the dilution of milk with specifically contaminated water

1
1366 special wards of the infirmaries, and we think that these might be regarded as more than mere rest-houses on the way to asylums. They might be made suitable for the reception of the class of patients we have in mind and be placed under the consulting charge of practising psychia- trists. With another recommendation of the Asylums Committee, that every alleged lunatic should go in the first place to a receiving house, we do not altogether sym- pathise. There are many patients who come under observa- tion too late for treatment at a mental hospital adapted for the class of patients we have above mentioned, and for whom the asylum is the proper place. It appears to us to be of little advantage that the journey to the asylum should be interrupted for a few days’ purposeless sojourn at a receiving house, where the presence of such patients would involve arrangements wholly inappropriate to the atmosphere of the mental hospital. THE DILUTION OF MILK WITH SPECIFICALLY CONTAMINATED WATER. THE addition of water to milk is not such an exceptional occurrence as to call for special reference in these columns, but when the water which is added is not only grossly polluted but is found to actually contain the organisms of enteric fever the affair assumes a special importance. A case has recently come to light near Preston in which water to the extent of 3’ 6 per cent. had been added and in which the county analyst discovered the enteric fever organisms. The milk itself as drawn from the cow’s udder was of excellent quality, but the water separately analysed yielded enteric fever bacilli. The bench quite rightly took a serious view of the offence and the defendants were mulcted in all to the extent of &44. A case such as this should turn <the attention of local authorities and their officers to the enormous importance as regards health of securing a pure water-supply for dairies and cowsheds, but we are afraid that, especially in rural districts, this question does not receive the attention which it deserves. The position of the wells supplying many dairies in rural districts is often such as to actually cause pollution, and this although the dairies may have been registered with the local authority for many years. There can be no doubt that the standard of - cleanliness of cowsheds in rural districts is far lower than it ought to be, and, although the milk cans are commonly washed with water which has been boiled, the utensils in which the cans are sometimes washed and those in which the milk is drawn are not infrequently used for other purposes. Water added to milk by way of dilution seldom undergoes any treatment whatever. In connexion with this important subject we are glad to see that a Milk and Dairies Bill .[No. 123], providing for reforms with respect to the sale of milk and the regulation of dairies, is being introduced into the House of Commons. Whatever may be its fate it will have some educational value, and many of its provisions represent a distinct advance on the existing general conditions. Amongst other things the Bill provides for the compulsory registration of dairymen and a penalty not exceeding .f:5 for failure to register, and the local authorities are empowered to refuse registration as well as to remove from the list dairies already registered. Procedure with regard to the inspection of dairies and the prohibition of the supply of milk is simplified, and advances are made upon Section 4 of the Infectious Diseases (Prevention) Act, 1890, Section 71 of the Public Health (London) Act, 1891, and the Milk Clauses incorporated in many local Acts. With respect to tuber. culous milk power is given to the local officers to require a cow to be milked in their presence, and the milk from any particular teat must, if so desired, be kept quite separate. A penalty is also imposed where the dairyman and those in his employ refuse to assist the officers in their investiga- tions, a provision which in practice would prove decidedly useful. Similarly, as regards the sale of tuberculous milk or the use of such milk in the manufacture of products for human consumption, a fine of .E10 is imposed unless proof is forthcoming that the milk has been boiled or otherwise sterilised. But this proviso as to sterilisation is obviously open to criticism. Greater facilities are afforded under the proposed legislation for procuring samples of milk, and power is conferred upon the Local Government Board by agreement with the Board of Agriculture and Fisheries to make any necessary orders as regards certain specified particulars, amongst which we note the pre- vention of impurities in milk, the cleanliness of milk vessels, the prohibition or regulation of preservatives, the identifica- tion of churns, and the prohibition or regulation of the mixing of the milk in one churn with the milk in another. The duty is also imposed upon the Local Government Board of making regulations under the Public Health (Regulations as to Food) Act, 1907, as regards the importation of milk or milk products ; and the Board may, after holding a local inquiry, make orders compelling a council in default to do its duty as regards the milk-supply. Presumably the provisions of this Bill would have the effect of enabling the existing regulations under the Dairies, Cow- sheds, and Milkshops Order to be replaced by something more modern and workable, and, if this alone were procured, a substantial step forward would be taken. In many in- stances thelexisting regulations are so vague and difficult to interpret that they possess very little practical utility from an administrative point of view. MEASLES AND THE POST-OFFICE AUTHORITIES. WE have received a copy of a report presented to the Brixham urban district council by Mr. George Blacker Elliott, the medical officer of health, concerning the action of the Post-Office authorities in regard to a case of measles occurring in the family of a postman. Briefly stated, the facts as reported by Mr. Elliott are that on April 15th the wife of a postman was taken ill with measles. On being informed of this next day, Mr. Elliott saw the postmaster and advised him to order the man off duty, so as to avoid the danger of infection. The postmaster stated that he had no power to do this, and accordingly Mr. Elliott telephoned to Torquay, where the head office for the district is situated. The officials there replied that they had no power to suspend the postman from duty, but promised to communicate with the authorities at the General Post Office. Three days afterwards the postman was ordered back to duty, and he has continued at his work from that time. Mr. Elliott has since learnt that the rule of the Post Office authorities is to the effect that no Post Office employee can be absent from duty on account of his coming from a household infected with measles. This is the more remarkable in view of the fact that there are stringent regulations barring employees from work if there is either scarlet fever or enteric fever in their homes. In commenting upon this case Mr. Elliott rightly maintains that it is not merely a matter of local interest, but one affecting the public health of the whole kingdom. Measles, as he points out, is by no means a trivial disease, when it is re- membered that the deaths in England and Wales alone have varied during a period of 30 or 40 years from 6000 to 14,000 in a year. It is, moreover, one which is readily spread by fomites, and there is every reason to believe that letters, telegrams, or postage stamps may act as infective agents when handled by a person who has been attending on a patient suffering from the disease. Moreover, the

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Page 1: THE DILUTION OF MILK WITH SPECIFICALLY CONTAMINATED WATER

1366

special wards of the infirmaries, and we think that these

might be regarded as more than mere rest-houses on the

way to asylums. They might be made suitable for the

reception of the class of patients we have in mind and beplaced under the consulting charge of practising psychia-trists. With another recommendation of the AsylumsCommittee, that every alleged lunatic should go in thefirst place to a receiving house, we do not altogether sym-pathise. There are many patients who come under observa-tion too late for treatment at a mental hospital adapted forthe class of patients we have above mentioned, and forwhom the asylum is the proper place. It appears to us to

be of little advantage that the journey to the asylum shouldbe interrupted for a few days’ purposeless sojourn at a

receiving house, where the presence of such patients wouldinvolve arrangements wholly inappropriate to the atmosphereof the mental hospital.

--

THE DILUTION OF MILK WITH SPECIFICALLYCONTAMINATED WATER.

THE addition of water to milk is not such an exceptionaloccurrence as to call for special reference in these columns,but when the water which is added is not only grosslypolluted but is found to actually contain the organisms ofenteric fever the affair assumes a special importance. A

case has recently come to light near Preston in which waterto the extent of 3’ 6 per cent. had been added and in whichthe county analyst discovered the enteric fever organisms.The milk itself as drawn from the cow’s udder was ofexcellent quality, but the water separately analysed yieldedenteric fever bacilli. The bench quite rightly took a seriousview of the offence and the defendants were mulcted in allto the extent of &44. A case such as this should turn<the attention of local authorities and their officers to theenormous importance as regards health of securing a purewater-supply for dairies and cowsheds, but we are afraidthat, especially in rural districts, this question does notreceive the attention which it deserves. The positionof the wells supplying many dairies in rural districts is

often such as to actually cause pollution, and this althoughthe dairies may have been registered with the local authorityfor many years. There can be no doubt that the standard of

- cleanliness of cowsheds in rural districts is far lower than

it ought to be, and, although the milk cans are commonlywashed with water which has been boiled, the utensils inwhich the cans are sometimes washed and those in which themilk is drawn are not infrequently used for other purposes.Water added to milk by way of dilution seldom undergoesany treatment whatever. In connexion with this importantsubject we are glad to see that a Milk and Dairies Bill

.[No. 123], providing for reforms with respect to the sale ofmilk and the regulation of dairies, is being introducedinto the House of Commons. Whatever may be its fate

it will have some educational value, and many of its

provisions represent a distinct advance on the existinggeneral conditions. Amongst other things the Bill providesfor the compulsory registration of dairymen and a penaltynot exceeding .f:5 for failure to register, and the local

authorities are empowered to refuse registration as wellas to remove from the list dairies already registered.Procedure with regard to the inspection of dairies andthe prohibition of the supply of milk is simplified, andadvances are made upon Section 4 of the InfectiousDiseases (Prevention) Act, 1890, Section 71 of the

Public Health (London) Act, 1891, and the Milk Clausesincorporated in many local Acts. With respect to tuber.culous milk power is given to the local officers to requirea cow to be milked in their presence, and the milk from any

particular teat must, if so desired, be kept quite separate.

A penalty is also imposed where the dairyman and those

in his employ refuse to assist the officers in their investiga-tions, a provision which in practice would prove decidedlyuseful. Similarly, as regards the sale of tuberculous milk orthe use of such milk in the manufacture of products for

human consumption, a fine of .E10 is imposed unless proof isforthcoming that the milk has been boiled or otherwise

sterilised. But this proviso as to sterilisation is obviouslyopen to criticism. Greater facilities are afforded underthe proposed legislation for procuring samples of milk,and power is conferred upon the Local GovernmentBoard by agreement with the Board of Agriculture andFisheries to make any necessary orders as regards certainspecified particulars, amongst which we note the pre-vention of impurities in milk, the cleanliness of milk vessels,the prohibition or regulation of preservatives, the identifica-tion of churns, and the prohibition or regulation of the

mixing of the milk in one churn with the milk in

another. The duty is also imposed upon the LocalGovernment Board of making regulations under the PublicHealth (Regulations as to Food) Act, 1907, as regards theimportation of milk or milk products ; and the Board may,after holding a local inquiry, make orders compelling acouncil in default to do its duty as regards the milk-supply.Presumably the provisions of this Bill would have the effectof enabling the existing regulations under the Dairies, Cow-sheds, and Milkshops Order to be replaced by somethingmore modern and workable, and, if this alone were procured,a substantial step forward would be taken. In many in-

stances thelexisting regulations are so vague and difficultto interpret that they possess very little practical utility froman administrative point of view.

MEASLES AND THE POST-OFFICE AUTHORITIES.

WE have received a copy of a report presented to theBrixham urban district council by Mr. George Blacker

Elliott, the medical officer of health, concerning the actionof the Post-Office authorities in regard to a case of measlesoccurring in the family of a postman. Briefly stated, thefacts as reported by Mr. Elliott are that on April 15th thewife of a postman was taken ill with measles. On beinginformed of this next day, Mr. Elliott saw the postmasterand advised him to order the man off duty, so as to avoid thedanger of infection. The postmaster stated that he had nopower to do this, and accordingly Mr. Elliott telephoned toTorquay, where the head office for the district is situated.The officials there replied that they had no power to suspendthe postman from duty, but promised to communicate with theauthorities at the General Post Office. Three days afterwardsthe postman was ordered back to duty, and he has continuedat his work from that time. Mr. Elliott has since learnt thatthe rule of the Post Office authorities is to the effect that noPost Office employee can be absent from duty on accountof his coming from a household infected with measles.This is the more remarkable in view of the fact that thereare stringent regulations barring employees from work if thereis either scarlet fever or enteric fever in their homes. In

commenting upon this case Mr. Elliott rightly maintains thatit is not merely a matter of local interest, but one affectingthe public health of the whole kingdom. Measles, as he

points out, is by no means a trivial disease, when it is re-

membered that the deaths in England and Wales alonehave varied during a period of 30 or 40 years from 6000to 14,000 in a year. It is, moreover, one which is readilyspread by fomites, and there is every reason to believe thatletters, telegrams, or postage stamps may act as infectiveagents when handled by a person who has been attendingon a patient suffering from the disease. Moreover, the