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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    ness of indefinite sort of throat affection in the families of two dairymen, whose businesses were interlaced, such ill- nesses following on scarlatina in other members of the families. At Grangemont in 1882 (No. T. F. 6) a case of enteric fever was found in the house from which milk was supplied. At Canterbury in 1886 (No. D. 6) the milkman and his family were found to be suflfering from sore throat. And at Limekilns in Fifeshire in 1892 (No. D. 14) a patient suffer- ing from diphtheria was ascertained to have been walking about the dairy premises the day following notification of his illness, in direct contact with dairy management. These instances serve to illustrate how great is the danger attend- ing on the occurrence of cases of infectious disease, either unsuspected or carelessly left in households connected with dairying and cognate businesses. Sick Nurses as Dairy Workers. The case of Limekilns leads me to draw attention to two or three instances in which the attendant on the infectious sick was also busied in dairy work. At Wolverhampton (No. S. i) in 1881 the milkseller was engaged in distributing milk during the illness of her children, whom she nursed through an attack of scarlatina, which disease was spread by the milk thus sold. At Dundee in 1883 (No. S. 9) the milk causing scarlatina in its consumers was stored in a kitchen wherein was laid a boy suffering from the same disease, and whose attendants carried on the dairying business. At Derby in 1884 (No. T. F. 16) the napkins of the initial fever patient at the farm were washed in the farm pump trough, whilst the mother-nurse of the patient was engaged in milking the cows and in washing the milk cans. Here, then, are in- stances of gross disregard for the common decencies of clean- liness and of the common right of man to secure that his food shall be served to him free from the conditions enticing disease and calculated to foster infection in the very means of life. Storage of Milk. The storage of milk has ever been an important matter in the course of inquiry into milkborne epidemics, and instances of neglect in the direction of exposure of milk to deleterious influences in this way have been by no means infrequent. At Shirley Warren, in Hampshire, in 1894 (No. S. 22), it was ascertained, while inquiring into an outbreak of scarlatina traced to milk, that the milk in question was placed without a cover in a penthouse, under the same roof as an adjoining house wherein was a boy suffering from the same disease, he having also access to the penthouse while in a stage of desquamation. At Shelf, in 1882 (No. T. F. 4), the conditions surrounding the stored milk were extremely bad, the milk being open to the absorption of drain air, sewage effluvia, and the emanations from an adjoining manure heap. At Dundee, in 1883 (No. T. F. 11), a boy was found to have been sleeping in a room communicating with the milk shop, while certified to be suffering from “ neuralgia,” though several members of the dairymen’s family were found to have suffered from enteric fever at the same time or thereabout. Very crude were the notions of a farmer selling milk found to be causing typhoid fever at Carlisle in 1886-87 (No. T. F. 20), the milk storeroom being a small pantiy between and con- tinuous with a kitchen and yard, the latter containing a slaughter house, cowsheds, and an ashpit privy containing the evacuations of a typhoid fever patient. At Edinburgh, in 1890 (No. T. F. 27), we find milk being passed into cans in a small building aerially and closely connected with a filthy cow byre. Deplorable were the surrounding circumstances affecting the storing of milk in a farm at Shildon, in 1893 (No. T. F. 38), the room used for storage having a window opening on to three uncovered midden privies, on to one of which at least were cast the untreated evacuations of a typhoid fever patient. The room was also open to emanations from a sewer close at hand. These instances suflice to demon- strate the serious state of things existing at our dairy farms and milk shops, a condition of affairs calling for remedy beyond the possibility of recurrence. Milk being a most ready absorbent, it becomes the more important that all deleterious influences that may be in any wise thought of as likely to operate to the danger of the consumers of the milk should be removed. At the same time, of course, I do not lose sight of the fact that occurrence of infectious disease in aerial relation with milk of a quality to cause disease in its consumers is by no means always the cause of the effect of such milk, but not infrequently only itself the result of ingestion of the milk on the farm or dairy premises. But however this may be, my main contention holds good. Quantity of Inffcted Milk used and Amount op Disease Resulting. One matter which has come to be very clearly demonstrated as time has gone on is the relationship existing between amount of milk consumed and the amount and severity of the disease induced by the implicated milk. Indeed, this point has come to be one of the methods by which the certainty of milk as a cause of disease has often been ascertained beyond doubt in well-to-do localities, taking much milk per house ; whilst the amount of disease per household has now come to be seen to depend on, first, the number of young children in the home, and secondly, on the quantity of unboiled milk consumed by those children. In Wimbledon and Merton, in 1886-87 (No. S. ii), the scarlatina attacked especially well-to- do people, and was seen to show preference for those persons who partook of most milk, the rateable value of houses and quantity of milk being important factors in determining the amount of disease to be expected. At Upton and Maccles- field, in 1889 (No. S. 18), in the outburst of scarlatina, there was a difference as between 45 and 89 per cent, of households attacked according as one-third or the whole of a pint of milk and upwards was taken, and a difference as between 12 and 50 per cent, of members of those households attacked. At Bush Hill Park, in 1891 (No. S. 21), the incidence of scar- latina was greatest on houses taking most milk, scarlatina attacking chiefly well-to-do households. The matter first came to be clearly defined when Mr. Power conducted his inquiry into milk diphtheria at York Town and Camberley in 1886 (No. D. 7), for there he found that the amount of milk consumed determined the amount of disease, 84 per cent, of better class customers, and only 22 per cent, of poorer cus- tomers, of the milk supply being attacked. In his summary of the chief facts of the outbreak, Mr. Power says : “ Though uniformly infective on leaving the farm, the milk had a very different effect in causing diphtheria according as it was dis- tributed to one and another class of consumers. This dif- ference of effect of the milk had to do with difference of amount (and related difference of use and difference of con- servation) of milk distributed in the two classes. The diph- theria among better class consumers was, as regards amount and fatality, so conspicuous that its relation to the milk ser- vice was readily seen; but among poor class consumers, it was so inconspicuous in amount and fatality that the fact of its relation to the milk service might readily have been over- looked. It is altogether doubtful, therefore, whether in the absence of the test of the milk which was furnished by the behaviour of the epidemic among customers of the better class, the ability of this milk service to cause diphtheria would have been detected.” Milk Outbreaks of Untraced Origin. It is not to be supposed that because a particular outbreak of disease attributed to the agency of infected milk has not been traced to the vera causa of the infective quality of the milk in question, therefore the theory is untenable. This supposition does not hold good in other phases of disease dissemination, as for example the waterborne diseases, con- cerning which it has been impossible at times to state with clearness borne out by irrefutable facts what was the precise method of contamination of the water which none the less caused the malady attributed to its agency. As an instance of a milk outbreak of this class I may mention that of Glasgow in 1882 (No. T.F. 7), where the typhoid fever arising in connection with a milk supply was wholly among persons consuming the milk, not one case being found to have been in an individual not using the milk. It was just as well that the disease should have been thus wholly limited to milk drinkers, since no trace was found of the means whereby the infective quality of the milk was induced. Infective Milk Operating at a Distance. There have been not a few instances in which the milk im- plicated in the spread of infectious disease has caused mis-