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Reprinted from The Journal of the American Medical Association,
September 28, 1907, Vol. xlix, py. 1088-1093.

Copyright, 1807.
American Medical Association, 193 Dearborn Ave., Chicago.

TIE MILK SUPPLY OF WASHINGTON, D. C.*

G. LLOYD MAGRUDER, M.D.
VASHINGTON, D. C.

During the summer of 1906, notwithstanding the
completion of, and the satisfactory results obtained
from, the Washington filtration works, it was found,
contrary to the general expectation, that there was no
diminution in the prevalence of typhoid fever. Owing
to the limited force of inspectors under the health offi-
cers and the entire absence of a bacteriologic laboratory
under his control, no extended investigation into the
causation of this condition could be conducted. Conse-
quently, in June, 1906, the District Commissioners re-
quested the aid of the Bureau of Public Health and Ma-
rine-Hospital Service toward solving this problem. The
work of the bureau covered the conditions that existed
within the limits of the District. Very early in the
course of the investigations attention was forcibly drawn
to the milk supply. A summary of work done was sub-
mitted to the District Commissioners in March last.
Ten per cent. of the cases of typhoid fever examined
were directly traced to milk infection. The study of
the methods of receiving, handling, caring for and dis-
tributing milk showed a most deplorable state of affairs.
This will be shown in great detail in the full report
which is to be issued shortly.

On June 6, 1894, I, as chairman of a committee, pre-
sented a report on typhoid fever in the District of Co-
lumbia to the medical society of the district. This re-
port was afterward presented to the district committees
of both houses of Congress and was printed as a public
document. While preparing this report the many in-
sanitary conditions connected with the milk supply were

*Read in the Section on Hygiene and Sanitary Science of the

American Medical Association, at the Fifty-eighth Annual Session,
held at Atjaniic City, June, 1807.

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noticed. “Contaminated milk” was mentioned as a
prominent cause of the disease. Among the recommen-
dations of this committee which were unanimously
adopted by the society were: “The construction of works
for the filtration of the Potomac water, the only proper
method of purification; the abandonment of all wells
as rapidly as possible within the city limits. Careful
purification and inspection of all dairies in the District
from which the milk supply is drawn; and the enact-
ment of a law whereby no milk shall be sold in the Dis-
trict without a permit from the health office. The in-
spection should cover an examination at the dairies of
all possible sources of infection, including the water
supply.” |

Karly in September, 1906, I had a conference with
the Hon. James Wilson, the Secretary of Agriculture,
and discussed with him the insanitary conditions that
had been observed on dairy farms, as well as the numer-
ous reports of contaminated waters, as shown by re-
peated chemical analyses. The advisability was urged
of carrying out the recommendation as to dairy farms
made by the committee of the medical society in 1894.
Repeated examinations of the milk supply in a number of
states and the general conditions surrounding the same
have been made by the Department of Agriculture. The
Secretary immediately took great interest in the sub-
JeCt. Fully appreciating that a study of the sources of
supply would be of great value, he directed that careful
and thorough inspection should be made of every source
of supply of milk to the city from the District of Co-
lumbia, Maryland and Virginia.

The results as obtained were from time to time re-
ported. Most astounding conditions were found to
exist. Especially interesting were the bacteriologic in-
vestigations of the water supply of sixty dairy farms,
which were made by the Department of Agriculture in
November and Hecember, taken without “selection in
Maryland, Virginia and the District of Columbia. These
showed that but 25 per cent. were under the danger line,

considering that 500 bacteria to the cubic centimeter,

when uncontaminated with sewage bacteria, is the limit
of perfect safety; twenty-seven showed the presence
of bacillus coi—45 per cent. A number of wells or
springs examined contained over 20,000 bacteria to the
evbic centimeter; one contained 27,200.

Giit
Author

(Porson)

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Two cases of fever were in actual existence on two
farms at the time of the examination of the water sup-
ply, one in Maryland and one in Virginia.

This knowledge, in the ight of the recent reports of
Dr. Schroeder showi ing the presence of the tubercle
bacillus in the feces of cows and those of Dr. Soper as
to the presence of the typhoid bacillus in the feces of a
patient, demands that greater attention should be paid
to water supplies showing the colon bacillus. The bac-
teriologic investigation of the water supply of farms has
been continued and additional reports are now available.
These show increased contamination, probably the re-
sult of spring rains and the warmer weather.

These studies have been found so interesting that the
Secretary of Agriculture has ordered a repetition of the
inspection of the 1,000 farms supplying Washington.
This inspection will ‘include a bacteriologic examination
of the water supply of each farm. The Bureau of Pub-
he Health and Marine-Hospital Service examined bac-
tericlogically 172 samples of milk during August and
September, with an average of 22 134,259 bacteria.
The Department of Agriculture supplemented this work
by examining 372 s samples from October 27 to Decem-
ber 3, 1906, “comparatively cool weather, and found an
average of 977,315. Recently the same department has
examined 130 samples of ice cream. Five of these sam-
ples contained less than 500,000 bacteria to the cubic
centimeter, the remainder ranged from over 1,000,000 to
364,000,000 per cubic centimeter. These figures draw at-
tention to a most dangerous factor as a probable cause
of disease.

The information obtained from these investigations
conducted by these two great departments of the govern-
ment, ‘the Department ‘ot Agriculture and the Bureau
of Public Health and Marine- Hospital Service, so im-
pressed the District Commissioners that they, on March
30, 1907, addressed a letter to a number of prominent
government officials and leading citizens inviting them
“to confer with respect to the milk supply in the District
of Columbia, and to advise them what further steps
should be taken to improve it, especially with reference
to the question of employing either certification of mitk
of standard excellence or the pasteurization of the Dis-
trict milk supply, or both, and what amendments should
be made to the commissioners’ bill for the better regu-

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iation of the milk business introduced in the last session
of Congress.”

On April 10 the men invited to this conference met
and organized the Millk Commission with the following
officers:

Chairman.—Gen. Geo. M. Sternberg, Surgeon General, U. S.
Army, retired. :

Vice Chairmen.—Dr, Harvey W. Wiley, Department of Ag-
riculture, and Dr. Geo. M. Kober, Professor of Hygiene, School
of Medicine, Georgetown University.

Secretary.—Dr. W. C. Woodward, District Health Officer,

Several subcommittees were appointed.

Subcommittee on Infant Feeding: Chairman, Dr. Harvey
W. Wiley, Chief of Bureau of Chemistry, U. 5S. Department
of Agriculture; Gen. Geo, M. Sternberg, Dr. Stitt, U. 8. Navy;
Dr. J. W. Kerr, Asst. Surgeon General, Bureau of Public
Health and Marine-Hospital Service; Drs. D. P. Hickling,
Wm. M. Sprigg, and W. C. Woodward.

Subcommittee on the Sanitary Condition of the Milk Sup-
ply: Chairman: Dr, Geo. M. Kober, Professor of Hygiene,
School of Medicine, Georgetown University. His associates
were Drs. A. D. Melvin, Chief of Bureau of Animal Industry,
U. S. Dept. of Agriculture; M. J. Rosenau, Director of Hy-
gienic Laboratory, U. 8. P. and M.-H. 8.; John R. Mohler,
Chief Pathologist, Bureau of Animal Industry, Department of
Agriculture; Chas. T. Mason, Asst. Surgeon General, .U. 5.
Army; G. Lloyd Magruder, Emeritus Professor of Materia
Medica and Therapeutics, School of Hygiene, Georgetown Uni-
versity, together with Messrs. E. H. Webster, Chief of Dairy
Division, Bureau of Animal Industry, Dept. of Agriculture,
Col. Robert G. Smith, milk producer, and E. Berliner.

The matter assigned to these committees was divided
into several subheads and was so carefully and exhaus-
tively considered by men well versed on the subject that
copious excerpts from the reports which were submitted
to the full commission on April 17 and May 1 and unan-
imously adopted, are presented in abstract with the feel-
ing that much of value will be given:

Extracts from the recommendations unanimously adopted
by the committee to consider milk in relation to the food of
infants:

1. The milk which is supplied to infants under the age of
3 years in the District of Columbia should be certified by the
health officer, and should contain not more than 10,000 bac-
teria per cubic centimeter, should be not more than twelve
hours old, and should be delivered in artificially cooled pack-
aces,

2. The health officer of the district should be authorized to

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advertise for dairies which will be willing to so modify their
barns, stables, ete., if necessary, as to secure a license from
him for the production of certified milk under the most modern
improved sanitary conditions.

3. Each cow furnishing the milk in the dairy should be tested,
under the supervision of the health officer, for tuberculosis or
other contagious or infectious diseases, and that any animal
<0 suffering be excluded from the herd.

4. A daily sample, or samples, drawn from the supply oi
each certified milk furnished to the city should be secured for
the purpose of making the bacterial count and determining
the chemical composition, ete.

5. Parents and guardians should be urged to use only certi-
fied milk, at least for infants’ food in the District of Columbia
for all infants under the age of 3 years.

6. If private dairies can not be induced to furnish certified
milk, the commissioners of the District of Columbia, as a
health measure affecting in the highest degree tne welfare oi
the District of Columbia, should be asked, if it can legally %e
done, to establish a municipal dairy for the purpose of furnish-
ing certified milk for the use of infants under 3 years of age
in the District of Columbia.

7. For the purpose of securing modified miik for infants in
ill health, according to the prescription of physicians the Milk
Commission of the District Medical Society should be re-
quested to secure the establishment of a laboratory under its
supervision in which only certified milk shall be used, and in
which, by the use of a separator, or otherwise, milk of a defi-
nite chemical composition may be prepared from certified
milk, in harmony with the physicians’ prescriptions relating
thereto.

10. The term ‘“‘certified milk” as used herein is to be applied
to milk secured at dairies subject to a periodic inspection, and
the products of which are subjected to constant analysis. The
cows providing the milk are to be properly fed, free of tuber-
culosis or other contagious diseases, and housed in clean
stables, properly ventilated, and they are to be supplied with
wholesome water and food, and kept clean. The milk is to be
drawn under precautions to avoid infection, is to be immedi-
ately strained and cooled, and packed in sterilized bottles
which are to be kept at a temperature of about 40 degrees F.
until delivered to the consumer.

VARIOUS DISEASES AND CONDITIONS OF CATTLE
THAT MAY AKFKECT THE QUALITY OF THE
MILK SUPPLY.

BY JOHN R. MOHLER.

The importance of obtaining a hygienic and wholesome milk
supply for the residents of this city is recognized by all inteli:-
gent people and should require no argument. Public health

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demands the purity of all milk and milk products. Next to
bread, milk is more extensively used as an article of diet than
any other foodstuff. It forms a portion of the food of almost
every person practically every day of the year. Moreover, un-
like many other articles of diet, milk is consumed in most
cases in an uncooked state, making it a very dangerous food
should it perchance contain any deleterious organisms. The
reasons for securing a supply of pure and wholesome milk are
so numerous and so important that the consumer should be-
come acquainted with some of the more essential of them in
order that he may render assistance in bringing about a satis-
factory improvement. Not only is milk a very suitable me-
dium for almost every description of germ life which may gain
access to it in its journey from the cow to the consumer, but
it may also become contaminated while still in the udder
through infectious or poisonous material present in the cow
herself. Consideration in this report will be given only to the
latter aspect of the question of a wholesome milk supply. In
this connection it will be necessary to keep in mind the re-
quirements of an awakened public for a clean and wholesome
milk as well as the effect of any unreasonavie or irrational
demand on the producer which may cause him heavy losses, or
even to discontinue his business.

It will also be apparent from the report of the Committee
on Sanitation that in order to produce milk in compliance
with the requirements hereinafter to be described, certain pre-
cautions must be taken which will necessarily entail additional
expense on the producer of this higher grade of milk. The
customer must therefore expect to pay his portion of any legit-
imate advance in the cost of production, and such increase in
the price of milk due to its improved quality should be con-
sidered as money well expended. Furthermore, we can not
have good milk of safe quality without a realization on the
part of the farmer, transportation agent, dairyman and house-
wife of the danger in utilizing old, warm or dirty milk. Edu-
cation is an important factor, therefore, in the improvement
of the milk supply which can not be accomplished through
laws and regulations alone. In view of these facts it is recom-
mended that the subject be taught in the schools, that popular
articles be frequently prepared for the press, that lectures
and demonstrations be given in towns and townships, that
pamphlets in plain language be prepared by the Health Officers
for general distribution, and especially that rules and sugges-
tions. with reasons therefor, be placed in the homes of dairy-
men and dairy attendants.

MILK FROM UNHEALTHY COWS AS A FACTOR IN THE SPREAD
OF DISEASE.

Tuberculosis.—Probably the most important disease of cows
from the standpoint of public health is tuberculosis, and it is

——_—_——

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also the most prevalent. Notwithstanding the announcement
of Koch that, in his opinion, tuberculosis in man and cattle
is a different disease, it is now the generally accepted opinion
among scientists that people, especially children, may become
infected with tuberculosis from cattle. It is not known to
what extent such infection occurs, nor is it possible to obtain
any definite percentage by the method formerly adopted of
looking for the primary lesions in the intestinal canal, al-
though much statistical evidence is recorded, showing that
even by these figutes primary intestinal tuberculosis of chil-
dren has been observed in as high as 45.5 per cent. of the
tuberculous cases examined. (Heller. )

Evidence which must be considered conclusive has been ob-
tained by the Bureau of Animal Industry as well as by Rav-
enel and a number of French investigators, showing that tuber-
culous infection may take place through the intestinal tract
without leaving any lesion in the abdominal cavity, the first
alteration being found in the lungs or thoracic glands. There-
fore the presence of pulmonary tuberculosis in infants with-
out intestinal lesions is no indication that the disease was
not transmitted by the food, and the statistics above referred
to are thus shown to be below the true percentage of cases of
tuberculosis of intestinal origin. These figures, however, do
not give any satisfactory idea as to whether the bacilli enter-
ing the intestines originated from human or bovine sources.
Owing to this fact, it follows that the only way of determining
the infection of people by bacilli of the bovine type will be to
study the lesions in the body of as many cases of human
tuberculosis as is possible.

The finding of the bovine type of tubercle bacillus in human.
lesions is the most direct and positive proof that tuberculosis:
of cattle is responsible for a certain amount of tuberculosis:
in the human family. Numerous experiments with this object
in view have already proven this fact. Thus the German com-
mission on tuberculosis examined 16 different cultures ob-
tained from tubercular lesions in children and found four
which were more virulent than is usual for human tubercle
bacilli, causing tuberculosis in the cattle inoculated with them,
and making 25 per cent. of the cases tested, affected with a
form of tuberculosis which, by Koch’s own method, must be
classified as of bovine origin. In a similar series of tests con-
ducted by the British royal commission on tuberculosis, 60
eases of the disease in the human were tested, with the result
that 14 cases were claimed by this commission to have been
infected from bovine sources. Ravenel reports that ‘of 5 cases
of tuberculosis in children, 2 received their infection from
cattle.

Theobald Smith has also reported on one culture of the bovine
tubercle bacillus obtained from the mesenteric glands of a
child, out of 5 cases examined, and according to a_ recent

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_

paper by Goodale, Smith has recently been at work on 7 other
cultures from different children, 4 of which conformed to his
idea of tubercle bacilli emanating from cattle. Of 4 cases of
generalized tuberculosis in children examined in the Biochemic
Division of the Bureau of Animal Industry, 2 were found to
be affected with very virulent organisms, which warranted the
conclusion that such children had been infected from bovine
source. -The Pathological Division of the same bureau has
likewise, out of the 9 cases of infantile tuberculosis examined,
obtained two cultures of tubercle bacilli that could not be
differentiated from bovine culture. In Europe so many similar
instances of bovine tubercle bacilli having been recovered from
human tissues are on record that it appears to your committee
entirely proven that man is susceptible to tuberculosis caused
by animal infections, and whale the proportion of such cases
can not be decided with even approximate accuracy, it is never-
theless incumbent on us to recommend such measures as will
guard against these sources of danger, when enforced.:

The two principal sources of infection from cattle and the
only ones necessary to be considered are the meat and milk
of tuberculous animals. The fact that most of the cases of
bovine tub-=-culosis above enumerated which occurred in the
human were cases of infantile tuberculosis points with grave
suspicion to the milk rather than the meat supply. This nat-
urally leads to the qnestion of how and under what condition
does the milk become infectious. That milk coming from a
tuberculous udder is capable of transmitting the infectious
principle is conceded by all who have given the subject any
consideration. It has been equally established that in ad-
vanced generalized tuberculosis the udder may secrete tubercle
bacilli without showing any indication of being affected.

Careful experiments performed by trained and eminently
responsible investigators have also demonstrated beyond rea-
sonable doubt that tubercle bacilli at certain times may be
present in the milk of cows affected with tuberculosis to a
degree that can be detected only by the tuberculin test, so
that in a herd of cows in the various stages of tuberculosis it
is to be expected that some of them will secrete tuberculous
milk, which, when mixed with other cows’ milk, makes the
entire product dangerous. Even when the tubercle bacilli are
not being excreted by the udder, it has been shown by Eber in
Germany and Schroeder in this country, that the dust and
manure of the stable where the diseased animals are kept are
in many cases contaminated with tubercle bacilli.

In a recent examination of the manure passed by twelve
cows just purchased from dairy farms in this city and affected
with tuberculosis to an extent only demonstrable by the tuber-
culin test, tubercle bacilli were found in over 41 per cent. of
the cases both by microscopic examination and animal inocula-
tions. The danger from this method of infecting milk is im-

oh

pressed on us as consumers when we realize that on an aver-
age probably 25 per cent. of all the cows which supply milk
to the district are tuberculous, and this is considered to be a
conservative estimate, judging from the results of recent tuber-
culin tests. Vital statistics show that 14 out of every 100
people that die succumb to tuberculosis, while of the remaining
86 more than one-half show lesions of tuberculosis on post-
mortem examination, although dying from some other cause...

The statement of von Behring above mentioned is particu-
larly pertinent in regard to the relationship of human tuber-
culosis to the milk supply, and especially in connection with the
results of those investigators who have studied market milk
and found from 5.2 to 55 per cent. of the samples examined
to contain tubercle bacilli. LeBlane considers the milk of
tuberculous cows dangerous even when bacilli are not pres-
ent, on account of the toxin it contains. Michellazzi has in-
jected such milk into tuberculous animals and obtained a re-
action. To eliminate all tuberculous cattle from the herd, or
to pasteurize ail milk coming from untested cattle, should
therefore be the object of all producers of milk and the sani-
tarians will be remiss in their whole duty should they neglect
to guard against the products of tuberculous animals in their
attempts to eradicate tuberculosis from man.

Other Diseases ——Foot-and-mouth disease, anthrax, cow-pox,
and rabies may be transmitted by the milk, and while no case
of actinomycosis in man has been traced to the use of milk it
is desirable that the use of milk of cows so affected should be
prohibited, especially when the disease affects the udder. Such
conditions as gastroenteritis and septic and febrile conditions
may render the milk injurious to the consumer. Local dis-
eases of the udder like Botryomycosis, mammitis, mastitis,
etc., may render the milk unwholesome, especially when pus
organisms are present. The color, taste and odor of milk may
be altered so as to make it unpalatable if not unwholesome;
these changes may be due to the food of the cow or to bacterial
changes in the milk after it is drawn from the udder. Milk
may acquire poisonous properties from the food eaten by the
cow. The milk produced shortly before or during the first
five days after parturition should not be used.

Recommendations.—In view of the facts above enumerated,
your committee desires to make the following recommenda-
tions:

1. All cows on dairy farms producing milk for the District
of Columbia shall be tagged, tattooed or otherwise marked, for
purpose of identification.

2. All milk produced on such dairy farms shall come either
from tuberculin tested cattle, which shall be retested at least
once a year, or be subjected to pasteurization under the super-
vision of the health department in case the herd is not tuber-
eulin tested,

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3. No additions to any herd, whether tested or not tested,
shall be made in the future without subjecting such cattle to
the tuberculin test. 7

4. No license shall in future be granted except to applicants
having herds free from tuberculosis.

5. The milk of cattle showing any of the udder affections
above mentioned, anthrax, rabies, gastroenteritis, septie condi-
tions or clinical symptoms of tuberculosis, shall not be utilized
as human food, even though the milk be pasteurized. Milk
from cows 15 days before and 5 days after parturition, and
that from animals receiving any of the deleterious iedica-
ments of foodstuffs previously mentioned shall likewise be ex-
cluded.

6. That the veterinary inspectors of the health department
make frequent visits to dairies having untested herds, in order
that they may discover all advanced cases of tuberculosis, or
udder tuberculosis, as early as possible.

MILK SEDIMENTS OR DIRTY MILK IN RELATION
TO DISEASE.

BY GEORGE M. KOBER, M.D.
Professor of Hygiene, School of Medicine, Georgetown University.

Every consumer of milk has doubtless observed the presence
of more or less foreign matter at the bottom of the bottle in
which it is kept; indeed, it is a matter of such common occur-
rence that it hardly excites our attention, and many are dis-
posed to look on it as a matter of course. Professor Soxhlet
of Munich was perhaps the first to point out that these depos-
its are largely made up of the excrementitious matter from
the cow, which adhering to the udder of the animal, gained
access to the bucket during the act of milking.

Tf these sediments are subjected to microscopical examina-
tion we will find that they are composed of epithelial débris,
hairs of the cow, organie and inorganic dust particles, excre-
mentitious matter, vegetable fibers, bacteria, fungi and spores
of every description; fully 90 per cent. of the germs are fecal
bacilli—all of which is not only disgusting but extremely sug-
gestive of danger. The number of micro-organisms is largely.
increased and we know that under a suitable temperature
bacterial development and consequent decomposition are ma-
terially hastened in such a medium. The greatest danger from
milk of this class is the possible presence of ptomains or toxins
produced by certain saprophytic germs from the albuminoids of
the milk.

The views of Vaughan, Booker, Escherich, Harrineton, Kober
and others on the relation of saprophytic germs and toxins to
cholera infantum and the summer diarrheas in bottle-fed chil-
dren are gaining ground and will doubtless lead to great re-
form in the management of dairies. It may be urged that all
such modern innovations involve unnecessary hardship, but it

11

should be remembered that by attacking all the various factors
concerned in the causation of the disease we may hope for the
best results. The reduction in the general mortality in the
registration area of the United States from 19.6 in 1890 to
16.2 per 1,000 shows what may be accomplished by preventive
medicine and sanitation.

Milk in Relation to Infectious Diseases ——Milk may acquire
infective properties after it leaves the udder of the animal.
Numerous instances have been observed in which outbreaks
of typhoid fever, scarlet fever and diphtheria, by their sudden
and explosive character, affecting families living in streets and
localities supplied by the same milkman, naturally pointed to
the milk supply as a common cause. Dr. Michael Taylor, how-
ever, was the first physician (in 1857) to point out definitely
that cow’s milk might serve as the medium of spreading
typhoid fever from a dairy where the disease prevailed. In
1867 he also showed that scarlet fever might be distributed in
the same way. In 1877 Mr. Jacob traced a diphtheria epi-
demic at Sutton to the milk supply. and in 1872 MacNamara
traced an outbreak of cholera at Calcutta to an infected dairy.
These facts*could not fail to sharpen the powers of observa-
tion in others, so that in consequence similar outbreaks were
more frequently reported. I was enabled to present to the
International Medical Congress held in Paris in 1900 the
history of 195 outbreaks of typhoid fever, ninety-nine of scarlet
fever and six of diphtheria, all traceable to milk supply.

It has been demonstrated that disease germs may not only
survive, but in many instances actually proliferate, in the milk,
and it is not a difficult matter to point out the many ways by
which these germs gain access, especially when some of the
employes are also engaged in nursing the sick, or are suffering
themselves from some mild infection while continuing their
duties, or are convalescent from the disease, and thus infect
the milk in handling it.

After the recital of numerous epidemics and milk-borne dis-
eases, I need hardly insist on the necessity of compulsory no-
tification of all infectious diseases, and that milk should not
be permitted to leave a farm, dairy or milk-shop during the
existence of any of these diseases among the inmates or em-
ployés, nor should the latter be permitted to reside in or visit
infected houses while engaged in the milk traffic without per-
mission from the health department. The farmer or retailer
should, in fact, be prepared by previous instructions to guard
the milk supply from these sources of danger ana call on the
authorities for an immediate inspection. To prevent great
loss incident to those restrictions, they may be modified so as
to use the milk after proper sterilization under the direction
of the health department. There is nothing strained in the
requirements of the proposed legislation and by their enforce-
ment we may hope to obtain such a standard of milk as will

12
-

not only effect a decided reduction in infantile mortality, but
will render the dissemination of infectious ciseases throug.
the milk supply a matter of history only. Until this is accom-
plished, we should patronize only such dealers as sell “‘eertificd
milk,” or subject the milk to pasteurization, or simply bring
the milk to the boiling point in the household, and, after cool-
ing, keep it on ice; this will not make bad milk good, but it will
at least destroy its infectiousness.

SANITARY INSPECTION OF DAIRIES AND DIS-
TRIBUTING DEPOTS.

BY E, H. WEBSTER.
Chief of Dairy Division, Bureau of Animal Industry.

A systematic sanitary inspection of dairy farms and milk-
distributing depots are anything but ideal; they are, in fact,
about as bad as it is possible to conceive. Stables are poorly
lighted, many having no windows whatever, and ventilation
is left to care for itself. Little attention is paid to floors,
ceilings, walks, or stable yards. Swine, horses and poultry
are often found in the same barn with the cows. Manure is
not removed, or, when removed, is thrown through*an opening
in the wall or just outside the door, frequently near the milk
room.

The necessary appliances for sterilizing and cooling in milk
room are often lacking, making it impossible properly to wash
and sterilize pails, cans, bottles and other appliances, or to
properly cool and hold at a low temperature the milk before
delivery. Milk dealers, as a rule, have more respect for san-
itation and have better appliances than the average farm, but
some common practices are deplorable. Very few have appli-
ances for sterilizing bottles.

The situation in Washington is not different from that con-
fronting the health departments of most of the cities of any
size throughout the country. The public is gradually awaken-
ing to the fact that these conditions must be changed. In oruer
to bring about these changes within the district, it is recom-
mended that:

1. A sufficient number of inspectors shall be employed so
that each inspector shall have not over 100 farm dairies.

2. These men shall have technical training in the produc-
tion and handling of milk.

3. The health officers shall have full authority to make rules
and regulations, and to enforce the same, so as to safeguard
the milk supply of the district from contamination through
carelessness, ignorance or malicious intent.

4. The health officer, or any authorized inspector, shall have
authority to revoke instantly the license or right to sell miik
in the city if the provisions in these regulations are not com-
pled with, where, in his judgment, such violation endange:'s
the health of the consumer.

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WATER SUPPLY OF DAIRY FARMS.
BY G. LLOYD MAGRUDER, M.D.
Emeritus Professor, Materia Medica and Therapeutics, School of
Medicine, Georgetown University.

The influence of a polluted water supply has long been rec-
ognized as a most potent cause of disease. Many virulent epi-
uemics have been directly traced to this origin. The literature
on this subiect is so full of instances that it is needless to cite
additional examples. Immediate closure of such water sup-
plies in cities, when sewage bacteria have been detected, has
been universally recommended. The recent report to the Dis-
trict Commissioners by the Bureau of Public Health and
Marine-Hospital Service lays special stress on this point.

How much more is this danger augmented when such _ bac-
teria are found in the water supply of the dairy farms. It is
well known that few farms have the proper facilities for boil-
ing the water that is used for washing the hands of the em-
ployés, the dairy utensils and the udders of cows. Such water
readily contaminates the milk, which contamination is rap-
idly increased by the multiplication of the bacteria when the
temperature is above 50 F.,

In view of the possible presence of the bacilli of typhoid
fever and tuberculosis, the question of sewage bacteria in the
water supplies of the dairy farms is a much more serious
matter than was formerly considered. ‘The knowledge that
typhoid fever was 21%4 times more prevalent in 1906 in the
counties of Maryland than in the city of Baltimore, and the
evidence, as stated elsewhere in this report that 148 out of
195 epidemics oi typhoid fever attributed to milk were directly
traced to the dairy farm, adds to the seriousness of these con-
ditions.

It has been observed that many wells, springs and cisterns
are loosely or not at all covered, poorly protected from surface
drainage, and, in numerous cases, are located in close prox-
imity to the barnyard or to the household privy, at times even
in places that catch the drainage from the same.

The examinations made by officials of the Department of
Acriculture during November and December, 1906, in com-
paratively cool weather, showed that, of the 60 water supplies
of dairy farms taken at random in Maryland, Virginia and
the District of Columbia, 16 contained less than 500 bacteria
per cubic centimeter and were free from Bacillus coli—6 below
this number contained the colon bacillus. The remaining 44
water suplies contained bacteria up to 27,200. Of these 44, 21
contained the colon bacillus.

These tests warranted the classification of these water sup-
plies as follows: 16 good, 15 fair, 17 suspicious, and 12 unfit
for use. From Professor Sedgwick’s classification 44 would
have been considered polluted. In a recent letter he says: “I

14

should say that all of the wells under consideration which
had more than 100 bacteria per cubic centimeter were to be
classed as suspicious, and that those having 500 or over were,
in all probability, polluted.”

The results of those examinations confirm the wisdom of the
recommendation made in 1894 by the committee of the Med-
ical Society of the District of Columbia on the prevalence
of typhoid fever, for the careful inspection of all dairy farms
for all possible sources of infection, including the water supply,
and prove that repeated chemical and bacterial tests should
be made of the water supplies of every dairy farm supplying
nilk to the City of Washington. They afford another proof
of the imperative need of a well-equipped chemical and_ bac-
teriological laboratory for the Health Officer.

Fortunately, many of these insanitary conditions on the
farm can be readily and easily remedied by the farmer himself,
by the exercise of a little care and at a very trifling cost.

All water, except that above suspicion, used for dairy pur-
poses should be boiled. Those engaged in the handling of
dairy products should be required to observe the greatest care
as to the cleanliness of their clothes and person. Frequent
washing of their hands should be practiced. The source of the
water supply shovld be at least fifty feet from any possible
infection, and a greater distance if in line of drainage from
any infection.

The wells, springs ana cisterns should be carefully walled
and covered to protect them from seepage, drippings and dust.
A well-built coping, extending a foot or more above the ground
would be very effectual. Preferably deep driven wells should
be used when possible. Owing to the inclination of the rock
formation in this vicinity, these are not always absolutely re-
liable. When a water supply is found to be polluted, it should
be thoroughly cleaned and properly disinfected.

All fecal discharges should be deposited in a safe place, and
those from fever cases in addition should be intelligently disin-
fected. Since freezing does not immediately kill bacteria, care-
ful supervision shouid also be observed over the supply of
water for and the location of ice ponds from which ice is
obtained for household and dairy purposes. By observing these
simple precautions, which would in no way be a hardship to
the producers, much would be accomplished toward securing a
better milk suppply.

The series of check experiments conducted during September,
October and November, 1906, by the Department of Agricul-
ture and those in charge of the filtration plant, demonstrated
its efficiency as a safeguard against typhoid infection from the
Potomac River. The report of the examinations of the Poto-
mac Water Supply for March confirms the deduction hereto-
fore made. .

15

COMMERCIAL CLASSES OF MILK.
BY A. D. MELVIN. M.D.
Chief of the Bureau of Animal Industry.

In view of the elaborate manner in which the necessity for
a pure milk supply has been pointed out, and of the many
obstacles in the way of obtaining such a supply except through
vigorous official supervision, it is believed that if the milk sup-
ply is divided into three classes as hereinafter described, and
an efficient supervision provided, the consumer will be amply
protected in securing clean and uncontaminated milk, therefore
the following recommendations are respectfully submitted:

That the milk supply of the city be divided into three classes,
to be known as Classes 1, 2 and 3.° The specifications for certi-
fied milk for infants to be the same as recommended by the
Milk Commission, and to be known as Class 1.

Class 2 to be clean, raw milk from healthy cows as deter-
mined by the tuberculin test and veterinary physical exam-
ination. The cows to be housed, fed and milked under good
conditions, but not necessarily equal to the conditions pro-
vided for Class 1, Pure water as determined by chemical and
bacteriologic examination, to be provided and the bacteriologic
count of the milk not to exceed 100,000 bacteria per e.c., at
the time the milk reaches the city, at any season of the year,
and determined by the health department at frequent inter-
vals. Milk to be delivered to the consumer in sterilized con-
tainers to be filled on the dairy farm and the temperature of
the milk not to exceed 50 F. until delivered to the consumer.

Class 3 to be milk from all other dairies not able to comply
with the requirements for Classes 1 and 2. This milk to be
clarified and pasteurized at central pasteurizing plants which
shall be under the personal supervision of an officer of the
health department. These pasteurizing plants may be pro-
vided by either private enterprise or by District government,
and shall be located within the city of Washington. Class &
milk shall not be permitted to exceed 60 F. in delivery from
the dairy to the pasteurizing plants. The milk from these
pasteurizing plants, placed in sterilized containers, shall be
delivered to the consumer at a temperature not exceeding
50 F. All milk of unknown origin shali be placed under Class
3 and subjected to clarification and pasteurization. It is also
provided that no cows suffering from any communicable dis-
ease, or any unfit condition to be determined on physical
examination by an authorized veterinarian, shall be permitted
in any dairies. It is further provided that cows which do not
show any physical signs of tuberculosis on veterinary exam-
ination, but which may have reacted to the tuberculin test,
may be included in dairies supplying milk of this class.

No dairy farm shall be permitted to supply milk of a higher
class than the class for which the permit has been issued and
each dairy farm supplying milk of a specified class shall be

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separate and distinct from any dairy farm of a ice meee
the same owner, however, may supply different classes of milk.
providing the dairy farms are separate and distinct, as above
indicated. All milk to be of good composition, free of adul-
terants and artificial coloring matter. The term “milk” to
include both milk and cream.

PASTEURIZATION.
BY M. J. ROSENAU, M.D.
Director Hygiene Laboratory, U. S. P. H. and M.-H. S.

Advantages —The advantage of pasteurization is that it is
a cheap and effective means of preventing the transmission of
infections diseases such as tuberculosis, typhoid fever, diph-
theria, scarlet fever, etc., commonly spread by milk.

Disadvantages.—1. Pasteurization promotes carelessness on
the farm and dairy, ete. (This may be controlled by proper
regulations, inspections and laboratory examinations. )

2, Pasteurization renuers milk less digestible. (While it is
generally conceded that boiled milk commonly induces con-
stipation, the majority of the evidence plainly indicates that
pasteurization has little, if any, effect on the digestibility of
the milk. )

3. Pasteurized milk favors the production of rickets and
scurvy. (There is no proof to this effect and authorities agree
that the danger is slight; and, further, that it may readily
be obviated. )

4. By destroying the non-spore-bearing bacteria, pasteuriza-

tion sometimes allows toxic organisms to grow and produce

serious poisons in the milk. (On the other hand, these same
poisons are more trequently produced in milk that has not
been pasteurized, and this danger may be obviated in pas-

teurized milk by cooling it quickly, keeping it cold and short-.

ening the time for distribution. )

5. Pasteurization is inefficient as a preservative; the milk
keeps only 12 to 24 hours longer than otherwise. (This is really
no disadvantage, for the quicker bad milk sours, the better.)

6. Pasteurization injures the taste of the milk. (This is not
so, 1f properly done.)

7. Pasteurization increases the cost of the milk. (True, but
it is the cheapest safeguard, and the expense of pasteuriza-
tion is offset by the keeping quality of the milk.)

Methods—The miik must be heated to a temperature of
65 C. (149 F.) for 20 minutes, or 70 C. (158 F.) for 10 min-
utes, as soon as practicable after the milking, in enclosed ves-
sels, preferably the final containers. After pasteurization, the
milk must be promptly cooled, kept cold and distributed with
promptness.

The advantages so far outweigh the disadvantages that I un-
hesitatinely recommend compulsory pasteurization of all milk
not certified under Class 1 and Class 2 of Dr. Melvin’s classi-
fieation.