Rosenau and Anderson, but with the 
help of Otto, working in Ehrlich's laboratory, and of others in f»voT of the theory of 
Rosenau and Anderson that the anaphylactic reaction is immime reaction. 

The second question naturally involved the nature of this antibody. Was it an 
antibody sui generis, different in nature from what we had previously worked with, 
or was it essentially similar to the various precipitins, agglutinins, and so forth, with 
which men were already familiar? This is a controversy which has not yet been en- 
tirely settled. In my paper to-day I hope to make a contribution to that question. 
Friedberger was the first to maintain that the anaphylactic antibody, which has 
been called by various terms, "sensibilisin," etc., is identical with the precipitins. 
The chief argument which he advanced was that if one studies the sera of immun- 
ized animals, one finds that the precipitin content goes parallel with the passively 
sensitizing value of that serum, and this observation was confirmed by Doerr, who, 
as you know is one of the most active and successful workers in anaphylaxis. It 
was disputed by others. Eraus, who is now in Argentina, attacked the theory by 
showing that the blood of guinea pigs which have been sensitized contains no pre- 
cipitins, so, as I have said, at this time the nature of anaphylactic antibody is still 
somewhat in doubt. 

The third main problem which has busied the workers in anaphylaxis concerns 
the site of the reaction. Where does the anaphylactic reaction occur? I might ex- 
plain this question more in detail as follows: If we admit, as we are all now ready to 
do, that anaphylaxis is the result of a reaction in the living body between antibody 
and antigen, where do these two substances unite in the body? Thinkers on this 
problem are divided into two schools: First, there is the humoral school, which 
holds that the reaction occurs in the blood. This theory is intimately connected 
with the so-called anaphylatoxin theory, because those who maintain that the reac- 
tion occurs in the blood — and I think that Friedemann was practically the first to 
advance this opinion, although it has been developed to its greatest extent by Fried- 
beiger — maintain at the same time that this reaction results in the production of a 
toxic substance, called anaphylatoxin, which, by its irritant action upon the cells 
of the body gives rise to the tjrpical anaphylactic symptoms, the convulsions, etc. 
This, then, is the humoral theory. 

The second theory of the site of the anaphylactic reaction is what might be called 
the cellular theory, which is opposed absolutely to the humoral theory and also ex- 
cludes the intervention of anaphylatoxin. The cellular theory, historically, really 
goes back, I should say, to the French school, to Besredka, who maintained, however, 
that the reaction occurred exclusively in the brain cells, whereas those who now 
accept the cellular theory include the cells of many other tissues of the body. This 
theory is based very largely on the observed response of the muscle cells of the iso- 
lated uterus to antigen. According to this interpretation, antigen-antibody reactions 
occurring in the blood are entirely unproductive of symptoms, and are only effective 
when mediated by the cells of the body. 



PUBUO HBALTH AND MBBIOIKB. 265 

The ceUular theory is at first sight not in itself incompatible with a belief in ana- 
phylatoxin. It is perfectly conceivable that within the cells the reaction of antibody 
and antigen should give rise to a toxic substance, which we may call for convenience 
anaphylatozin; but the development of the cellular theory has precluded such an 
interpretation. Dale has advanced the following argument on that aspect of the 
problem: The uterus of a normal guinea pig when suspended in a neutral solutioui 
such as Locke's fluid or Ringer's fluid, and attached to a writing lever which runs 
upon a drum, describes a regular and characteristic series of rhythmical contractionB, 
If one takes the uterus of a guinea pig which has been sensitized, say, to horse serums 
suspends it in this way, allows it to write its tracing, and then adds horse serum to 
the bath, the uterus at once executes a violent contraction, and the curve shoots up 
at once. Now, there are several reasons for believing that this reaction can not be 
due to the production of a chemical substance. Dale himself showed that the reac* 
tion had no determinable latent period. He concluded that it is inconceivable on 
physiological grounds that the production of a secondary chemical substance by fer- 
ment action should take place with such rapidity. He stated also that the result 
produced in the living animal could not conceivably be due to a chemical substance 
formed from such minute amounts as one-ten thousandths of a gram of protein, which 
we know will produce the anaphylactic reaction. 

These views of Dale have been accepted by physiologists. Bayliss, for example, 
in his last book, Principles of General Phjrsiology, states that he also believes that it 
is inconceivable that the chemical reaction should mediate and precede the anaphy- 
lactic response. But the other argument is very much stronger. Doerr has shown, 
and those coming after him, of whom I am one, have emphasised the fact that you 
can not get the anaphylactic reaction if you introduce into the opposite jugular veins 
of a guinea pig antigen and antibody simultaneously. Now there you have the 
ideal conditions for reaction in the blood stream, antigen and antibody coming 
together, and yet nothing happens. On the other hand, the uterus of a guinea pig 
which has been washed out with a liter of solution and contains no blood reacts 
violentiy to antigen. If one accepts the cellular theory, one is practically bound 
thereby to reject the anaphylatoxin or chemical theory and to accept what has been 
called the physical theory. 

And that brings me to the fourth problem, which I wish to sketchr— the problem 
of the immune mechanism. When I speak of the immune mechanism I am not 
speaking of the gross physiological mechanism, whether it be spasm of the bronchial 
muscles or what not, but to the cellular mechanism. Are we dealing with a chemical 
reaction, in which the reaction of antigen and antibody results in the production of 
a third toxic substance, a so-called anaphylatoxin? Or are we dealing with what 
has been called a purely physical process—in other words, something like an electric 
shock, whereby the sensitized cell, simply in virtue of the presence of antigen, 
wi