and wide distribution of the poison-producing bacteria. Furthermore, during the summer time these bacteria grow abundantly in all kinds of filth. Within recent years the medical profession has so urgently called attention to the danger of infected milk that there has been a great improvement in the care of this article of diet, but that there is yet room for more scientific and thorough work in this direction must be granted. The sterilization and Pasteurization of milk have doubtlessly saved the lives of many children, but every intelligent physician knows that even the most careful mother or nurse often fails to secure a milk that is altogether safe.
It is true that milk often contains germs the spores of which are not destroyed by the ordinary methods of sterilization and Pasteurization. However, these germs are not the most dangerous ones found in milk. Moreover, every mother and nurse should remember that in the preparation of sterilized milk for the child it is not only necessary to heat the milk, but, after it has been heated to a temperature sufficiently high and sufficiently prolonged, the milk must subsequently be kept at a low temperature until the child is ready to take it, when it may be warmed. It should be borne in mind that the subsequent cooling of the milk and keeping it at a low temperature is a necessary feature in the preparation of it as a food for the infant.
Cheese Poisoning.—Under this heading we shall include the ill effects that may follow the eating of not only cheese but other milk products, such as ice cream, cream custard, cream puffs, etc. Any poison formed in milk may exist in the various milk products, and it is impossible to draw any sharp line of distinction between milk poisoning and cheese poisoning. However, the distinction is greater than is at first apparent. Under the head of milk poisoning we have called especial attention to those substances formed in milk to which children are particularly susceptible, while in cheese and other milk products there are formed poisonous substances against which age does not give immunity. Since milk is practically the sole food during the first year or eighteen months of life, the effect of its poisons upon infants is of the greatest importance; on the other hand, milk products are seldom taken by the infant, but are frequent articles of diet in after life.
In 1884 the writer succeeded in isolating from poisonous cheese a highly active basic substance, to which he gave the name tyrotoxicon. The symptoms produced by this poison are quite marked, but differ in degree according to the amount of the poison taken. At first there is dryness of the mouth, followed by constriction of the fauces, then nausea, vomiting, and purging. The first vomited
