.\Isr\x. 
 
'icprinlcd from The Journal of the American Medical Association^ 
 September 28, 1907, Vol. xiix, pp. 1088-1098. 
 
 Copyright, 1£07. 
 American Medical Association. JO) Dcarhorn Arc, Chicago. 
 
 THE mhK SUPPLY OF AVASHI^^GTOX, D. C* 
 
 G. LLOYU MAGRUDER, M.D. 
 
 AVASniXGTOX, D. C. 
 
 During the summer of 190G, 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 
 withm the limits of the District. Very early in the 
 course of the investigations attention was ""f orcibly 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 
 
 *F:pad in the Section on Hygiene and Sanitary Science of the 
 American Medical Association., at the Fifty-eighth Annual Session, 
 lu-'id at Atlannc Cily. .Tune,li;07. 
 

 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 wdiich 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." 
 
 Early 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. 
 Eepeated 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 December, 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 coli — 45 per cent. A number of wells or 
 springs examined contained over 20,000 bacteria to the 
 cubic centimeter; one contained 27,200. 
 
 Gift 
 Author 
 
 (Person) 
 
3 
 
 Two cases of fever were in actual existence on two 
 farms at the time of the examination of the water sup- 
 })ly, one in Mar3'land and one in A^irginia. 
 
 This knowledge, in the light of the recent reports of 
 Dr. Schroeder showing 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 showdng the colon bacillus. The bac- 
 teriologic investigation of the w^ater 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 Washingion. 
 This inspection will include a bacteriologic examination 
 of the water supply of each farm. The Bureau of Pub- 
 lic Health and Marine-Hospital Service examined bac- 
 teriologic? lly 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 samples from October 27 to Decem- 
 ber 3, 190G, comparatively cool weather,- and found an 
 average of 977,315. Eecently 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 
 3G4,000,000 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 of 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 milk 
 of standard excellence or the pasteurization of the Dis- 
 trict milk supph^, or both, and what amendments should 
 be made to the commissioners' bill for the better regu- 
 
latioii of the milk business introduced in tlie last session 
 of Congress." 
 
 On April 10 the men invited to this conference met 
 and organized the Milk 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 Hj'giene, 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. S. Department 
 of Agriculture; Gen. Geo. M. Sternberg, Dr. Stitt, U. S. 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 tlie ^lilk 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. Pvosenau, Director of Hy- 
 gienic Laboratory, U. S. P. and M.-H. S. ; John R. ]Mohler. 
 Chief Pathologist, Bureau of Animal Industry, Department of 
 Agriculture; Chas. T. Mason, Asst. Surgeon General, U. S. 
 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 Agricultvu-e, 
 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 tAvelve 
 hours old, and should be delivered in artificially cooled pack- 
 
 OD'CS. 
 
 •2. Th? health officer of the district should be authorized to 
 
advertise for dairies wliich will be willing to so modify their 
 barns, stables, etc., 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 
 so suffering be excluded from the herd. 
 
 4. A daily sample, or samples, drawn from the supply of 
 each certified milk furnished to the city should be secured for 
 the purpose of making the bacterial count and determining 
 the chemical composition, etc. 
 
 5. Parents and guardians should be urged to use onh' certi- 
 iled milk, at least for infants' food in the District of Columbia 
 for all infants under tho 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 afli'ecting in the highest degree tne welfare of 
 the District of Columbia, should be asked, if it can legally be 
 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 milk 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 Avith tlie 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 l)e 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 AFFECT THE QUALITY OF THE 
 
 MILK SUPPLY. 
 
 BY JOHN R. MOIILEK. 
 
 The importance of obtaining a hygienic and wholesome milk 
 supply for the residents of this city is recognized by all intelli- 
 gent people and should require no argument. Public health 
 
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 ma\- 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 coav to the consumer, but 
 it may also become coiitaminated 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 
 tnis connection it will be necessary to keep in mind the re- 
 quirements of an awakened public for a clean and w^iolesome 
 milk as well as the effect of any unreasonaule or irrational 
 demand on the producer which may cause iiim 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 qualitj^ 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. f]du- 
 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 IX THE SPREAD 
 OF DISEASE. 
 
 TvJberculo-^is. — P'-obably th.e most important disease of cows 
 from the standpoint of public health is tuberculosis, and it is 
 
also the most prevalent. Xotwithstanding 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 figures 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 10 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 Avhich, 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, 00 
 cases 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 
 
paper by Goodale, Smith has recently been at work on 7 otlier 
 cultures from diiferent children, 4 of which conformed lo 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 afl'ected with very virulent organism's, 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 manj'- 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 while 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 tubr-rculosis above enumerated which occurred in the 
 human were cases of infantile tuberculosis points with grave 
 suspicion to the milk rather than the meat si^.pply. This nat- 
 urally leads to the question 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 Avith 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 tlie 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 infectin<x milk is im- 
 
i) 
 
 pressed on us as tonsaniers 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. LeBlanc 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 tuberciilous 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 ue 
 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 ]?otryomycosis, mammitis, mastitis, 
 etc., nuiy 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 tlie health departn;ent in case the herd is not tn])er- 
 culin tested. 
 
10 
 
 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. 
 
 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, septic 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 medica- 
 ments of foodstuffs previously mentioned shall likewise be ex- 
 cluded. 
 
 (). 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 ]\IILK IX RELATION 
 TO DISEASE. 
 
 BY GEORGE M. KOBER, M.D. 
 Professor of Hygiene, School of Medicine, Georgetown Univt'-.-.-ity. 
 
 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. 
 
 If these sediments are subjected to microscopical examina- 
 tion we will find that they are composed of epithelial debris, 
 hairs of the cow, organic 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 Vnughan. Booker, Escherich, Harrington. Kober 
 and others on the relation of saprophytic germs and toxins to 
 cholera infantum and the summer diarrheas in bottle-fed chil- 
 dren are G'aininij jxroiind and will doubtless lead to great re- 
 form in the management of dairie?;. It may be uro-ed that all 
 sucli modern innovations involve unnecessary hardship, but it 
 
11 
 
 should Ije 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.G in 1890 to 
 1G.2 per 1,000 shows what may be accomplished by preventive 
 medicine and sanitation. 
 
 MiJk in Relation to Infectious Diseases. — !Milk may acquire 
 infective properties after it leaves the udder of the animal. 
 Numerous instances have l)een 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 
 1807 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 ^[acXamarn 
 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 ]\redical 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 diflficult 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 sufiTering 
 themselves from some mild infection wdiile 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- 
 ployes, nor should the latter be permitted to reside in or visit 
 infected houses while engaged in the milk traffic Avithout per- 
 mission from the health department. The farmer or retailer 
 should, in fact, be prepared bv previous instructions to guard 
 the milk supply from these sources of danger ana call on the 
 authorities for an immediate inspection. To ])revent 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 depirtinent. 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 diseases througa 
 the milk supply a matter of history only. Until this is accom- 
 plished, we should patronize only such dealers as sell "certified 
 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. II. WEBSTER. 
 
 Chief of Dah-y 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 j^ards. 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 orner 
 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 milk 
 in the city if the provisions in these regulations are not com- 
 plied with, where, in his judgment, such violation endangers 
 the health of the consumer. 
 
13 
 WATER SUrrLY OF DAIRY FAR:\rS. 
 
 BY G. LLOYD MAGKUDER, M.D. 
 
 Kmeritus Professor, Materia Medica and Therapeutics, Scliool of 
 Medicine, Georgetown University. 
 
 The inlliionce of a polluted Avater 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 s)ip- 
 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 Healtli and 
 Marine-Hospital Service lays special stress on this point. 
 
 How much more is this danger augmented when such bac- 
 teria ore found in the water supply of the dairy farms. It is 
 well known that few farms have the proper facilities for boil- 
 ing tlie water tliat is used for washing the hands of the em- 
 ployes, 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 wlien 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 nuich more serious 
 matter tlian was formerly considered. The knowledge thnt 
 typhoid fever was 2% times more prevalent in 190G in the 
 counties of Maryland than in the city of Baltimore, and the 
 evidence, as stated elsewhere in this report that 148 out of 
 19o epidemics of 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 eases, are located in close prox- 
 imity to the barnyard or to the household privy, at times even 
 in places that catch the drainage from tlie same. 
 
 The examinations made by officials of the Department of 
 Agriculture during November and December, 1900, in com- 
 ])aratively cool weather, showed that, of the CO water supplies 
 of dairj^ farms taken at random in Maryland, Virginia and 
 the District of Columbia, 10 contained less than 500 bacteria 
 per cubic centimeter and were free from Bacillus colt — G 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: 10 good, 15 fair, 17 suspicious, and 12 unfit 
 for use. From Professor Sedgwick's classification 44 would 
 Imve [)een considered polluted. In a recent letter he snys: ''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 
 milk 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 should be at least fifty feet from any possible 
 infection, and a greater distance if in line of drainage from 
 any infection. 
 
 The wells, springs and 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 those 
 simple precautions, which Avould 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, 1900, 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 
 
 COMMKKCIAI. CLASSES OF MILK. 
 
 IJY A. I). MELVIX. 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 
 ^lilk Commission, and to be known as Class I. 
 
 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 I. Pure water as determined by chemical and 
 bacteriologic examination, to be provided and the bacteriologic 
 count of tlie milk not to exceed 100.000 bacteria per c.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 3 
 milk shall not be permitted to exceed GO 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 shall be placed under Class 
 3 and subjected to clarification and pasteurization. It is also 
 provided that no cows suO'ering from any communicable din- 
 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 cow^s which do not 
 show any physical signs of tuberculosis on veterinary exam- 
 ination, but wdiich 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 
 
LIBRARY OF CONGRESS 
 
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 separate and distinct from any dairy farm of a different class; 
 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. P.OSENAU, 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 
 infectious 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, etc. (This may be controlled by proper 
 regulations, inspections and laboratory examinations.) 
 
 2. Pasteurization rentiers milk less digestible. (While it is 
 generally conceded that boiled milk commonly induces con- 
 stipation, the majority of the evidence plainly indicates tliat 
 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 frequently 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 jiot 
 so, if properly done.) 
 
 7. Pasteurization increases the cost of the milk. (True, 1r.it 
 it is the cheapest safeguard, and the expense of pasteuriza- 
 tion is offset by the keeping quality of the milk. ) 
 
 Methods. — The milk 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- 
 liesitatingly recommend compulsory pasteurization of all milk 
 not certified under Class 1 and Class 2 of Dr. Melvin's classi- 
 fV-r.tio;i. 
 
LIBRARY OF CONGRESS 
 
 Hiiniiliiil 
 
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 003 184 053 3 
 
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 Hollinger Corp. 
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