- Email: [email protected]
THE MILK AND DAIRIES BILL AND THE BACTERIOLOGICAL EXAMINATION OF MILK.
44 was a man aged 48. paroxysmal algesia of
His complaint was infallible methods of judging of the purity of milk, the right upper limb. and which, though constantly shown to be more or It resisted all forms of treatment and made the less fallacious for public health work, yet have such patient’s life unbearable. An operation was finally an attraction for the hygienic enthusiast that it is agreed upon. The posterior roots of the seventh well-nigh impossible to shake his belief in their and eighth cervical nerves and the first dorsal infallibility. There can be little doubt that the introduction even of a general quantitative bacterio. were divided; the operation was performed with relative ease. The immediate result was relief of the logical examination of milk will be fraught with pain. There was in addition complete anaesthesia great difficulties and much unnecessary disturbance of the skin areas supplied by the divided nerves. to those engaged in the milk trade, and should there The reflexes were almost abolished. Recurrence be added to this anything approaching a qualitative of pain, however, followed, and two months examination, then there is scope for any quantity of later a second operation was performed at which misguided energy. It appears to be forgotten by those who advocate the fifth and sixth cervical and second dorsal There was some difficulty this sort of control that no country has adopted it nerves were divided. for legal purposes except in the case of certain on account of adhesions resulting from the previous operation. The final result, however, was special milks which are sold under certain fixed permanent relief of the pain. Now it was noted conditions and for which a special price is paid. that there was, as before, complete anaesthesia. Quantitative Enumeration of Bacteria in Milk. The reflexes were abolished. Movements were But there are some considerations which must be affected to some extent. There was no definite those who advocate a simple loss of power, but rather some unsteadiness of carefully weighed by enumeration of the bacteria present in quantitative action, some ataxia. This was more marked when a sample of milk as a criterion of its cleanliness The patient could, howthe eyes were closed. and age, and which, if rightly apprehended, show ever, perform all ordinary movementswith fair that such a simple enumeration, while direct in its There was some loss of tone of the accuracy. answer as to numbers, gives no reply as to the muscles. It was of interest to note that there was means by which such numbers are attained. no adiadokokinesia, an observation confirmatory these are some of the considerations :— Briefly of Babinski’s views of the nature and origin of I. We have no reliable data as to what the this curious sign. In so far as the result showed content of milk should be when bacteriological abolition of the pain, it can be said that the operamilk is delivered to the public after such reasonably tion was successful and justifiable. proper handling as is possible in commercial work. Figures purporting to give such informaare undoubtedly, but the conditions tion there ON the occasion of the tercentenary of the obtained are not under which these were the foundation of the University of Groningen How often milk is the conditions of practice. of has of honoris causâ Doctor Medicine degree been conferred upon Sir Edward Schafer and obtained from a cow direct, and simply kept in a vessel of some kind and examined after Professor J. N. Langley. 24 or 48 hours at certain fixed temperatures, and Now the consequent multiplication ascertained. butter-maker knows that if he wants his any THE MILK AND DAIRIES BILL AND THE " starters " to sour more rapidly he must stir them BACTERIOLOGICAL EXAMINATION well at intervals, and in ordinary practice milk from the time it leaves the cow till it gets to the conOF MILK. sumer is in constant motion, which without doubt BY R. TANNER HEWLETT, M.D. LOND, F.R.C.P. LOND., produces a profound effect on bacteriological multiD.P.H., PROFESSOR OF BACTERIOLOGY IN THE UNIVERSITY OF LONDON plication. Again, the process of straining, especially (KING’S COLLEGE). when centrifugal cleaners are used, and also of cooling, all tend to increase the apparent number THE Milk and Dairies Bill, 1914, contains one of effective organisms by breaking up colonies and important alteration, or rather addition to its pre- rendering active organisms which by enclosure in decessors. In Clause 5, Section 2, it grants powers such colonies had ceased to be available. The to health authorities to take samples of milk for following experiment will show the effect of a " bacteriological examination." Now, judging by centrifugal cleaner, which while actually removing the Bill of 1912, Clause 2, Section 3, it is by no many organisms (as could be seen by the qualitative means improbable that to the framers of the Bill character of the experiments) apparently increases this bacteriological examination is intended to the bacterial count. Six churns of milk were mixed cover examination for B. tuberculosis only, either and passed through a centrifugal cleaner running by microscopical or inoculation methods. In such at about 600 revolutions per minute; before a sense and so far the idea is good, and is rendered passing, 3,900,000 organisms per c.c.; after passing, acceptable by the additional enactment that such 5,400,000 organisms per c.c. Also the effect of samples shall be divided into three parts and the agitation becomes the more marked as the bacterionecessary check examinations made as may be logical content increases, and it is just at the time when multiplication has already taken placedesired. Unfortunately, in Clause 15 the word " bacterio- namely, after arrival at the distributor’s premiseslogical " is not defined, and it is certain that by that it undergoes the most drastic agitation, and most health authorities it will be regarded in the rate of increase is accelerated out of all due its widest sense, an assumption rendered all the proportion. more probable by amendments which have been II. Any value which might attach to a quantitamoved in committee to add the words " or other tive examination is completely lost if at any to "bacteriological." This addition would include stage the milk be subjected to pasteurisation. It the whole field of biological, enzymic, and physical is quite possible to pasteurise milk in such a tests, which are constantly brought forward as being manner that there is no outward indication that
patient severe
"
45 this has been done, and yet the bacterial content be brought within any desired limits, and there would also be no indication as to how often this might have been practised. This is probably one of the most potent objections to bacteriological standards on account of the false idea of freshness which they may imply. This is not the place to enter into the question of the merits or demerits of pasteurisation, but, at any rate, it does not make for improvement in the milk-supply.
Bacterial
Development in
Milk in Ice-rooms and Ice-boxes. III. With the effect of weather vagaries, of actual climatic conditions, as opposed to temperature, and of the awkward concurrence of an impoverished and tepid water-supply on farms at times when prolonged or excessive heat renders a plentiful and cold supply for cooling most necessary, there is not space here to deal, but the effect of holding milk in ice-rooms on bacterial development touches this question of bacteriological examination very closely. It must be clearly understood that since (at least in the case of London) milk reaches the distributor each day during the hours of 12 midnight and 4 A.M., and again from 11 A.M. to 4 P.M., and that the usual times of delivery of milk to the consumer are from 5 A.M. to 7 A.M., and from 12 midday to 3 P.M., nearly half the day’s supply arrives at a distributing station after the last round (12 midday) has been dispatched. The milk so arriving must be held for the next morning’s delivery. This necessitates some hours’ storage in ice-rooms, and for practical purposes a temperature of 45° F. is generally attained. It might be supposed that at this temperature multiplication would be so slow as to be almost negligible, but the results of a few experiments show that this is not the case, and the higher the initial count on going into the ice-room, the greater will be the development during storage. 1. A churn of milk chilled to 45° F. on the cooler contained 483,000 bacteria per c.c. The same kept 18 hours in the ice-room at 43°-45°F. then contained 970,000 per c.c. 2. The following results were obtained with churns of milk taken after passing a centrifugal cleaner, these being then kept in the
If small samples kept constant at 43°-45° F. show the increase stated above, what will it be when the conditions are those of the ice-box, and yet when samples are divided into three it is impossible that all will be kept under identical conditions or be examined at the same interval of time. What a fruitful source of discrepancy and unjust deduction is here ! The following is an actual experiment made under such conditions. Two samples of milk were taken and placed for one hour in an ordinary good type of ice-box, such as is used for sending samples for bacteriological examination by rail or post, the copper receptacle being well packed with ice. A quantitative examination was then made in each case and the bottles returned to the box and kept in it for 24 hours and again examined. The temperature of the milks was then 60° F., with an outside temperature of 64°. The results were as follows : 24 hours later.
Start.
Sample
1
......
168,000
.........
550,000
36,500,000 Sample 2 ......10,800,000 These samples were deliberately chosen to have a high and a low initial count respectively, and in each case show a very marked increase during an interval which would be a normal one if samples were dispatched by rail to bacteriological laboratories, as .........
would be the
case
in most instances.
EPSOM COLLEGE. THE annual general meeting of the governors of Epsom College was held at the office in Soho-square on June 26th, Sir Henry Morris, the treasurer of the College, being in the chair. He was supported by a very large number of governors, amongst whom were : Mr. S. Boyd,
Sir John F.
H. Broadbent, Mr. J. Paul Bush, Dr. F. Charlesworth, Sir William S. Church, Sir Thomas Boor Crosby, Sir Dyce Duckworth, Mr. A. P. Eldred, Dr. L. Grant, Dr. W. S. A. Griffith, Dr. F. de Havilland Hall, Mr. H. E. Haynes, Mr. H. Hilliard, Mr. D. Keele, Mr. J. B. Lawford, Mr. J. H. Morgan, Mr. W. A. Propert, Dr. G. Rankin, Sir James Reid, Dr. St. Clair B. Shadwell, Colonel Bruce M. Skinner, A.M.S., Dr. S. Sunderland, Dr. F. Taylor,
Dr. W. E. Wynter, and Mr. E. P. Young. The SECRETARY read the report of the scrutineers as to the successful candidates for pensionerships and foundation scholarships as follows :-
The SECRETARY reported that as vacancies had arisen since the voting papers were printed, Emma M. Daniell would be elected a" Pugh " pensioner and William G. Hughes would be elected a foundation scholar at the Council meeting which would be held immediately after the
annual general meeting. These all have a very direct bearing on the ’ The annual report of the Council to the governors stated results of taking samples of milk and placing them that the foundation had suffered during the years 1912 and in ice-boxes and sending them to laboratories for 1913 by the uncertainty which had overshadowed medical examination. The temperature of an ordinary good practice throughout the country, many medical men having withdrawn their contributions. The Council urged upon all ice-box is by no means steady, as the following friends of the College to do their best to secure fresh annual readings will show :subscriptions in order that the work hitherto carried out by Temperature.
the
Medical Foundation might be maintained. This the provision of 50 pensionerships of .E.30 a year for members, or widows of members, of the medical profession in reduced circumstances, and of 50 foundation scholarships, by means of which board, clothing and pocket money, and an education of the highest class are given
Royal comprised
His complaint was infallible methods of judging of the purity of milk, the right upper limb. and which, though constantly shown to be more or It resisted all forms of treatment and made the less fallacious for public health work, yet have such patient’s life unbearable. An operation was finally an attraction for the hygienic enthusiast that it is agreed upon. The posterior roots of the seventh well-nigh impossible to shake his belief in their and eighth cervical nerves and the first dorsal infallibility. There can be little doubt that the introduction even of a general quantitative bacterio. were divided; the operation was performed with relative ease. The immediate result was relief of the logical examination of milk will be fraught with pain. There was in addition complete anaesthesia great difficulties and much unnecessary disturbance of the skin areas supplied by the divided nerves. to those engaged in the milk trade, and should there The reflexes were almost abolished. Recurrence be added to this anything approaching a qualitative of pain, however, followed, and two months examination, then there is scope for any quantity of later a second operation was performed at which misguided energy. It appears to be forgotten by those who advocate the fifth and sixth cervical and second dorsal There was some difficulty this sort of control that no country has adopted it nerves were divided. for legal purposes except in the case of certain on account of adhesions resulting from the previous operation. The final result, however, was special milks which are sold under certain fixed permanent relief of the pain. Now it was noted conditions and for which a special price is paid. that there was, as before, complete anaesthesia. Quantitative Enumeration of Bacteria in Milk. The reflexes were abolished. Movements were But there are some considerations which must be affected to some extent. There was no definite those who advocate a simple loss of power, but rather some unsteadiness of carefully weighed by enumeration of the bacteria present in quantitative action, some ataxia. This was more marked when a sample of milk as a criterion of its cleanliness The patient could, howthe eyes were closed. and age, and which, if rightly apprehended, show ever, perform all ordinary movementswith fair that such a simple enumeration, while direct in its There was some loss of tone of the accuracy. answer as to numbers, gives no reply as to the muscles. It was of interest to note that there was means by which such numbers are attained. no adiadokokinesia, an observation confirmatory these are some of the considerations :— Briefly of Babinski’s views of the nature and origin of I. We have no reliable data as to what the this curious sign. In so far as the result showed content of milk should be when bacteriological abolition of the pain, it can be said that the operamilk is delivered to the public after such reasonably tion was successful and justifiable. proper handling as is possible in commercial work. Figures purporting to give such informaare undoubtedly, but the conditions tion there ON the occasion of the tercentenary of the obtained are not under which these were the foundation of the University of Groningen How often milk is the conditions of practice. of has of honoris causâ Doctor Medicine degree been conferred upon Sir Edward Schafer and obtained from a cow direct, and simply kept in a vessel of some kind and examined after Professor J. N. Langley. 24 or 48 hours at certain fixed temperatures, and Now the consequent multiplication ascertained. butter-maker knows that if he wants his any THE MILK AND DAIRIES BILL AND THE " starters " to sour more rapidly he must stir them BACTERIOLOGICAL EXAMINATION well at intervals, and in ordinary practice milk from the time it leaves the cow till it gets to the conOF MILK. sumer is in constant motion, which without doubt BY R. TANNER HEWLETT, M.D. LOND, F.R.C.P. LOND., produces a profound effect on bacteriological multiD.P.H., PROFESSOR OF BACTERIOLOGY IN THE UNIVERSITY OF LONDON plication. Again, the process of straining, especially (KING’S COLLEGE). when centrifugal cleaners are used, and also of cooling, all tend to increase the apparent number THE Milk and Dairies Bill, 1914, contains one of effective organisms by breaking up colonies and important alteration, or rather addition to its pre- rendering active organisms which by enclosure in decessors. In Clause 5, Section 2, it grants powers such colonies had ceased to be available. The to health authorities to take samples of milk for following experiment will show the effect of a " bacteriological examination." Now, judging by centrifugal cleaner, which while actually removing the Bill of 1912, Clause 2, Section 3, it is by no many organisms (as could be seen by the qualitative means improbable that to the framers of the Bill character of the experiments) apparently increases this bacteriological examination is intended to the bacterial count. Six churns of milk were mixed cover examination for B. tuberculosis only, either and passed through a centrifugal cleaner running by microscopical or inoculation methods. In such at about 600 revolutions per minute; before a sense and so far the idea is good, and is rendered passing, 3,900,000 organisms per c.c.; after passing, acceptable by the additional enactment that such 5,400,000 organisms per c.c. Also the effect of samples shall be divided into three parts and the agitation becomes the more marked as the bacterionecessary check examinations made as may be logical content increases, and it is just at the time when multiplication has already taken placedesired. Unfortunately, in Clause 15 the word " bacterio- namely, after arrival at the distributor’s premiseslogical " is not defined, and it is certain that by that it undergoes the most drastic agitation, and most health authorities it will be regarded in the rate of increase is accelerated out of all due its widest sense, an assumption rendered all the proportion. more probable by amendments which have been II. Any value which might attach to a quantitamoved in committee to add the words " or other tive examination is completely lost if at any to "bacteriological." This addition would include stage the milk be subjected to pasteurisation. It the whole field of biological, enzymic, and physical is quite possible to pasteurise milk in such a tests, which are constantly brought forward as being manner that there is no outward indication that
patient severe
"
45 this has been done, and yet the bacterial content be brought within any desired limits, and there would also be no indication as to how often this might have been practised. This is probably one of the most potent objections to bacteriological standards on account of the false idea of freshness which they may imply. This is not the place to enter into the question of the merits or demerits of pasteurisation, but, at any rate, it does not make for improvement in the milk-supply.
Bacterial
Development in
Milk in Ice-rooms and Ice-boxes. III. With the effect of weather vagaries, of actual climatic conditions, as opposed to temperature, and of the awkward concurrence of an impoverished and tepid water-supply on farms at times when prolonged or excessive heat renders a plentiful and cold supply for cooling most necessary, there is not space here to deal, but the effect of holding milk in ice-rooms on bacterial development touches this question of bacteriological examination very closely. It must be clearly understood that since (at least in the case of London) milk reaches the distributor each day during the hours of 12 midnight and 4 A.M., and again from 11 A.M. to 4 P.M., and that the usual times of delivery of milk to the consumer are from 5 A.M. to 7 A.M., and from 12 midday to 3 P.M., nearly half the day’s supply arrives at a distributing station after the last round (12 midday) has been dispatched. The milk so arriving must be held for the next morning’s delivery. This necessitates some hours’ storage in ice-rooms, and for practical purposes a temperature of 45° F. is generally attained. It might be supposed that at this temperature multiplication would be so slow as to be almost negligible, but the results of a few experiments show that this is not the case, and the higher the initial count on going into the ice-room, the greater will be the development during storage. 1. A churn of milk chilled to 45° F. on the cooler contained 483,000 bacteria per c.c. The same kept 18 hours in the ice-room at 43°-45°F. then contained 970,000 per c.c. 2. The following results were obtained with churns of milk taken after passing a centrifugal cleaner, these being then kept in the
If small samples kept constant at 43°-45° F. show the increase stated above, what will it be when the conditions are those of the ice-box, and yet when samples are divided into three it is impossible that all will be kept under identical conditions or be examined at the same interval of time. What a fruitful source of discrepancy and unjust deduction is here ! The following is an actual experiment made under such conditions. Two samples of milk were taken and placed for one hour in an ordinary good type of ice-box, such as is used for sending samples for bacteriological examination by rail or post, the copper receptacle being well packed with ice. A quantitative examination was then made in each case and the bottles returned to the box and kept in it for 24 hours and again examined. The temperature of the milks was then 60° F., with an outside temperature of 64°. The results were as follows : 24 hours later.
Start.
Sample
1
......
168,000
.........
550,000
36,500,000 Sample 2 ......10,800,000 These samples were deliberately chosen to have a high and a low initial count respectively, and in each case show a very marked increase during an interval which would be a normal one if samples were dispatched by rail to bacteriological laboratories, as .........
would be the
case
in most instances.
EPSOM COLLEGE. THE annual general meeting of the governors of Epsom College was held at the office in Soho-square on June 26th, Sir Henry Morris, the treasurer of the College, being in the chair. He was supported by a very large number of governors, amongst whom were : Mr. S. Boyd,
Sir John F.
H. Broadbent, Mr. J. Paul Bush, Dr. F. Charlesworth, Sir William S. Church, Sir Thomas Boor Crosby, Sir Dyce Duckworth, Mr. A. P. Eldred, Dr. L. Grant, Dr. W. S. A. Griffith, Dr. F. de Havilland Hall, Mr. H. E. Haynes, Mr. H. Hilliard, Mr. D. Keele, Mr. J. B. Lawford, Mr. J. H. Morgan, Mr. W. A. Propert, Dr. G. Rankin, Sir James Reid, Dr. St. Clair B. Shadwell, Colonel Bruce M. Skinner, A.M.S., Dr. S. Sunderland, Dr. F. Taylor,
Dr. W. E. Wynter, and Mr. E. P. Young. The SECRETARY read the report of the scrutineers as to the successful candidates for pensionerships and foundation scholarships as follows :-
The SECRETARY reported that as vacancies had arisen since the voting papers were printed, Emma M. Daniell would be elected a" Pugh " pensioner and William G. Hughes would be elected a foundation scholar at the Council meeting which would be held immediately after the
annual general meeting. These all have a very direct bearing on the ’ The annual report of the Council to the governors stated results of taking samples of milk and placing them that the foundation had suffered during the years 1912 and in ice-boxes and sending them to laboratories for 1913 by the uncertainty which had overshadowed medical examination. The temperature of an ordinary good practice throughout the country, many medical men having withdrawn their contributions. The Council urged upon all ice-box is by no means steady, as the following friends of the College to do their best to secure fresh annual readings will show :subscriptions in order that the work hitherto carried out by Temperature.
the
Medical Foundation might be maintained. This the provision of 50 pensionerships of .E.30 a year for members, or widows of members, of the medical profession in reduced circumstances, and of 50 foundation scholarships, by means of which board, clothing and pocket money, and an education of the highest class are given
Royal comprised