WILLIAM ROYAL STOKES, M. D., Sc. D.,
          Bureau    of Bacteriology of State and City Departments of Health,
                                     Baltimore, Md.
       Read before Laboratory Section, American Public Health Association, at New Orleans, La.,
                                           October 30, 1919.

         Prohibition has boomed soft drinks so that more than ever there
         is need of rigid inspection. Dr. Stokes finds beverages with five-
         figure counts and empty "sterile" bottles always with some
         bacteria, sometimes with millions. This paper should attract
         the attention of health officers to their soft drink problems.

THE recent search for that evasive                           these materials have been subjected to
     substance known as a ptomain has                        inefficient sterilization. These two
     emphasized the fact that most of the                    latter organisms do not produce direct
cases of so-called ptomain poisoning                         infection by increase in the intestine
are either due to bacterial infection or                     but produce their poisonous products
to such other causes as oxalic acid                          of metabolism in the food. When the
poisoning, over-eating, tartar emetic                        food is consumed the poisons pro-
poisoning, acute and chronic nephritis                       duce serious and even fatal intestinal
and other similar conditions, as shown                       diseases.
by the work of Rosenau* and his as-                             Owing to these facts the State De-
sistants.                                                    partment of Health through Dr.
  These bacterial infections are usually                     Frederick C. Blanck, State Food and
produced by various members of the                           Drug Commissioner, instituted an ex-
intermediate or hog cholera group                            amination of the various soft drinks
such as the Alpha and Beta para-                             which are being sold throughout the
typhoid bacillus and B. enteritidis. Pro-                    state. Many of these drinks were sold
teus vulgaris, an intestinal oeganism,                       in large quantities at the various can-
can also produce intestinal disturb-                         tonments during the war, and this sug-
ances, and all of these infections are                       gested an additional reason for their
due to the increase of the organisms in                      careful supervision. A great many of
the intestine and definite infection at                      these drinks contain the various carbo-
times accompanied by bacteremia with                         hydrates, and it is well known that the
the *presence of the organisms in the                        intestinal otganisms develop favorably
blood.                                                       in such media, even splitting up the
  B. coli, a normal inhabitant of the                        sugars inta various gases and minute
intestine, seems to produce certain                          traces of alcohol.
poisons in the foods before they are                           Allen, LaBach, Pinnell and Brown,**
eaten, .and the B. botulinus, a deadly                       of the Kentucky Agricultural Experi-
anaerobic organism, also produces its                        ment Station, made a thorough investi-
soluble toxin in sausages, meat pud-                         gation of the bacteriological condition
dings and canned corn products when                          of the various non-alcoholic, carbon-
 *Med, Clinic of North America, Vol. 2,   p.   1541.          **BUll. No. 192, June, 1915.
            BACTERIOLOGICAL EXAMINATION OF SOFT DRINKS                           309
ated beverages sold in Kentucky. They        be used the filter should be frequently
also made a number of examinations of        examined in order to see that a pure
various materials involved in the proc-      filtrate is obtained, and it goes with-
esses of production. Their article con-      out saying that the water used should
tains a complete tabulated report upon       be free from colon bacilli and with a
a large number of examinations of            low bacterial count.
these beverages as well as the city or          Our investigation is explained in de-
filtered water used in the manufacture       tail in the following tables, the object
of the beverages, the rinse water used       of this investigation being to deter-
for the bottles, the water from caps,        mine the number of bacteria present
old caps, and the supposedly clean or        in the samples and to see whether any
sterile empty bottles before filling.        of these goods contained intestinal or-
The city waters examined showed              ganisms. No special search was made
counts ranging from 100,000 to 300,000       for organisms other than the colon
bacteria per cubic centimeter, the fil-      bacillus, the normal inhabitant of the
tered water from 120,000 to 700,000 per      intestine, but the presence of this or-
c.c., the water used for rinsing bottles     ganism in the fluids certainly suggests
from 180,000 to 960,000 per c.c., the        danger from the other pathogenic in-
water off caps (one examination) 750,-       testinal bacteria. The results which
000 per c.c. old caps (one examination)      were obtained are set forth in detail
165,000 per c.c., and the clean or sterile   in tables 1 and 2.
empty bottles from 1,900 to 310,000             I am indebted to Mr. S. Caskey for
bacteria per c.c. The various bever-         much assistance in the routine exami-
ages showed counts ranging from 10,-         nation of the above products named
000 to 850,000 bacteria per c.c.             below. (See next page.)
   Although the water used for manu-
facture very often showed a high bac-         CONSIDERATION OF RESULTS OBTAINED.
terial count yet the products oftenf            An examination of table No. 1 will
showed very low bacterial counts, and        show that in a number of instances the
they accounted for this result by the        maximum count of these soft drink
destructive or inhibitory effect of          products was innumerable whilst other
carbodioxide upon bacteria.                  maximum counts show results of five
   The unfiltered water contained a          figures. A large number of the samples
maximum B. coli count of 5,190 and a         also showed the presence of sugar-
minimum of 0; the filtered water con-        splitting or fermentative bacteria, as
tained no colon bacilli. The rinse           shown by positive presumptive tests
water showed a maximum of 106 and a          in 10 cubic centimeters, 1 cubic centi-
minimum of 0; the empty bottles had          meter and even 1/10 of a cubic centi-
a maximum of 1,440 and a minimum of          meter. In the final attempt to isolate
0 and the beverages showed a maxi-           the colon bacillus, as expressed by the
mum B. coli count of 450 and a mini-         final test, it can be seen that we were
mum of 0.                                    often unable to isolate this organism,
   They believe that the bottles should      but the fermentation may have been
be cleaned of all possible dirt by the       produced by yeasts, the lactose split-
proper kind of bottle washer and then        ting aerobic spore-bearing organisms
sterilized with live steam for from 30       recently isolated f rom water, the
to 40 minutes, and the bottler should        anaerobic spore-bearing organisms, or
guard against any possible recontami-        other aerobic gas producing bacteria.
nation brought about by cooling with         In many instances we were unable to
contaminated water. If filtered water        obtain any colonies from the plates
310                      THE AMERICAN JOURNAL                                              OF        PUBLIC HEALTH
examined, but no special attempt was                                                   Colon bacilli were isolated in a number
made to isolate other organisms be-                                                    of samples even in as small a quantity
sides the colon bacillus.                                                              as 1/10 of a cubic centimeter. This is
  We tested out a number of empty                                                      an interesting point, since it may be
bottles for sterility and found a maxi-                                                that improperly sterilized bottles are
mum count of innumerable and a mini-                                                   often a cause of the bacterial contami-
mum count of 500 bacteria per bottle.                                                   niation of the soft drinks, and we
                                                                      TABLE No.                  1


                                                                                       Colon Examinations
                                      Bacterial                                         Presumptive Test                                     Final Test
                                   Count       370
         Flavor                                          INo.
                                    Max.      Min.          Exam.                 10   cc.           1   cc.       0.1 cc.        10 cc.          1   cc.       0.1 cc.

Ginger Ale     ............        In.*              0           92                43                    22               1          17               8            0
Lemon ................              In.              0           83                41                    13           0              10                4           0
Sarsaparilla .    . . .             In.              0           83                40                    26           4              16               14           3
Orange...... ....                   2,800            0           42                19                    11           3               4                2           0
Strawberry ............             In.              0           44                24                    17           5              12                8           3
Root Beer .............            350               0           14                    3                  2           0                2               2           0
Birch-Beer.                        20,000            0            7                    3                  3               1            0              0            0
Vanilla Soda.                         450            5            6                    4                  2           0                2              2            0
Chocolate .............              In.             0           10                    3                  3           0                0              0            0
Grape .38                                            0            8                    3                  3           0                0              0            0
CocaCola..                              600          3            6                    4                  2           0                0               0           0
Champagone                            275         0               8                    2                  2           2                0               2           2
Raspberry ..         .              3,200        20               6                    4                  0           0                1               0           0
Miscellaneous.                     38,000            0           47                    8                  5               0            4               3           O

                                                EMPTY BOTTLES FOR STERILITY

                                      Per Bottle
Bottles..J                           In.        500       II26           1I        17                    12           8        1115          i12                   8

    *In. indicates Innumerable.

                                                                  TABLE No. 2

                                                1-         51-         101-            251-              501-      1001-  I   50001-       10001- 20001- Innum-
                                        0       50         100         250        |500                   1000     |5000       10000 20000             50000      erable

Ginger Ale                                  8   54          7             4                  4                4       8          1           0              0          2
Lemon                                 10        47           5            4                  2                4      10          0           0              0          1
Sarsaparilla                          10        26          12            3                  4                7      8           5           0              0          5
Orange              ........          10        23          3             2                  2                0      2           0           0              0          0
Strawberry..                        l       6   23          5                 1              1                0      3           3           0              0          2
Root Beer                                   5    7           0            0                  1                0      0           0           0              0          0
Birch Beer               .......            2    2           0            0                  0                0      0           1            1             1          0
Vanilla                                     0    2           1                1              1                0      0           0           0              0          0
Chocolate                                   3    2           0                1              0                0       1          0           0              0          3
Grape                                       2    6         0              0                0                  0      0           0           0              0          0
Coca Cola                                        4         0              0                0                  1      0           0           0              0          0
Champagone                                  2    3          0                 1              1                0      0           0           0              0          0
Raspberry                                   0    0           2            3                  1                0       1          0           0              0          0

                          ......                                                             2
Miscellaneous                         15        17           6            5                                   0       1          0           0              1          0

                                                EMIPTY BOTTLES FOR STERILITY
                                                         Bacterial Count Per Bottle

                      1-             501- | 1,001- 50,001- 100,001- 250,001- 500,001-                                             1 m.            5 m.           In.*
                     500            1000    50,000 1000,000 250,000 500,000 1 mil.                                                5 m.            20 m.

Bottles .......          1              1            2           1                     2                  2           5              3                2            2

    *In. indicates Innumerable.
           BACTERIOLOGICAL EXAMINATION                   OF   SOFT DRINKS                  311
usually found a small amount of fluid fore, this is probably explained by the
in the bottom of the bottles. Even a great increase which may take place in
few bacteria remaining after steriliza- the small amount of water often left
tion might increase in this fluid and in the bottle after sterilization.
thus produce the high bacterial counts
often obtained from the washings from                   CONCLUSIONS
the bottles. These bottles were washed      1. Many soft drinks contain vari-
out with 100 cubic centimeters of able numbers of bacteria and this large
sterile water and the dilutions were bacterial content may be partially ex-
  made from such an amount.               plained by the improper sterilization
   An examination of table No 2 will of bottles.
show the bacterial counts arranged ac-      2. A few bacteria remaining in the
cording to groups between certain bottles may increase in the small quan-
fixed limits. A certain number of the tity of water often left in the bottles
soft drinks tested, therefore, showed no
bacteria present; others showed bac- after sterilization. Dust organisms
teria varying between a count of 1 to getting into the bottles may also re-
50, and these groups are continued to sist sterilization even if the bottles are
as high a limit as from 20,000 to 50,000, properly dried.
A few of the plates showed innumer-         This matter may be of some impor-
able colonies and could not therefore     tance in relation to the possibility of
be estimated.                             intestinal infection, since the organ-
   An examination of the bacterial isms which produce so-called food
counts for sterility shows that some of poisoning often find a favorable culture
 the bottles contained millions of bac- medium in the carbo-hydrates of these
 teria per bottle, and, as mentioned be- soft drinks.

  Poland 200 Years Behind in Therapy.-               Recently this ancient system of practice has
The native doctors in Poland are using the        been violently overthrown. American Red
drawing of blood for their principal curative     Cross doctors and nurses came into the dis-
method, just as was the custom generally a        trict and found typhus and many other dis-
couple of hundred years ago. In just the          eases flourishing, with no medical attention
same way these doctors usually combine the        except that which the barber could bestow.
profession of the barber with that of "leech,"    An American hospital with all modern medi-
just as in the olden time, and indeed the         cines and equipment was installed and the
striped barber's pole is merely a sign of the     barbers soon lost the medical and surgical
blood-letting capacity of this artificer when     end of their practice. Their aid was enlisted,
the sign was invented. And just as these
men applied leeches for the purpose, whereby
                                                  however, in closely shaving be-whiskered men
the name of the worm became a synonym for         and clipping short the hair of those who were
the practicer of medicine, so their modern        infested with vermin. Just now, after weeks
disciples in Poland have been in the habit of     of strenuous medical campaigning, headway
using the leech. If the man got well the bar-     is being made against the disease which the
ber-doctor had made a miraculous cure; if         barbers' leeches had so long failed to *cure.
he died, it was but the will of God.              Leech-craft has gone out of Poland.

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