MEASLES.

TABLE No. 50.

Mortality from Measles from 1884 to 1892, inclusive.

13

* Population estimated for all but census years.

This table shows the number of deaths returned from measles since 1884.

living population.*

MILK AS A VEHICLE OF INFECTION.

BY J. J. BERRY, M. D., MEMBER OF THE STATE BOARD OF HEALTH, PORTSMOUTH, N. H.

While the attention of the public has often been called to the dangers and disadvantages of adulterated milk, very little account has been made of the important rôle which it plays as a medium for the transmission of disease. The food of infancy and childhood should be above suspicion, yet few outside of the medical profession, realize the many dangers to which the little ones are daily exposed by the consumption of milk. Indeed, when we consider the source, the preparation, the manner of transportation, and the methods of administering this food, it is surprising that the deaths are not more marked and more disastrous. Nevertheless, the record is bad enough, for the sanitary history of the past ten years is replete with fatalities and epidemics, produced and propagated by the substance in question.

Milk possesses several elements of danger. The indirect effects of adulteration have been often considered. It is an undoubted fact that many children among the poorer classes of our cities, die every year of starvation. This insufficient nutriment, which, as found in the tenementhouse, is hardly deserving the name of milk, utterly fails to preserve vitality, and the infant promptly acquires disease and as readily succumbs to the same. The quality of the milk may be impaired, not only by adulteration, but by disease or improper feeding of the herd from which it is derived, for, though it may contain no specific germ or poison,

there is often found such a variation in its normal constituents, as to render it decidedly unwholesome. The relation between milk supply and infant mortality has been shown by Girard in a paper read before the French Society of Public Medicine. The examination by competent inspectors of all milk supplied by dairymen to the people of Paris, has resulted in a wonderful improvement in its quality, and since 1881, the infant mortality has decreased from 22.5 per thousand to 17 per thousand.

As the result of his investigations in New Orleans, Prof. Metz, in his report for 1892, showed that the city by its new system of milk inspection, would save from 500 to 1,000 children, annually. During the year 1883, New York city under milk inspection, diminished the infant mortality 3,673, over the previous year, when there was no inspection. Dr. Egbert found that during the year 1891, 5,488 children under 1 year, died from cholera infantum and various wasting diseases, and that most of them had been fed on cow's milk, which had been found to have been in various stages of fermentation. Such a record is indeed a reproach upon our latter day civilization, and a melancholy commentary upon the sanitary status of our country as well.

The tendency of milk under perfectly normal conditions, to absorb and retain various bacteria, was commented upon by Prof. Sedgwick in a paper read in 1891, before the Society of Arts. He showed that milk drawn from a clean, well kept Holstein cow, and received into a sterilized bottle, yielded on an average 530 bacteria per cubic centimetre. When little care was used to exclude dust from the cow or stable, an average of 30,500 per cubic centimetre was found. In 57 samples of city milk examined in 1890, he discovered an average of 2,355,500, while in samples collected from various grocery stores, the number was very much larger. He holds that the two conditions favoring such an abundance of bacteria are uncleanliness, which furnishes the conditions for decomposition, and staleness, which affords the

necessary time for the development of these organisms. The chief danger to communities, however, is afforded by the presence of various specific germs in the milk consumed. The opportunities for such infection are many and varied. This fluid absorbs from the surrounding atmosphere, not only many volatile substances, but likewise the floating particles of dust and germs of disease, which may be present. More than this, it is an excellent culture fluid, and, once contaminated, bacteria increase and multiply in it with great rapidity. The diseases which are most often transmitted in this way are scarlet-fever, diphtheria, typhoid fever, and tubercular disease, though nearly all affections possessing infectious properties may be propagated in the same manner. The history of various epidemics bears out the truth of these statements. In a report by the editor of the British Medical Journal, it is shown that up to 1881, there had occurred in Europe, as the result of infected milk, seventy-one epidemics, consisting of nearly 5,000 cases. Since that time many similar outbreaks have existed, both here and in Europe, which have added to the above cases two or three thousand more. Moreover, it is certain that a great many have occurred which were never traced to their proper source and reported.

Diphtheria may be propagated, not only by infected milk, but by the diseased animal. Cole of Australia reported in 1882 an epidemic of this disease traceable to the milk of a cow suffering from a diphtheritic affection, and which closely resembled the cases previously noted by Power of England. Additional proof of the identity of the two diseases is afforded, by Prof. Damman of Germany, whose assistants contracted typical forms of diphtheria while treating a number of calves suffering from sore throats. A much more common mode of infection, however, is by milk which has become contaminated by the germs of the disease. The virulence, tenacious character, and great vitality of the latter, render them peculiarly dangerous

and difficult to guard against. Hence a substance like milk, when carried into an infected atmosphere, or placed in receptacles which have been touched by a person suffering from diphtheria in any of its forms or stages, becomes at once a most dangerous article of food, and may prove to be the source of a wide-spread epidemic. wide-spread epidemic. An outbreak which appeared last summer in Hightstown, N. J., consisting of 28 cases with 11 deaths, is a striking illustration of the facts quoted. The Medical News, in reporting the investigations of the state board of health, says,

"Further investigation disclosed the fact that a German boy who washed cans and did the milking at the dairy in question, called on a local physician, who found the boy's throat covered with the membranous patches. He pronounced the case diphtheria. The boy had been ailing for several days, and it is supposed that while at work he contaminated the milk, and that in this congenial soil the germs rapidly multiplied and infected the entire supply. An additional fact that strengthens the theory is that of the only two other cases known out of the village, one was the daughter of the dairyman and the other his niece, a neighbor.

"A striking feature of the case is that the sick boy, who is supposed to have caused the epidemic, was not seriously sick at any time. When the doctor examined him his tonsils were covered with pseudo-membrane, but it soon disappeared after a little treatment, and he was not confined to his bed at all. It, therefore, appears that this most malignant epidemic originated in a case of walking diphtheria.'

999

A recent epidemic occuring in this city proved itself very similar to the above, both as to causation and results. An employé on a milk farm in the suburbs, who washed all the cans, delivered milk, and exercised a general supervision of affairs, contracted diphtheria, and after performing the above duties for a while, finally took to his bed, and