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food value of good milk; and divisions of vital statistics for the recording of morbidity and mortality statistics, information which is important in showing the need for milk supervision work and the results obtained.
Local boards of health are equipped with medical health officers, who are entrusted with the enforcement of the health measures, and should be as well qualified as anyone in the average community to assume the general supervision of the local milk supplies from a health point of view; milk inspectors, who work under the direction of the local board or department of health, and coordinate their sanitary inspection work on dairy herds, dairies, and Pasteurization plants with the medical inspectors' work on the examination of employees, and identification and suppression of communicable diseases associated with milk supplies. Experience in Minnesota has indicated that veterinarians are usually the persons best qualified in the local communities to assume the duties of milk inspectors.
There is a great need at the present time for uniform standards of the general requirements for the Pasteurization of milk. This can be well illustrated by the variety of definitions for Pasteurization that appear in State laws and regulations and municipal ordinances on this subject. Information reported by the committee on milk supply of the sanitary engineering section, American Public Health Association, in 1920, showed that three Federal departments had officially defined Pasteurization, and all of these definitions differed as to their requirements. Ten States had officially defined the process, and an analysis of these definitions showed that only two States had nearly uniform requirements. It would seem that the time has come when an agreement could be reached on some of the fundamentals relating to the Pasteurization process, and especially on such an important principle as a uniform definition for the Pasteurization of milk.
It is undoubtedly true that the variety of local conditions found throughout the country, or even in one State, makes it impossible to have entirely uniform requirements on all phases of supervision work, but there are certain fundamental requirements which should be uniform. For example, it would be ridiculous to state that the temperature and time requirements for Pasteurization in one State or city in this country should be different from that of another, but that is the situation which actually exists at the present time.
It is the opinion of the writer that some official agency should call together a representative group of Federal, State, and municipal otticials, with representatives from the various organizations interested or affected by regulatory measures. to discuss the standardization of certain fundamental features relating to the Pasteurization of milk. It would seem that the logical agency to call together such a group would be a Federal department, and the one most interested in the health supervision of milk. In 1922, the Surgeon General of the United States Public Health Service called together such a representative committee to aid the service in the revision of the United States Treasury standards for interstate water supplies. This committee is now functioning, and a great good should result from their deliberations. It is hoped that some Federal department may see merit in the plan suggested, and act, for there is certainly a great need for some official meeting place for Federal, State, and municipal officials with the representatives of the great technical and trade organizations, who have all played their respective parts in the progress made thus far in the improvement of milk supplies, both from a health and from a commercial point of view.
Chairman WELD. Is there any discussion of Mr. Whittaker's paper? He has brought out some facts which show clearly the improvement which may result from the regulation of supervision of Pasteurization of milk by State authorities.
Dr. H. W. REDFIELD. Various investigations have been conducted along this line. In New York, the Federal Government, the New York State government, and the New York City government and a number of leading men helped us in the educational work, and their findings will be published, I think, in the Public Health Service in the near future.
Mr. WHITTAKER. That is a point I wanted to bring out. There is a function for some committee that would carry this out. That was one of the things I was thinking about when I mentioned my committee.
Chairman W'Eld. The next paper has for its subject “ Milk in relation to child life and health.” The author is Mr. Ben Davies, of the United Dairies (Ltd.), London, England. In the absence of Mr. Davies, the paper is to be read by Mr. Tudor Price, the son of Sir William Price, director of United Dairies. Mr. Price. [Applause.]
MILK IN RELATION TO CHILD LIFE AND HEALTH.
BEN DAVIES, United Dairies, Ltd., London.
When one regards the great mass of critical literature on the milk question, the wonder grows that milk should still be held in such high esteem. Milk suffers the criticism of the learned, the half learned, and the ignorant. Its alleged faults have been the excuse for drastic experiments in legislation, which have been herald and placarded by would-be reformers, by sensation-loving journalists, as well as by fanatics, fools, and faddists, few of whom are ever halted by a sense of limitation due to our possible ignorance of vital factors of the problem. The farm, the cow, the dairy, and the dairyman have been indicted for the high rate of infant mortality, for the spread of tubercle, and for that scourge of baby life, diarrheal disease. The effect of much of the propaganda in favor of graded milk and the like has been to undermine confidence in the supply of milk which is ordinarily available. In many cases it appears that this is the deliberate intention, and that 99 per cent of the milk supply is thus slandered, in order to make a market at a higher price for an ultimate 1 per cent. It is idle to extol the virtues of milk, its food value, its vitamins, or its importance in household economics, and at the same time to suggest that the only supply available is likely to be a menace to health and even to life, as is not infrequently done.
How much of this is true? Could a dairy congress better apply its time than to the consideration of a topic so vital, so fundamental in its influence on legislation, on administration, and on human welfare, particularly in all great centers of population? Let it not be thought there is no more to be known on such matters. There is always the vast difference between knowledge and understanding, “ Knowledge comes, but wisdom lingers." The true import of and inference from acknowledged facts may not be known, and may result in a false suggestion which effectually suppresses the truth by sending us to seek relief in a wrong direction. The tragedy of suffering is as much a tragedy of active error as a tragedy of passive ignorance. Many a stronghold, invested by enemies,' has fallen because its defenders, while watching vigilantly in many quarters, still left open to insidious attack an avenue supposed to be naturally secure. And for this reason it is true that one might discover the worst enemies of baby life among those who count themselves its best friends.
The object of this paper is not to escape responsibility which may properly be laid on producer and distributor on the score of health and decency. Its purpose is to consider whether the ordinary milk of commerce is responsible for illness among children, and if so, to what extent, and for what reason. Further, and to put the matter quite plainly, whether “any old milk” is not infinitely more advantageous than no milk at all; and, finally, what steps are necessary to give a supply which is absolutely safe at reasonable cost, and which can be made available in every large city within such reasonable time as perhaps several years. Its purpose also is to help in saving the lives of babies, which are being and will continue to be sacrificed in myriads the world over, while in our ignorance we know not how to shield them, nor, indeed, what it is that we have to shield them from.
Multitudes imagine that the chief use of milk is for the sustenance of babies and children. This is a great mistake, for the great bulk of milk in one form or another is consumed by adults. But the driving force in legislation and administration comes from the importance of pure milk for the nourishment of the human infant. and therefore the problem must be studied from this standpoint, and by regarding the progress of a baby as the most sensitive index we can have of the value of its food. A high rate of infant mortality is a reflection on the morals and intelligence of any community that suffers it, but until we have traced the cause of the trouble we shall continue to wallow in a morass of costly, harassing, and ineffective expedients. To quote a great authority, Newsholme: "To act helpfully we must know thoroughly the summation of conditions which form the evil to be attacked."
There are three distinct considerations which have to be taken into account when legislating on the milk question, viz, (1) health, (2) sentiment, and (3) economics. Each has its place, and they can not be confused without danger. The consumer has a right to require that all milk, and not merely a particular grade, be produced under conditions which attain a proper standard of cleanliness, if for no other reason, than merely as a matter of sentiment and de
cency. And an offense against that standard should involve prompt and condign penalties. Let producer and distributor exalt their office, and treat milk with the respect it deserves, and it will grow in appreciation and value in the eyes of the user. At the same time, one must recognize that a matter may be uneconomic without being dangerous to health—for instance, the souring of milk-and while any contamination may be offensive to sentiment, some contamination may be innocuous as regards any effect on health.
It is not necessary to search the records and statistics of the world in order to understand the case. This rests upon a few incontrovertible facts which apply with equal force to all large cities. These fundamental facts have been known for many years for two decades at least—though their significance has been grasped by relatively few of either our legislators or our health administrators. And it is doubtful if even among communities where infant mortality has been most successfully reduced there is any clear understanding as to which of all the efforts put forth is chiefly responsible for sucii reduction.
It is agreed by responsible authorities that infant mortality tables afford a reliable index as to the sickness rate among children—that the “damage rate” closely corresponds with the death rate. A casual consideration of infant mortality tables—the writer has only in detail those of England and Wales, although having a general familiarity with those of the United States--shows that apart from congenital causes and prematurity and immaturity, the chief causes of infant deaths are bronchitis, pneumonia, diarrhea and enteritis; that measles, and especially whooping cough, are infinitely more serious causes of death than any single form of tuberculous disease; that since 1906 there has been a great fall in the number of deaths from diarrheal disease; and that the deaths from pneumonia and bronchitis remain much the same. These last three diseases still account for over 30 per cent of all infant deaths.
In order to attain a sense of proportion, the figures under the aforementioned headings are appended for three years, 1906, 1911, and 1921, these years having been chosen because they were alike for prolonged and excessive summer temperatures, which have always proved inimical to infant welfare. The figures for atrophy, debility, and marasmus should also be included, but a difference in the form of the tables for the year 1921 makes this difficult. It is enough to state here that the death rate under this heading has about halvel in 1921 as compared with the earlier dates.
Let us begin with tubercle, for which it has been widely alleged that milk is a seriously responsible cause. The foregoing table shows there has been a great decline in the number of deaths from this cause.
Tubercle reveals itself in protean form. The local government board of England and Wales states, as a result of an inquiry made on its behalf, that “it is likely that tuberculosis among children in England is commonly of human origin in fivesixths of the cases, while about one-sixth of them are of bovine origin.” If this same ratio applies to the mortality, then it would mean that in 1921 there was 1 death from bovine tubercle for every 4,000 births. Let us declare that we will never rest until the safety of the milk supply has been absolutely verified; but, at the same time, we ask what warrant is there here for alarmist and malignant attacks on milk?
Let us look at the question from another standpoint, that of the reactions to tuberculin among cattle of different ages: Delépine (of Manchester) gave the following results:
Per cent reactions
3. + 13. 2 24.1 33. 5 48.9
Animals under 1 ve:tr-
Animals 5 to 9 years_ Koch and Calmette, whose eminence and authority command respect, declare that human infection by bovine tubercle is unimportant. At all events there is no question, I believe, that bovine tubercle bacilli are more virulent to bovines than to humans. Is it not strange, therefore, if tuberculous milk is as great and as common a danger as some suggest, that so small a proportion of calves show signs of the disease? Older animals contract the disease in an accelerating ratio, but not from milk!
May we not assume, therefore, that a large proportion of such calves as contract the disease do so by direct infection from other animals, and but rarely from milk? It can not be supposed that calves are immune from channels of infection to which mature animals succumb.
No unprejudiced student can doubt the value of scientific Pasteurization in protecting milk from tubercular infection as from other infections. This process must be accorded no small share of the credit for the steady improvement in, for instance, the London milk supply in recent years. Thus, milk arriving at London railway termini for some years past has yielded a steadily decreasing number of tuberculous samples, as the following figures show:
Per cent of virulent
3. 48 Most of the samples taken were of un-Pasteurized milk, but the proportion of Pasteurized milk is large and increasing, and must account for much of the improvement found.