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A pure milk supply
April, 19o~]
A Pure Milk Supply
437
A PURE MILK SUPPLY* BY A. J. LAIRD, M.D., Medical Officer of Heal~h of the Borough of Crewe. AN outstanding feature in connection with the milk supply of this country is the striking unanimity of opinion which exists among sanitarians with regard to the unsatisfactory methods of its production and manipulation. Nowhere probably is there tess necessity for pointing out the great importance of a pure milk supply than at such a meeting as this. Those whose duty brings them into close touch with eowkeepers and dairymen, know how milk at every step of its passage from the cow to the consumer is loaded with all manner of impurity, bacterial and otherwise. It wilt be impossible in the time at my disposal to deal with anything like the whole question of milk supply. I have therefore restricted myself to only one aspect of the problem, viz. the practicability of obtaining a naturally pure milk supply. The necessity for such limitation is obvious ; not that what I omit is unimportant, but because standing out pre-eminently before all other considerations this is one of far greater importance to the public than all the others combined. No matter whether it concerns municipal farms or dep6ts, large trading companies, or only small dairies and cowsheds, the main object to be attained should ever be kept clearly in view--the production of a naturally pure milk. This may seem a most unnecessary thing to say, but I believe that so far as the ordinary cowkeeper or dairyman is concerned, it is the last thing to receive his attention, if it should enter his mind at all. In considering this subject one may ask, whether it is beyond the power of the dairyman to produce clean milk. To answer this question one has only to consider what has been done in the way of private enterprise by dairy companies at home and abroad, by milk commissions in the United States, and by private individuals. The question resolves itself to some extent into what the public have a reasonable right to get, and what may reasonably be expected of the milk producer in order to comply with ~his. Unfortunately, however, in this matter the public does not realize the necessity for reform thai exists, and it is therefore our duty to see that their interests in this respect receive some at least of the attention which they deserve. * Read at a Meeting of the North-Western Branch, January 20, 1905.
438
A Pure Milk Supply
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In spite of the great advances in knowledge of the chemistry and bacteriology of milk, it is a striking fact that the dealers in this important article of diet should show such an absolute ignorance of the proper conditions under which it should be produced. Much attention has of late been directed to the subject, and although it is pretty generally admitted that our milk supplies are anything but satisfactory, energy seems to have been directed not so much, as one might have expected, in the direction of prevention, as in the remedy of evils after they have arisen. The opinion among the general public seems to be gaining ground, and I believe that it is one for which the medical profession is mainly responsible, that sterilization by boiling is all that is required to make the milk supply all that can be desired.* I ~h]nk that it ought to be made perfectly clear that this is not so, and that such a measure as boiling in the home or sterilizing in a municipal milk depbt is not the last word on the question, but is only a palliative measure taken under certain circumstances, in order to prevent a greater evil; that it is really only a choice of the lesser evil. Apart altogether from this, it seems not at all unlikely that the pasteurizing or sterilizing of the milk alters materially its physiological properties and diminishes its value as a food, but this is an aspect of the question into which I do not wish to enter. It is obvious that the milk supply of large cities and small towns must present many points of variance. In the one the source of production is often a very considerable distance of[, while in the latter the milk is produced for local consumption. The dangerous elements of time, railway transit, and passage through the hands of a contractor are thus absent in the smaller towns. The milk passes fairly rapidly, generally witl~a twelve hours, from the producer to the consumer, whereas city milk takes twice or three times as long. The sanitary condition of cowsheds has been frequently discussed, and the great need for improvement generally admitted. I shall, therefore, content myself with directing your attention to a number of photographs of cowsheds which I have had taken recently. These show, although only in a limited degree, the character of the exteriors of the cowsheds and their surroundings. The photographer found it absolutely impossible to take any of the interiors owing to the want of sufficient light. Structurally, however, many of the cowsheds are fairly good ; the chief trouble does not lie in the character of the building. It is the method in which the business is carried on that calls most urgently for reform. At a visit to one of our best cowsheds, I found the dairy*Vide ReTort of Royal Commission on Physical Dete~ioration, p. 54 (280).
COWSHED
I.
Shed No. / . - - L o o s e wooden s t r u c t u r e , slate roof, wooden ventilator on top.
M a n u r e at
end of shed.
Shed Aro. 2 . - - B u i l t of old railway sleepers ; roof partly glazed a n d partly corrugated iron ; two wooden ventilators on top. Cubic space 350 cubic feet per cow. No provision for lighting.
COWSHED
II.
New wooden shed, tiled roof, built to cottage dwelling-house 7 yards away; 3 yards away. No lighting or ventilation.
COWSHED
pig-sty
III.
Cowshed about 30 yards from house. Loose wooden structure, corrugated iron roof unlined. Manure 3 yards from shed. No provision for lighting or ventilation.
COWSHED
[ V.
Loose wooden structure, corrugated iron and wood roof. Built adjoining row of cottages, right up to privy and ash-pit.
Wooden structure.
Privy and ash-pit on right of photo.
COWSHED
V.
Cowshed, built at rear of cottage dwelling-house. Wooden structure, unlined corrugated iron roof, adjoining pig-sty. Manure 6 yards away. Ceiling 6 feet high.
COWSHED
VI.
Cowshed, built 5 yards from old farm cottage. Old brick structure with wood fi~ings. Ceiling 6~ feet high. No lighting. 300 cubic feet per cow.
April, 1905]
A Pure Milk Supply
439
man cleaning out a ditch into wtfich the cesspool overflowed. He came direct from that occupation to the milking without washing his hands. The milk was poured from the pails into a large can which stood on the walk in the cowshed, and was then strained through a coarse cloth which the milkman had proudly shown me, and then folded across his dirty trousers. In this district grooming and washing the flanks and udders are practically unheard of, while washing the milker's hands or wearing a clean overall during the process of milking are unknown. In only two instances do dairymen own coolers. Much of the business is in the hands of men who keep only two or three cows and supply their neighbours, while all the shops from which milk is sold do small retail businesses, including the sate (generally from the same counter) of such miscellaneous articles as toys, vegetables, paraffin oil, etc. The milk vessels are all uncovered, and the milk is removed by means of a dipper, which is then hooked on the inside of the vessel. Such, generally speaking, are the conditions surrounding the production and sale of milk in a small town, although there is much else that is 'objectionable in the intimate association of the domestic llfe of the family with the business both of producer and seller. Bacteriological examination of milk has been made by a numberof workers, e.g. Swithinbank and Newman,* Park,+ Delepme,+ aml others, and has shown the gross contamination that takes place under oMinary circumstances. The good effect of grooming, washing the udders, Cleanliness of the milker's hands and clothing, a n d of cooling the milk to 40 ° or 45° F. after milking, has also been shown by the same workers, and one naturally asks whether there is really anything extraordinary in this that a dair)-man could not. do. I think you will agree with me that there is nothing in all this that the ordinary intelligent milk dealer could not do for himself, and, if he will not do it, should be compelled to carry out. How then does it come about that it is practically never done ? The principal reason lies with the milk dealer himself. We are all aware that no class of men regard any change of precedent with more suspicion than the farmer. What was good enough for his grandfather is good enough for him, he says. All this talk about grooming cows, washing udders, etc., is in his opinion so much new-fangled humbug. It wonld seem that the only way to overcome this conservatism is by compulsion, and it is just here that our weakness becomes most apparent. The feasibility of any scheme for the improvement of the quality * Bacteriology of Milk.
+Journ~ of Hygiene, vol. i. p. 391.
~ Ibid. vol. iii. p. 79.
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of the milk supply may be more readily gauged by considering what has already been done. So far as I am aware, there is at present no such thing in existence as a municipal milk supply in the same sense that we have a municipal water supply. There are, of course, many places where, for example, the hospital milk supplies are obtained from farms directly under municipal control; but apart from these and sterilized milk dep6ts, the entire ownership and control of the milk supply to the community is still considered by the majority to be outside the scope of municipal enterprise. As offering a readier means of influencing milk dealers, the granting of annual certificates promises to be of considerable value. This plan was first tried, I believe, in the United States, and is actually in operation in Sunderland, and from the results obtained there it seems worth imitating. The success of this scheme must depend entirely upon the efficiency of the inspection of the farms, and it is one of the main obstacles to its adoption that this would be almost impossible in the case of large cities obtaining their supplies from another district many miles away. This, however, is only one more reason why the regulations under the Dairies, Cowsheds and Milkshops Orders should be made compulsory, and for the power of granting greater power of control to County Councils over small areas likely to be lax in their administration. The establishment of municipal depSts for the pasteurization or sterilization of milk is growing rapidly in favour, and is to be commended in so far as the results obtained are immediate. Their sphere of influence is a limited one however, and they do not remove the great need for the improvement of the general supply. Their establishment is a practical admission that the entire food of a portion of the community is in such a dangerous state as to render its sterilization necessary, and that other means to obtain a pure milk supply are inadequate, and have failed to achieve what was expected from them. The opinion of the writer of the articles on the "Milk Supply of Towns," which appeared in the British Medical Journal in 1903, is one with which I entirely agree, viz. that " The money subscribed by the municipality might more wisely be expended on establishing dairies for the supply of clean, pure, fresh milk, which in this country is all that is necessary, except perhaps during the few weeks of a hot summer (when we get one). Would it not be sufficient to advise mothers to scald at once, or have the milk scalded at the dairies supplying the poor--sufficient, that is, if the Sanitary Authorities insist upon a reasonable standard of bacterial pmSty, cooling and cleanliness."
Apr~l,~9o5]
A Pure Milk Supply
441
It is, however, to such private enterprises as the great Danish or British dairy companies that we must look for guidance, or to such an example as Mr. Sorensen h ~ shown at York. At present, in England, the production of clean milk is a specialty, and the number of places producing it can be counted on the fingers of one hand. They are large companies or dairies, run on scientific principles by specially trained men. There is at the present time only a very limited demand for pure clean milk, and so long as the public demand the largest possible qUANTITY for their money, trade competition is not likely to result in a milk of the very best QUALITY. It is absolutely necessary, therefore, that societies such as this should state very clearly what is required, and use every possible means at its disposal to obtain it. The objects to be aimed at are easily defined, viz. absolute cleanliness in every detail of the milk business, coupled with immediate cooling and rapid transit. The means by which such ends are to be obtained are many, and will probably not be the same for every locality. According to Professor Del~pine,* milk "is usually infected at the farm or in transit," while Dr. Newsholmet believes that infection most commonly takes place at home, "though the filthy conditions under which cows are milked must largely help in the same direction." The conflict of opinion is only apparent, and the whole truth is that at every stage of its passage from the cow to the consumer there is a risk of contamination, the degree of danger differing with varying circumstances in its production, storage, and distribution. With regard to the reforms which are necessary in the milk trade, the primary need is for the compulsory registration ef all purveyors of milk, no matter to whom or in what quantities the milk is sold. The recent enteric fever outbreak near Northwich seems to have had its origin in one of these unregistered dairies, and is one more instance showing the necessity for the removal of Article 6 (6) from the Order of 1885. Probably an even more necessary step in the improvement of the milk supply is that Article 13 of the same Order should be amended, its permissive nature being removed and the making of regulations made compulsory. From the information supplied to the British Medical Journcd by the Medical Officers of Health of many counties and combined districts, it would seem that the number of Local Authorities who have not made any regulations at.all is very large. The next great obstacle lies in the laxity of the Local Authorities charged with the carrying out of the dairy regulations. The large Corporations have shown what can be done to improve the milk * Journal of tIygiene, vol. iii. No 1. f P~blic Health, December, 1899.
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supply, and generally speaking town cowsheds now are far in advance of those in the country. By the aid of special powers they have influenced to some extent dairymen sending milk in to the cities, but for the rest of the country, the wholesome stimulus which seems necessary is non-existent. If the necessary power of supervision were granted to County Councils, it is more than likely that improvement would soon be made. There would then be a reasonable guarantee that the regulations would be enforced, and a greater uniformity of administration that would remove many difficulties. The Model regulations themselves requil~ amending. There is a great want of specific detail, each being left to establish his own standards of "sufficiency" or " adequacy" in matters of light, ventilation, cubic space (when the cows are habitually turned out), etc. This is particularly unfortunate in localities where (as seems to be not uncommon) plans for new dairies and cowsheds are never submitted to the Health Department. The new regulations of the City of London and Southend-on-Sea, requiring all milk vessels to be provided with suitable covers, are in the right direction. To these might be usefully added regulations prohibiting the use of dippers, and making cooling compulsory. We know what proportions of the normal constituents of milk should be present, but have no standard to guide us regarding the abnormal constituents which generally are, and never should be, present. The best measure of these foreign matters is undoubtedly the bacterial content, and the establishment of a bacterial standard would prove of the utmost service, and probably be the most powerful lever in checking the wrongful and dirty methods now practised. To obtain the best results it would then be found that absolute cleanliness and ifnmediate cooling of the milk was essential. And if the increase in the bacterial content is to be checked until the milk is delivered to the customer, milkshops will require to show considerable improvement. There now seems to be no reason why any added contamination of milk should take place during its transit by rail: The Railway Companies Association has stated definitely that any farmer may send his milk in locked churns, and pay on the net weight of the milk. It ought therefore to be made compulsory for all milk to be so sent. It still, however, remains for the railway companies to provide suitable ventilated refrigerating vans for the reception of the milk, and sheds at railway stations where it can be kept while awaiting shipment, without being exposed to the heat of the sun. I am aware that much I have said may in the opinion of many be practically impossible of attainment, and the means by which the
April, 1905]
A Pure Milk Supply
443
reform in the milk supply is to be achieved open to debate, yet the objects at which we aim are the s a m e - - t h e production of a naturally pure, wholesome milk supply, which shall reach the consumer in t h a t condition. DISCUSSION. Dm W~EATL~r advocated more inspection and fewer regulations. They were getting so many regulations now that it was extremely difficult to enforce them all. He was strongly of opinion that the trade should be shut out from control in a matter of this kind, although at present such was very far from being the case, and in his opinion the dairies, etc,, regulations had been largely nullified by having to be enforced in a large number of districts by farmers, dairy-owners, and the like. Of the two> opinions which had been given on the question of c6ntamination of milk, he rather inclined to Dr. Newsholme's view that contamination at the homes of the people was the more potent for misclfief, and what lent support to this view in his opinion was that if diarrhcea were due to contamination at the farm why was it not most prevalent in June or July when bacterial life at the farm, was probably most vigorous and therefore the chances of contamination were greater ? DR. GREENWOODasked the reader of the paper whether in Crewe he had endeavoured to get the farmers to wash the udders and flanks of the cows. In Blackburn, following upon a plan initiated by Dr. Wheatley, he had attempted to. have this done, but the farmers strongly objected to it, and stated that it was the cause of mammitis in their cattle. DR. GARSTA~Gwished to thank the large towns for the manner in which they had, by enforcing the provisions of their private Acts in the country, brought the country farmers more up to the requisite standard. He was perfectly certain that in the strong powers possessed for example by the Corporation oi Manchester, country Medical Officers had also given to them a lever by which they could move farmers better than in any other way. He did not think more regulations were required, but some proper method of carrying o u t the emsting regulations withouthaving to rely upon interested bodies of men. D~. Buc~Ax said that the town dairymen were entirely in the hands of the farmers, and were actually afraid of them. Even though, as he believed was frequently the case, the weight or quantity of milk was wrong, and the quality of it was bad, the town dairymen dare not complain, for the farmers would immediately tell them they could sell their milk somewhere else, and they would be left without a supply. He agreed with Dr. Laird that a bacterial standard for milk would be an excellent idea. THE P~ESIDE~T also supported the view taken by Dr. Newsholme that the greater part of the contamination was due to the homes of the people. AS one of the best levers to enable one to get proper conditions observed in the handling Of milk, he thought he mentioned annual licensing of dairies and cowsheds, the licence to be refused if t h e dairyman or cow-keeper had not observed the regulations made for his guidance during the previous y e a r . He was also in favour of the Sanitary Authority granting a certificate to Iarmers who kept their places and their cattle in a really good sanitary condition. DR. M. ¥OVNG was in agreement with Dr. Wheatley that any Council or Committee having to do with the enforcement of dairy regulations, should be, like Licensing Committees, swept clear of all those actively
444
A Pure Milk Supply
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ao~th
interested in the matter. He thought that further regulations were required, particularly upon one point, namely the cleanliness of vessels, etc., used by persons who simply hawked milk in the streets. As regards the selling of milk in shops where paraffin oil or picldes or vinegar were sold from open or loosely-closed jars, he had been in the habit of prohibiting this under Section 11 of the Dairies, Cowsheds and Milk Shops Order of 1885, relying upon the words " f o r any purpose incompatible for the proper preservation and cleanliness of nfill~ store, milk vessels, and milk, etc.," and he believed that this was a perfectly proper and fair thing to do. Dm LArRD agreed in the main with the remarks made by the previous speakers. In Crewe he did not know of an)- farmer who washed the udders of his cows, but he certainly knew of one man who carefully groomed his cows. In regard to the sale of pickles, etc., he was afraid that if he adopted Dr. Young's attitude it would mean stopping all the milk supply of Crewe that was sold through milk shops. He thanked the meeting for the attention given to his paper.
DR. WM. P. NorRIs has been promoted to be Chairman and chief Medical Inspector of the Board of Public Health of Victoria, rendered vacant by the death of Dr. GresswelI. PU$ AND BACTERIA IN MILK.--In 1900 it was pointed out by Dr. D. H. Bergey that a high cellular and bacterial content of milk appears to be associated with some inflammatory process within the udder. Since then Dr. Bergey (University el Pennsylvania Medical Bulletin, J u l y August, 1904) has studied the milk of several cows during an entire period of lactation in order to obtain information concerning the relation Of the period of lactation to the cellular and bacterial content. The milk of one of the cows selected for observation showed, previous to the preceding period of lactation, a slight amount of pus in association with stap.hvlocoeci. That of cow No. 2, examined for the first time after calving, showed no pus, but merely the normal leueocytic content, which is equivalent to the presence of not more than ten cells per field of a one-twelfth immersion lens. Cow No. 3 was su~ering with contagious mamrnitis, and her milk after calving showed large amounts of yellow pus and very large numbers of streptococci. The milk of all three of these cows was examined at intervals of one or two months, until the close of the period of lactation, a period of nine months. The results of the investigation led to the following conclusions : (1) The occurrence of pus in cows' milk is probably always associated with the presence in the udder of some inflammatory reaction brought about by the presence of some of the ordinary pyogenic bacteria, especially of streptococci ; (2) When a cow's udder has once become infected with the pyogenic bacteria, the disease tends to persist for a long time, probably extending over several periods of lactation; (3) Lactation has no causative influence per se upon the cellular and bacterial content of cows' milk, although it probably tends toward the aggravation of the disease when the udder is once infected ; (4) Contagious mammitis, the " gelbe g a l t " of European writers, appears to be merely a severe form of mammitis due to a variety of streptococci, which, on account of its chromogenie properties, gives to the milk its peculiar golden-yellow colour.
A Pure Milk Supply
437
A PURE MILK SUPPLY* BY A. J. LAIRD, M.D., Medical Officer of Heal~h of the Borough of Crewe. AN outstanding feature in connection with the milk supply of this country is the striking unanimity of opinion which exists among sanitarians with regard to the unsatisfactory methods of its production and manipulation. Nowhere probably is there tess necessity for pointing out the great importance of a pure milk supply than at such a meeting as this. Those whose duty brings them into close touch with eowkeepers and dairymen, know how milk at every step of its passage from the cow to the consumer is loaded with all manner of impurity, bacterial and otherwise. It wilt be impossible in the time at my disposal to deal with anything like the whole question of milk supply. I have therefore restricted myself to only one aspect of the problem, viz. the practicability of obtaining a naturally pure milk supply. The necessity for such limitation is obvious ; not that what I omit is unimportant, but because standing out pre-eminently before all other considerations this is one of far greater importance to the public than all the others combined. No matter whether it concerns municipal farms or dep6ts, large trading companies, or only small dairies and cowsheds, the main object to be attained should ever be kept clearly in view--the production of a naturally pure milk. This may seem a most unnecessary thing to say, but I believe that so far as the ordinary cowkeeper or dairyman is concerned, it is the last thing to receive his attention, if it should enter his mind at all. In considering this subject one may ask, whether it is beyond the power of the dairyman to produce clean milk. To answer this question one has only to consider what has been done in the way of private enterprise by dairy companies at home and abroad, by milk commissions in the United States, and by private individuals. The question resolves itself to some extent into what the public have a reasonable right to get, and what may reasonably be expected of the milk producer in order to comply with ~his. Unfortunately, however, in this matter the public does not realize the necessity for reform thai exists, and it is therefore our duty to see that their interests in this respect receive some at least of the attention which they deserve. * Read at a Meeting of the North-Western Branch, January 20, 1905.
438
A Pure Milk Supply
[Public ~realOx
In spite of the great advances in knowledge of the chemistry and bacteriology of milk, it is a striking fact that the dealers in this important article of diet should show such an absolute ignorance of the proper conditions under which it should be produced. Much attention has of late been directed to the subject, and although it is pretty generally admitted that our milk supplies are anything but satisfactory, energy seems to have been directed not so much, as one might have expected, in the direction of prevention, as in the remedy of evils after they have arisen. The opinion among the general public seems to be gaining ground, and I believe that it is one for which the medical profession is mainly responsible, that sterilization by boiling is all that is required to make the milk supply all that can be desired.* I ~h]nk that it ought to be made perfectly clear that this is not so, and that such a measure as boiling in the home or sterilizing in a municipal milk depbt is not the last word on the question, but is only a palliative measure taken under certain circumstances, in order to prevent a greater evil; that it is really only a choice of the lesser evil. Apart altogether from this, it seems not at all unlikely that the pasteurizing or sterilizing of the milk alters materially its physiological properties and diminishes its value as a food, but this is an aspect of the question into which I do not wish to enter. It is obvious that the milk supply of large cities and small towns must present many points of variance. In the one the source of production is often a very considerable distance of[, while in the latter the milk is produced for local consumption. The dangerous elements of time, railway transit, and passage through the hands of a contractor are thus absent in the smaller towns. The milk passes fairly rapidly, generally witl~a twelve hours, from the producer to the consumer, whereas city milk takes twice or three times as long. The sanitary condition of cowsheds has been frequently discussed, and the great need for improvement generally admitted. I shall, therefore, content myself with directing your attention to a number of photographs of cowsheds which I have had taken recently. These show, although only in a limited degree, the character of the exteriors of the cowsheds and their surroundings. The photographer found it absolutely impossible to take any of the interiors owing to the want of sufficient light. Structurally, however, many of the cowsheds are fairly good ; the chief trouble does not lie in the character of the building. It is the method in which the business is carried on that calls most urgently for reform. At a visit to one of our best cowsheds, I found the dairy*Vide ReTort of Royal Commission on Physical Dete~ioration, p. 54 (280).
COWSHED
I.
Shed No. / . - - L o o s e wooden s t r u c t u r e , slate roof, wooden ventilator on top.
M a n u r e at
end of shed.
Shed Aro. 2 . - - B u i l t of old railway sleepers ; roof partly glazed a n d partly corrugated iron ; two wooden ventilators on top. Cubic space 350 cubic feet per cow. No provision for lighting.
COWSHED
II.
New wooden shed, tiled roof, built to cottage dwelling-house 7 yards away; 3 yards away. No lighting or ventilation.
COWSHED
pig-sty
III.
Cowshed about 30 yards from house. Loose wooden structure, corrugated iron roof unlined. Manure 3 yards from shed. No provision for lighting or ventilation.
COWSHED
[ V.
Loose wooden structure, corrugated iron and wood roof. Built adjoining row of cottages, right up to privy and ash-pit.
Wooden structure.
Privy and ash-pit on right of photo.
COWSHED
V.
Cowshed, built at rear of cottage dwelling-house. Wooden structure, unlined corrugated iron roof, adjoining pig-sty. Manure 6 yards away. Ceiling 6 feet high.
COWSHED
VI.
Cowshed, built 5 yards from old farm cottage. Old brick structure with wood fi~ings. Ceiling 6~ feet high. No lighting. 300 cubic feet per cow.
April, 1905]
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439
man cleaning out a ditch into wtfich the cesspool overflowed. He came direct from that occupation to the milking without washing his hands. The milk was poured from the pails into a large can which stood on the walk in the cowshed, and was then strained through a coarse cloth which the milkman had proudly shown me, and then folded across his dirty trousers. In this district grooming and washing the flanks and udders are practically unheard of, while washing the milker's hands or wearing a clean overall during the process of milking are unknown. In only two instances do dairymen own coolers. Much of the business is in the hands of men who keep only two or three cows and supply their neighbours, while all the shops from which milk is sold do small retail businesses, including the sate (generally from the same counter) of such miscellaneous articles as toys, vegetables, paraffin oil, etc. The milk vessels are all uncovered, and the milk is removed by means of a dipper, which is then hooked on the inside of the vessel. Such, generally speaking, are the conditions surrounding the production and sale of milk in a small town, although there is much else that is 'objectionable in the intimate association of the domestic llfe of the family with the business both of producer and seller. Bacteriological examination of milk has been made by a numberof workers, e.g. Swithinbank and Newman,* Park,+ Delepme,+ aml others, and has shown the gross contamination that takes place under oMinary circumstances. The good effect of grooming, washing the udders, Cleanliness of the milker's hands and clothing, a n d of cooling the milk to 40 ° or 45° F. after milking, has also been shown by the same workers, and one naturally asks whether there is really anything extraordinary in this that a dair)-man could not. do. I think you will agree with me that there is nothing in all this that the ordinary intelligent milk dealer could not do for himself, and, if he will not do it, should be compelled to carry out. How then does it come about that it is practically never done ? The principal reason lies with the milk dealer himself. We are all aware that no class of men regard any change of precedent with more suspicion than the farmer. What was good enough for his grandfather is good enough for him, he says. All this talk about grooming cows, washing udders, etc., is in his opinion so much new-fangled humbug. It wonld seem that the only way to overcome this conservatism is by compulsion, and it is just here that our weakness becomes most apparent. The feasibility of any scheme for the improvement of the quality * Bacteriology of Milk.
+Journ~ of Hygiene, vol. i. p. 391.
~ Ibid. vol. iii. p. 79.
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LPablio Health
of the milk supply may be more readily gauged by considering what has already been done. So far as I am aware, there is at present no such thing in existence as a municipal milk supply in the same sense that we have a municipal water supply. There are, of course, many places where, for example, the hospital milk supplies are obtained from farms directly under municipal control; but apart from these and sterilized milk dep6ts, the entire ownership and control of the milk supply to the community is still considered by the majority to be outside the scope of municipal enterprise. As offering a readier means of influencing milk dealers, the granting of annual certificates promises to be of considerable value. This plan was first tried, I believe, in the United States, and is actually in operation in Sunderland, and from the results obtained there it seems worth imitating. The success of this scheme must depend entirely upon the efficiency of the inspection of the farms, and it is one of the main obstacles to its adoption that this would be almost impossible in the case of large cities obtaining their supplies from another district many miles away. This, however, is only one more reason why the regulations under the Dairies, Cowsheds and Milkshops Orders should be made compulsory, and for the power of granting greater power of control to County Councils over small areas likely to be lax in their administration. The establishment of municipal depSts for the pasteurization or sterilization of milk is growing rapidly in favour, and is to be commended in so far as the results obtained are immediate. Their sphere of influence is a limited one however, and they do not remove the great need for the improvement of the general supply. Their establishment is a practical admission that the entire food of a portion of the community is in such a dangerous state as to render its sterilization necessary, and that other means to obtain a pure milk supply are inadequate, and have failed to achieve what was expected from them. The opinion of the writer of the articles on the "Milk Supply of Towns," which appeared in the British Medical Journal in 1903, is one with which I entirely agree, viz. that " The money subscribed by the municipality might more wisely be expended on establishing dairies for the supply of clean, pure, fresh milk, which in this country is all that is necessary, except perhaps during the few weeks of a hot summer (when we get one). Would it not be sufficient to advise mothers to scald at once, or have the milk scalded at the dairies supplying the poor--sufficient, that is, if the Sanitary Authorities insist upon a reasonable standard of bacterial pmSty, cooling and cleanliness."
Apr~l,~9o5]
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It is, however, to such private enterprises as the great Danish or British dairy companies that we must look for guidance, or to such an example as Mr. Sorensen h ~ shown at York. At present, in England, the production of clean milk is a specialty, and the number of places producing it can be counted on the fingers of one hand. They are large companies or dairies, run on scientific principles by specially trained men. There is at the present time only a very limited demand for pure clean milk, and so long as the public demand the largest possible qUANTITY for their money, trade competition is not likely to result in a milk of the very best QUALITY. It is absolutely necessary, therefore, that societies such as this should state very clearly what is required, and use every possible means at its disposal to obtain it. The objects to be aimed at are easily defined, viz. absolute cleanliness in every detail of the milk business, coupled with immediate cooling and rapid transit. The means by which such ends are to be obtained are many, and will probably not be the same for every locality. According to Professor Del~pine,* milk "is usually infected at the farm or in transit," while Dr. Newsholmet believes that infection most commonly takes place at home, "though the filthy conditions under which cows are milked must largely help in the same direction." The conflict of opinion is only apparent, and the whole truth is that at every stage of its passage from the cow to the consumer there is a risk of contamination, the degree of danger differing with varying circumstances in its production, storage, and distribution. With regard to the reforms which are necessary in the milk trade, the primary need is for the compulsory registration ef all purveyors of milk, no matter to whom or in what quantities the milk is sold. The recent enteric fever outbreak near Northwich seems to have had its origin in one of these unregistered dairies, and is one more instance showing the necessity for the removal of Article 6 (6) from the Order of 1885. Probably an even more necessary step in the improvement of the milk supply is that Article 13 of the same Order should be amended, its permissive nature being removed and the making of regulations made compulsory. From the information supplied to the British Medical Journcd by the Medical Officers of Health of many counties and combined districts, it would seem that the number of Local Authorities who have not made any regulations at.all is very large. The next great obstacle lies in the laxity of the Local Authorities charged with the carrying out of the dairy regulations. The large Corporations have shown what can be done to improve the milk * Journal of tIygiene, vol. iii. No 1. f P~blic Health, December, 1899.
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supply, and generally speaking town cowsheds now are far in advance of those in the country. By the aid of special powers they have influenced to some extent dairymen sending milk in to the cities, but for the rest of the country, the wholesome stimulus which seems necessary is non-existent. If the necessary power of supervision were granted to County Councils, it is more than likely that improvement would soon be made. There would then be a reasonable guarantee that the regulations would be enforced, and a greater uniformity of administration that would remove many difficulties. The Model regulations themselves requil~ amending. There is a great want of specific detail, each being left to establish his own standards of "sufficiency" or " adequacy" in matters of light, ventilation, cubic space (when the cows are habitually turned out), etc. This is particularly unfortunate in localities where (as seems to be not uncommon) plans for new dairies and cowsheds are never submitted to the Health Department. The new regulations of the City of London and Southend-on-Sea, requiring all milk vessels to be provided with suitable covers, are in the right direction. To these might be usefully added regulations prohibiting the use of dippers, and making cooling compulsory. We know what proportions of the normal constituents of milk should be present, but have no standard to guide us regarding the abnormal constituents which generally are, and never should be, present. The best measure of these foreign matters is undoubtedly the bacterial content, and the establishment of a bacterial standard would prove of the utmost service, and probably be the most powerful lever in checking the wrongful and dirty methods now practised. To obtain the best results it would then be found that absolute cleanliness and ifnmediate cooling of the milk was essential. And if the increase in the bacterial content is to be checked until the milk is delivered to the customer, milkshops will require to show considerable improvement. There now seems to be no reason why any added contamination of milk should take place during its transit by rail: The Railway Companies Association has stated definitely that any farmer may send his milk in locked churns, and pay on the net weight of the milk. It ought therefore to be made compulsory for all milk to be so sent. It still, however, remains for the railway companies to provide suitable ventilated refrigerating vans for the reception of the milk, and sheds at railway stations where it can be kept while awaiting shipment, without being exposed to the heat of the sun. I am aware that much I have said may in the opinion of many be practically impossible of attainment, and the means by which the
April, 1905]
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reform in the milk supply is to be achieved open to debate, yet the objects at which we aim are the s a m e - - t h e production of a naturally pure, wholesome milk supply, which shall reach the consumer in t h a t condition. DISCUSSION. Dm W~EATL~r advocated more inspection and fewer regulations. They were getting so many regulations now that it was extremely difficult to enforce them all. He was strongly of opinion that the trade should be shut out from control in a matter of this kind, although at present such was very far from being the case, and in his opinion the dairies, etc,, regulations had been largely nullified by having to be enforced in a large number of districts by farmers, dairy-owners, and the like. Of the two> opinions which had been given on the question of c6ntamination of milk, he rather inclined to Dr. Newsholme's view that contamination at the homes of the people was the more potent for misclfief, and what lent support to this view in his opinion was that if diarrhcea were due to contamination at the farm why was it not most prevalent in June or July when bacterial life at the farm, was probably most vigorous and therefore the chances of contamination were greater ? DR. GREENWOODasked the reader of the paper whether in Crewe he had endeavoured to get the farmers to wash the udders and flanks of the cows. In Blackburn, following upon a plan initiated by Dr. Wheatley, he had attempted to. have this done, but the farmers strongly objected to it, and stated that it was the cause of mammitis in their cattle. DR. GARSTA~Gwished to thank the large towns for the manner in which they had, by enforcing the provisions of their private Acts in the country, brought the country farmers more up to the requisite standard. He was perfectly certain that in the strong powers possessed for example by the Corporation oi Manchester, country Medical Officers had also given to them a lever by which they could move farmers better than in any other way. He did not think more regulations were required, but some proper method of carrying o u t the emsting regulations withouthaving to rely upon interested bodies of men. D~. Buc~Ax said that the town dairymen were entirely in the hands of the farmers, and were actually afraid of them. Even though, as he believed was frequently the case, the weight or quantity of milk was wrong, and the quality of it was bad, the town dairymen dare not complain, for the farmers would immediately tell them they could sell their milk somewhere else, and they would be left without a supply. He agreed with Dr. Laird that a bacterial standard for milk would be an excellent idea. THE P~ESIDE~T also supported the view taken by Dr. Newsholme that the greater part of the contamination was due to the homes of the people. AS one of the best levers to enable one to get proper conditions observed in the handling Of milk, he thought he mentioned annual licensing of dairies and cowsheds, the licence to be refused if t h e dairyman or cow-keeper had not observed the regulations made for his guidance during the previous y e a r . He was also in favour of the Sanitary Authority granting a certificate to Iarmers who kept their places and their cattle in a really good sanitary condition. DR. M. ¥OVNG was in agreement with Dr. Wheatley that any Council or Committee having to do with the enforcement of dairy regulations, should be, like Licensing Committees, swept clear of all those actively
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interested in the matter. He thought that further regulations were required, particularly upon one point, namely the cleanliness of vessels, etc., used by persons who simply hawked milk in the streets. As regards the selling of milk in shops where paraffin oil or picldes or vinegar were sold from open or loosely-closed jars, he had been in the habit of prohibiting this under Section 11 of the Dairies, Cowsheds and Milk Shops Order of 1885, relying upon the words " f o r any purpose incompatible for the proper preservation and cleanliness of nfill~ store, milk vessels, and milk, etc.," and he believed that this was a perfectly proper and fair thing to do. Dm LArRD agreed in the main with the remarks made by the previous speakers. In Crewe he did not know of an)- farmer who washed the udders of his cows, but he certainly knew of one man who carefully groomed his cows. In regard to the sale of pickles, etc., he was afraid that if he adopted Dr. Young's attitude it would mean stopping all the milk supply of Crewe that was sold through milk shops. He thanked the meeting for the attention given to his paper.
DR. WM. P. NorRIs has been promoted to be Chairman and chief Medical Inspector of the Board of Public Health of Victoria, rendered vacant by the death of Dr. GresswelI. PU$ AND BACTERIA IN MILK.--In 1900 it was pointed out by Dr. D. H. Bergey that a high cellular and bacterial content of milk appears to be associated with some inflammatory process within the udder. Since then Dr. Bergey (University el Pennsylvania Medical Bulletin, J u l y August, 1904) has studied the milk of several cows during an entire period of lactation in order to obtain information concerning the relation Of the period of lactation to the cellular and bacterial content. The milk of one of the cows selected for observation showed, previous to the preceding period of lactation, a slight amount of pus in association with stap.hvlocoeci. That of cow No. 2, examined for the first time after calving, showed no pus, but merely the normal leueocytic content, which is equivalent to the presence of not more than ten cells per field of a one-twelfth immersion lens. Cow No. 3 was su~ering with contagious mamrnitis, and her milk after calving showed large amounts of yellow pus and very large numbers of streptococci. The milk of all three of these cows was examined at intervals of one or two months, until the close of the period of lactation, a period of nine months. The results of the investigation led to the following conclusions : (1) The occurrence of pus in cows' milk is probably always associated with the presence in the udder of some inflammatory reaction brought about by the presence of some of the ordinary pyogenic bacteria, especially of streptococci ; (2) When a cow's udder has once become infected with the pyogenic bacteria, the disease tends to persist for a long time, probably extending over several periods of lactation; (3) Lactation has no causative influence per se upon the cellular and bacterial content of cows' milk, although it probably tends toward the aggravation of the disease when the udder is once infected ; (4) Contagious mammitis, the " gelbe g a l t " of European writers, appears to be merely a severe form of mammitis due to a variety of streptococci, which, on account of its chromogenie properties, gives to the milk its peculiar golden-yellow colour.