On the seizure and condemnation of tuberculous meat

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ON THE SEIZURE AND CONDEMNATION OF TUBERCULOUS MEAT.~ I. BY J. MITCHELL WILSON, M.D., D.P.H., Medical Officer of Health of Doncaster.

I BEG tO propose that this Branch approve of the instructions relating to the condemnation of tuberculous meat issued by the Local Government Board as being the most authoritative and trustworthy guide for the medical officers of health in dealing with n~eat affected with tuberculosis. The instructions are part of the recommendations of the Royal Commission which recently considered this question. Mr. Shirley Murphy and-the late Sir Richard Thorne Thorne were members of that Commission, and approved of these recommendations. I think we may rest content that the recommendations to which these eminent medical authorities agreed will prove to be an adequate protection to the health of the community, and therefore we ought to adopt and act upon their decision. It is important that any action which is based upon scientific investigations should not be so far in advance of ascertained facts ~hat we shall fail t5 convince the intelligent layman of the reason~bleness of our requirements. The Royal Commission took a large amount of evidence representing the best.scientific, medical, and veterinary opinions, and also the views of others, as meat-salesmen, etc., who were well qualified to put before the Commission the ~ommercial bearing of the subject. It was found that very divergent views were held, and corresponding differences in practice were carried out, which entailed greater hardships in one town or distric~ than in,another. Consequently very considerable friction ~arose between medical officers of health and the owners of the meat. The instructions of the Local Government Board go a long way to reconcile these divergent views, and now represent, I think, the ~definite position of safeguarding the public health and of satisfying public opinion, as represented by the eminent laymen who were members of the l~oyal Commission. Our action can scarcely be said to be optihnal, for the Local Government Board "request that all District Councils shall call ~:~ Discussion at the meeting of the Yorkshire Branch o~ the Inc0rporated Society o~ Medical Officers of Health, December, 1900.

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upon their officials who are meat inspectors to act in accordance with the instructions." What grounds, then, has the medical officer of health for following any other course ? Is it that in his opinion tuberculosis is a disease due to the presence of a bacillus, and that that bacillus is probably circulating with the blood-stream, and although its presence cannot be demonstrated in the muscular tissues, yet it cannot be proved t~hat it is not there, and that, as a corollary, to consume the meat of such an animal under the usual conditions of cooking may give rise to the same tuberculosis ? This view is deserving of every consideration as a scientific proposition, but how shall the medical officer of health use it when called upon to make out a case for seizing and destroying meat, which action the owner resists ? The general public, and especially those interested in the meat trade, are now well aware of the recommendations of the Royal Commission, which are issued as instructions by the Local Government Ba~rd, and such persons may be trusted to claim these as a sort of minimum protection tc~ which they are entitled before any of their property is seized. To put a definite case which might arise any day: Supposing the medical officer of health has succeeded in obtaining from a magistrate a n order to destroy a carcass of meat where the evidence of tuberculosis is confined to the liver. According to the Board's: instructions, that carcass, if otherwis~healthy, is not to be con-demned. What other positive evidence or facts can the medical officer of health offer in order to secure a conviction, or to justify the seizure ? Is it to be on the grounds that in his opinion the presence of tuberculosis in the liver is proof that the whole of the~ muscular and fatty tissues are also affected ? There is very little doubt that the results of Dr. Sidney Martin's~ experiments would be brought forward in opposition. Dr. Martin showed that of eighty-one susceptible animals fed with raw meat: from the carcasses of cows all more or less affected with tuberculosis, not One developed that disease. Such an experimenl as this is~ said to afford merely negative evidence, and therefore to be n o t trustworthy. It would, however, be sufficient to so impress t h e mind of any magistrate as to probably prevent a conviction being obtained, and following upon that the officer's council being mulcted in damages, and his own action to some extent discredited. In my opinion, until we can produce some trustworthy evidence that in a reasonable percentage of cases tuberculosis had been and could be produced by consuming meat of some animal which hag suffered from tuberculosis to the limited extent set forth in the instruciions of the Local Government Board, our only logica~

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and safe ground in taking action in the matter should be based upon these instructions. We are all equally anxious to protect the health of those who reside in our districts, and as tuberculosis is the same disease in animals wherever it is found, I think it is most essential that our actions should be guided as far as possible by some general rule. The want of this uniformity drew from ~he Commission the unfortunate statement that "Chaos is the only word to express the absence of system in the inspection and seizure of tuberculous meat." In the report it is stated : "Assuming that seizure of meat should be strictly confined to such meat as is dangerous to the health of man, we entertain no doubt that in certain places a great deal of ~neat is seized which is perfectly safe and wholesome food." For our good name's sake as medical officers of health, and to satisfy the reasonable demands of butchers, meat traders, and farmers, we should strive to regulate our action in this matter by adopting the uniform standard laid down by the Local Government :Board. When we have reached the uniform standard, then I consider a very strong case will be made out for requiring that all the meat which is offered for Sale shall be subject to a systematic inspection. I mean not only that of home-fed animals, but also that imported from abroad. I can quite understand the farmer and butcher complaining of the stringency of our inspection at public slaughter-houses, while an enormous quantity of dead meat is sold which has undergone little or no inspection. If we could agree on the first proposition, then the ground would be cleared, and we would be better able to consider what, if anything, can be done to define more satisfactorily the terms localized and general tuberculosis. We would be also better able to support another recommendation of the Royal Commission--viz., that public slaughter-houses should be provided in all populous districts, and that a more systematic inspection should be made of all our meat before it is allowed to be sold. II. BY J.

WRIGHT

~[ASON, M.:B.,

Medical ~Officer of Health of Hull.

I ~ v E much pleasure in acceding to the request of our Secretary to speak on "Tuberculous Meat," and I will briefly confine myself to an expression of opinion on the questions submitted by the Central Society for our consideration.

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Modern research having solved many of the abstruse problems connected with disease, the true nature of tuberculosis has been finally settled, and it has been added to the tong list of successful achievements which signalize th~advancement of the present era. Tuberculosis is a disease, communicable from the lower animals to man by means of a bacillus, which may infect the air we breathe, the food we eat, or may be directly introduced into the blood. The danger of partaking of flesh of tuberculous animals is contained in the free bacilli circulating in the fluids of the body. Like other preventable diseases, tuberctl~osis has its period of incubation before its characteristic appearance makes it recognisable. Local tuberculosis is, therefore, an outward sign of a general disease. Referring to the questions submitted for our observation, there has been much difference of opinion with regard to the inspection and seizure of meat of tuberculous animals. In my opinion, the Report of the Royal Commission on Tuberculosis i~ not a universal guide as to the conditions under which a carcass should or should not be condemned. The varying conditions presented in each individual case often fall very short of the conditions contained in the instructions as to the seizure of a carcass or portion thereof. The Royal Commission, however, recommended the Local Government Board to issue instructions from time to time for the guidance of meat inspectors, prescribing the degree of tuberculous disease which, in the opinion of the Board, should cause a carcass or part thereof to be seized. Owing to the greater tendency to generalization of tuberculosis in swine, it was considered that the presence of tubercular deposits in any degree should involve the seizure of the whole carcass and of the organs. We are officially instructed to regard tuberculosis in swine as a disease of animals which renders the meat unfit for human food, and tuberculosis in oxen and cows as a disease of animals which ordinarily renders portions only of the carcass unfit for the food of man, though in the later stages it may render the whole carcass unfit for food. In my opinion, it is for the medical officer of health only to decide what is and what is not fit for human food, and interpret its injurious effects if partaken of as food. He must accept that responsibility, and deal with the ease as presented to him, having full regard to the duty he owes to his authority and the public generally. Whilst the instructions of the Royal Commission may have assisted some, I for one do not altogether accept their recommendations, and in my opinion they :fall short of an ideal standard. Cases present unique differences, and do not come

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within the sphere of fixed principles, and consequently have to be dealt with individually and on their distinctive merits. It is only by such conferences as these that we may formulate ideas and effect uniformity in dealing with such cases as come under our notice officially, and if thought necessary approach che Local Government Board with a view to procuring a more uniform and systematic inspection of all animals before and after slaughter. It was the great difference of opinion, and the absence of a uniform system of inspection, that led the Royal Commission to make their recommendations. As I have previously mentioned, bovine tuberculosis is infectious, and it has been proved that tuberculosis in animals and human beings is interchangeable, and it is therefore of the first importance to have a more general and systematic inspection, and that all inspectors engaged in this work should be qualified by special training. The establishment generally of public abattoirs in urban and rural districts is most desirable, to which all animals should be removed for slaughter, and all carcasses should be submRted for inspection before being disposed of for human food; and meat of a doubtful character, if passed, might be submitted to sterilization, as is carried out at tGhe Institute in Germany known as the "Friebank." Much of the tuberculosis in cattle occurs in dairies; hence the necessity of a veterinary inspection of all animals, and the cowsheds in which they are housed meeting with all the requirements of the Cowsheds, Dairies, and Milkshops Orders of 1879 and 1885. I fully reeognise the importance of veterinary inspection, and am of opinion that the Royal College of Veterinary Surgeons should undertake the granting of special diplomas, qualifying persons for the special duties of meat inspection and all the diseases contagious to animals. But, as I have already stated, it is for the medical officer of health ~o colxdemn or otherwise a carcass, and define the injurious effects involved if consumed. It is for the veterinary surgeon to define ~he nature of the disease. M1 animals should be submitted to tuberculin test, and, if discovered to be suffering from tuberculosis, should be slaughtered, and liberal compensation granted by the State. Tuberculosis should, in my opinion, be included in the Contagious Diseases (Animals) Act. Tuberculous cows continue to give milk in large quantities up to an advanced stage of the disease, thus differing from animals affected with foot and mouth disease, p]em'o-pneumonia, anthrax, or cattle plague.

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If we recognise phthisis as an infectious disease--and some advocate that it should be made notifiable--why should not tuberculosis in cattle also be recognised as a contagious disease, and measures be adopted in accordance with the scientific knowledge brought to bear on the question to treat it as such ? The isolation and treatment of consumptives in sanatoria has of late exercised the minds of all sanitarians. As I would recommend the isolation in hospi~l of phthisical patients, so would I apply the pole-axe--as in contagious diseases--to tuberculous animals. [A series of photographs of animals affected with tuberculous disease was submitted by the author.]

III. BY F. W. 5IARTIN, M.R.C.S., L.R.C.P. Edin., etc., 5Iedical Officer of Health of Brighouse.

DR. IGYE, when informing me of the subjects for discussion on Friday next, the 14th instant, asked if I would contribute a short paper on the difficulties attending the seizure of apparently unsound meat. Our worthy Secretary remarked in his note that he knew the subject of meat seizure was of great interest to me, and considering the Corporation I represent was cast in damages to the amount of over £1,000 through the unsuccessful prosecution of a local butcher for being in possession of the carcass of a cow affected with generalized tuberculosis, I must admit that I am especially interested in this question. I will not trouble you with the details of the wearying law processes connected with our case, as on a former occasion at Pudsey I brought the whole of the facts before a meeting of the Branch. I will only trespass upon your time to mention briefly a few of the most important particulars bearing upon it, in case any of the members may not have heard the fuller details. Acting upon my representation, supported also by that of a veterinary surgeon, the magistrate to whom I applied for an order to destroy the carcass in question had no hesitation whatever in granting the request, and the destruction was carried out, everything being done in order as required by Section 117 of the Public Health Acts, At the subsequent Police Court proceedings, when the butcher was summoned for being in possession of a carcass unfit for the food of man, objection was taken by defendant's counsel to the summons, on the ground that " t h e only penalty for being in possession of such meat was the seizure and destruction of the

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same." After conferring with their clerk, the Bench declared that there was no case, and here ended stage one. I need not trouble you with my views on the advice given to my sanitary committee by the legal advisers to the Corporation. It suffices to say that the latter wished the matter to drop, and being assured of no ill consequences thereby, took no further action. The awakening from their dream of security was rather startling, for after some time had elapsed we were threatened with a claim for £1,000 damages. An arbitration case followed, with one arbitrator representing the other side; and then an unsuccessful appeal at Leeds completed our discomfiture. It seems to me a very serious matter that a Corporation acting on the advice of its medical officer of health in a case of this kind should run the risk of' having to pay heavy pecuniary damages when acting solely with regard to the safety of the public health. It is, of course, a well-recognised fact that a coach-and-four can be driven through any Act of Parliament. Can anything be done in the future by way of amendment of the Acts relating to meat seizure to prevent this interesting process being accomplished to our detriment ? Personally I am of the opinion that the law should be so amended that on the seizure of a carcass, or any meat or food unfit for the use of man, and after the warrant for the destruction of the same has been granted by a justice of the peace, there should be no chance of iniury to a Corporation through this action of its health officeri I would suggest that the veterinary surgeon and medical officer of health should work together in all cases of meatseizure, the first to give his opinion as to the nature and extent of the disease, the latter to say whether the seized meat is fit or unfit for human food. There should be no chance of the public thinking that a medical officer of health was acting t h e part of a faddist in the matter. But it would be useless to do this in one district if it were l~t also adopted in another, and if any alteration of the taw is to be effected, then all must work on the same lines. My reason for mentioning this is that early this year I was present at a dinner of the Butchers' Association in this district. The post-prandial speeches were of a distinctly violent character, stigmatizing the Corporaiion and its officials in the most impartial manner. I, of course, was known to all the men in this town, but a member of the Association from a much larger town in the West Riding perhaps was not aware there was a "chiel amang them ~akin' notes." In the course of h i s withering denunciation of the tyranny exercised in my district, he said that in a certain town of the West

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Riding things were carried out on a much more satisfactory basis. If the meat inspector--he mentioned his name also, but I need not - - h a d occasion to examine the carcass of a beast suspected, he would give instructions to the dressers of the same to make it look as well as possible, and he would examine it later on. Now, I believe this speaker was relating the truth, and not so much in a boastful manner did he mention this, but to show that what was good enough for the big place he mentioned should surely be equally satisfactory for us. The regulations laid down by the Local Government Board with regard to meat seizure are, to my thinking, sufficiently explicit, but in order to have proper supervision of all meat supplied to the public, private slaughter-houses should be abolished in all districts, urban or rural, and competent managers of the public slaughterhouses should be appointed--men who would not be afraid of doing their duty. But with any amendment of the Acts, unless all medical officers of health are agreed to work together on the same basis as to what they will seize and what they will pass for food, the changes would only be futile.

ACUTE SEROUS MENINGITIS AND SEROPURULENT MENINGITIS DUE TO STREPTOCOCCI. An instructive contribution to the pathogenesis of meningeal inflammations occurring in the course of acute diseases is made by Nob~court and Deles~tre (Annales de Mddecine et Ch#urgie Infantiles, April 15, 1900, p. 261). During an epidemic of bronchopneumonia in the service of Hutinel at the Hospice des EnfantsAssist~s two eases were observed, both terminating fatally, one of which presented the lesions of an acute serous cerebral meningitis, the other of a seropurulent cerebro-spinal meningitis, in both of which the same organism--a streptococcus--was found. The first case was an infant, aged twenty months, admitted for bronchopneumonia. Five days after admission meningeal symptoms appeared: rigidity of the neck, vomiting, Kernig's sign, strabismus, irregularity of the pulse and respiration, cerebral t£che, and moderate elevation of temperature. Sevenclays later a measles eruption appeared coincident wi~h au amehoration of the cerebral symptoms, but the pulmonary condition became aggravated, and death occurred on the following day. At the autopsy, in addition to the lesions of bronchopneumonia, there was observed a diffuse, oedematous congestion of the meninges of the convexity of the hemispheres, more marked posteriorly. The cerebro-spinal fluid was abundant, but clear and limpid, as was also that of the lateral ventricles. There was no solid exudate and no tubercles. The spinal meninges were unaffected. Cultures of the cerebrospinal fluid, obtained by lumbar puncture during life and also at the autopsy, showed the presence of a streptococcus (pure). A second case observed in a child, aged four years, who had presented meningitic symptoms for two days before death, showed at the