THE PREVENTION 
or 
Cholera Infanta ani Kioto! Diseases, 
AND or 
POISONING BY CHEESE, MILK, ETC. 
ABSTRACT OF A PAPER ON THE CHEMISTRY OF TYROTOXICON, 
ITS ACTION UPON LOWER ANIMALS, AND ITS RELATION 
TO THE SUMMER DIARRHEAS OF INFANCY. 
By YICTOE C, YAUGHAN, M, B., PL B, 
PROFESSOR OF PHYSIOLOGICAL C'TEMISTRY IN THE UNIVERSITY OF 
MICHIGAN, AND MEMBER OF THE STATE BOARD OF HEALTH. 
[123.] 
[At the meeting of the State Board of Health, April 12, 1887, Dr. Vaughan made a 
report on tyrotoxicon, the poison which he has found in poisonous cheese, milk, 
ice cream, and oysters. His full report will appear in the annual report, in advance of 
which this abstract is published by the State Board of Health, for the information of 
the people.] 
Since the last report in regard to tyrotoxicon,* it has been ascertained 
that if some butyric acid ferment be prepared as is ordinardy done in the 
preparation of butyric acid, and some of this be added to normal milk, and 
the whole be kept in closely stoppered b >ttles for 8 or 10 days, the poison 
will be developed in the milk in considerable quantity. The milk should be 
filtered, the filtrate neutralized with sodium carbonate, and then extracted 
with ether. 
Having a strong solution of the poison in absolute alcohol, which had been 
obtained from milk inoculated as stated above, we added to it some platinum 
chloride and began to evap irate on the water-bath. As soon as the alcohol 
evaporated, the residue exploded with great violence. This experiment was 
repeated a number of times with like results. From some of this alcoholic 
solution, the platinum was removed with hydrogen sulphide gas; but the 
filtrate was then found to have lost its explosive property. This reminded 
us that diazobenzol compounds form with platinum chloride a highly explo- 
sive compound, and that these are also decomposed by hydrogen sulphide. 
Some diazobenzol nitrate was prepared according to the method of Griess, and 
comparisons made between this and tyrotoxicon. 
* Proceedings of State Board of Health of Michigan, Oct., 1886, and annual report of the sam 
board, pp. 164-164. 2 
THE PREVENTION OF 
[Here are given in detail the chemical experiments and experiments with animals, 
by which the identity of tyrotoxicon with diazobenzol is established.] 
I think it highly probable that diazobenzol, or some closely allied sub- 
stance, will be found in all those foods which from putrefactive changes pro- 
duce nausea, vomiting, and diarrhea. In some oysters which produced these 
symptoms, I have recently found tyrotoxicon. 
Tyrotoxicon and Cholera Infantum and Like Affections. 
The experiments upon animals (which are given in the full paper to be 
published in the annual report of the State Board of Health) convince me 
that the development of tyrotoxicon in milk is a frequent cause of cholera 
infantum and kindred affections. When we remember that these diseases are 
most prevalent among the poor classes of our large cities where fresh milk is 
almost unknown, we can readily understand their frequency. By such 
people milk is often not obtained until it has begun to sour, then it is kept 
at a high temperature and often in a most foul atmosphere, and we all 
know something of the readiness with which milk takes up bad odors. This 
milk is then eaten by the little ones who are weakened by poverty and 
everything that poverty means, insufficient food generally, and that of the 
poorest quality, insufficient clothing, insufficient and vitiated air. With 
these facts before us, it is not surprising that in all our large cities thousands 
of children die annually from the summer diarrheas. Moreover, in our 
country places, how little attention is given to the food of children, we all 
know from actual observation. Cows stand and are milked in filthy barns 
and yards. The udders are generally, so far as my observation goes, not 
washed before the milking; the vessels for the milk are frequently found 
not as clean as they should be. Then there are the thousands of children 
that must draw their sustenance from bottles, the cleansing of which is in 
many families not properly attended to. Crusts of decomposing milk form 
around the neck of the bottle, in the tube and nipple, and lead to the rapid 
decomposition of the entire contents of the bottle. I think that one of the 
most important advantages to be secured to breast-fed children arises from 
the lessened danger of infection of the milk with germs which may produce 
poisonous ptomaines. 
I would not claim that decomposed milk is the sole cause of the summer 
diarrheas of children, nor would I claim that tyrotoxicon is the only poison 
that may be developed in milk. It is only one of a large class of bodies 
which are produced by putrefaction, and many of these are cathartic in 
action. 
Rules for the Prevention of the Development of Tyrotoxicon 
in Milk. 
1, The cows should be healthy and the milk of any animal which seems indisposed 
should not be mixed with that from the perfectly healthy animals. 
2. Cows must not be fed upon swill, or the refuse of breweries or glucose fac- 
tories, or any other fermented food. 
B. Cows must not be allowed to drink stagnant water; but must have free access to 
pure, fresh water. CHOLERA INFANTUM AND KINDRED DISEASES. 
3 
4. Cows must not be heated or worried before being milked. 
5. The pasture must be free from noxious weeds, and the barn and yard must be 
kept clean. 
6. The udder should be washed, if at all dirty, before the milking. 
7. The milk must be at once thoroughly cooled. This is best done by placing the 
milk can in a tank of cold spring water or ice-water, the water being of the same 
depth as the milk in the can. It would be well if the water in the tank could be kept 
flowing; indeed, this will be necessary unless ice-water is used. The tank should be 
thoroughly cleaned every day to prevent bad odors. The can should remain uncovered 
during the cooling, and the milk should be gently stirred. The temperature should be 
reduced to 60° F. within an hour. The can should remain in the cool water until ready 
for delivery. 
8. In summer, when ready for delivery, the top should be placed on the can and a 
cloth wet in cold water should be spread over the can, or refrigerator cans may be used; 
at no season should the milk be frozen, but no buyer should receive milk which has a 
temperature higher than 65° F. 
9. After the milk has been received by the consumer, it should be kept in a perfectly 
clean place, free from dust, at a temperature not exceeding 60° F. Milk should not be 
allowed to stand uncovered, even for a short time, in sleeping or living rooms. In many 
of the better houses in the country and villages, and occasionally in the cities, the drain 
from the refrigeratordeads into a cesspool or kitchen drain. This is highly dangerous; 
there should be no connection between the refrigerator and any receptacle of filth. 
10. The only vessels in which milk should be kept are tin, glass or procelain. After 
using the vessel, it should be scalded and then, if possible, exposed to the air. 
Prevention of Summer Diarrheas. 
But in the prevention of the summer diarrheas, attention to the food 
must not stop with its introduction into the body. The ferment which pro- 
duces tyrotoxicon is widely distributed, and it only awaits conditions suitable 
for its development. We do not know exactly what germ it is that produces 
this poison ; but it is either the butyric acid ferment, or some ferment which 
is frequently developed along with the bacillis butyricus, because I have 
found that if some butyric acid ferment be prepared according to the method 
usually followed in making butyric acid, and milk be inoculated with this 
and allowed to stand at the temperature of the body for a few hours, or at 
the ordinary tempeiature of the room for several days, the poison will appear. 
Moreover, as is well known, the bacillus butyricus grows best in the absence 
of air. We have already seen that the exclusion of air favors the develop- 
ment of tyrotoxicon. We are aware of the fact that the butyric acid ferment 
frequently does develop in the stomach. Therefore, I think that the pre- 
vention of these diseases necessitates some attention to digestion. If the 
food lies in the stomach or intestine undigested, putrefactive changes will 
occur there. 
During the hot months, children who are allowed to take food at will often 
drink large quantities of milk simply for the purpose of quenching thirst. 
I feel that this overloading the stomach with milk, caused by thirst, often is 
of no little detriment. It is hardly necessary to specify in regard to other 
ways in which attention should be given to the digestive organs of children. 4 
THE PREVENTION OF CHOLERA INFANTUM AND KINDRED DISEASES. 
Those that partake of other foods with their milk should be allowed only 
the most wholesome articles, and these should be in the most perfect condi- 
tion. Moreover, the depressing effects of extreme heat on the nervous sys- 
tem and its consequent injury to digestion should always be borne in mind. 
What to do When Summer Diarrheas Occur. 
The first thing to do is to stop the administration of milTc in any form. The 
ferment is present in the alimentary canal and giving the best of milk would 
simply be supplying the germ with material for the production of the poison. 
This no-milk treatment is not by any means a new idea; but the reason for 
it has not been hitherto understood. Now that we know that a powerful 
poison is formed from the putrefaction of milk, the necessity of its exclusion 
must become apparent to all. 
[Here Dr. Vaughan quotes from one of his former reports on tyrotoxicon,* an account 
of a case of cholera infantum due to tyrotoxicon in milk. It occurred in his own prac- 
tice, and admirably illustrates the necessity of withholding milk in such cases.] 
The food used may consist of chicken and mutton broths, beef juice, and 
rice or barley water. With this list no difficulty will be experienced in giv- 
ing the child sufficient nourishment. 
From the Maryland Medical Journal, June 25, 1887. 
“ Three years ago Prof. Vaughan discovered in poisonous cheese a ptomaine which 
produced nausea, vomiting and diarrhea. Later this same poison was found in ice 
cream and in milk. Chemically this poison is known as diazobenzol, which may be 
made artificially by the action of nitrous acid gas at a low temperature upon the nitrate, 
butyrate, or other salt of anilin. It is decomposed when heated to near the boiling 
point. It is developed in milk by the growth of a germ, which multiplies very rapidly 
when the conditions are favorable. The favorable conditions consist principally of 
exclusion of air, or the presence of a limited supply of air, and a comparatively warm 
temperature, the germ developing most rapidly at about 98° F. Uncleanliness increases 
the tendency of milk to decompose, and the improper feeding of the cow tends to pro- 
duce the same putrefactive changes. 
“ From one grain to one and a half grains of this poison administered to cats causes 
death within two hours. The administration of smaller doses leads to vomiting, diar- 
rhea, rapid emaciation, and death from exhaustion. ‘In other words,’ says Professor 
Vaughan, ‘it establishes a cholera infantum condition.’ ” 
* Proceedings of the Board of Health of Michigan, October, 1886, p. i; and the annual report 
of same board for 1886, p. 163.