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TUBERCULOUS MEAT: UNIFORMITY AS TO SEIZURE. * BY WILLIABI BERRY, F.R.C.S.I., BIedical Officer of tIealth of ~Vigan. As there is considerable difference of opinion amongst medical officers of health and meat inspectors as to the seizure of tuberculous .meat, I have taken the.liberty of inviting discussion here to-day to see if we can arrive at some definite idea as to what is "localized" and what "generalized" tuberculosis. If we start with the assumption .that tuberculosis is a systemic affection, and therefore cannot be localized, we have a definite line to work upon, and then the flesh of all beasts in which a trace of tuberculosis is discovered must be condemned and destroyed. This, no doubt, was the view held by many before the issue of the report of the Royal Commission on Tuberculosis in 1898, for I find in Vacher's " F o o d Inspector's Handbook, 1892" (p. 3"4), the following : " There has been much discussion as to whether the eareases of all animals infected with tuberculosis should be held as unfit for human food. Indeed, mary years ago it was generally allowed that if the disease was alJ2areutly limited to the lungs, and not far ~dvanced, and the carcase looked well, the inspector would be justified in passing the meat. However, this is not the approved view now." And further : " T h e disease is, therefore, not to be regarded as localized because it is only apparent in the' lungs, for through the lungs circulates the whole blood, and sooner or later the bacillus is carried into the system." Then he quotes the report of a departmental committee on tuberculosis, which, reporting on July 16th, 1888, expressed the opinion that, "although the bacilli may be found but rarely in the flesh, still the chance of their being present either there or in the blood is too probable to ever allow the flesh of a tuberculous animal being used for food under any circumstances either for man or the lower animals." Then, again, Professor Walley in his book, entitled a "Practical Guide to Meat Inspection," says (p. 157) : "At the Paris Congress of 1888 a resolution was passqd (there being only three dissentients) in favour of the total seizure Read before the North-Western :Branch of the Incorporated Society of Medical Officersof Health, November, 1899.
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and destruction of all flesh derived from tuberculous animals, whatever the extent of the specific lesions found in such animals." The same author mentions that since the holding of the Paris Congress of 1888 the following decree has been promulgated in France, and I quote this to show what were considered as generalized lesions : " The flesh of tubercular animals shall be excluded from consumption-(1) If the lesions are generalized, that is to say, not confined exclusively to the visceral organs and their lymphatic glands ; (2) If the lesions, although localized, have invaded the greater part of an organ, or are manifested by an eruption on the walls of the chest or abdominal cavity." On the occasion of a second sitting of tile International Congress held at Paris on September 2nd, 1889, the following important resolution was (with four dissentients only) adopted: " T h e r e is reason to prevent the consumption by men or animals of the flesh of tuberculous animals, mammals or birds, whatever the degree of tuberculosis, or whatever the apparent quality of the meat." Now, since that time we have in this country had two l~oyal Commissions on Tuberculosis, the f i r s t , i n 1890, and the second 1895-98, experiments having been made for both Commissions with tuberculous meat. The secretary of the last Commission in a joint work on " Cattle Tuberculosis " says : " There can be no doubt that in the past a great quantity of meat has been destroyed by the officers of local authorities which might very well have been consumed, because it has been found that only rarely does the tubercle bacillus lodge in the muscular substance itself ; and prbvided the organs containing the tuberculous deposits are destroyed, the meat itself may be s o u n d ? '-~-
After speaking of the findings of the first Iloyal Commission, which reported i n 1895 that bovine and h u m a n tuberculosis were identical, and that risk of acquiring tuberculous disease was incurred by taking t u b e r c u l o u s m a t t e r into the body, ~he second Iloyal Commission reported as follows : " A t the same time, we think that there has been a tendency in some minds to exaggerate the extent of the risk arising from me.'.t."t " As to the amount and distribution of tuberculous disease which justifies the seizure and condemnation of a carcase as " Cattle Tuberculosis," by Legge and Sessions, Introduction, p. ix. "]" Para~aph 11 of Report..
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unfit for human food, the widest discrepancy prevails in opinion and practice. Chaos is the only word to express the absence of system in the inspection and seizure of tuberculous meat, and it has in our opinion become necessary that regulations should be formulated for the guidance of those who are concerned in dealing with this subject. " In :Belfast the presence of tuberculosis in any de~ee is held to be ground for seizure; on the other hand, in Islington the veterinary inspector of the Corporation of the City of London only seizes those caresses wherein tuberculosis is generalized and the meat in poor condition. In Dublin the medical officer of health used to seize on the slightest evidence of tuberculosis, but he has recently modified his views, and only seizes caresses which are somewhat extensively affected. In Sheffield seizure is made of .~ carcase showing the slightest trace of tuberculosis. In Manchester, in cases where the disease is localized, the affected part is removed and destroyed, the remainder is passed. " Numerous instances of similar discrepancy will be found in the evidence. The above, taken almost at random, may be sufficient to illustrate the present condition of inspection applied to tuberculous caresses. ~ Then in paragraph 23 we have the following statement : ":Producers and traders are making no unreasonable demand when they ask that a reeoguised standard should be observed, and that meat which, after effective inspection, is pronounced fit for sale in one market, shoulc~ not be liable to seizure in another because the inspecting authority happens to differ in opinion as to the extent of tuberculosis which may be dangerous." Again in paragraph 25 we have it stated that such a stage of experience and knowledge has been attained as to the nature of tuberculosis and the effect of tuberculous meat upon the human consumer as to enable a uniform standard to be prescribed for the guidance of meat inspectors; and, further, the Commissioners say that, "Assuming that seizure of meat "should be confined to such as is dangerous to human health, we entertain no doubt that in certain places a great deal of meat is seized which is perfectly safe and wholesome food," and " t h a t some limit should be observed in the latitude permitted to medical or veterinary officers in fixing independent standards of soundness in different placgs." I think it would be well, therefore, if we could adopt some kind" of standard of uniformity as to what should be considered "generalized " and what "localized " tuberculosis. The conclusion of the Royal Commission as to the principles which should b e observed in the inspection of tuberculous caresses of cattle are a s follows : 1: TI~ entire carcase and all the organs may be seized, (a) When there is miliary tuberculosis of both lungs.
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(b) When tuberculous lesions are ~resent on the pleura and peritoneum. (c) When tuberculous lesions are present in the muscular system, or in the lymphatic glands embedded in or between the ~nuscles.
(el) When tuberculous lesions exist in any part of an emaciated carcase. 2. The carcase, i f otherwise healthy, shall ~zot be condemned, but every 2art of it co,taining tuberculous lesions shall be seized, (a) When the lesions are confined to the lungs and the thoracic lymphatic glands. (b) When the lesions are confined to the liver. (c) When the lesions are confined to the pharyngeal lymphatic glands. .(d) When the lesions are confined to any combination of the foregoing, but are collectively small in extent. These instructions seem to me to be p r e t t y conclusive as to what the Iloyal Commissioners t h o u g h t , to be " g e n e r a l " and what " l o c a l " tuberculosis, and I abstract the following from Legge and Sessions's book on " Cattle Tuberculosis ":* " Tuberculosis in cattle, as found by post-mortem examination, generally occurs in one or two forms : 1. Where organs and their glands only are affected ; 2. When there has been invasion of the serous membranes. The former is the more frequent form in cattle, and the latter is almost invariably secondary to disease of the organs. In meat inspection the poin t that is of the utmost importance to decide is whether an animal is affected with localized or generalized tuberculosis. The term 'localized' is used when the disease is limited to one organ or spreads to another organ by contiguity or by the lymphatic channels, or through the portal circulation (i.e., the circulation between the intestinal tract and the liver),, but not by means of the general blood-stream of the body. As examples of it are tuberculosis of the retropharyngeal lymphatic glands with tuberculosis of the lungs and bronchial lymphatic glands, tuberculosis of the intestines and mesenterie lymphatic glands, tuberculosis of the lungs and pleura, tuberculosis of the intestines and liver. " B y 'geheralized' tuberculosis is meant the spread of the disease by the passage of tubercle bacilli into the main bloodstream, or into the thoracic duct, and their conveyance thence to different organs and parts of the body, such as the lungs, liver, spleen, kidneys, bones and muscular tissue. If the bacilli in this case enter in large numbers into the blood-stream, then acute miliary tuberculosis (galloping consumption) results ; but it by no means follows that in generalized tuberculosis all the organs and tissues become equally infected. Some tissues offer a particular resisting power to the organisms. The lungs a r e always attacked, then come in order the abdominal organs, the serous membranes, the lymphatic glands of the muscular tissue, the udder, kidneys, and lastly the bones." * 0T. cit.,'p. 51.
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Professor 0stertag, of Berlin, the highest authority on meat inspection in Germany, believes that tuberculosis of the serous membranes only rarely lead s to a generalization of the disease, except the disease commence in the uterus, and looks on deposits on them as a local condition. This certainly is not my view, for if we have extensive deposits on the pleura and peritoneum they are evidence of generalized tuberculosis. It has been proved by the experiments, made in feeding animals that the muscular tissue of tuberculous animals as 'a rule contains no b~eilli, or at least not enough to cause disease in the animals experimented on, and that for the flesh to be injurious we must have a high degree of tuberculosis. In conclusion, I would say that if we have a well-fed beast with lesions such as are classified in the first group of recommendations of the Iloyal Commissioners, we should condemn ; and if on the other hand we have a well-fed beast coming under the second category of ree0mmendations, it should be passed after eliminating the affected parts. If the carcase be wasted and the flesh slimy and soft, we shot{Id be justified in condemning it, although the evidence of tuberculosis was only slight.. I know there may be cases in which it is a matter of opinion as to which head the carcase may come under, but as a general rule, unless we have evidence of acute miliary tuberculosis, the condition of the carcase must be considered. With numerous deposits in the pleural cavity, on the upper and under surface of the diaphragm, and the peritoneum well studded, although the lungs or liver may not be much affected, I think the extensive surface of deposit justifies the conclusion that we have general tuberculosis. It is quite evident from the findings of the last Commission that we must retreat from the method of seizing all earcases that are affected with tuberculosis, and mu~t have a definite idea as to what constitutes "local" and what "general " tuberculosis. DISCUSSION. Professor Dr.Lr':PIXSthought that little exception could be taken to the findings of:the Royal Commission, although some points might give rise to misconception. With regard to the earlier measures that were taken, which arc now regarded as too severe, they were framed when the exact distribution of the tubercular virus was not so well understood ; they were tentative and perfectly correct according to the knowledge of that day. Everyone acknowledged that the carcase should be destroyed when the virus had passed into the blood-stream, and the same danger existed when lymphatics embedded in the muscles were affected. Professor Del~pine then referred to the difficulties in carrying out the recommendations, as exemplified by the recent Birkenhead meat case. He said it seemed to be necessary to get some third person to examine the lesions, microscopically, as neither the evidence of the medical officer of health nor of the inspector was accepted as absolute proof of the presence of tuberculous lesions. Dr. Young thought the instructions good, and that they could not do otherwise than follow them. Dr. "WHEATr.v.Ysaid that the recommendations were seen, if examined care-
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fully, to be stringent. There were few cases, except these with small localized lesions, in which the pleura and peritoneum, or some glhnds embedded in muscles, were not affected. There was no direction given for those cases in which the lungs and one of the abdominal organs were affected. Dr. SEnGEA.~T thanked Dr. Berry for introducing this interesting discussion. ~Ie spoke of the difficulties that had to be encountered years ago, and said that they seemed to be increasing rather than decreasing. It appeared as if a bacteriolo~cal laboratory, absolutely at the disposal of sanitary authorities, established for this and other work, would become a necessity.
PAnAFFIN AS ADULTERANT
OF
I~IAIlGARINE.- It iS SO commonly
assumed that margarine is invariably a wholesome food, that the evidence on the subject given by a chemist, Mr. J. F. Geisler, in a paper prepared for the American Chemical Society, deserves consideration. H e states that paraffin has been found at different times in a number of samples of margarine, in proportions rahging from 5 to 112 per cent. H e first detected it in 1893, and reported the fact to the New York State Department of Agriculture, whose experts afterwards found a considerable number of samples of margarine containing paraffin to the extent of 9"72 to 11"25 per cent. The publicity given to the subject at that time led to a temporary discontinuance of the use of paraffin in such large quantities, and it was not until the present year that Mr. Geisler again noticed .~he presence of the adulterant in the course of his customary analyses of margarine. During the last few months, however, he has found 5 to 11"76 per cent. of paraffin in samples of margarine sold in shops in New York and Brooklyn, either as margarine or as butter. The object of the use of paraffin, Mr. Geisler explains, is to make a thoroughly homogeneous mixture of the several fats and oils by preventing their separation, thus improving the consistency and appearance of the margarine, and rendering its distinction from butter by physical tests difficult. As the paraffin is probably introduced in the oleomargarine (~he oil), of which margarine is mainly composed, and by far the greater portion of that oil used in Europe comes from the United States, it is almost certain that the adulterant will be found in margarine sold in this country if chemists search for it. Then it will be a question for medical authorities to decide as to whether theparaffin, in the proportions found, is likely to be distinctly injurious to the health of consumers of margarine.--Standard.