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Milk Bottles as a Possible Cause of Epidemics*
MILK BOTTLES
503
MILK BOTTLES AS A POSSIBLE CAUSE OF EPIDEMICS.* By E. G. GIBBS-SMITH, M.D., D.P.H., M edical Officer of H ealth , T edditLgtatl, AND
FREDERICK HOBDAY, C.M.G., F.R.C.V.S., F.R.S.E., Pn:ncipal of th e R o_va/. V eterinary College. TI-I AT diseases can be, a nd a re, s pread by milk 1s common k nowledge .
As far back as 1878 P owe r aclcl ucecl evidence tha t a n outb reak of diphtheria in Kilburn a nd St. J ohn 's Wood, London , was spread by milk. Trask summarised 51 outb reaks of d iphth eri a spread by milk, but found it impossible to locate th e source of infection in a number of the outbreaks. In his book , " Milk and Public H ealth," pu bli shed in r grz, Savage g ives, on the whole, about the most compre hensive desc ription a nd explanation o f the subj ect . In s ummarising the epidemics which have b een regarded as being due to milk in this country, he says, " Out of r g epidemics investigated , the source of in fection , although m ost certainly clue to milk , could no t be precisely traced , but the remainder of the epid emics were traceable in m os t cases quite defi nitely to a diseased cow! " Of known cases he q uo te r o epidemics, leaving 9 unaccounted for. In r go8 Trask compi led a list of 317 out breaks of ty ph oid fever a nd a large number of sca rlet feve r cases sprca
504
THE VETERINARY JOUR NAL
the public. With all the improvements in milk distribution (and we admit th ere a re many), in our opinion there a re more needed , a nd urgently needed , fo r that matter. Some m ay think we are making much of a trivial matter, b.ut we do not look upon it as such; be it trivial or otherwise, it should not be overlooked. Many so-called t rifles are often overlooked , or not given suffi cien t attention. It is frequently a tiny spark th at causes th e confl agration. It is the province of th e hygienist to prevent disease, and it mus t be within that province to bring every matter, whe ther great or small , to noUce with that one end in view. It is no argument again st an asse rtion of what may happen, to say th a t such a h appeni ng has not been recorded if there is the smallest possibility of such an event taking place, especially when it has reference to the spread of disease. From the few facts we have quoted it is q uite evident that it is possible to spread disease by imperfectly cleaned milk vessels . It is not only possible , but highly probable that a good many cases in which t he source of the troubl e has not been definitely traced , may have arisen in this way. As a further proof of what is possible , we have made a simple test relative to bottle washing as it is frequently carried out by small distributors. We arc in
MILK BOTTLES
505
possible for a small trader to be sure of immunity against trouble caused by imperfec tly-cleaned bottles. The cost of la bour to secure !:' Uch immunity would he prohibiti ve. Hundreds of small trade rs do nothing more than wash th eir bottles in a simila r way to that whi ch ours were wash ed in the test mentioned. It come to this: Is the system of milk dist ribution by bottles a d<'si rable one ? W e contend that the system as at present generally adopted-namely, by means of a disc-capped bottle- is a very bad one from every p oint of view. The advantages of the system have taken a firm hold on th e publi c mind, a nd t he propaganda issued by re tai lers in favour of it (can we say entirely pro bono publico ?) may make it somewhat difficult to relax that hold. What a re th e advantages? Closed bottl es inevitably suggest cleanl iness and sa fet y, and short measure, being detectable at a glance , has become a th ing o f the past. Disadvantages have barely occurred to the general public,. and yet we say they are many and formid a ble, and th ey far outweigh th e adYantages. It su,rely demands but little reflection to see that the bottle in commonest use 1:s a thoroughly unhygienic vessel for its purpose . The narrowness of the nee!? makes it diffiwlt to clean ; the groove round the bottom inside edge , occasioned by the com ,exity of the base, is a more serious objection and still 1.rorse is the shape of the neck and method of cappin,o . No matter what care is ta ken and no matter how well th e bottle is sent out from the distributing depot, a rim disc-capped bottle is li able to a hu.-ndred and one contaminations by the tim e it is opened fo r nse. The h ollow at the top of the neck of a one-pint rim disc-capped bottle is about I ~ in. in diameter and kin. deev A considerable amount of infection not only can . but does, collect on the di sc and , apart from the fact that man y of thecappings allow of a small leakage, wh en the bottle is opened a good deal of the accumulation goes into the milk. The dust which accumulates when these bottles are left at street doors, in areas , and on the stairwavs of .tfats, i'S obvious. An y day on e may see milk being left at a house at the same time t hat th e dust is being collected , and a lmost any day one can see bot tles contaminated b y dogs. ·M any people have become so sat isfied with the feeling of secu rity regarding th eir milk that they do not think of these things , a nd will leave bottles of milk standing a bout on floors and landings for h ours. We have alread y mentioned th e ques tion of cleaning bottl es. A short time ago one of us Yisited a small dairy where the cleansing was done by hand . What did we find ? Cold water only on th e premises, and any hot water used was carri ed in a pail from a house abo ut 100 yard away. An inspec tion of some of the bottles ready for refillin g, confirmed our suspicions. Th e bottom edge of the
.506
THE VETERINARY JOURNAL
inside of some contained quantities of congealed milk. Let us appre.ciate how infectious diseases may b e spread in this way. Empty bottles may be collected from an infectious house, rinsed , refilled and sold again . Retailers take these bottle round on a nice-looking handbarrow glittering with polished brass a nd with every outward sign of perfectly protected milk. Moreover , many of the roundsmen are .quite willing to oblige casual customers with a bottle of milk filled just round the corner, the milk from a supply-can carried in his barrow, .the bottle, a clean-look ing empty , collec ted on the round a nd capped with a disc from his pocket. The great maj ority of people a re now receiving milk which is far more liable to contamination than it was by the old me thod. Many people never dream of rinsing out a milk bottle, taking it for granted that they will ge t a clea n one eve ry time they buy milk. Some of them not only ne ver rinse them, but they deposit them anywhere ; som etimes on the rubbish-heap, in a filth y back-yard where they get filthy matter inside the bottle as well as out. Such people would not throw their empty milkjilgs on the rubbish-heap, and would th erefore be much safe r from infection if they were responsible for keeping their own milk vessels clean ; and so would t heir neighbours ! Milk cans were said t o be diffi cult to clean ; but bottles, unless done in elaborate machines, are much more so. Fig. 2. Shape o f bottle s howin g ton What remedies can be suggested ? which allows dust-proof cappi ng: and which has a rounded .interior bottom I :\uthorities should b e g iven powe r wh1ch can be readily stenhzed. · ~ io condemn unsuitable storage and delivery vessels. 2. A destructible container for reta il delivery would do away with bottle-cleaning difficulties. 3. If b ottles a re used at all , th ey should be of a standard shape( something on these lines :4· i\11 bottles or containers should be capped in such a way as to make it easy to remove the cap without any dirt ente ring the bottle. Such innovations would certainly be a step in the right direc tion . What objections could be raised ) Exception might be taken to furth er legislation in the matter by some people, but legislation , as it applies ·t o milk distribution , is not at all too severe at present. When one talks of a destructible container, the question of cost
OBSER VATIONS ON CALCIUM DEFICIENCY 507 is at once raised, but against that can be reckoned the cost of bottle breakages and cleaning , which must be considerable . .No doubt there are difficulties in the way of establishing this method, but surely they could be overcome. The destructible container would prove a great boon t o the small retailer. To do away with all the disc-capped! bottles and insist upon a standard bottle would only affect the big firms, and small retailers would benefi t rather than otherwise ; for when further legislation is suggested , one must give a thought t 01 the general effect on the industry. We quite expect some adverse criticisf!1 from large distributors, who will say, what we willingl admit, that they t a ke every care and send out their bottles in a perfectly satisfactory condition. They may say, why should theY; be asked to do away with valuable machinery and material because the small retailer falls short of doing his business in the most satisfact ory way? Whatever they say, we feel confident that they cannot support a case in favour of th e present rim disc-capped bottle. It is the duty of those in charge of the public health not to let any pecuniary interests of large distributors st and in the way of the a,bolition of any m eth od of distribution which either does, or is likely to ,, jeopardise the health of the community.
OBSERVATIONS ON CALCIUM DEFICIENt¥ AS A CAUSE OF CERTAIN DISEASES OF ANIMALS AND MAN.* By C. E. CORLETTE, M.D., Ch.M., D.P.H., Senior Surgeon lo the S_ydney H ospital ; L ecturer 1:n· Clinical Surgery, University of Sydney. (Continued.) Weill & Mouriquand's Experiments on Pigeons. An extremely interesting paper was published in 1918 by .W eiU and Mouriquand(33) on what they called " Syndrome biriberique experimental chronique." Whereas avian polyneuritis of the type induced by polished rice comes on between the twentieth and fortieth day, Weill and Mouriquand , experimenting with pigeons, describe as chronic b eri beri a paralysis that did not appear, on their dietary, until many month s, sometimes over <1: year , had elapsed. P ost-mortem examination showed serious lesions (osteoporosis) in the bones. Th ey say " these chronic beri beri symptoms exhibit a complete resistance to medication by raw cortical substance," this substance having been • Reprinted from "The Medical ] ournaJ of i'lustralia."
Feb. 18/ 28.
503
MILK BOTTLES AS A POSSIBLE CAUSE OF EPIDEMICS.* By E. G. GIBBS-SMITH, M.D., D.P.H., M edical Officer of H ealth , T edditLgtatl, AND
FREDERICK HOBDAY, C.M.G., F.R.C.V.S., F.R.S.E., Pn:ncipal of th e R o_va/. V eterinary College. TI-I AT diseases can be, a nd a re, s pread by milk 1s common k nowledge .
As far back as 1878 P owe r aclcl ucecl evidence tha t a n outb reak of diphtheria in Kilburn a nd St. J ohn 's Wood, London , was spread by milk. Trask summarised 51 outb reaks of d iphth eri a spread by milk, but found it impossible to locate th e source of infection in a number of the outbreaks. In his book , " Milk and Public H ealth," pu bli shed in r grz, Savage g ives, on the whole, about the most compre hensive desc ription a nd explanation o f the subj ect . In s ummarising the epidemics which have b een regarded as being due to milk in this country, he says, " Out of r g epidemics investigated , the source of in fection , although m ost certainly clue to milk , could no t be precisely traced , but the remainder of the epid emics were traceable in m os t cases quite defi nitely to a diseased cow! " Of known cases he q uo te r o epidemics, leaving 9 unaccounted for. In r go8 Trask compi led a list of 317 out breaks of ty ph oid fever a nd a large number of sca rlet feve r cases sprca
504
THE VETERINARY JOUR NAL
the public. With all the improvements in milk distribution (and we admit th ere a re many), in our opinion there a re more needed , a nd urgently needed , fo r that matter. Some m ay think we are making much of a trivial matter, b.ut we do not look upon it as such; be it trivial or otherwise, it should not be overlooked. Many so-called t rifles are often overlooked , or not given suffi cien t attention. It is frequently a tiny spark th at causes th e confl agration. It is the province of th e hygienist to prevent disease, and it mus t be within that province to bring every matter, whe ther great or small , to noUce with that one end in view. It is no argument again st an asse rtion of what may happen, to say th a t such a h appeni ng has not been recorded if there is the smallest possibility of such an event taking place, especially when it has reference to the spread of disease. From the few facts we have quoted it is q uite evident that it is possible to spread disease by imperfectly cleaned milk vessels . It is not only possible , but highly probable that a good many cases in which t he source of the troubl e has not been definitely traced , may have arisen in this way. As a further proof of what is possible , we have made a simple test relative to bottle washing as it is frequently carried out by small distributors. We arc in
MILK BOTTLES
505
possible for a small trader to be sure of immunity against trouble caused by imperfec tly-cleaned bottles. The cost of la bour to secure !:' Uch immunity would he prohibiti ve. Hundreds of small trade rs do nothing more than wash th eir bottles in a simila r way to that whi ch ours were wash ed in the test mentioned. It come to this: Is the system of milk dist ribution by bottles a d<'si rable one ? W e contend that the system as at present generally adopted-namely, by means of a disc-capped bottle- is a very bad one from every p oint of view. The advantages of the system have taken a firm hold on th e publi c mind, a nd t he propaganda issued by re tai lers in favour of it (can we say entirely pro bono publico ?) may make it somewhat difficult to relax that hold. What a re th e advantages? Closed bottl es inevitably suggest cleanl iness and sa fet y, and short measure, being detectable at a glance , has become a th ing o f the past. Disadvantages have barely occurred to the general public,. and yet we say they are many and formid a ble, and th ey far outweigh th e adYantages. It su,rely demands but little reflection to see that the bottle in commonest use 1:s a thoroughly unhygienic vessel for its purpose . The narrowness of the nee!? makes it diffiwlt to clean ; the groove round the bottom inside edge , occasioned by the com ,exity of the base, is a more serious objection and still 1.rorse is the shape of the neck and method of cappin,o . No matter what care is ta ken and no matter how well th e bottle is sent out from the distributing depot, a rim disc-capped bottle is li able to a hu.-ndred and one contaminations by the tim e it is opened fo r nse. The h ollow at the top of the neck of a one-pint rim disc-capped bottle is about I ~ in. in diameter and kin. deev A considerable amount of infection not only can . but does, collect on the di sc and , apart from the fact that man y of thecappings allow of a small leakage, wh en the bottle is opened a good deal of the accumulation goes into the milk. The dust which accumulates when these bottles are left at street doors, in areas , and on the stairwavs of .tfats, i'S obvious. An y day on e may see milk being left at a house at the same time t hat th e dust is being collected , and a lmost any day one can see bot tles contaminated b y dogs. ·M any people have become so sat isfied with the feeling of secu rity regarding th eir milk that they do not think of these things , a nd will leave bottles of milk standing a bout on floors and landings for h ours. We have alread y mentioned th e ques tion of cleaning bottl es. A short time ago one of us Yisited a small dairy where the cleansing was done by hand . What did we find ? Cold water only on th e premises, and any hot water used was carri ed in a pail from a house abo ut 100 yard away. An inspec tion of some of the bottles ready for refillin g, confirmed our suspicions. Th e bottom edge of the
.506
THE VETERINARY JOURNAL
inside of some contained quantities of congealed milk. Let us appre.ciate how infectious diseases may b e spread in this way. Empty bottles may be collected from an infectious house, rinsed , refilled and sold again . Retailers take these bottle round on a nice-looking handbarrow glittering with polished brass a nd with every outward sign of perfectly protected milk. Moreover , many of the roundsmen are .quite willing to oblige casual customers with a bottle of milk filled just round the corner, the milk from a supply-can carried in his barrow, .the bottle, a clean-look ing empty , collec ted on the round a nd capped with a disc from his pocket. The great maj ority of people a re now receiving milk which is far more liable to contamination than it was by the old me thod. Many people never dream of rinsing out a milk bottle, taking it for granted that they will ge t a clea n one eve ry time they buy milk. Some of them not only ne ver rinse them, but they deposit them anywhere ; som etimes on the rubbish-heap, in a filth y back-yard where they get filthy matter inside the bottle as well as out. Such people would not throw their empty milkjilgs on the rubbish-heap, and would th erefore be much safe r from infection if they were responsible for keeping their own milk vessels clean ; and so would t heir neighbours ! Milk cans were said t o be diffi cult to clean ; but bottles, unless done in elaborate machines, are much more so. Fig. 2. Shape o f bottle s howin g ton What remedies can be suggested ? which allows dust-proof cappi ng: and which has a rounded .interior bottom I :\uthorities should b e g iven powe r wh1ch can be readily stenhzed. · ~ io condemn unsuitable storage and delivery vessels. 2. A destructible container for reta il delivery would do away with bottle-cleaning difficulties. 3. If b ottles a re used at all , th ey should be of a standard shape( something on these lines :4· i\11 bottles or containers should be capped in such a way as to make it easy to remove the cap without any dirt ente ring the bottle. Such innovations would certainly be a step in the right direc tion . What objections could be raised ) Exception might be taken to furth er legislation in the matter by some people, but legislation , as it applies ·t o milk distribution , is not at all too severe at present. When one talks of a destructible container, the question of cost
OBSER VATIONS ON CALCIUM DEFICIENCY 507 is at once raised, but against that can be reckoned the cost of bottle breakages and cleaning , which must be considerable . .No doubt there are difficulties in the way of establishing this method, but surely they could be overcome. The destructible container would prove a great boon t o the small retailer. To do away with all the disc-capped! bottles and insist upon a standard bottle would only affect the big firms, and small retailers would benefi t rather than otherwise ; for when further legislation is suggested , one must give a thought t 01 the general effect on the industry. We quite expect some adverse criticisf!1 from large distributors, who will say, what we willingl admit, that they t a ke every care and send out their bottles in a perfectly satisfactory condition. They may say, why should theY; be asked to do away with valuable machinery and material because the small retailer falls short of doing his business in the most satisfact ory way? Whatever they say, we feel confident that they cannot support a case in favour of th e present rim disc-capped bottle. It is the duty of those in charge of the public health not to let any pecuniary interests of large distributors st and in the way of the a,bolition of any m eth od of distribution which either does, or is likely to ,, jeopardise the health of the community.
OBSERVATIONS ON CALCIUM DEFICIENt¥ AS A CAUSE OF CERTAIN DISEASES OF ANIMALS AND MAN.* By C. E. CORLETTE, M.D., Ch.M., D.P.H., Senior Surgeon lo the S_ydney H ospital ; L ecturer 1:n· Clinical Surgery, University of Sydney. (Continued.) Weill & Mouriquand's Experiments on Pigeons. An extremely interesting paper was published in 1918 by .W eiU and Mouriquand(33) on what they called " Syndrome biriberique experimental chronique." Whereas avian polyneuritis of the type induced by polished rice comes on between the twentieth and fortieth day, Weill and Mouriquand , experimenting with pigeons, describe as chronic b eri beri a paralysis that did not appear, on their dietary, until many month s, sometimes over <1: year , had elapsed. P ost-mortem examination showed serious lesions (osteoporosis) in the bones. Th ey say " these chronic beri beri symptoms exhibit a complete resistance to medication by raw cortical substance," this substance having been • Reprinted from "The Medical ] ournaJ of i'lustralia."
Feb. 18/ 28.