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nation, is collected by dealers, in small portions, from perhaps twenty farms, and after a long journey in wagons and cars finally arrives at its destination, where it is again subjected to similar treatment before it reaches the consumer. Such milk under the very best conditions is scarcely a suitable food for children. What must it be at other times?

In relation to these facts, Professor Sedgwick says, "We may as well ask ourselves, whether, in the place of private care and watchfulness, we have provided any efficient or adequate inspection of the stables from which the milk supply comes, or any even approximately adequate supervision of it after its arrival. There is at present, so far as I am aware, no systematic inspection, whatsoever, of the farms, stables, or herds from which public milk supplies come. After its arrival in the city, inspectors protect us, more or less effectually, from its adulteration with water. The dwellers in the cities take such milk as it comes, asking no questions. They have surrendered their primitive safeguards, and have placed none in their stead. By the present system of inspection, we are protected from fraud, but not from filth or disease." This is particularly true in the state of New Hampshire, where the various laws bearing upon this matter are seldom, if ever, enforced.

It is unfortunate that the milk supply of our cities, is derived from so many different sources, and that it cannot be obtained exclusively from large dairy farms, which are under constant sanitary supervision in all their departments. Under present conditions, proper inspection is almost an impossibility, and we are forced to rely upon the honesty and intelligence of the individual. The consumer has no means of determining the quality of the milk, except by sight and taste, and, in case of doubt, is obliged to rely upon sterilization by steaming or boiling, in order to render it potable. The avoidance of infected milk is, however, more important than the treatment of that which has already suffered

contamination. The enactment of sanitary laws will accomplish much, yet the source of our milk supply can never be above suspicion until the business of production and sale is conducted by large dairies under the care of reliable and intelligent persons, and subject to frequent inspection by state or government boards.

A DISSERTATION

ON THE

TRANSPORTATION OF PERSONS ILL WITH CONTAGIOUS OR INFECTIOUS DISEASE.1

BY G. P. CONN, M. D., CONCORD.

That railroads and steamships, in their capacity of common carriers, may and do become disseminators of infectious and contagious diseases, can be assumed without any fear of the assertion being controverted.

It is a well known fact, that small-pox came into Montreal in 1885 amid all the luxurious appointments of our justly celebrated Pullman service,-that yellow-fever came into Grenada and Memphis, as well as other towns, in 1878, riding in all kinds of coaches, that steamship lines every year bring to our shores more or less that are suffering from typhus fever or other contagious diseases, and that experience has proved that all forms of transportation may and do become the avenues by which disease finds its way from place to place.

It is an equally safe assertion, that there is no one connected with the management of our railroads but will disclaim any intention of their lines being used to spread disease, and at the same time, they would gladly welcome any reliable information that would enable their lines to formulate rules and regulations that would overcome the

1Read at annual meeting of railway surgeons of New York at Academy of Medicine, Nov. 15, 1893, and published in the Times and Register, Philadelphia, Dec. 2, 1893.

difficulties that now surround the problem of sanitation as applied to railway transportation.

The public, since the epidemic of yellow-fever in 1878–79, have become critical and easily alarmed upon questions bearing directly, or indirectly, upon the health of individuals, families, or communities, and therefore state boards of health, as well as municipal health officers, oftentimes feel called upon to exercise authority at different points, much to the discomfiture of the management and patrons of great through lines of travel.

If we had a central or national board of health, that could act in conjunction with the interstate commerce commission, it is possible something might be done to give to the public and the management of roads some uniform method by which all might be governed; but as we have nothing of the kind, it is quite time that associations like this and our national association of railway surgeons were discussing this subject, for we may at any time, in our association with railways and their management, be brought face to face with an epidemic travelling across our country with the devastating power of a cyclone.

To show that I am not the only one who holds this belief, I will instance the following: So long ago as 1884, W. Thornton Parker, surgeon U. S. A., then stationed in New Mexico, in a paper read before the American Public Health Association, entered an emphatic protest against allowing people ill with contagious and infectious diseases to occupy cars in which the public were expected to travel. To quote from his paper, he said-"Not only are the ordinary cars thus constantly contaminated, but the more luxurious and expensive sleeping cars are very much used for cases suffering with whooping cough, scarlatina, and other diseases. Patients convalescing from contagious diseases are very commonly met with. I understand that quite recently a very prominent and educated lady travelled from San Francisco to Boston, and even beyond, with children

sick with the whooping cough. In this case, a private compartment was used; but of course the danger of infecting other children was only lessened, not removed. Several cases of that most dreaded of all diseases of children, scarletfever, have to my knowledge been communicated in this way. A healthy child occupies the same seat where a convalescing scarlet-fever patient has been sitting, and falls a victim to this terrible disease. Such license is an outrage on the traveling public, and should not be tolerated another day."

Such was the language of an acute observer nearly ten years since, and while state and local boards of health have made great advancement in most matters connected with sanitation, the conditions remains the same in our railway cars. I am not certain but the conditions are worse, for I believe that with the opening of new avenues for travel, far more people are passing over our roads in the pursuit of health than was thought possible ten years since.

At that time Dr. Parker suggested that railway station officials, conductors, and others connected with the train department, be required to prohibit persons suffering from contagious diseases from occupying cars used by the general travelling public. Surely a commendable suggestion, but I fear impractical, as these men could not be expected to diagnose diseases. He added that a hospital sleeper could be furnished on through lines, and a medical inspector for large stations like those of New York, Chicago, St. Louis, and other large places, and said these inspectors should have the legal authority to force patients suffering from contagious diseases or convalescing from infectious disorders into these special cars. To-day this would not be considered practical, for small-pox and diphtheria, scarletfever, and measles would not be considered fit subjects to be placed in the same car.

As another instance, allow me to quote from the address of Medical Director Albert L. Gihon, U. S. N. In the

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