A report on the influence of milk in spreading zymotic disease : with a tabular analysis of forty-eight outbreaks / by Ernest Hart.

  • Hart, Ernest, 1835-1898.
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: A report on the influence of milk in spreading zymotic disease : with a tabular analysis of forty-eight outbreaks / by Ernest Hart. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    Introduction. It is now just upon sixteen years since I read my paper at tlie International Medical Congress of 1881 on the Influence of Milk in Spreading Zymotic Disease. I was at that time able to place on record 73 outbreaks of disease as having been tract d to the agency of milk. Of these, there were 50 in which enteric fever was in question, ir were of scarlatina, and 7 of diphtheria. I dealt in my paper in brief with the history of infectious disease as traceable to milk, and went on to show what were the lessons which were to be learned as a result of a consideration of the several outbreaks and their surrounding circumstances, with suggestions for further legislative action. This paper, with its voluminous abstracts and tables, was printed in the Transactions of the Congress. Some important administrative improvements have followed, and the paper and tabulations have served as a mine of facts and references for subsequent writers at home and abroad. It has seemed to me, however, that the time has come when it would be advantageous to compare the intervening years’ experience with our previous knowledge of milkborne disease, and to see how we stand to-day in the matter. Accordingly, I have issued extensively systematic series of queries to all medical officers and others concerned with any milk epi- demics of which I have been able to find either casual or other notice, and have carefully tabulated them and en- deavoured to supplement and to organise on a unform basis all the available information which I have been able to pro- cure from various sources on this subject. The labour has been very considerable, and has extended over no small period of time, but I hope that the results will be considered commensurate. Thus I have have striven to render as complete as possible the history of milksproad infectious disease since 1881. At the same time I may as well state at the outset that I have had occasion to omit many so-called “milk outbreaks” on account of the scanty thread which ran through the argument for milk as the vera causa of the particular epidemic, and I have included only such as have seemed to me to bear the light of close investigation upon them in this connection. There are other and well founded milk outbieaks which find no place in my summary of facts by reason of my ignorance of the circumstances; of this I feel quite sure, as it seems impossible to cull all the data necessary for a complete and absolutely compiehensive record of milkborne occurrences of infectious maladies. But if these things be, they only serve to emphasise the magni- tude of the statistics of preventable sickness which are in evidence in relation with milk as a cause. I am, therefore, the less troubled at the absence of record of local outbreaks of which others may know, though I should have been glad if my publicly expressed desire for information of facts had included the missing data. And here I would take the oppor- tunity of tendering my sincere thanks to those health officers who have kindly responded to my wishes, and have placed at my dispr'sal their own personal experience of milkspread disease. To the reports of the Medical Department of the Local Government Board, also, I am greatly and largely indebted, the admirable manner in which the facts arising in connection with the investigated occurrences have been handled having facilitated my deductions in no small degree. As on the last occasion, I have stated the particulars of the recorded outbreaks in the abstract under the following head- ings : I, Date of outbreak; 2, locality; 3, reporter; 4, total num- ber of cases; 5, deaths ; 6, number of cases amongst drinkers of infected milk; 7, percentage to total cases ; 8, number of families supplied by milkman: 9, number of such families invaded; 10. percentage; 11, sanitary circumstances of farm or dairy from which milk was derived ; 12, exciting cause of outbreak; 13, circumstances implicating milk ; 14, facts show- ing si.ecial incidence of the disease; 15, references to sources of information. The 73 outbreaks in my 1881 abstract have given place to an additional 95 on the present occasion—namely, typhoid fever 48, as against 50; scarlatina 32, as against 15 ; and diph- theria and allied throat ailments 15, as against 7. I am con- fident even so that these but touch the fringe of the matter, especially if I had sought abroad for evidences of epidemics traced to milk. As a matter of fact, I have been content to locate myself to the four quarters of the United Kingdom, except in one or two instances where special trouble has been taken to bring to my notice the recorded facts. Fresh Elements since 1881. It will be unnecessary for me to in any wise refer to the question of causation of disease by the agency of milk as being contentious in any degree. As far back as the seventies the matter was practically placed within the pale of certainty, and assuredly by 1881 the public had come to recognise the relationship between milk and disease as clearly proven. At the same time the matter has undergone rapid development, to a large extent due to the very able and elaborate investiga- tions conducted by Mr. W. H. Power, F R.S., the assistant medical officer of the Local Government Board, whose lucid reports, aided by the bacteriological inquiries of Dr. Klein, have demonstrated beyond doubt that there is direct causal relationship between conditions of milch cows and disease in the human subject, in the cases of diphtheria and scarla- tina. The Hendon outbreak of 1885, of which I shall have occasion to speak, has become classical in <he region of epi- demiology, the relationship of teat and udder eruptions in the milch cow to scarlatina in man having been brought pro- minently forward in masterly fashion in the papers published by the late Sir George Buchanan, and containing reports from the pens of Mr. Power, the late Dr. Cameron of Hendon, and Dr. Klein. It is the recognition of the cow as herself having to do with the infective quality of her milk that has chiefly marked the last ten or twelve years in the direction of added knowledge as to milkborne disease. It has been a hard fight to secure the verdict of veterinary authorities in favour of the view held at Whitehall, but just as the theory of aerially-spread small-pox had to be maintained in the face of great opposition, finally to be accepted by the leading public health experts of the day, so has the theory of cow- borne maladies had to be contended for, but the result in the long run has been the same. I therefore am in the pleasant position to-day of being able to start at once on a short statement of the chief facts given in ray abstract, without the necessity of having to prove that milk can cause infectious sickness. My task is rather to de- monstrate wherein Ije the principal needs for further care in the processes of dairying and the like ; and the task is of a nature to afford sanitarians with material for uncomfortable reflection, seeing that its fulfilment must bring out facts which are to our national discredit. First of all, then, I will deal with those phases of disease outbreaks which are exhibited by two or all three, of the dis- eases which form the bulk of local occurrences finding place in my abstract. Obstructive Difficulties in Local Inquiries. I may perhaps at the outset refer to a circumstance which militates against attempts to elucidate the origin and method of spi-ead of milkborne disease, and that is the wilful with- holding of information pertinent to the success of the investi- gation. Such withholding has in the past been practised on more than one occasion and by more than one class of indi- viduals. Take, for example, the case of the outbreak of diphtheria at Ealing in January, 1887 (No. D. 8), and inquired into by Mr. Power for the Local (Government Board, where the reporter states that mainly default of evidence was due to disregard by particular people in Ealing of appeals made to them directly and individually for information on the