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 3 1924 001 127 848 
 
 CORNELL UNIVERSITY 
 
 25^7 
 
 G-?"? THE 
 
 3f lamer Veterinary ^library 
 
 FOUNDED by" 
 
 ROSWELL P. FLOWER 
 
 for the use of the 
 
 N. Y. State Veterinary College 
 
 1897 
 
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REPORTS 
 
 TO THE 
 
 LOCAL GOVERNMENT BOARD 
 
 PUBLIC HEALTH AND MEDICAL 
 MATTERS. 
 
 {NEW SERIES No. 1.) 
 
 Dr. Eastwood's Report to tlie Local Govern- 
 ment Board on American Methods for the 
 Control and Improvement of the Milk 
 Supply. 
 
 LONDON: 
 
 PRINTED FOR HIS MAJESTY'S STATIONERY OFFICE, 
 
 Bv DARLING & SON, Ltd., 34-40, Bacon Street, E. 
 
 And to be purchased, either directly or through any Bookseller, from 
 
 "WYMAN AND SONS, Ltd., Fetter Lane, E.G. ; or 
 
 ' OLIVER .« BOYD, Tweeddale Gourt, Edinburgh ; or 
 
 E. PONSONBY, 116, Grafton Street, Dublin. 
 
 1909. 
 Price Sixpence. 
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Dr Eastwood's Report to the Local Govern- 
 ment Board on American Methods for the 
 Control and Improvement of the Milk 
 Supply. 
 
 The information contained in this report was obtained by me 
 in the United States during the months of September and 
 October, 1908. The States to which I devoted particular 
 attention are :— Minnesota, Wisconsin, Illinois, Maryland, Penn- 
 sylvania, New York, and Massachusetts ; I also spent some time 
 in the District of Columbia. 
 
 My work has been carried on in accordance with the instruc- 
 tions of the Medical Officer of the Board, who desired me to 
 study, from the standpoint of practical administration, American 
 methods directed to the control and improvement of the milk 
 supply. 
 
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CONTKOL OF BOVINE TUBERCULOSIS IX WISCONSIN. 
 
 PART I. 
 
 The conditions of the Milch Cows, with 
 Special Reference to the Detection of 
 Tuberculosis and the Policy of Compen- 
 sation. 
 
 THE METHODS OF VARIOUS STATES. 
 Wisconsin. 
 
 My information concerning the health of the dairy cattle in 
 this State was obtained at Madison from the Agricultural 
 Experiment Station of the University of Wisconsin. Most 
 of my facts wen; derived from ]\Ir. C. Hoifmann, who is 
 devoting special attention to this subject under the direction of 
 Dr. H. L. Russell. 
 
 The application of the tuberculin test has shown that tuber- 
 culosis is common throughout the State and is particularly 
 prevalent in the older and more densely populated districts. The 
 Northern two-thirds of the State are of comparatively recent 
 development and are thinly populated. In this area the total 
 number of animals tuberculin tested during a period of three 
 years (1905-8) amounted to 23,351. Out of this number positive 
 reactions were obtained in 781 cases, or 3*5 per cent. The 
 cattle tested constituted 1,586 distinct herds, amongst which 281, 
 or 17*7 per cent., contained infected animals. In the Southern 
 third of the State, which has been settled for a longer period and 
 is more densely populated, 43,176 animals were tested during the 
 same period and gave reactions in 4,570 cases, or 10*5 per cent. 
 The animals formed 2,164 herds, of which 941, or 43*4 per cent., 
 showed infection. 
 
 On my enquiring whether there was any evidence that the 
 amount of bovine tuberculosis was diminishing in the State of 
 Wisconsin, Mr. HofFmann produced the following data. During 
 a period of 12 months (1905-6) 9,718 animals were tested, and of 
 these 1,726, or 17"7 per cent., reacted. The animals comprised 
 486 herds, the number of herds found infected being 257, or 52*8 
 per cent. During the next 12 months (1906-7) 15,816 animals 
 were tested; 1,291, or 8*1 per cent, reacted. These animals 
 constituted 868 herds, amongst which 314, or 36*1 per cent., were 
 found infected. During the next period of 12 months (1907-8) 
 40,993 animals were tested and 2,334, or 5'6 per cent., reacted. 
 The animals formed 2,396 herds, of which 651, or 26"9 per cent., 
 were found infected. All the above figures refer to separate 
 tests on different animals. These data show that the use of 
 the tuberculin test is increasing ; they also afford some ground 
 for believing that the amount of tuberculosis is on the decline. 
 
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2 CONTROL 01' BOVINE TUBERCULOSIS 
 
 Much work remains to be done before the condition of all the 
 cattle throughout the State will be ascertained. I was unable 
 to obtain complete sta,tistics of the proportion of tested and 
 untested cattle in the whole State but was shown the data which 
 had been obtained from a very large number of counties. The 
 percentage of tested animals varied very considerably. In some 
 counties it was 5 per cent, or less ; the highest figure I noticed 
 was 57-4 per cent.; the majority of the figures were distributed 
 irregularly in intermediate positions between 5 and 50. The 
 Northern two-thirds of the State seem to be more enterprising 
 in this respect than the Southern third. In the former area the 
 number of animals tested during the last year was nearly seven 
 times as great as the number tested the year previously, whereas 
 in the South the number of tests was less than double that of the 
 previous year. 
 
 The facts quoted abo-ve indicate that in the State of Wisconsin 
 the efforts to eradicate bovine tuberculosis are making some 
 progress. To what causes is this encouraging position attribut- 
 able ? As Mr. Hoffmann's share of the work brings him into 
 direct and intimate contact with the farmers, his experience 
 has the value of first hand information. He attributes the 
 success of their work to the following causes : — 
 
 1. First and foremost, the post mortem demonstrations to 
 farmers. These are arranged at county fairs in various 
 parts of the State, in the Agricultural College, and where- 
 ever opportunity arises. They are prefaced by a popular 
 lecture explaining the financial loss arising from tuberculous 
 cattle, the insidious nature of the disease, and the economic 
 advantages of detecting and eradicating it at an early stage. 
 The farmers are invited to inspect a batch of animals which 
 have reacted to the tuberculin test, and special attention is 
 called to those beasts which from their external appearance 
 would be regarded as perfectly healthy. The animals are 
 then slaughtered and the extent and nature of the disease is 
 demonstrated to the farmers. In this way the practical 
 value of the tuberculin test is proved far more convincingly 
 than by verbal arguments and theories. 
 
 2. The publication, at freqvient intervals, of practical 
 advice to farmers in the bulletins of the Agricultural Ex- 
 periment Station, which is in cooperation with the Wisconsin 
 Live Stock Sanitary Board. 
 
 3. The free distribution of tuberculin, on condition that 
 the farmer obtaining it furnishes a complete record of the 
 test. 
 
 4. All students at the Agricultural College are taught 
 how to employ the test. Special short courses are arranged 
 for farmers at convenient seasons of the year. The number 
 of students receiving this instruction now amounts to 1,000 
 per annum. 
 
 5. The farmer is offered the choice of three methods for 
 the disposal of infected animals. 
 
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IN WISCONSIN. 3 
 
 ((J.) The cattle, if in good physical condition, may be 
 sent under the auspices of the State Live Stock 
 Sanitary Board to some centre for slaughter where 
 they can be examined by inspectors of the Federal 
 Government. The owner receives the fuU net 
 value of the animals which pass the inspection. 
 (b.) The cattle may be appraised by three 
 appraisers appointed hy the local justice of the 
 peace. The maximum appraisal must not exceed 
 fifty dollars. The owner is entitled to two-thirds 
 of the appraised valuation, but before he receives 
 payment the local health officer must certify that 
 the bams and premises in which the reacting stock 
 were kept have been efficiently disinfected. The 
 State authorities have the cattle slaughtered under 
 Federal inspection and retain the proceeds fi-om 
 their sale, (c.) If the att'ected cattle are valuable 
 pvire bred animals, the owner may hold them in 
 quarantine, under the loiles of the State Live 
 Stock Sanitary Board, and is allowed to adopt the 
 Bang system. This system requires (1) permanent 
 separation of reacting from non-reacting animals, 
 (2) separation, iiiiiiiediately after birth, of all 
 calves bo)-n of reacting animals, and (3) feeding 
 of all calves with milk, which, if obtained from 
 reacting animals, has been heated at a temperatuie 
 sufficient to kill any tubercle bacilli which may be 
 present. 
 
 6. The farmers who have adopted the test approve of it 
 and recommend it to their friends. 
 
 7. Farmers are advised not to replenish their herd exeej)t 
 from tested animals. 
 
 8. Fourteen cities have adopted a regulation requiring 
 that cows supplying milk shall be tuberculin tested. These 
 regulations alfect 25 per cent, of the people in the State. 
 (Population of Wisconsin in 1900=2,069,042 ; popidation 
 of the cities requiring the test=523,302.) 
 
 The official body in which the control of bovine tuberculosis 
 is vested in the State of Wisconsin is the Live Stock Sanitary 
 Board. This Board consists of three members of the State 
 Board of Agriculture, toiiether with the bacteriologist of the 
 State Agricultural College and the State Veterinarian. The 
 duty of the Board is " To protect the health of domestic animals 
 of the State, and to determine and employ the most efficient and 
 priictical means for the prevention, suppression, control, and 
 eradication of dangerous, contagious, or infections diseases 
 among domestic animals." It is unnecessary to give a detailed 
 accoimt of tiie enactments governing the action of this Board, 
 but it may be noted that it is part of their duty to see that 
 cattle are not imported into the State for breeding or dairy 
 })urposes unless they have successfully passed the tuberculin test- 
 
 An important feature of the AVisconsin system is the active 
 
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4 CONTROL OF BOVINE TUBEKCULOSIS 
 
 co-operation of an educational body, the Agricultural College, 
 with a sanitary authority, the Live Stock Sanitary Board. In 
 addition to disseminating scientific and practical instruction 
 amongst the farmers, the experiment station of the Agricul- 
 tural branch of the University assumes the responsibility of 
 supervising a large amount of the tuberculin testing. The 
 annual returns of the tuberculin tests officially recognised by the 
 State are made under two heads — (1) tests made by the Stute 
 Veterinarian, and (2) tests made by the Agricultural Experi- 
 ment Station. The figures which I have quoted above 
 represent the combined totals of (1) and (2). 
 
 It is the policy of the Agricultural Experiment Station to 
 encourage the farmers to do the actual work of testing them- 
 selves. When a farmer applies to the Experiment Station for 
 tuberculin he is required to fill up a form stating the details of 
 his requirements and imdertaking — (1) to make the test within 
 30 days after the receipt of the tuberculin and to furnish 
 the station with a full report of the test on the form provided for 
 that purpose ; (2) in case any tuberculous animals ai'e found in 
 his herd, to remove them at once from the healthy portion of 
 the herd ; and (3) in case any tuberculous animals are found, 
 thoroughly to disinfect the stables occupied by the herd. This 
 undertaking has to be signed by the owner of the herd and by 
 the person making the test. The Experiment Station examines 
 the report of (the temperature records and then informs the owner 
 of the result of the test, the duty of the person actually making 
 the test being merely to record observations, not to interpret 
 them. Of the tests supervised in this way by the Experiment 
 Station during the year 1907-8, 25,719 were performed by the 
 farmers themselves, and 3,099 by veterinarians. The farmers' 
 tests seem to have been carefully recorded, the number which it 
 was found necessary to discard being only 77 ; the work of the 
 veterinarians, I was informed, exhibited a higher proportion of 
 error. The tuberculin which the Experiment Station supplies 
 to applicants is obtained free of charge from the Bureau of 
 Animal Industry at Washington. 
 
 The facts which I have quoted certainly indicate that some 
 progress is being made in Wisconsin towards the eradication of 
 bovine tuberculosis. Will this progress be maintained ? Perhaps 
 an answer to this question may be given with more i:;onfidence in 
 the course of the next few years, when further evidence will 
 have accumulated with regard to the following points : — (1) The 
 proof that after repeated testing the herds now certified to be 
 clean remain clean ; (2) the increase in the number of such 
 herds ; (3) the success of the farmers who are now trying to 
 eradicate the disease by the Bang method or by vaccination ; 
 (4) the extent to which farmers continue to resort to the alterna- 
 tive method of slaughter for the disposal of their tuberculous 
 stock ; (5) the continued willingness of the State to meet 
 demands for compensation which are made upon it; (6) the 
 evidence of an actual preference on the part of the public for 
 dairy prodtice from lierds which are free from tuberculosis. 
 
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IN WISCONSIN. 
 
 What appears to me the most encouraging feature of the system 
 now on its trial in Wisconsin is that it is mainly based on an 
 ap2)eal to the business instincts of the farmer. A large nvimber 
 of the farmers are enterprising, prosperous, making money 
 ra])iclly, and correspondingly anxious to make more. This is the 
 type nf person who is capable of looking to the future, and of 
 appreciating tlie financial advantages of eliminating tuberculosis, 
 without being deterred by the temporary disadvantages arising 
 from the length of time and difficulty involved in the attainment 
 of this object. He anticipates a better return from his cattle, a 
 better reputation and a higher price for his dairy products, and 
 an increased value for land in districts known to he free from 
 bovine tubercidosis. He would resent, and do his best to evade, 
 any attempts at coercion, and his desire to safeguard the interest.-, 
 of human health may not be more than commensurate with the 
 demand on the ]iart of his customers for food products frei^ from 
 pathogenic germs : but when he finds that rivals are ti-ying to 
 make more money l)y getting rid of bovine tuberciilnsis, his best 
 energies are stimulated, and he is determined not to be left 
 behind in the competition. 
 
 A feature of the Wisconsin system which has excited much 
 interest and not a little hostile criticism is that a large number of 
 tuberculin tests are performed by the farmers themselve-. The 
 State Agricultural College met with a storm of Djiposition from 
 the veterinary interests when it firsl advocated this policy, but 
 has steadily adhered to it, and believes that the method i< 
 thoroughly justified by the results. After I left Madison I had 
 many opportunities of discussing this point, both with men 
 whom I met in Washington at tlie Tuberculosis Congress and 
 in the course of my visits to several other towns in tlie Eastern 
 States. Opinions were by no means unanimous. Several men, 
 including prominent veterinary authoritit's spoke with approval 
 of the policy adopted in Wisconsin. The adverse criticisms may 
 be summarised as follows: — (1) The encouragement of the 
 farmers to do the testing themselves was detrimi^ntal to the 
 interests of the veterinary profession. (2) It was undesirable to 
 place tuberculin In the hands of farmers, since it gave them the 
 opportunity for "doping." (3) The farmers who performed 
 the test lacked the requisite scientific and clinical knowledge .; 
 the test was often applied to aninial^ which were not in a suitable 
 condition for it, and consequently a large percentage of error 
 crept in, rises of temperature supposed to be diagnostic being 
 frequently obtained when they were really due to some other 
 cause. (4) These blunders gave the tuberculin test a bad reput 
 and deterred farmers from avaihng themselves of its advantages 
 when employed by skilled veterinarians. 
 
 With regard to these four points I think the following com- 
 ments are justifiable. (1) It would certainly be to the interests 
 of the veterinarians to be employed in making the tests which 
 the farmers now do for themselves. (2) The fanners have to 
 give an account of all the tuberculin they receive ; possibly a 
 few of them try to u^e it dishonestly, if they think they can 
 
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6 CONTROL OF BOVINE TUBERCULOSIS 
 
 escape detection ; but the unscrupulous farmer who wants to 
 " dope " has never any difficulty in obtaining tuberculin privately 
 from a commercial firm. (3) I have not heen able to obtain 
 any precise or published statement as to the magnitude and 
 nature of the farmers' errors ; it would be interesting to know 
 how often this alleged lack of knowledge leads him (a) to record 
 an apparently tuberculous re-action in a non-tuberculous animal, 
 or ( 6 ) to miss a tuberculous re-actioe in an animal which ought 
 to have given it ; the former mistake, however undesirable, is 
 obviously less detrimental to the suppression of tuberculosis than 
 the latter. (4)1 have been unable to find any evidence that the 
 action of the Wisconsin farmers has damaged the repute of the 
 tuberculin test. 
 
 In conclusion, there may possibly be some little element of 
 truth in the adverse criticisms directed against the Wisconsin 
 methods ; precisely how much I do not feel competent to say. 
 It is clear that these criticisms are actuated, to some extent, 
 by a feeling that the Wisconsin authorities are interfering with 
 the legitimate pecuniary interests of the veterinary profession. 
 With regard to purely disinterested scientific consideration!;, 
 there is a complete consensus of opinion that the diagnosis of 
 tuberculosis by the tuberculin test demands both care and skill. 
 In this connection it must be pointed out that the Wisconsin 
 farmers have received instruction in the work at the Agricultural 
 College, and have obtained more practical information about the 
 test than is possessed by many veterinarians in remote country 
 districts of the Western States ; they are not entrusted with the 
 diagnosis, but merely with the inoculations and taking of 
 temperatures ; the diagnosis is made by highly competent 
 authorities at the Experiment Station, after careful scrutiny 
 of the records, and rejection of all charts showing signs of 
 careless work. Apart from the desire not to incur unnecessary 
 expense, an intelligent farmer, with these facilities at his 
 command, has reasonable ground for thinking that he can do 
 the work as well as a good veterinarian, and better than a 
 veterinarian of doubtful reliability. It is also worth noting that 
 in States where the work of tuberculin testing is mainly in the 
 hands of veterinarians, I have not found more tangible evidence 
 of progress towards the eradication of the disease than I have 
 found. in Wisconsin. 
 
 Pennsylvania. 
 
 During my visit to Philadelphia I obtained valuable informa- 
 tion concerning the control of bovine tuberculosis in Pennsylvania 
 from Dr. Leonard Pearson, the State Veterinarian. 
 
 In the Commonwealth of Pennsylvania the management of 
 afi'airs is in the hands of the State Live Stock Sanitary Board, 
 constituted in 1895. This Board consists of the Governor of the 
 Commonwealth, the Secretary of Agriculture, the State Dairy 
 and Food Commissioner, and the State Veterinarian. Its duties 
 are " to protect the health of the domestic animals of the State " 
 and " to determine and employ the most efficient and practical 
 
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IN PENNSYLVANIA. 7 
 
 means for the prevention, suppression, control or eradication of 
 dangerous, contagious or infectious diseases among the domestic 
 animals." 
 
 Attention may be called to some of the powers conferred on 
 this body. By an Act passed in 1897 they are authorised to 
 prevent the introduction from other States of "dairy cows and 
 such other cattle as are for breeding purposes" which have not 
 passed the tuberculin test. From an Act passed in 1905 
 "to further define the duties and powers of the State Live 
 Stock Sanitary Board " I quote the following provisions : — 
 ■'Section 1 That all practitioners of Veterinary Medi- 
 cine in Pennsylvania shall, immediately upon gaining informa- 
 tion thereof, report to the Secretary of the State Live Stock 
 Sanitary Board the occurrence among animals of any one of the 
 following diseases advanced or generahsed tuber- 
 culosis or tuberculosis of the udder Section 2. No 
 
 person who has knowledge of the existence of any one of the 
 
 diseases enumerated in Section one of this Act shall 
 
 (;on(;eal or attempt to conceal such diseased animal, or knci\\ ledge of 
 such diseased animal, from a member or aij;eiit of the State Live 
 Stock Sanitary Board Section 5. The maxi- 
 mum limit of appraisement that shall hereafter be allowed for 
 animals that it shall be deein(d to be neeessar}- lo destrov, to 
 prevent the further spread of a dangerous, contagi(nis oi' infections 
 disease, shall be as follows : For a horse or nude, forty dollar> ; 
 for a bovine animal, of pure breed or registereil stock, fifty 
 dollai'S ; for a bovine animal, of grade or common slock, twenty- 
 five dollars ; for a sheep or pig, ten dollars : provideil, however, 
 that the amount of appraisement shall not, in any case, exceed 
 three-fourths of the actual value of the animal at the time of 
 appraisement ; and provided further that tiie total apprai- eiuents, 
 in any one year, shall not exceed thirty-fivt! thousand dollars." 
 
 When a farmer wishes to obtain assistance; with a view to 
 eradicating tuberculosis, he is required to comply with certain 
 conditions. These are best explained by quoting extracTs from 
 the letter which he must address to the Live Stock Sanitary 
 Board. " I have reason to believe that some of my cattle are 
 afflicted with tuberculosis, and I wish to have my entire herd 
 inspected, and tested with tubercidin, if such test is deemed 
 necessary by your representative, and the diseased animals 
 disposed of according to the rules and regulations of the State 
 Live Stock Sanitary Board. I understand that this inspection 
 and test are to be made at the expense of the Commonwealth 
 and, in consideration thereof, I agree thoroughly to disinfect the 
 premises and correct faulty sanitary conditions and thereafter to 
 observe the precautions and measures and to employ the means 
 recommended by your Board to prevent the re-introduction and 
 re-development of tuberculosis in my herd. In particular, I 
 agree to purchase no cows for addition to my herd until they 
 have been proved by tuberculin test to be free from tuberculosis, 
 and if 20 per cent, of my present herd shall be found to be 
 tuberculous, I will have a re-test made under the supervision of 
 
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8 GONTEOL OF BOVINE TUBERCULOSIS 
 
 your Board, at my own expense, within eight months from the 
 
 time of the State inspection It is agreed, 
 
 that cattle showing physical symptoms of tuberculosis or that 
 re-act to tuberculin, shall at once be separated from cattle showing 
 no evidence of tuberculosis, and shall be quarantined ; their 
 milk shall not be used for any purpose until it has been 
 pasteurised for ten minutes at 165°F., or has been boiled. The 
 further disposition of such quarantined cattle shall be as 
 follows : — 1. Cattle affected with tuberculosis of the udder, 
 or with advanced or generalised tuberculosis, shall be appraised 
 and killed. The carcases of such cattle shall be disposed of 
 on the farm by cremation or burial, or shall be disposed of 
 through an approved fertilizer works. 2. Cattle that re-act to 
 tuberculin, but that show no physical (external) signs of tuber- 
 culosis, may be continued in quarantine, subject to the conditions 
 in respect to separation from sound cattle and the steriUsation 
 or adequate pasteurisation of milk as stated above, and subject 
 to the further provision that calves^ from cows so quarantined 
 shall, immediately after birth, be removed from contact with 
 quarantined cattle, and from infected premises, and shall be fed 
 with milk from sound cows, or sterilised or adequately pasteurised 
 milk from quarantined cows. 3. Quarantined cattle, as described 
 under paragraph 2, may, upon special permit, be removed to a 
 slaughter-house, there to be killed in the presence of a veterinary 
 inspector of the federal or of a local meat inspection service, 
 or in the presence of an agent of the State Live Stock Sanitary 
 Board. The disposition of the carcases shall be in accordance 
 with the rules of the United States Meat Inspection Service, 
 or of the State Live Stock Sanitary Board. If, after such 
 inspection, the carcase be passed, the owner shall receive the 
 entire income from the sale thereof, in lieu of indemnity from 
 the State. If the carcase is condemned, it shall be appraised as 
 
 beef as provided by the Act " The Act referred 
 
 to allows compensation at the rate of " not more than five cents 
 per pound for the dressed meat, nor more than twenty-five 
 dollars for the entire carcase." To obtain the highest rate, the 
 meat must be of the best quality, described as " choice or prime." 
 Beef which is " medium to good " is rated at 3| to 4^ cents per 
 pound ; an inferior quality, termed in the trade " sUppery or 
 cutter," is rated at 2^ to 3^ cents per pound, and the lowest 
 grade, termed " Bologna or canner," is rated at 2 to 2^ cents 
 per pound. 
 
 In considering the practical working of the above enactments 
 it is instructive to refer to the report made by the State Veter- 
 inarian in 1906. In urging the desirability for establishing 
 better methods for dealing with tuberculous cows. Dr. Pearson 
 remarks : — " The State Live Stock Sanitary Board is not pre- 
 pared to provide compensation for all of the tuberculous cattle that 
 are reported. It is still less prepared to provide compensation 
 for all of the tuberculous cattle that might be found if a systematic 
 inspection of dairy herds were instituted. Consequently, this 
 
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IN PENNSYLVANIA. 9 
 
 outlet for tuberculous cattle, thorough appraisal and destruction 
 by the State is not sufficient. The only other outlet is the 
 slaughter-house, and to butcher mUch cows is to incur a great 
 loss. Many of these cows might safely be used for varying 
 periods, up to a few years, in the dairy and for breeding if certain 
 well-known and perfectly well-understood and established pre- 
 cautions were observed. If certain farms could be provided and 
 set aside for maintaining herds of cows that have re-acted to the 
 tuberculin test, this would provide another outlet for such 
 animals .... If there wei'e n certain demand for re-acting 
 cows from men who would isolate them and keep them under the 
 strict sanitary supervision that would be necessary, an additional 
 encouragement would be affi^rded the owner of tuberculous cows 
 to get rid of them by providing a higher price than is paid by 
 the State. This would gi-eatly facilitate the concentration and 
 sequestration of infected cows, under conditions where they could 
 be carefully watched and their products pasteurised so that they 
 could do no harm, and would tend to encourage their removal 
 from unwatched, uninspected herds where they now exist in large 
 numbers and where the raw, virulent milk is sent to market with- 
 out pasteurisation or restriction of any kind. ... A good 
 deal of progress in the repression of tuberculosis of cattle is being 
 made, but the disease is so widespread and so dangerous that it 
 is desirable that more ra])id progress shall be made. The 
 question is largely one of finance." 
 
 Treatment of cattle by the Bang method has lieen recom- 
 mended to the people of Pennsylvania, but does not seem to have 
 become popular. Dr. Pearson writes : — " It is important to 
 note that the Bang system has never been widely used outside of 
 Denmark, and its use is diminishing rather than growing in that 
 country. That is not because it is not effective — it is effective — 
 but because it involves extra labour, watchfulness, care and 
 expense for such a long time that only a few herd owners have 
 the courage and perseverance to carry it out. It is unfortunate 
 that this is so, for this system furnishes a method to gradually 
 eradicate tuberculosis at a minimum of loss. It is conservative 
 to the last degree. Those who have carried it out correctly have 
 had good results. But we have to take the facts as they are 
 and to recognise that the Bang system in its entirety is not likely 
 to be used extensively in this country." 
 
 For several years the question of vaccinating cattle against 
 tuberculosis has engaged the attention of the State Live Stock 
 Sanitary Board, and an experimental herd, containing over 100 
 animals has been established for the purpose of studying the 
 value of this method. The vaccine u>;ed is a shghtly virulent 
 virus isolated from the sputum of a consumptive girl. It is of 
 rather low virulence for guinea-pigs, is not virulent for rabbits, 
 and has never been known to cause infection in cattle unless 
 given in enormous dosage to young calves. The method 
 employed is to administer Intravenously three successive doses of 
 living bacilli at intervals of from six to eight weeks. In 
 
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10 CONTROL OF BOVINE TUBEECULOSI8 
 
 September, 1906, Dr. Pearson reviewed the results of the work 
 and wrote : — " Not one animal that has been vaccinated in 
 
 accordance with the method that we are now using 
 
 has become tuberculous from natural exposure to the disease, nor 
 has an animal been injured by vaccination. With such evidence, 
 covering four years and a large [number of cattle, we have felt 
 that we are amply justified in recommending vaccination and in 
 
 applying it in practice It is planned to introduce 
 
 it gradually, using it at first where it is most needed and where 
 
 the conditions are such as to give it a fair trial. , It 
 
 is for the present applied only by specially trained men from the 
 State Laboratory. Cattle have been vaccinated in nearly all 
 parts of the State, and the method is having a chance to prove its 
 
 wolth under widely varying conditions It is 
 
 quite premature to apply vaccination against tuberculosis 
 
 promiscuously — to exploit it commercially This 
 
 control should not be left in the hands of a commercial house 
 interested in placing the greatest possible amount of produce on 
 
 the market Vaccination against tuberculosis is 
 
 free in this State so far as the resources of the State Live Stock 
 Sanitary Board will permit. The process is useful in all breeding 
 herds where there is tuberculosis, and by its use sound animals 
 can be produced from tainted ancestry more easily and surely 
 than by the Bang method, and their continued freedom from 
 infection can be insured. Already prospective buyers are 
 inquiring of me as to where they may find vaccinated cattle, and 
 this preference is likely to increase and to develop a definite 
 market demand." 
 
 Some idea of the magnitude of the problem to be dealt with in 
 Pennsylvania and of the public money expended on it by the 
 State may be gathered from the foUomng statistics taken from 
 the Report of the Pennsylvania Department of Agriculture for 
 the year 1906. According to the last available estimate of the 
 United States Department of Agricultm-e, there were in 
 Pennsylvania 1,141,494 milch cows valued at $41,093,784, and 
 984,750 other cattle valued at .$17,479,308. For the year 1906 
 the State Live Stock Sanitary Board of Pennsylvania had avail- 
 able $45,000 for its general work in repressing diseases of animals. 
 Expenditures under this fund were as follows : — for tuberculous 
 cattle, $23,344 ; for inspecting tuberculous cattle and herds, 
 $3,886 ; for horses afflicted with glanders, $2,941 ; for inspections 
 for the repression of diseases other than tuberculosis, for 
 vaccination, &c., $4,293 ; for the cost of enforcing quarantines, 
 for materials used in making tubercLilin, for making and shippino- 
 tuberculin, for the diagnosis of specimens, &c., $3,309 ; for oflfice 
 and miscellaneous expenses, $4,554 ; for the enforcement 
 of the law requiring the inspection of cattle shipped from 
 other States, $2,670. For the same year the Veterinarian 
 reports : — " During the year it has been necessary to condemn 
 1,536 tuberculous cattle from 858 herds. A very much larger 
 number of tuberculous cattle than this is annually disposed of tn 
 
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IN PENNSYLVANIA. 11 
 
 cattle buyers, who re-sell them for slaughter. The tuberculous 
 (!Ows that are appraised and paid for by the State are the pro- 
 perty of conscientious men who would not knowingly sell an 
 infected animal where it might spread disease, or they are cows 
 that are suffering with tuberculosis in such advanced forms that 
 they are not saleable, or they are cattle that re-act to the tuber- 
 culin test when this test is applied to the entire herd." 
 
 With regard to the Pennsylvania method and its worldng, 
 the following observations may be offered. 
 
 1. Three types of tuberculosis in cattle are regarded as 
 particularly dangerous, and concealment of these is prohibited 
 by law. These are : — (a) advanced tuberculosis, (b) generalised 
 tuberculosis, and (e) tuberculosis of the udder. 
 
 2. The total annual sum available for compensation is 
 obviously insufficient to do much towards eradicating the 
 disease. 
 
 3. Farmers are invited to apply to the Sanitary Board for 
 the testing of their herds. I understand that applications are 
 so numerous that it is impossible for tho Board tn grant an 
 inspection in every case. An effort is made to select for 
 inspection those herds Avhich, from tlie <lcscrii)tion furnished by 
 llic farmer, are most likely to contain diseased animals. When 
 herd owners desire an inspection, but have no s])((ial grounds 
 for thinking disease exists, they may ol)tain it, but must ])av 
 for it; if the herd is found to l)e free fr(im tul)erculosis they 
 receive a certificate of health. 
 
 4. When a farmer is to have his herd tested free of charge, 
 and to receive compensation for re-acting animals, lie nuist sign 
 an agreement, tlie gist of which is that the State will clean up 
 the inan's herd, jnovided that the man will keep it elean. The 
 State forthwith ])erfiirnis its part of the bargain, but is there 
 any adequate guarantee that the farmer will perform liis ? I 
 was not able to obtain any statistics as to the number of herds, 
 inspected free of charge by the State, which have remained 
 clean. It seems difficult to understand how this " agreement " 
 can be regarded as a valid contract, with a legal sanction behind 
 it compelling the farmer to fulfil his part of the bargain. 
 
 5. When the farmers keep their re-acting animals in quarantine, 
 under the requirements specified, it must require a large amount 
 of vigilant State supervision to see that these requirements are 
 faithfully observed, and continue to be so observed. 
 
 6. The permament value attaching to the a-^sistance afforded 
 hv the State must depend on the enterprise of the individual 
 farmer, on the earnestness of his desire to keep his herd firee 
 from disease, and on the facilities for his doing so on a basis 
 commercially satisfactory to him. 
 
 7. It seems that the existing regulations have not been 
 effective in preventing the s;ile of milk containing living tubercle 
 bacilli. 
 
 8. Dr. Pearson's scheme for utilising infected cows on a 
 commercial ba-is is interesting ; but under present conditions, at 
 
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12 CONTKOL OF BOVINE TUEEECULOSIS 
 
 least in most countries, it seems to be more profitable and more 
 feasible to conceal, or not seek to discover, the condition of such 
 animals, and to obtain for their products the same market value 
 as that obtainable for the products of healthy animals. 
 
 9. It is significant and disappointing to find that the 
 Pennsylvanian farmers, though apparently desirous of eradi- 
 cating tuberculosis and aware that success must depend largely 
 on their own efforts, have not made more use of the Bang 
 system. 
 
 10. Dr. Pearson has done a great deal to stimulate interest in 
 vaccination against tuberculosis, and in many parts of the States 
 I have heard favourable opinions of his work. The method of 
 keeping down tuberculosis by means of vaccine treatment is very 
 commonly spoken of as " the Pearson method." At a large dairy 
 farm which I visited in the State of Maryland I was told by the 
 owner, who was exceptionally well informed and enterprising, 
 that the elimination of tuberculosis from his cattle was largely 
 due to the vaccine treatment which had been carried out under 
 the direction of Dr. Pearson. Results such as these are distinctly 
 encouraging ; but it seems safest, at present, to regard the 
 method as still on its trial, and to remember that its reliability 
 has not been substantiated on so extensive a scale as has that of 
 the Bang method. 
 
 11. Statistics indicate that much remains to be done before 
 tuberculosis can be eradicated from the very large number of 
 dairy cattle in Pennsylvania. I am told that progress is being 
 made, though perhaps slowly, and that the inspections of animals 
 slaughtered for meat indicate some diminution in the amount 
 of tuberculosis. The work of the Pennsylvanian Live Stock 
 Sanitary Board has a high reputation throughout the United 
 States. 
 
 Massachusetts, 
 
 During my stay in Boston, Dr. Austin Peters, Chief of the 
 State Cattle Bureau, kindly provided me with information con- 
 cerning the methods of dealing with bovine tuberculosis in 
 Massachusetts, 
 
 In 1892 the Massachusetts Legislature declared tuberculosis 
 to be one of the contagious diseases of animals, and the control of 
 the disease was taken in hand by the Board of Cattle Com- 
 missioners. During their first year of oflSce this Board destroyed 
 81 tuberculous cattle without appraisal or payment. In 1894 
 the Board introduced the use of tuberculin for diagnosis and 
 employed it on a large scale. The test was applied to aU cattle 
 quarantined on suspicion by local inspectors, and upon cattle 
 brought into Massachusetts from adjoining States. The Com- 
 missioners also commenced a systematic testing of entire herds 
 and declared that it was their intention to test all the herds in 
 the State and kill re-acting animals, starting in the South-east 
 corner. In this year it was provided that one-half the value of 
 cattle killed as tuberculous by State authority should be paid by 
 
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I\ MASSACHUSETTS. 
 
 l3 
 
 the Commonwealth, the appraisal to be based on the value of the 
 animals for food or milk. In 1895 the law regarding compensa- 
 tion was changed, and the full appraised value (not exceeding $60) 
 for each animal killed was allowed, provided that the condemned 
 animal had been owned in the Commonwealth for at least six 
 months prioi- to condemnation. In 1899 the limit of value for a 
 tuberculous animal was reduced to $40. In 1902 the Board of 
 Commissioners was abolished and their powers were vested in one 
 man, the Chief of a newlj-constituted Cattle Bureau. The cost 
 to the State of compensating for cattle under the auspices of the 
 Cattle Commission or Cattle Bureau is shown in the following 
 table :— 
 
 
 Year, 
 
 Number of 
 
 Amount paid 
 
 
 
 Cattle Killed. 
 
 for Cattle. 
 
 
 
 1896 
 
 5,748 
 
 189,216 
 
 
 
 1897 
 
 5,529 
 
 188,534 
 
 
 
 1898 
 
 297 
 
 8,057 
 
 
 
 1899 
 
 785 
 
 17,277 
 
 
 
 1900 
 
 1,423 
 
 30,870 
 
 
 
 1901 
 
 1,341 
 
 27,424 
 
 
 
 1902 
 
 1,001 
 
 21,137 
 
 
 
 190.3 
 
 1,843 
 
 42,454 
 
 
 
 1904 
 
 1,658 
 
 35,54(5 
 
 
 
 1905 
 
 1,625 
 
 34,133 
 
 
 
 1906 
 
 1,737 
 
 35,952 
 
 
 
 1907 
 
 2,030 
 
 42,326 
 
 
 
 Totals. 
 
 25,017 
 
 5:672,842 
 average price 
 
 
 During the 12 years recorded the 
 
 jaid per 
 
 head foi 
 
 • the cattle kill 
 
 ed is $26-89. 
 
 The maximum 
 
 ax'crage 
 
 price per annum was $34, paid in 1897. Since then the average 
 price has diminished, and during the last few years it has been 
 between .'ij!20 and $2\. Dr. Peters explains tliese fluctuations 
 as follows : — "' The reason for the high prices paid in 1896-97 
 was due to the fact that all animals quarantined by the local 
 inspectors and many large herds were tested with tuberculin, 
 and all re-acting animals killed, no matter how slightly diseased 
 they might be, and many of these animals were apparently in 
 good physical condition, "while at the present time only animals 
 that show marked physical (nidence of disease, or that have 
 nodulated udders, are killed, and nearly all are condemned on 
 a physical examination." 
 
 It will be noted that in the years 1896-97, the sums expended 
 were very large. The experience of these years revealed the 
 wide extent to which tuberculosis was prevalent, and the 
 enormous cost of the project on which the authorities had 
 embarked. Then a re-action set in, which is well shown by the 
 relatively small >nms expended in the two following years. 
 
 B 
 
 342?.-. 
 
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14 CONTROL OF BOVINE TUBEKCULOSIS 
 
 After this period, as the annual expenditures show, there was 
 a renewal of enterprise, but on a much more modest and less 
 expensive scale than in the first two years. 
 
 Has the Commonwealth of Massachusetts obtained good value 
 for its money ? In answer to this question I quote the following 
 remarks of Dr. Peters :— " It is doubtful if the work at present 
 being carried on against bovine tuberculosis in Massachusetts 
 accomplishes much in the direction of decreasing the percentage 
 of tuberculosis among the herds of the State, as a fresh crop 
 of badly diseased cattle, mostly cows, is harvested year after 
 year ; if anything, it would appear that there is a slight increase, 
 as the number of condemned cattle has gradually increased a 
 little, varying somewhat from year to year, from 1,423 in 1900 
 to 2,0:J0 in 1907. To do more work and gain greater headway, 
 larger annual appropriations for the use of the Cattle Bureau 
 will be needed. The greatest possible amount of work is being 
 done with the means available at the present time." 
 
 With a view to protecting the Commonwealth against the 
 introduction of tuberculosis from other States or countries, it is 
 enacted that cattle imported into Massachusetts shall be delivered 
 directly to special quarantine stations at one of three places, 
 Watertown, Brighton and Somerville. They there come under 
 the following restriction : — " All cattle, except those for imme- 
 diate slaughter, or calves under six months old, intended to be 
 kept in the State permanently, must be tested with tuberculin by 
 an agent of the Cattle Bureau after arrival at destination, the 
 only exception being cattle brought in from foreign countries 
 which have passed a test given by an agent of the United 
 States Bureau of Animal Industry." 
 
 Over 21,000 head of cattle are brought into the State annually 
 for dairy and breeding purposes, and as these are tested, there is 
 a large number of reliable animals available for purchase. Com- 
 menting on this fact. Dr. Peters remarks : — " If every farmer 
 when he buys a new cow would disinfect the stalls where the old 
 ones stood, and then buy only tested cows to replace the old ones, 
 there would be much less tuberculosis than there is to-day ainong 
 the milkmen's herds in Eastern Massachusetts ; but, as it is, 
 many of these healthy cows are taken to infected barns and later 
 sold to the State or to the bologna sausage maker because they 
 have gone to pieces with tuberculosis. The average milkman 
 will buy any good-looking cow he sees on the Brighton market 
 and does not seem to care whether she is a healthy tested cow 
 from without the State or an untested Massachusetts cow." 
 
 There is a special restriction on the use of tubercuKn in 
 Massachusetts, the law being as follows : — " Tuberculin as a 
 diagnostic agent for the detection of tuberculosis in domestic 
 animals shall be used only upon cattle brought into the Com- 
 monwealth and upon cattle at Brighton, Watertown and Somer- 
 ville ; but it may be used as such diagnostic agent on any animal 
 in any other part of the Commonwealth, with the consent in 
 writing of the owner or person in possession thereof, and upon 
 
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IN MASSACHUSETTS. 15 
 
 animal?; which have been condemned as tiibin-cnlous upon physical 
 examination bj a competent veterinaiy surgeon. Such test< by 
 the u;se of tuberculin shall be made without charge to citizen* o£ 
 the Commonwealth, and in all other cases the expense of such 
 tests shall be paid by the owners of such animals or by the 
 person in possession thereof." 
 
 With regard to the work in Massachusetts the following 
 observations may be made. 
 
 1. As soon as the authorities attempted to destroy 
 animals on a large scale, they foimd it necessarv to give 
 compensation. 
 
 2. Owing to the enormous cost which would have been 
 involved, the original project of systematically working through 
 the country and wiping out every animal which re-acted to the 
 test had to be abandoned. 
 
 .3. An additional feature of extravagance in the early part of the 
 work was that all meat from re-acting animals, however slightly 
 diseased, was regarded as unfit for food. This was rectified in 
 18'*8, when the principles of the United States Bureau of Animal 
 Industry regarding the condemnation of carcases were adopted. 
 
 4. In the earlier dates, at least, the farmers do not appear to 
 have appreciated the spirit in which com])ensation was oflTered. 
 I am informed that they did not treat it as an incentive to get rid 
 of tuberculosis, but desired to avail themselves of the help of tlie 
 State "as a matter of speculation, with the idea of selling a lot 
 of old milked-out cows to the Commonwealth for more than they 
 were worth." 
 
 5. The average price paid in compensation has fallen from .34 
 to about $20, the reduction being due to the fact that at the 
 present time only animals which show marked physical evidence 
 of disease are killed. This cannot be regarded as pure economy 
 unless it can be shown that the less severely diseased animals are 
 dealt with in a satisfactory manner. If these latter animals are 
 allowed to live until they become severely diseased and to 
 disseminate the disease to others, the compensation for the badly 
 diseased animals will do nothing towards checking tubei-culosis, 
 but will rather encourage its propagation. To encourage a 
 farmer to make all the profit he can out of a cow until she is 
 broken down with disease and then to give him a solatium of $20 
 would be an ideal method of fostering and disseminating 
 tuberculosis. 
 
 6. The Chief of the Cattle Biu-eau thinks that tuberculosis 
 has not diminished, but that, '' if anything " it has slightly 
 increased. He adds that to "gain greater headway" the 
 expenditure of more money is necessary. 
 
 7. Massachusetts, like most of the States which I have visited, 
 is extremely anxious not to be made the dumping ground of the 
 tuberculous rubbish from other States. This is perhaps one of 
 the more encouraging features in the American campaign against 
 bovine tuberculosis. Nothing stimulates the enthusiasm of a 
 State more readily than the fear that its neighbours are 
 
 M2ir> B i 
 
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16 CONTROL OP BOVINE TUBEECULOSIS 
 
 trying to impose on it. It is easy to get money voted for 
 the purpose of defeating the supposed sinister designs of other 
 communities, and a good deal of trouble is taken to see that the 
 work is done effectively. The consequence is that in the ^large 
 number of reliably tested cattle which come in from other States 
 the farmer has a valuable source from which to replenish his 
 herds. 
 
 8, In order to reap the full financial advantage from these 
 imported cattle the farmer should not merely avoid introducing 
 them into infected barns, but should see that they are allowed to 
 associate with none but healthy tuberculin-tested animals. But 
 without the adoption of systematic tuberculin testing in the home 
 dairies this is not possible. Owing to the limited use of tuber- 
 culin in Massachusetts, it seems that the danger of infecting 
 imported cattle by contact with home-bred cattle is not adequately 
 guarded against, and consequently the care taken to secure a 
 yearly influx of healthy cattle does not seem to result in a per- 
 manent addition to the healthy stock of the community. 
 
 Minnesota. 
 
 Whilst travelhng in this State, I spent some days in 
 Minneapolis and the adjoining capital city of St. Paul. At 
 the latter city I visited Dr. Bracken, Secretary of the State 
 Board of Health for Minnesota, and through his kindness was 
 put in touch with the veterinary department of the sanitary 
 service. 
 
 The central authority responsible for the control of bovine 
 tuberculosis is the State Live Stock Sanitary Board. This 
 Board consists of five members. It is enacted that " three shall 
 be persons financially interested in the breeding of live stock 
 in the State ; and the other two practising veterinarians and 
 graduates of a regularly organised and recognised veterinary 
 college." It is unlawful to bring into the State animals which 
 have not been examined and found free from disease, and in the 
 case of cattle the tuberculin test is demanded. When convicted 
 of violating this law, " any transportation company, corporation, 
 
 or agent thereof shall be fined for each offence not 
 
 less than |500, nor more than |1,000, or be imprisoned for not 
 more than one year." 
 
 Provision is also made for the testing, by officials of the Board, 
 of herds of cattle within the State, and compensation is given 
 for animals which re-act and are condemned. The animals are 
 appraised, the maximum appraisal being $35 for a^ cow of 
 common stock and $75 for a pure-bred cow. If upon slaughter 
 the animal is found free from disease, the owner receives the 
 full amount of appraisal, less the value of the carcase. But if 
 the animal is found diseased, " the value of the carcase shall 
 be deducted from the appraised value ot the living animal, and 
 three-fourths of the remainder shall be paid to the owner by the 
 Stfitc, provided, the animal has been kept for one year in good 
 
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IN MIN'NESUTA. 
 
 17 
 
 faith in the State prior to killing thereof." In commenting on 
 these maximum values for appraisal, which appear to have heen 
 fixed on the assumption that condemned animals could, for 
 purpose of appraisal, be regarded as sound animals, the 
 Attorney-General has declared that it is unconstitutional to 
 appraise animals infected with tuberculosis as sound animals, 
 and that they should be appraised " at their actual cash value 
 immediately prior to killing." 
 
 For the year ending July 31st, 1907, the State tested 18,022 
 cattle, including 1,957 imported cattle, and killed, on account of 
 tuberculosis, 1,165, out of which 54 were imported cattle. The 
 statistics of cattle tested within the State are tabulated according 
 to the counties where they are located, and my attention was 
 called to certain counties which show a relatively low percentage 
 of infected animals. I select the following examples : — 
 
 County. 
 
 Number of 
 Animals Tested. 
 
 Number Killed. 
 
 Hennepin 
 
 Ramsey 
 
 Ric3 
 
 St. Louis 
 
 4,856 
 3,402 
 1,071 
 1,831 
 
 IMl 
 
 102 
 
 58 
 
 36 
 
 As a further illustration of the amount (if work done and the 
 cost of compensation incurred by the State, the assistant 
 secretary kindly co{)ied out for me the statistics tor the year 
 ending July 31st, 1908. The lumiber of pedigree eattle tested 
 was 1,329, and of these, 490 re-acted, or 36'8 per cent. Of the 
 re-acting animals, 428 were killed, 199 of them being passed as fit 
 for food and the rest condemned. The appraised value of these 
 428 animals was |27,770 (average !^63-94), the value of the 
 carcases |5,296 ; and the amount due from the State for 
 compensation was ijl 7,460. The number of cattle belonging- to 
 common stock which were tested was 25,887. Of these, 2,000 
 (or 7"72 per cent.) re-acted, and 1,940 were then killed. 851 
 were passed as fit for food, and 946 were condemned. In 52 no 
 lesions were found, and eonstquently the State was ret^uired to 
 pay the full appraised value of these. The total appraised value 
 of all the animals appraised was s51,027, and the amount due 
 from the State as compensation for them was 827,104. The 
 tuberculin used in the above tests was received fi-ee of charge 
 from the Bureau of Animal Industry at Washington, 
 
 The Secretary to the Board has been endeavouring to convince 
 dealers that it would be profitable to establish a business confined 
 exclusively to eattle proved by the tuberculin test to be free 
 from disease. In his report lor the year ending July 31st, 1[07, 
 he states that a firm has established business on these lines. 
 They buy Minnesota cattle at their own risk and get themtested 
 and tagged by the Live Sl( ck Sai.itary Board free of charge, as 
 
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18 CONTROL Oir BOVINE TUBEKCULOSIS 
 
 the Boivd thinks that an enterprise of this nature deserves 
 encouragement. It is stated that dairymen who desire_ such 
 cattle may buy from this firm " at practically the same price as 
 that asked for untested cattle." If this is the case, it is difficult 
 to see what commercial advantages the firm in question has been 
 able to secure for itself. 
 
 With regard to the working of the Minnesota system, I found 
 that opinions differed as to the amount of substantial progress 
 which had been made towards the eradication of tuberculosis. 
 Some people considered that the results were highly satisfactory ; 
 others were less sanguine. Last season a Bill was brought before 
 the Legislature proposing the compulsory testing with tuberculin 
 of all cattle within the State. The Bill was rejected, as it was 
 recognised that the amount and cost of the work involved would 
 be so great as to render the task impossible. I was unable to 
 obtain statistics as to the percentage of cattle in the State which 
 have not yet been tested. The figures I have quoted show that 
 a good deal of work is being done and that the State is willing to 
 expend a fairly large annual sum in compensation. Is the State 
 obtaining good value for its money ? Is the percentage of 
 healthy stock increasing ? I was not able to obtain the data 
 requisite to formulate an answer to these questions on a statistical 
 basis. What seemed to me the most interesting feature about 
 the work was the widespread desire to enhance the reputation of 
 Minnesota as a State possessing a large number of tested and 
 healthy cattle. The commercial advantages of such a reputation 
 are recognised ; and as any claims to this reputation are always 
 keenly criticised by commercial rivals, there is a strong incentive, 
 to continue the work along lines yielding substantial evidence of 
 progress. 
 
 New York State. 
 
 Whilst at Ithaca I had the opportunity of discussing the 
 subject of bovine tuberculosis with Professor Veranus A. Moore, 
 of the New York State Veterinary College of Cornell University. 
 
 The State of New York vests important powers in the Comr 
 missioner of the Department of Agriculture. He may direct 
 that an animal shall be condemned, quarantined or slaughtered as 
 tuberculous if it shall be found to be tuberculous by a physical 
 examination. If the owner of animals suspected of being 
 tuberculous desires to have such animals tested with tuberculin, 
 a test .shall be made by a medical or veterinary practitioner 
 designated by the Commissionei-, provided that the owner first 
 enters into a written agreement that he will disinfect his premises 
 and either consent to the slaughter of the animals responding to 
 the test or hold them and their products in strict quarantine, 
 pursuant to the Commissioner's directions. The Commissioner 
 may also, " in his discretion," order a tuberculin test to be made, 
 and may cause re-acting animals to be slaughtered or held in 
 strict -quarantine. The written agreement which the owner has 
 to sign contains ten requirements, viz., (1) separation of healthy 
 
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IX XEW YORK STATE. 19 
 
 iinimals from all animals having or suspected of having tuber- 
 culosis, (2) disinfection, (3) improvement of faulty sanitary 
 conditions, (4) to allow a retest at such time or times as the 
 Commissioner deems necessary, in case tuberculosis is indicated 
 by the tuberculin test, (5) to permit the slaughter of any animal 
 having tuberculosis of the udder " or the disease elsewhere so far 
 advanced as to be indicated by physical examination," (6) to 
 quarantine or " propei'ly dispose of" all other re acting animals, 
 (7) to carry out such other measures as may be recommended by 
 the department to maintain the herd free from tuberculosis, (8) 
 " not to use or sell for food or feeding purposes any milk from 
 an animal believed, after a physical examination, to have tuber- 
 culosis ; nor to sell such milk for any other purpose except upon 
 approval of the Commissioner of Agriculture," (9) " not to use 
 for sale, feeding or otherwise, milk from any other animal 
 believed, after a tuberculin test, to have tuberculosis, unless such 
 milk has been pasteurised at 185"^ F.," (10) "not to add any 
 animal to the healthy herd unless it is found to be free from 
 tuberculosis (by tuberculin test, if such test was used for the 
 herd ; and by at least two tuberculin tests if the animal to be 
 added came from an infected liei-d)." Three different methods 
 of examining herds are ofl'ered by the State, and the applicant is 
 required to say which he wants. These mcthocls are — (1) the 
 tuberculin test, (2) physical examination + a tuberculin test, if the 
 physical examination indicates the presence of tuberculosis, (3) 
 physical examination alone. 
 
 Under the direction of the Commissionei' there is a Chief 
 Veterinarian who has general charge of the enforcement of the 
 Act relative to the control of bovine tuberculosis and is also re- 
 quired to disseminate, through farmers' institutes or otherwise, 
 information concerning the care of animals, the prevention of 
 disease, methods of feeding, and methods of improving the breed 
 or milking qualities of cattle. 
 
 Compensation is given under certain conditions, the maximimi 
 appraised value being |75. When an animal on slaughter is 
 found to be free from disease the full appraised value is given ; 
 if the animal has localised tuberculosis the owner receives 80 per 
 cent, of the appraised value ; and if the animal has generalised 
 tubercidosis the owner receives 50 per cent. 
 
 The laws of New York State relating to diseases of domestic 
 animals have been frequently revised ; the extracts quoted above 
 are fi-om a copy of the law as amended up to July 1st, 1908. 
 
 How much has already been accomplished in ^' ew York State? 
 Professor Veranus ^Moore, who holds a high reputation through- 
 out the States as a carefid and impartial critic, does not take a 
 very favourable view. The amount of money voted for the 
 execution of the law has varied from year to year, and prior to 
 1907, when it was .SoO,000, the sum has not exceeded .$35,000. 
 As the expenses involved by other infectious diseases of animals, 
 including rabies, anthrax, and glanders, have to be paid out of this 
 fund, the amount left for luberculo.-is has been entirely inadequate 
 
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20 CONTROL OF BOVINE TUBERCULOSIS. 
 
 for effective work. Writing in Octo'ber, 1907, Professor ^oore 
 says :— " The law, although carried out, has not had the effect of 
 reducing permanently the amount of tuberculosis in the cattle of 
 the State. As interpreted and executed, herds, or as many of 
 them as the available funds permit, are examined when then- 
 owners apply for such examination, or upon the complaint or 
 those suspecting that milk is being sold from diseased cows. The 
 latter class of cases, when investigated, is under authority of a 
 statute relating to pure milk. While the statute provides for 
 proper disinfection it does not make provision for retesting and 
 the further elimination of re-acting animals. The result is that 
 within a few years after the re-actors are killed the herd is hable 
 to be as extensively diseased as in the beginning, beca,use of the 
 holding over of animals which were infected at the time of the 
 test but in which the disease had not begun to develop or in 
 which it was temporarily healing. Under such conditions the 
 State can continue to buy diseased animals, as the cattle owners 
 are continuing to raise tuberculous ones. . . . The New 
 York law does not seem to fully take into account the nature of 
 the diseases it is supposed to control. This is especially true of 
 tuberculosis, for the statute concerning it does not seem to be 
 intended for the carrying out of efficient and systematic methods 
 I or its eradication but rather to simply touch in a palliative way 
 the herds here and there where it is or where it is thought to be 
 most apparent and its effects most distressing." 
 
 Conclusions and Suggestions. 
 
 Is it possible to eradicate bovine tuberculosis ? In recording 
 the information which I have obtained from America, I have 
 given prominence to what seem encouraging features in the 
 problem ; and from these it would appear that under specially 
 favourable conditions, where the farmers are enterprising, well 
 informed, and prosperous, where the country is comparatively 
 new and thinly populated, and where the proportion of infected 
 to healthy animals is relatively low, areas of considerable size 
 may become eventually free from the disease. But, regarding 
 the conditions of the country as a whole, the general outlook is 
 not hopeful. The disease is so widely disseminated, and the 
 economic obstacles to its elimination are so excessively great, 
 that it is impossible, even by a generous interpretation of the 
 efforts which are being made, to put together tangible evidence 
 of substantial success on the lines which have hitherto been fol- 
 lowed. Tuberculosis progresses so insidiously, persists so long 
 before manifesting its presence by physical signs, and has taken 
 so firm a hold on the stock of the country, that there is not the 
 least hope of being able to stamp it out by the application of any 
 simple and drastic measures which have been effective in eliminating 
 other infectious diseases. This, I consider, is the first lesson to be 
 learnt from the disappointing results which have attended some 
 of the American schemes. It is, so far as my observations enable 
 me to speak, useless to attempt the formulation of amj general 
 
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CONCLUSIONS AN'D SUGGESTIONS. 21 
 
 plan for the ronipUte eradication of bovine tuberculosis througliout 
 this country icithin a limited period. 
 
 As the embarcation on too comprehensive a scheme leads to 
 failure and the wastage of public money, it is evident that the 
 problem must be attacked piecemeal. In aiTanging a plan of 
 campaign the first thing to decide upon is how to dispose of 
 the rubbish, i.e., dairy cows which are so obviously diseased 
 that they have no market value as live stock. They must be 
 destroyed. This is a necessity about which all American 
 authorities are agreed. It is a matter of importance to define 
 the essential reason for this necessity, and upon this point I 
 have had several discussions with my American fi-iends. Their 
 general opinion, which I believe to be thoroughly sound, is that 
 the community must view the question from the commercial 
 standpoint, and that the essential reason why these animals 
 should be destroyed is that they are a menace to the agricultural 
 interests of the community. Obviously the interests of public 
 health are also involved ; but as they are coincident with those 
 of agriculture in this matter, it is an advantage to avoid com- 
 plicating the problem by their introduction, and to deal with the 
 question on purely commercial lines. It is imperative, in the 
 interests of agricuHure, that dairy cows with advanced or generalised 
 tuberculosis, or with tuberculosis of the udder, should be destroyed. 
 
 In order to discover these dangerous animals an efficient 
 service of inspectors is required. This is essential before any 
 further progress can be made towards eradicating the disease, 
 and the use of public money for this purpose is requisite. The 
 public must be prepared to meet all the cost of adequately inspecting 
 the condition of dairy cattle. 
 
 In addition to bearing this cost, it has been proposed that the 
 State should pay compensation for the condemned animals. 
 When cattle are so obviously infected with tuberculdsis that the 
 owner can get nothing for them in the open market as live stock, 
 why should the State pay for them ? This is a topic upon which 
 American experience of compensation throws useful light. INIy 
 study of the problem has led me to form the following opinions. 
 The amount of money which even the richest community can 
 afford to spend in the interests of agriculture is limited, and 
 usually appears insuflScient to meet all the reasonable demands 
 which agriculture may make upon it. It is therefore necessary 
 to consider how the siun available can be spent most usefully. 
 If the State compensates for tuberculous animals which are 
 worthless on the open market, will the money so spent be 
 productive, in the economic sense of the term, i.e., will it increase 
 the food producing value of the herds in the community ? 
 Emphatically, no. It is impossible to study American experi- 
 ence of compensation without forming a definite opinion on that 
 point. When a herd contains animals broken down with tuber- 
 culosis, it practically always contains also other animals in a less 
 advanced, but progressive, stage of the disease. The mere 
 elimination of the former animals does not produce a clean herd ; 
 the other infected animals gradually develop the condition of 
 
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22 CONtKOL OF BOVINE tUflEECULOSIS. 
 
 those already slaughtered, and continue by their faecal and other 
 discharges, to pass on the infection to new arrivals. So the 
 process goes on indefinitely, and the payment of compensation 
 for broken-down beasts is a positive encouragement for its 
 continuation. Public money expended for this purpose _is_ worse 
 than wasted ; by rewarding the fanner who is unwilling or 
 unable to adopt effective measures of control, it actually aids in 
 the continued propagation of the disease, and so contributes to a 
 further diminution of the food-producing value of the live stock 
 in the community. No community which is seriously desirous 
 of fostering commercial interests can be justified in adopting this 
 suicidal policy. It is essential, in the interests of agriculture, 
 that compensation should net he. paid out of the public funds for 
 slaughtered cattle showing advanced or generalised tuberculosis, or 
 tuberculosis of the udder. 
 
 The next step towards the eradication of tuberculosis is to 
 discover and separate the uninfected animals and the animals 
 which are in an early stage of the disease. For this purpose the 
 use of the tuberculin test is necessary, and a repetition of the test, 
 some months later, on each non-reacting animal is desirable. 
 And as a healthy animal is in constant danger of infection unless 
 separated from infected animals, the search for healthy animals 
 must include the testing of all animals with which non-reacting 
 animals are in contact. This means the adoption of tuberculin 
 testing on a large scale, and to entire herds. Most of the 
 American workers recognise the importance of this principle that 
 in order to profit by the information which the test affords it is 
 necessary to extend the test to every animal in a herd. If the 
 test is to be of value in the suppression of disease, it must be 
 employed as a necessary guarantee of health, not merely as an 
 aid to diagnosis in cases where disease is suspected. A man will 
 never clean up his herd if he relies on the tinkering policy of 
 -waiting until a cow shows suspicious signs, getting her tested, 
 weeding her out, and then waiting until the next suspicious case 
 arises. But here the average farmer is confronted with a serious 
 and very often an insuperable, practical difficulty. Tuberculin test- 
 ing requires skill and costs money. To quote an example, the 
 managing director of a large firm of milk contractors in this 
 country recently told me that whenever the firm's inspector found 
 a suspicious case, a sample of milk was sent to a competent 
 veterinarian for microscopic examination. If the veterinarian 
 reported that tubercle bacilli were present, the cow was at once 
 eliminated ; if the veterinarian did not find tubercle bacilli, the 
 cow was subjected to the tuberculin test. The reason that the 
 firm resorted in the first instance to such a notoriously uncertain 
 test as microscopic examination of the milk was a desire to save 
 the expense of the tubercuKn test whenever it was possible to 
 make the diagnosis without it, the charge for the tuberculin test 
 bemg two guineas per cow. This illustration shows the absurdity 
 of expecting an ordinary farmer to test his entire herd at his 
 own expense. In many parts of America the State offers to 
 come to the aid of the farmer and to do the testing of all Jbis. cattle 
 
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CONCLUSIONS AND SUGGKSTIOXS. 'la 
 
 free of charge, pi'ovided that the farmer will enter into an 
 " agreement " to take certain steps towards the eradication of 
 tuberculosis. The aspect of this system, which seems deserving 
 of admiration and imitation, is the offer of the State to test the 
 farmer's entire stock. The feature which appears less commend- 
 able is the " agreement," since there is not adequate provision for 
 compelling the farmer to fulfil all he contracts to do. Many of 
 the clauses in the agreement are often a dead letter, not worth 
 the paper they are printed on ; the offer of such a contract is 
 bad business, and therefore bad policy. Substitute for the 
 " agreement " payment in cash, and the method would be 
 admirable. On receipt of a minimum fee from the farmer, say 
 two guineas, the public authority might undertake to send a 
 skilled veterinarian, well acquainted with the agricultural condi- 
 tions of the district, who should test all the farmer's cattle, 
 inspect his premises, offer suggestions as to the best methods of 
 dealing with the re-acting animals, and, if desired to do so, 
 discuss and advise upon the farmer's business affairs in connection 
 with his cattle. .And there the transaction should end. No 
 interference, coercion, or compulsory slaughter ; no compensa- 
 tion ; and no promises for the future. In some cases, farmers 
 living near together might combine and so reduce the expense. 
 The fees would not cover the cost of the work, but they would 
 be the best guarantee available tliat the farmers were able and 
 earnest in their desire to improve the general condition of their 
 stock ; and this guarantee might be taken as suflHcit'nt to justify 
 the requisite expenditure of pvtblic money on the work of testing. 
 It would be desirable to have all the tuberculin prepared in a 
 central laboratory supported by Imperial funds, and, in order to 
 facilitate the requisite central supervision and control, it would 
 be advantageous to require that reports of all the tests made, and 
 of their results, should be sent to the central laboratory. In 
 Washington, for example, the Bureau of Animal Industry 
 furnishes tuberculin to Federal, State, County, and City officials 
 on condition that the testing shall be done by skilled persons 
 under official supervision, and that the residts of the work shall 
 be reported to the Bureau. When visiting their laboratory I was 
 informed that for the year ending June 30th, 1908, 215,000 
 doses were sent out, and that their cost, including all working 
 expenses, bottling and packing, amoimted to about two cents per 
 dose. The above considerations may be summarised as follows: — 
 The testiny of entire herds with tuberculin should be encouraged, and 
 for this purpose the assistance of pubhc money is requisite and desir- 
 able. 
 
 In considering what further expenditure out of available 
 public funds may be devoted to the agricultm-al interest, it is 
 again useful to learn a lesson from American experience. In the 
 campaign against bovine tuberculosis the strength of the enemy 
 is so overwhelming that money expended on a frontal attack 
 is generally money wasted. The public money spent on badly 
 infected herds, spent on merely reducing the amount of disease 
 without completely enulieating it, is rarely of permanent value. 
 
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24 CONTROL OF BOVINE TDBEECULOSlS. 
 
 It would he better to "begin with the easier and less expensive 
 task of seeking the healthy herds, trying to keep them healthy, 
 and trying to increase their number. When on the first^ test no 
 re-acting animals are found, practical encouragement might be 
 given to the farmer by offering to tag all his animals for him, 
 and, on condition that he introduces no fresh beasts among them, 
 to give him a second test free of charge. If the second test, 
 which should be made without warning, confirmed the first, the 
 farmer might feel reasonably confident that he possessed a 
 healthy herd. A herd which has successfully passed two suc- 
 cessive tests gives a better foothold for fighting the disease than 
 six herds which have passed only one test. A further step 
 would be to fix a minimum percentage of reactions, and to extend 
 the same offer to farmers whose herds, on the first test, gave a 
 percentage of reactions below this minimum, provided that the 
 re acting animals were at once separated ; then, if the second test 
 revealed no reactions, to offer a third' free test. A slight increase 
 in the number of thoroughly sound herds means substantial pro- 
 gress, and justifies the money spent on it. Public nwney spent on 
 re-testing, with a view to establishing thoroughly the soundness of 
 herds giving on the first test either no reactions or only a small 
 percentage of reactions, looidd be money well spent. 
 
 With regard to the re-acting animals, it must be freely 
 admitted that the farmer has an extremely difficult task. Can 
 the State help him ? It is obvious, from what has been tried in 
 America, that the amount of financial aid which the State can 
 afford to extend to him, if it can afford any, will only go a small 
 way ; and as a corollary from American experience it is clear 
 that the State is not likely to get good value for its money, i.e., 
 bring about an increase in the productive value of farm stock, unless 
 the offer is made with due regard to commercial principles. The 
 following considerations, arising partly out of Dr. Pearson's sug- 
 gestions for the segregation of re-acting but clinically healthy cows 
 may be mentioned. In fighting a disease which is constantly 
 spreading, it is very important, especially at the start, not merely 
 to secure thoroughly healthy foci and to increase their number, but 
 also to increase the number of these areas quickly, so that the 
 healthy zones may expand or multiply at a more rapid rate than 
 the extension of the disease. As the saving of time means the 
 saying of money, there is a prima facie case for asking the State 
 if it will aid such an enterprise. To suggest a possible instance ; 
 in a district where the value of the tuberculin test is appreciated, 
 and where it is possible to replenish stock by the purchase of clean 
 animals, there may be found perhaps a dozen herds, in each of 
 which the re-acting cows are few in number and possess a fairly 
 good market value. If the owners of these are merely advised 
 to adopt the Bang system, it will take several years before any 
 of the twelve farms are completeh' cleaned up, and probably 
 some of them never will be. But if the infection could be 
 removed from all these farms at once, it would he a substantial 
 benefit to the community at large. To secure this result 
 
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CONCLUSIONS AND SUGGESTIONS. 25 
 
 promptly might be worth the expenditure of publir money. On 
 this account the local authoritj- might be justified, in certain 
 carefully selected cases, in ofTering to buy up all of the re-acting 
 animals on generous terms, viz., at prices based on the assumption 
 that the animals were all worth what they would be if treated on 
 the Bang system with the maximum possible care and skill. As 
 this would be above the market price, a private dealer could not 
 afford to offer such generous terms ; therefore there would be 
 a strong inducement for the farmers to accept these terms and to 
 start at once with the advantage of clean herds. The local 
 authority would collect all the re-acting cows iu an establishment 
 under its own control, with an official guarantee of the adequacy 
 of the pasteurisation ; the business would be conducted as it 
 actually is conducted under the ordinary Bang methods, whether 
 for the supply of public institutions or for the general market. 
 In so far as the farmer would receive more than the market 
 price for his tuberculous animals, he would receive " compensa- 
 tion." This appears to me to be the maximum, at least in the 
 old country, which can under any circumstances be advantageously 
 offered by way of compensation to the individual out of the 
 public funds. Re- acting animals possessing a market value might 
 under special circumstances be taken over by the coininnnity at a 
 price exceeding their market value ; but n^ifh this limitetl exception, 
 compensation out of the public funds does not appear to be justijiahle. 
 There is another way in which the farmer may be helped, by 
 furnishing him with accurate information concerning the financial 
 loss which bovine tuberculosis involves, the economic advantages 
 of getting a clean herd, and practical methods of obtaining a 
 clean herd. In all the American States which I visited there 
 was a consensus of opinion that vigorous educational campaigns 
 on these lines were productive of good. In many of the States 
 the local and the State inspectors and the veterinarians are 
 doing steady work in this direction by talking to the farmers 
 and stimulating their interest in the subject. Publication of 
 practical articles in the local papers and dissemination of pamphlets 
 from the Agricultural Stations are also doing excellent service. 
 I have before me one of the Wisconsin pamphlets. It is some- 
 thing like an electioneering manifesto and is termed " The 
 'Let Alone' vs. the 'Take Hold' Policy"; the arguments 
 on either side are set forth in parallel columns, with the intention 
 of inducing the farmer to decide for himseK that the '• Take 
 Hold " policy of getting rid of tuberculosis is the more advan- 
 tageous. Whilst tiiis kind of literature does good, practical 
 demonstrations are of still greater educational value. In 
 Wisconsin the post-mortem demonstrations at county fairs of 
 re-acting beasts, apparently healthy before slaughter, have proved 
 to be a very powerful argument in favour of employing the 
 tuberculin test. There is another kind of practical teaching 
 which, it seems to me, might be utilised to a greater extent — the 
 force of example. If local authorities had expei-iment stations 
 devoted to the practical solution of business problems, they 
 
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26 CONTROL OF BOVINE TUBEKCUL08I8. 
 
 would be more likely to succeed in inducing the f ai-mer to do 
 what he is, or ought to be, told to do. To take a few examples. 
 Farmers are iold that when they have got clean herds they must 
 keep them clean. Easier said than done. A single oversight 
 on the part of owners who are keenly alive to the importance of 
 keeping their herds clean may undo the work of years. ^ I 
 visited a fai-mer who started with a clean herd consisting 
 of very valuable pedigree stock. He lent a bull to a 
 neighbour for a few weeks. Some time after the animal's 
 return tuberculosis broke out. The farmer is a wealthy man 
 and determined to stamp out the disease however much it might 
 cost. After three years he has succeeded, but at the sacrifice of 
 160 animals, some of them prize winners. For an ordinary 
 farmer, with his living to earn, such a course would have 
 been impossible. In another State I visited a farmer who was 
 making his living out of his dairy and was producing certified 
 milk. His herd was clean ; so I was interested to know w:hat 
 precautions he took in buying fresh cows. He considered him- 
 self very smart and explained his methods with much- self- 
 satisfaction ; but this explanation convinced me that the care he 
 took did not amount to absolute security against introducing the 
 disease. How long his herd will remain clean is more or less a 
 matter of chance. When the disease breaks out in a previously 
 clean herd, owned by a man with a good local reputution for his 
 care and vigilance, much discouragement is caused, and a general 
 impression may be created that the task of keeping out tuber- 
 culosis i& so difficult as to be practically impossible. The 
 possession by the local authorities of a clean herd or herds, 
 intended for the supply of public institutions, would be a valuable 
 object lesson. There is nothing impossible about the task of 
 keeping out infection ; it is merely a question of exercising 
 sufficient care ; and it ought not to be impossible to appoint 
 competent men for the work. The most effective way of teach- 
 ing the farmer the way to success, is to show him, in his own 
 district, that success actually is being achieved. Local authorities, 
 by establishing and maintaining clean herds for the supply of pvblic 
 institutions, woidd provide a valuable means of edueatiiig the 
 farmer. 
 
 The above considerations all serve to emphasise the difficulties 
 of making headway against bovine tuberculosis ; but it must not 
 be forgotten that these difficulties are no more than commen- 
 surate with the magnitude of the financial interests which are 
 involved. At the Tuberculosis Congress in Washington 
 Dr. Melvin, Chief of the United States Bureau of Animal 
 Industry, stated that the loss on animals in which tuberculosis is 
 found in the Federal Meat Inspection Service is estimated at 
 $2,382,433 per annum ; and he estimates that if the same 
 conditions were applied to animals slaughtered without Federal 
 inspection the annual loss on animals slaughtered for food in the 
 United States would be increased to |4,354,855. Tuberculosis 
 is also responsible for a serious depreciation in the yalue of stock. 
 
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CONCLUSIONS AND SOGGBSTIONS. 27 
 
 Assiiininu; that living tuberculous raik-h cows aie annually 
 depreciated to the extent of one-tenth of what the h)ss would be 
 if they were slaughtered, other cattle one-third, and hogs (which 
 usually contract their infection from bovines) one-half, he finds 
 that the total annual depreciation .amounts to ,$8,046,219. The 
 annual loss from decrease in milk production is estimated at 
 $1,150,000, and to this must be added considerable loss from 
 impairment of breeding qualities. Taking all these items into 
 account, the annual loss attributable to tubercidosis amongst farm 
 animals in the United States amounts to a total of not less than 
 $14,000,000. I consider that these figures, whilst not justifying 
 contribution from the public funds of a single cent towards 
 schemes which fail to satisfy the elementary principles of 
 economics, prove that on schemes where the capital expenditure 
 is likely to bring adequate returns, calculable on a financial 
 basis, public money ought to be freely spent and could be well 
 invested. The difficulty at present seems to lie not so much in the 
 lack of public support of ajinanciul nature as in the lack of evidence 
 that the agricultural interest is prepared to turn to good advantage 
 such effective public support as might be offered. 
 
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28 BASIS OF LOCAL AUTHOBITY. 
 
 PART II. 
 
 The Control of the Milk Supply in the 
 Interests of the Consumer. 
 
 A.— THE POWERS OP LOCAL AUTHORITIES. 
 (1.) The Essential Basis of Authority. 
 
 Before I left England for America the Medical Officer put me 
 in communication with Dr. Charles Harrington, Secretary of the 
 State Board of Health of Massachusetts, who was highly 
 esteemed on both sides of the Atlantic for his wide knowledge 
 and impartial criticism of questions affecting the milk supply. 
 The news of his death receired shortly after I reached the 
 States, disappointed me in the hope that I might receive 
 valuable advice from him. But on my visit to Boston the 
 officials at the State House kindly furnished me with information 
 regarding Dr. Harrington's work, together with copies of some 
 of his latest articles on the milk question. 
 
 Dr. Harrington was of opinion that the powers vested in the 
 English local authorities are inadequate. Contrasting English 
 with American methods, he wrote, with reference to his own 
 country : — " In this country, happily, these things are better 
 ordered in those States which have adequate health laws. In 
 Massachusetts, for example, the local Board of Health of even 
 the smallest town has power to exclude the milk of an infected 
 or simply dirty dairy, whether that dairy be local or far distant, 
 and without anything more than its own order." 
 
 It has been my purpose to see how far I can substantiate this 
 criticism by my own observations of American methods. The 
 details of the various systems in vogue in different American cities 
 vary considerably ; but underlying them all there is the general 
 principle that the local authority has the right and the duty of 
 defining the conditions under which milk may be sold without 
 danger to the public health, and of prohibiting the sale, within 
 the area over which it holds authority, of milk not satisfying 
 these requirements. As these requirements include provisions 
 that the milk, from its source to its destination, shall not be 
 exposed to conditions liable to render it unwholesome as food, a 
 powerful control is indirectly exercised upon the producer living 
 outside the district, since he cannot obtain a market within the 
 district for milk not satisfying the local regulations as regards its 
 production and handling. 
 
 Eegarding the legal basis of the local authority's power an 
 important decision was pronounced by the Supreme Court of the 
 
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BASIS OF LOCAL AUTHORITY. 29 
 
 United States on December 11th, 1905. The action which was 
 then decided had commenced as a criminal prosecution in 1902, 
 and involved the right of the Board of Health of New York 
 City to adopt an ordinance requiiing a person engaged in the 
 sale of milk in that city to obtain a permit. Section 66 of this, 
 ordinance runs : — " No milk shall be received, held, kept, oflfered 
 for sale or delivered in the City of New York without a permit 
 in writing from the Board of Health and subject to the 
 conditions thereof." Simon Lieberman was arrested on a 
 warrant issued by a magistrate, charging him with a violation of 
 this Section. From the Magistrate's Court the case went to the 
 iVppellate Division of the Supreme Court, and thence to the 
 Court of Appeals of the State of New York. The findings of 
 these three courts were in favour of the Department of Health, 
 and it was decided by the Court of Appeals that the ordinance 
 requiring a permit to sell milk was reasonable and valid, that it 
 was not unconstitutional, and that the Board of Health acted 
 within the scope of its powers when it adopted the ordinance in 
 question. An appeal was then taken to the Supreme Court of 
 the United States. This court, with the concurrence of all the 
 judges, upheld the previous decision that the ordinance was 
 reasonable, valid, iind not unconstitutional. In delivering the 
 opinion of the Court, Mr. Justice Day said : — " That the Board 
 of Health had power to pass the Sanitary Code, which includes 
 this section, is not open to question here, as it has been 
 affirmatively decided in the State Court. The objections im 
 Federal grounds for our consideration are two-fold : First, that 
 the section under consideration devolves upon tiie Board of 
 Health absolute and despotic power to grant or withhold 
 permits to milk dealers, and is, therefore, not due process of law ; 
 second, that singling out the milk business for regulation is a 
 denial of the equal protection of the laws to people engaged 
 
 therein The contention of counsel for plaintiff in error 
 
 is not that a business so directly affecting the health of the 
 inhabitants of the city as the furnishing of milk may not be the 
 subject of regulation under the authority of the State, but that 
 the Court of Apjieals of New York has sustained this right of 
 regulation to the extent of authorizing the Board of Health to 
 exercise arbitrary power in the selection of those it may see fit 
 to permit to sell milk under the Section quoted ; and, thus 
 construed, it works the deprivation of the plaintiff in error's 
 liberty and property without due process of law. We do not so 
 understand the decision of the highest court of New York. . . . 
 There is nothing in the record to show that the action against 
 him was arbitrary or oppressive and without a fair and reasonable 
 exercise of that discretion which the law reposes in the Board of 
 Hi'alth. We have, ihen, an ordinance which, as construed in the 
 highest court of the State, authorizes the exercise of a legal 
 discretion in the granting or withholding of pennits to transact a 
 business which, unless controlled, may be highly dangerous to 
 the health of the community, and no affirmative showing that 
 3i225 C 
 
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30 BASIS OF I/OCA'i. authority; 
 
 the power has been exerted in so arbitrary and oppressive a 
 manner as to deprive the appellant of his property or liberty 
 without due process of law. ..... Nor do we think there is 
 
 forpe in the contention that the plaintiff in error has been denied 
 the equal protection of the laws because of the allegation^ thfit 
 the milk busiqess is the only business dealing in foods which is 
 thus regulated by the Sanitary Code. All milk dealers 
 within the city are equally affected by the regulations of 
 the Sanitary Code. It is primarily for the State to select the 
 Icinds of business which shall be the subjects of regulation, and 
 if the business affected is one which may be properly the subject 
 of such legislation, it is no valid objection that similar regulations 
 are pot injposed upon other businesses of a different kind." 
 
 ■ The precedent established by this , legal decision has 
 sti-eiigthened the hands of the local hep,lth authorities ip the 
 exercise of ^ direct control over the milk supply. Ti-ade 
 interests are very powerful in America, and the milk dealers are 
 well orgE^nised ; if they can fight a point, they will. The result 
 of this test case is therefore of very high significance. 
 
 Equally essential as a basis for local control and iptervention 
 is the support of public opinion. In discussing milk regulations 
 with the health officers in the various cities which I visited, I 
 always found it reqriisite to discriminate between a rule which is 
 a more or less idle ornament of the sanitary code and a rule which 
 is actually epforced. The difference between the two coincides 
 with the difference between rules which are not effectively 
 supported by public opinion and rules which are. The public 
 authority knows that it is useless to attempt to enforce rules of 
 the former type ; the dealer fears to disobey rules of the latter 
 type, because if he does, legal proceedings will follow, an^ the 
 publicity given to these in the newspapers will ruin his business. 
 The above features of the American systenis may be 
 supimarised as follows, Jt is true in fact that in America the 
 local sanitary authoriti/ enforces refjnlations fbr the control of the 
 milk supply by the exercise of its otvn imaided poivers, and that the 
 exercise of sucfi powers is sanctioned both by law and hy pnhlic 
 opinion. 
 
 (2.) Examples of Local Regulations. 
 
 It is frankly recognised in America that what the local 
 authority actually enforces may be less than commensurate with 
 its official code of rules and regulations. A not vinpoTnmon 
 American method of setting to work is first to decide what objects 
 ought to be attained, forthwith to pass an ordinance enacting thftt 
 these objects must be attained, and then to discover how f»v the 
 ordinance can be enforced. Disadvantages of this method arc 
 that the frequent faihires to execute the ordinance tend to fostei' ft 
 popular disrespect for authority, whilst the officials concerned, 
 bmng uns^ble to do thoroughly what they are supposed to da, ave 
 enoouraged in habits of superficial work. On the other hapd it 
 must be recognised that this method is often pursued by eftrpest 
 
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LOCAL RBOrLATIONS IN COLUMBIA. 31 
 
 men who find that a " try on " policy, with some admixture of 
 bluff, is the best means of dealing with people of an independent 
 and resistive type ; and the existence of a regulation which is 
 perhaps ineffective for the time being may serve as a useful 
 warning of what is likely to be enforced in the future. Looking 
 a little beneath the surface, one finds that the process of establish- 
 ing a refoi-m in America commonly passes through three stages. 
 First there is the stage of enthusiasm. An ideal set of regula- 
 tions controlling the milk supply has been passed by a majority 
 vote, and the supporters of the scheme write and talk as though 
 the whole problem had been settled. Then a reaction sets in : 
 it is realised that many of the regulations are too drastic to 
 be enforced, and the candid critic comes forward to declare that 
 the whole scheme is an empty pretence and a humbug. This 
 phase of reaction gradually subsides ; it is discovered that 
 after all some small but substantial progress has been made, and 
 the work is continued more cautiously, less ambitiously, and more 
 effectively. In studying American regidations it is useful to 
 bear these general considerations in mind, in order to avoid 
 falling into one of two opposite errors, the error of supposing that 
 much more has been accomplished than is actually the case, ami 
 the error of supposing that the so-callod icfoi'ms arc an empty 
 pretence devoid of substantial results. 
 
 The Distkict ov Columbia. 
 
 During my stay at Washington, Dr. Woodward, ILnlth 
 Officer of the District of Columbia, kindly furnished me with 
 information regarding the milk regulations of this District. 
 
 The District of Columbia is an area of GO square miles, lying 
 between the States of Maryland and Virginia, and consists of 
 the city of Washington together with an outlying suburban area. 
 It is imder the direct control of the Government of the Unitrd 
 States, and all legislation of any considerable imjmrtance nttcct- 
 ing it is enacted by the Federal Congress. The ndministration 
 of affairs is entrusted to a Board of C\)iHmissioners, and whilst 
 the general duties of this Board are executive, it has legislative 
 powers in matters not considered of sufficient importance to 
 reqiiire reference to Congress. 
 
 Special interest attaches to a law, passed by Congress in 1895, 
 which requires that milk produced outside the District of 
 Columbia shall not be introduced for sale in that District unless 
 its production conforms to the requirements of the District, under 
 the guarantee of inspection by the District's agents. Apart 
 from its powers of control over the District of Columbia, 
 Congress has the right to regidate interstate commerce ; there- 
 fore a law, emanating from this body, which gives a local 
 authority an indirect power of control over producers in States 
 outside its area is of especial significance as establishing a pre- 
 cedent. In view of the establishment of this principle in the 
 District of Columbia, local authorities elsewhere have had less 
 3422:. C 2 
 
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32 LOCAL REGULATIONS 
 
 hesitation in placing similar restrictions on the sale of milk 
 produced in areas over which thej have no direct legal powers 
 of inspection. _ _ . 
 
 The clause of the Act of 1895 in which this principle is 
 estabhshed runs as follows :— " That no person shall bring or 
 send into the District of Colxunbia for sale any milk without a 
 permit so to do from the health officer of said District ; applica- 
 tion for said permit shall be made in writing, upon a form 
 prescribed by said health officer, and shall be accompanied by 
 such detailed description of the dairy farm or dairy where said 
 milk is produced or stored as said health officer may require, and 
 by a sworn statement as to the physical condition of the cattle 
 supplying said milk : Provided, that no applicant for said permit 
 shall be restrained from conducting business until said application . 
 has been acted upon by the health officer of the District of 
 Columbia or his duly appointed agent. If after examination of 
 said application said health officer is satisfied that said milk wiU 
 be brought into the District of Columbia for sale or consumption 
 without danger to public health, he shall issue, without charge to 
 the applicant, a permit so to do, on condition that none but pure 
 and unadulterated milk shall be, with knowledge of its impurity, 
 brought into said District ; that in the management of said dairy 
 or dairy farm said applicant shall be governed by the regulations 
 of the health office of the District of Columbia, approved by the 
 Commissioners of the District of Columbia, issued for dairies 
 and. dairy farms in said District, when said regulations do not 
 conflict with the law of the State in which said dairy or dairy 
 farm is located, and that said dairy or dairy farm may be 
 inspected at any time without notice by the health officer of the 
 District of Columbia or his duly appointed representative : 
 Provided, That said permit may be suspended or revoked at any 
 time without notice by said health officer whenever the milk 
 supply from said dairy or dairy farm is exposed to infection by 
 Asiatic cholera, anthrax, diphtheria, erysipelas, scarlet fever, 
 smallpox, splenic fever, tuberculosis, typhoid fever, typhus fever, 
 or yellow fever, so as to render its distribution dangerous to 
 public health." 
 
 For producers residing within the District of Columbia the 
 Act contains a similar clause requiring the issue of a permit. 
 
 The above legislation has undoubtedly been of great value 
 as establishing a precedent for the formulation in other localities 
 of ordinances based on similar principles. 
 
 "With regard to the working of the regulations in the District 
 of Columbia, Dr. Woodward states that the total number of 
 farms licensed to produce milk within the District or to send it in 
 from the adjacent States of Maryland and Virginia^ is 960. 
 Milk is also sent in from twenty farms in Pennrylvania and 
 twenty farms in New York State. The funds available are not 
 sufficient to cover the cost of inspecting these forty farms ; they 
 are therefore permitted to send in milk without licenses, under 
 the provision of the law which authorises the sending in of milk 
 
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ix NEW YOKlc ctrt. 33 
 
 immediately after the filing of an application and until the 
 health officer has in^'estigated the application ; the investigation 
 in these cases is indefinitely postponed. The territory actually 
 inspected is divided into six districts, with one inspector 
 assigned to each. If the inspector finds a farm not conforming 
 to the regulations, the steps taken depend on whether the farm 
 is Mrithin or without the District of Columbia. If it is within, 
 the owner of the farm is prosecuted in the police court. If the 
 farm is outside the District, the owner is threatened with with- 
 drawal of the permit ; but unless the violation of the regulations 
 is very serious, or unless similar offences have occurred re- 
 peatedly, summary action is not taken, but the offender is given 
 an opportunity of correcting the faulty conditions and of 
 showing cause why the permit should not be revoked. 
 
 Dr. Woodward considers that the 1895 law leaves room for 
 improvement, and writes : — " It has been impossible for the 
 health officer to submit to the Commissioners or for the Commis- 
 sioners to submit to Congress any bill to regulate the sale of 
 milk in the District with the assurance that it would not meet 
 with more or less formidable opposition from persons interested 
 in the production and sale of milk, either individually or as an 
 organisation. The fight to obtain better legislation to regulate 
 the sale of milk has always been carried to the committee room, 
 at the Capitol, and the fight has always been lost." But as 
 evidence that the law, as it actually stands, has been productive 
 of good Dr. Woodward points to the diminution in infantile 
 diarrhoja which has taken place since the law was passed in 1895. 
 During the five years 1880-84, tlie death-rate from diarrha-al 
 diseases of infants was 162 per 100,000 ; during the next five 
 years it was 16H, and during 1890-94 it was 175. But during 
 1895-99 the rate fell to 135 ; during the next five years it fell to 
 109, and during the years 1905 and 1906 it was, respectively, 
 104 and 97. Whilst recognising that jjost hoc is not necessarily 
 equivalent to propter hoc, Dr. Woodward finds that the only 
 cause which can be reasonabl}' assigned for the improvement 
 slidwii by these statistics is the institution of a stricter control 
 over the milk supply. 
 
 New Yokk City. 
 
 The working of the New York system hinges on the regulation 
 that " no milk shall be received, held, kept, offered for sale or 
 delivered in the City of New York without a permit from the 
 Board of Health and subject to the conditions thereof." When 
 an appHcation for a permit is made, a copy of these conditions is 
 given to the applicant and his premises are examined by an 
 inspector. If the character of the premises is such that a permit 
 cannot be recommended, the inspector informs the applicant of 
 the defects which must be remedied, and after a reasonable 
 length of time makes a reinspection. If the conditions are still 
 found to be unsanitary the inspector reports on the facts and 
 
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34 LOCAL REGULATIONS 
 
 recommends that the application for a permit be denied. Wher^ 
 the conditions are found to be suitable for the proper care and 
 handling of mUk, the dealer is recommended for a permit and this 
 is granted by the Board of Health. 
 
 From the " Rules and Regulations for the Care and Storage 
 of Milk " I select the following for quotation :— " Milk must not 
 be transferred from cans to bottles or other vessels on str«ets or 
 on ferries or at depots, except when transferred to vessel of 
 
 purchaser at time of delivery The vessels in which 
 
 milk is kept for sale must be protected by means of a suitable 
 covered receptacle and so placed in the store as to prevent dust 
 from the street or other impurities falling into it." 
 
 Section 53 of the Code prohibits the introduction into the city 
 or the offering for sale within the city of any milk which is 
 " adulterated " ; and for the purpose of this Code milk is 
 regarded as " adulterated " if it falls under one or more of nine 
 specified definitions. From these definitions I select the following : 
 — (a) " Milk drawn from animals fed on distillery waste, or any 
 substance in a state of fermentation or putrefaction, or on any 
 unwholesome food " ; (b) " milk drawn from cows kept in a 
 crowded or unhealthy condition " ; (c) " milk the temperature of 
 which is higher than 50° F." 
 
 Section 54 ordains that "any milk found to be adulterated 
 which has been brought into the City of New York or is held or 
 offered for sale in said city, may be seized and destroyed by any 
 inspector, or other officer of this Department authorized to 
 inspect milk." 
 
 Every applicant for a permit to sell milk either in a shop or 
 from a wagon must inform the Department of the source frMn 
 which he obtains this milk. This information is followed up by 
 the Department ; the sources supplying the place from which 
 the retailer obtains his milk are ascertained, and these are traced 
 back to the actual producers. This is a task of considerable 
 magnitude, since the milk supply of the city is obtained from a 
 very large areuj including parts of five different States, and some 
 of it comes from a distance of 400 miles. 
 
 The control exercised by the city over milk produced in areas 
 outside its limits is based on the following rule of the Department 
 of Health : — " As a condition to the issuance of permits for the 
 sale of milk in the City of New York, all places where such milk 
 is produced or handled must be open to inspection by employees 
 of the Department of Health of the City of New York." These 
 inspectors have no authority to compel occupiers of places outside 
 the geographical limits of the city to submit to inspeeti&n, but 
 the threat that refusal will be followed by exclusion of the milk 
 from the city is found to be effective. When the inspectors find 
 the sanitary conditions unsatisfactory, the owner is informied 
 that reform is necessary if he wishes to continue to supply New 
 York City with milk. 
 
 SpeciaJ; arrangements have been made to ensure the early, noti- 
 fication of infectious disease in any person handling milk. The 
 
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IN NEW YORK CITY. 35 
 
 folkmiDg regtilations affecting the dairy farms aad the cie.tmeries, 
 or collecting stations which receive and collect milk from 
 ifldividnal farms and transfer it to the railway, may be quoted : — 
 " Evcfy cl'eamery or milk station which ships milk or cream, or 
 both, to the City of New York, shall be required, through its 
 agtnts, to furnish to the Department of Health of the said city 
 on Monday of each week a report stating the existence or non- 
 e*iBtelice of any one of the following infectious diseases in the 
 households of all persons employed in the collecting or handling- 
 of milk, either at the creamery, or at the farms or dailies 
 supplying it; namely, typhoid fever, tuberculosis, diphtheria, 
 
 scarlet fever, dysentery, or any other infectious disease 
 
 Every creamery or milk station shall require each dairyman or 
 farmer sending milk or cream or both to such creamery or milk 
 station to report in writing on Saturday of each week as to the 
 existence or non-existence of any one of the above-mentioned 
 infectious diseases in the household of every employee in his 
 farm or dairy, who is connected in any way with the care or 
 
 handling of milk These weekly reports shall be kept 
 
 on file at each creamery or milk station for a period of at least 
 six months after their receipt aud shall be always open to the 
 inspection of the representatives of the Depaitmeiit of Health." 
 Then follow rules for the prompt exclusion of all persons 
 suffering from infectious disease, the final rcg-ulation being that 
 "the failure of any creamery or milk station, farm tr dairy, to 
 comply with provisions of these resolutions may be Ci iisidered 
 sufficient cause for the exclusion of such milk or cream from the 
 City of New York." 
 
 During my stay in New York the authorities in the Depart- 
 ment of Health very kindly explained to me their methods of 
 organisation, and, as I was anxious to see some of the actual 
 work, attached me to inspectors serving for day and for night 
 duty. 
 
 I was told that the number of permits which have been issued 
 for stores in the city of New York is between twelve and 
 thirteen thousand ; and in addition to these there are 4,600 
 permits issued for wagons. The average daily consumption of 
 milk in the city is estimated at 1,800,000 quarts. 
 
 An inspector took me to one of the poorest districts in the 
 East End of New York where the inhabitants are mostly Jews. 
 This inspector has about 700 milk shops in his district and finds 
 that it takes about two months to make a complete round of 
 inspection. The shops are very close together, often next door 
 to each other, and not more than a small amount of milk is sold 
 in each. The inspector told me that the sale is not usually less 
 than half a can (a can contains 10 gallons) and that the average 
 sale is about two cans a day. Formerly tliere ^^ed to be many 
 small shops, mostly Italian, which sold no more than four or 
 five quarts a day, but these have dropped out, no permits being- 
 new granted to them. On my return to the head office I \vas 
 told that it was hoped to make a further reduction- in the number 
 
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36 LOCAL REGULATIONS 
 
 of shops, gradually eliminating those which now sell the smallest 
 quantities. The shops which sell milk are general grocery stores 
 and are frequented hy people of the poorest class who usually buy 
 provisions for not more than one meal at a time and like to get all 
 they require at one shop. The storekeeper makes little or no profit 
 out of his milk, but it is an important part of his business, 
 because if he did not sell it many of his customers would go 
 elsewhere for their other requirements. In most of the shops I 
 visited the milk was sold " loose " i.e., served out of a can ;. in a 
 few, bottled milk was sold. I learnt from the inspector that the 
 usual price for loose mUk was five to six. cents a quart, the price 
 for bottled milk being eight cents. 
 
 I was interested in'comparing what I saw with the conditions 
 which prevail in a similar district in the East End of London. 
 Shortly before I sailed from Englanil, Dr. Manby kindly took 
 me on a tour of inspection in a very poor district on the north 
 side of Commercial Koad, E., and we spent some hours in the 
 quarter entirely occupied by Jews. Between the shopkeepers in 
 this quarter of London and those whom, I visited in New York 
 there was a close resemblance. In both cities a large proportion 
 of them belong to the lowest order of tradesmen in whom it is 
 particularly diflScult to instil elementary notions of cleanliness 
 and sanitation. But the New York shops were certainly less 
 filthy and less malodorous ; in fact many of them were fairly 
 clean and tidy and free from any offensive smell. The difference 
 in the way in which the milk was kept was still more striking. 
 Visiting about 25 New York shops in succession, I found that in all 
 of them the loose milk was kept in the 10 gallon can in which it had 
 . been received, and that this can was covered with a closely-fitting 
 lid. With three or four exceptions, the can was placed, within a 
 bin, also covered with a lid, and ice was placed between the wall 
 of the bin and the wall of the can In the exceptional cases the 
 can was not placed in any receptacle but was standing .at or 
 outside, the shop door, apparently just as it had been left on 
 delivery. In these cases the inspector warned the dealer that 
 he was disobeying the regulations. In the London district which 
 1 visited the mUk is kept in all sorts of receptacles, which are 
 frequently uncovered, and no attempt is made to keep it cool. If 
 the New York shops which I saw included samples of the worst 
 class, which the inspector assured me was the case, they compare 
 favourably with what is found in London. I was informed that 
 the relatively satisfactory system in New York was the result of 
 some years' patient work and that the original condition was 
 quite as bad as what I described to be the present state of affairs 
 in the East End of London. The improvement is certainly due 
 to the knowledge that the permit will be promptly revoked if, 
 after reasonable warning, the requirements of the Board are not 
 satisfied. 
 
 It is sometimes thought that the permit system places in the 
 hands of the inspectors an autocratic power which is liable, to 
 abuse. When the inspectors are officious, domineering, and 
 
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IN NEW YORK CITY. 37 
 
 unscrupulous, this is probably the case. In New York great 
 improvement seems to have been eflFected in recent years in the 
 type of men selected for the post, and the system now appears to 
 work well, without causing serious friction or hardship. ^ly 
 personal observations were necessarily very limited, but, so far as 
 they went, they gave me the impression that permits were not 
 revoked Avithout very good cause, e.g., in the case of very stupid 
 or very obstinate people who resolutely refused to adopt simple 
 sanitar} precautions, or when a person had been repeatedly 
 convicted in the courts for selling adulterated milk. And the 
 hardship of losing a permit is not so great as it might appear. 
 What a man usually does is nominally to transfer the business to 
 his wife or other relative ; and then a fresh application for a 
 permit is made in a new name, and, if on inspection the conditions 
 are found satisfactory, is granted. 
 
 Further evidence that the permit system respects the principle 
 of equal rights for all is afforded by the extremely large number 
 of permits granted in the district which I visited. If the sale of 
 milk were limited to shops which sold nothing but dairy products, 
 the shops being sufficiently numerous for one to be within easy 
 reach of every consumer, no hardship would be inflicted on the 
 general grocery stores. They would all be treated alike, losing a 
 business which at present brings them little or no profit ami some- 
 times a loss, and retaining on equal terms . their claims to their 
 present customers. The customer would suffer no more than the 
 very slight inconvenience of having to purchase in two shops in- 
 stead of one ; and, in compensation for this, lie would be able to 
 purchase milk kept under better conditions and bettor insprcted. 
 The facilities for ready, frequent, and efficient inspection would 
 be greatly increased. It is interesting to note that !Ne\v York, 
 notwithstanding its reputation for drastic measiues in the 
 interests of public health, has not been able to institute this much 
 needed reform. A similar reform is equally or even more 
 needed in the East End of London ; but apparently in both 
 cities the privilege of selling milk which the grocers at present 
 possess is regarded as inviolable. 
 
 If ail inspector finds milk to be obviously "adulterated," 
 according to the definition of this term adopted by the sanitary 
 cnde, he is allowed to seize it without further aelo and pour it 
 into the sewei-, no compensation being given to the owner. When 
 an inspector takes this step he must report his action to the 
 Board of Health, stating the amount of milk destroyed and the 
 reason for destroying it. According to the Annual Reports of 
 the Department of Health, 39,613 quarts of adulterated milk 
 were destroyed in 1905 and 41,395 quarts in 1906. Most of this 
 work of destruction is performed under the sanction of the clause 
 which defines as " adulterated " milk found to be at a temperature 
 of more than .30' F. In actual practice the inspector allows the 
 dealer a margin of ■>' and does not destroy the milk imless the 
 thermometer reading is above oc>' F. In justification for thi^ 
 destruction of milk exceeding the legal temperature it may be 
 pointed out that even in the poorest districts of New York facilities 
 
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58 LOCAL BEG^ULATIOIIS 
 
 exist for keeping the milk cool by surrounding it with ice, and that 
 milk properly cooled can be sold at the low price of five to &ix cents 
 a quart; the importance of keeping it cool is due to the fact that 
 the bacterial content of milk multiplies rapidly at teHiperatltl-es 
 exceeding 50° F. The dangers arising from milk not kept at a 
 low temperature are naturally greater when the milk is 30 or 40 
 hours old than when it is literally " warm from the cow," btit in 
 enforcing the rule it does not seem practically possible to make 
 allowance for this difference ; consequently the New York Jews, 
 who, like the Jews in the East End of London, prefer to consume 
 their milk "warm from the cow," find it difficult to observe this 
 custom. From talks which I had with inspectors I gathered that 
 the people of New York are now well accustomed to seeing milk 
 destroyed for exceeding the legal temperature and that the in- 
 spectors exercise this power without exciting popular indignation. 
 With a view to being able to trace milk back from the consumer 
 to the source of supply, the Health Department attaches great im- 
 portance to keeping full records of the farms supplying the various 
 creameries or receiving stations and of the destinations in New 
 York of milk sent from each of these creameries. To further the 
 same object, they have recently (April 22nd, 1908), adopted a rule 
 that " all containers from which milk is sold to the consumer shall 
 bear a label or tag stating, if shipped from a creamery, the location 
 of said creamery and the date of shipment; if shipped directly from 
 a dairy, the location of said dairy and the date of shipment." On 
 the day of my first visit, the Health Department happened to be 
 dealing with a case which afforded a good practical illustration of 
 their system. Two hours previously they had received a telegrain 
 from a doctor, 200 miles away, stating that he had a case of 
 typhoid fever on a farm supplying a creamery which sent milk to 
 New York. The Health Department of New York had at once 
 notified the creamery that all milk then on its way to New York 
 would be refused admission and that no more would be received 
 until the supply from that particular farm had been excludedi 
 The Department's nearest country inspector had been ordered to 
 visit the creamery and see that these instructions were carried 
 out ; another inspector, located nearer to New York, had been 
 ordered to visit a railway junction and warn the officials that milk 
 from the creamery in question would not be admitted ; the dealers in 
 the city receiving milk from this source had been notified, and 
 inspectors had been instructed to visit them and see that the 
 supply was stopped. Finally, one of the inspeetoi-s to whom I 
 had been attached for the purpose of seeing some night work was 
 instructed to examine certain trains on arrival and destroy any 
 milk he might find coming from this source. On investigation »t 
 the station we found that the milk had been stopped half way on 
 its journey, so I was unable to witness an actual case of 
 " dumping." If a case of typhoid fever had been diagnosed in 
 England, under similar circumstances, how long would it have 
 taken. before the danger of disseminating the disease through the 
 vehicle of milk could have been prevanted ? 
 
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IN CHICAGO. 39 
 
 A few fact.^ may be quoted for the purpose of illustrating tlie 
 work done bj- the City Department of Health in controlling the 
 production and handling of milk before it arrives within the city^ 
 limits-. In 1905, with the co-operation of the railroad officials 
 of four lines on which milk is conveyed to New York City, 
 inspectors of the Department were sent out and were given an 
 oppoi'tunity to examine every creamery along the line at which 
 milk was received and handled before being sent into the City. 
 The number of creameries inspected during this year was 326. 
 After each tour of inspection, the owners and operators of the 
 creameries were summoned to the Chief Sanitary inspector's 
 office in New York ; the unsanitary conditions found in the 
 various places were brought to their 'notice, and the reqiiisite 
 recommendations for improvement were made. During the same 
 year 176 creameries were re-inspected, some of them several 
 times. In over 50 of these the first re-inspection showed that all 
 the recommendations had been comjjlied with, and at the end of 
 the year about 125 were reported as being in an entirely 
 satisfactory condition. Some of the creameries inspected were 
 found in such a bad condition that it was necessary to exclude 
 their milk from the city. During the year 1906, fifteen 
 inspectors were employed, and 708 creameries and 11,000 farms 
 and dairies were inspected. At the present time (1908) the 
 Department employs 27 country inspectors in the work of exam- 
 ining the creameries and the farms from which these creameries 
 receive their supply. As the number of farms supplying milk 
 for the City is estimated at over 40,000, the task of supervision 
 is very heavy, and an addition to the number of inspectors is 
 considered desirable. An excellent feature in the system of 
 inspection is the taking of photographs, -svhich are sent to the 
 New York office, and there collected and indexed. This collec- 
 tion, which was shown to me, now contains photographs of all 
 the creameries and of a large niunber of the farms. Many of 
 the places have been photographed twice, before and after the 
 prescribed alterations have been made. When a question arist> 
 as to the sanitary condition of a particular dairy or creamery, 
 the head inspector finds this collection of photographs a valuable 
 aid to the verbal descriptions. 
 
 Chicago. 
 
 The rules framed b}' the Chicago Department of Health for 
 the regulation of the milk supply are remarkably drastic. 
 
 The entrance of all "unclean" milk into the city of Chicago 
 is forbidden, " unclean " milk being defined as " all milk pro- 
 duced on farms or prepared, handled or otherwise treated on the 
 premises or in places whei-e the rules of the Department are 
 violated." All unclean, unwholesome or infected milk is to be 
 condemned. " Such milk shall be returned to the producer and 
 tagged with the ' Department Condemned ' tag, and condemn- 
 ation slip shall be mailed to the shipper at once ; if, following 
 thifl, the said producer or shipper again sends into the city 
 
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46 LOCAL REGULATIONS 
 
 unclean, unwholesome or infected milk, the same shall be coti- 
 demned and rendered unfit for human food, by coloring or 
 otherwise treating, or shall be poured into the sewer." 
 
 £t is required that the cows "must be healthy and free from 
 tuberculosis." Milk from cows reacting to tuberculin " shall 
 be rejected unless it shall have first been pasteurised at a tempera- 
 ture of 175°F. or over for 30 seconds or longer in a stream not 
 more than a quarter of an inch thick." The department regards 
 pasteurisation as no more than a temporary measure, and intends 
 that tuberculosis shall be entirely eradicated from the dairy 
 herds supplying food for the city. This, it is conceded, cannot 
 be accomplished immediately ; and therefore five years grace is 
 allowed. The ordinance which comes into force on January 1st, 
 1909, prohibits the sale, under penalty of confiscation, of milk,; 
 cream, buttermilk or ice cream, " unless such milk or cream or 
 the milk or cream contained in buttermilk or ice creain be 
 obtained from cows that have given a satisfactory negative tuber- 
 culin test within one year ; the cows having been satisfactorily 
 tested shall be marked ' tuberculin tested ' and shall be numbered 
 and a certificate shall be filed with the division of milk inspection 
 of the Department of Health of the City of Chicago upon 
 forms furnished by the Commissioner of Health, giving the 
 number, a brief description of the animal, the date of the taking 
 of said test and the name of the owner. Said certificate shall be 
 signed by the person making such test ; provided, however, that 
 from January 1st, 19u9, for a period of fiVe years, to wit, until 
 January 1st, 1914, milk or cream cr buttermilk and ice cream 
 made from milk or cream, obtained from cows not tuberculin 
 tested or not free from tuberculosis, may be sold within the City 
 of Chicago if the milk or cream from said cows is pasteurised 
 according to the rules and regulations of the Department of 
 Health of the City of Chicago." Similar restrictions have been 
 placed on the sale of butter and cheese. It is made unlawful, 
 under penalty of confiscation, to sell in Chicago butter or cheese 
 which does not bear upon the package either the words " Made 
 of milk (or cream) from cows free from tuberculosis as shown 
 by tuberculin test," or the words " Made from milk (or cream) 
 pasteurised according to the rules and regulations of the Depart- 
 ment of Health of the City of Chicago." 
 
 Another regulation regarding cows providing milk for Chicago 
 may be quoted. " The feeding of slops, refuse of any distillery 
 or brewery, glucose or any malt, or ensilage that has been 
 subject to fermentation, putrefaction or decomposition is 
 prohibited." 
 
 Amongst the contagious diseases which are considered of 
 importance in relation to milk, attention is called to consumption. 
 " Milkers and attendants in the cow stable and milk room should 
 be free from tuberculosis." But to this is added the qualifying 
 clause that " a consumptive can be harmless if he is intelligent 
 and can be trusted to carry out the physician's instructions " ; 
 
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IN CHICAGO. 41 
 
 these words are svipplemented by advice on the sanitary disposal 
 of sputum. 
 
 Licenses have to be obtained for " milk stations," i.e., places 
 where milk is received from the country, for "milk depots," i.e., 
 places where milk is received and is prepared for distribution, and 
 for " stores," which are defined as " all places and rooms where milk 
 is sold, together with other foodstuff's, such as groceries, meats, 
 bakery goods, delicatessen articles and confectionery." The 
 annual fee charged for a license is $10, the licenses being renew- 
 able on May 1st of each year. By a rule recently passed, " no 
 application for license shall bs approved by the Commissioner of 
 Health after May 1st, 1908, if the records of the milk division 
 show that the depot, store or any part of the establishment in 
 which the business is to be conducted is in an unsanitaiy 
 
 condition No application for license shall be approved 
 
 if applicant lias a bad record If at any time after the 
 
 granting of such license the holder fails to comply with the 
 sanitary regulations of the department, or repeatedly sells or 
 ofifers for sale, or has in his possession for the purpose of selling, 
 milk and cream below the grade prescribed by the ordinances or 
 rules of the Department of Health, the Chief Food Inspector 
 shall recommend to the Commissioner of Health that his license 
 be revoked with or without further notice. Said Commissioner 
 of Health may grant the defendant a hearing, if he deems this 
 necessary." The temperature at which milk is stored must not 
 exceed 50'' F. Empty cans and bottles " must lie cleaned and 
 washed with hot water " before returning to the wholesale 
 dealer or farmer. One of the latest rules, passed June 22n(l, 
 1908, for the protection of milk runs as follows : — " No person, 
 firm or corporation shall sell, offer for sale, expose for sale or 
 keep with the intention of selling any milk or cream in stores or 
 in other places where other merchandise than milk or cream is 
 sold, unless the milk or cream is kept, offered for sale, exposed 
 for sale, or sold in tightly closed and capped bottles or receptacles 
 of a similar character, such as shall be approved by the Conmiis- 
 sioner of Health of the City of Chicago." 
 
 In order to prevent the entrance into the city of milk coming 
 from dairies which fail to comply with the sanitary requirements 
 of the Department, an inspector is constantly employed at the 
 receiving platforms in the city, with instructions that such milk 
 must either be destroyed or returned to the dairies. The annual 
 reports state that li29 eight-gallon cans were "dumped" in 1905 
 and 1,804 in 1906. In the years 1904, 1905 and 1906, the 
 numbers of dairies inspected were, respectively, 2,857 ; 3,146 ; 
 and 4,029. In the report for the last of these years it is stated 
 that " every dairy shipping milk to C'liicac;-o within a radius of 
 115 miles —beyond this distance no milk is shipped here because 
 of tlie freight cost — is now inspected every month."' 
 
 The ordinance re(iuiring the pasteurisation of milk coming 
 from cows not guaranteed healthy by the tuberculin test does 
 not come into force until 1909, At the tiuv of my visit to 
 
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42 LOCAL EEGULATIONS 
 
 Chicago (September, 1908) many of the firms in the city were 
 arranging for pasteurising equipment and were consulting the 
 Health Department as to the types of machinery which would 
 meet the Department's requirement. The rapid method, i.e., 
 short exposure of the milk in a thin streani to a fairly high 
 temperature, seemed to be the one most in favour, and a,t the 
 time of my visit the Department was discussing the adoption of 
 a standard test for the purpose of ascertaining whether pasteuris- 
 ation was efficiently conducted. 
 
 The Department has taken a firm stand against the use of 
 unwholesome material such as " wet malt " for the feeding of 
 milch cows. In 1901 it was found that 19 per cent, of the dairies 
 inspected were using this food ; in 1905 the percentage was 
 reduced to 8, and in 1906 only a little over 3 per cent, of the 
 4,029 dairies inspected were using this objectionable material. 
 The action of the Department in enforcing its rule prohibiting the 
 use of wet malt was vigorously resisted by powerful commercial 
 interests ; the legality of the rule was contested, and finally one 
 offender, who had been fined by the Criminal Court, appealed, 
 and his case was brought before the Appellate Court of Cork 
 County. The Appeal Court upheld the decision of the lower 
 court, on the ground that the disputed clause of the ordinance 
 was " necessary for the preservation of the health of the^ people 
 and to guard against disease." 
 
 The work in the milk inspection department seems to be con- 
 ducted on excellent business principles. The report for 1905 
 states : — " The amount collected by the city for milk licences 
 was $49,295-39 ; for fines, milk suits, $8,008-00 ; for ice licenses, 
 $7,027"oO ; ice fines, $98*00 ; revenue from condemned calves, 
 $621-18 ; making a grand total of $65,050-60, Subtractipg from 
 this amount the total cost of running the entire laboratory, 
 $36,128-12, we have a net gain of $28,922-36." The report for 
 1906 states : — " The income from the work in the Milk Division, 
 in licenses and penalties, has increased from $57,305 in 1905 
 to upward of $75,000 this year." The item "revenue from 
 condeumed calves "' will not escape attention ; it may cause some 
 surprise to those who advocate compensation for such animals. 
 
 This last paragraph may be appropriately supplemented by 
 another quotation from the report for 1906. "The Commis- 
 sioner has not waited for any Pure Food Law or for the enact- 
 ment and enforcement of National or State legislation, but has 
 utilized existing resources and authority more fully than ever 
 before." 
 
 One of the features of the laboratory work is that the general 
 public is encouraged to make use of it in order to ascertain the 
 quality of the milk they are buying. Thus in 1906, private 
 individuals submitted 9,407 samples of milk and cream fot- 
 analysis ; 6-8 per cent, of these were found to be below the legal 
 standard. It is found that when a customer confronts the dealer 
 with the results of one these analyses marked " below grade " 
 a very salutory impression is created in the mind of the latter. 
 
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IN MINNEAPOLIS. 43 
 
 For information regarding the Chicago regulations I am greatlj 
 indebted to Dr. Evans, the Commissioner of Health, and hfs 
 assistant, Dr. Uiehn. Sly stay in Chicago was not sufficiently 
 prolonged to enable me to form an independent opinion of the 
 results achieved. 
 
 Minneapolis. 
 
 I visited the Board of Health of this city and had the pleasure 
 of interviews with Dr. Hall, Commissioner of Health, and Dr. 
 Corbett, Bacteriologist. 
 
 Every person selling milk within the pity must obtain fi'om the 
 Commissioner of Health an annual license, which is issued free 
 of charge and is granted on condition that the regulations of the 
 city's " milk ordinance " are complied with. When an applica- 
 tion to sell milk is granted the city demands the right of 
 inspecting the source of supply. " Any such applicant, or any 
 person from whom such applicant obtains or is to obtain his 
 milk, shall permit the officers of the Department of Health of the 
 City of Minneapolis to inspect the dairy and dairy herd 
 of such applicant, or the dairy and daiiy herd of the 
 pei'son or persons from whom the applicant obtains or is to 
 obtain his milk, together with all appliances and milk vessels 
 
 used therein, and any refusal to permit the inspection 
 
 above referred to shall be deemed a sufficient ground upon which 
 the City Council maj' refuse to issue the license applied for, and 
 for such cause may revoke the same after its issue." Another 
 condition which must be fulfilled before a license is granted is 
 that the Commissioner of Health shall roceivp a certificato, 
 signed by a licensed veterinary surgeon, stating that the cows 
 from which the milk is to be obtained " ha\ c been by him 
 
 inspected, examined and tested with tuberculin and 
 
 found free from tuberculosis and other contagious disensos, and 
 giving the results of such Inspection and test as to each and every 
 animal so examined and tested." 
 
 It is also required that dairy herds shall be tested annually, so 
 long as the milk derived from them is sold within the city. With 
 regard to the cost of the work the following regidation is made : 
 — " The Department of Health of said city shall furnish all the 
 tubermiliii, stationery and tags necessary and required for 
 making such inspection, examination and test of dairies and 
 dairy herds, but the actual and reasonable cost of making such 
 inspection, examination and test, not to exceed fifty cents for 
 each animal examined and tested, and six cents per mile for each 
 mile actually travelled by the veterinarian making such inspection 
 in going to and returning from the place of making such inspec- 
 tion, shall be paid by the applicant for such license to sell milk 
 in the City of Minneapolis and the owner of the dairy and dairy 
 herds inspected as herein piovided." 
 
 Amongst the nine definitions of "adulterated" milk established 
 by the Milk Ordinance, the three following may be mentioned : 
 — (a) " Milk drawn from animals fed on distillery waste, or any 
 
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44 LOCAL REGULATIONS 
 
 substance in a state of fermentation or putrefaction or on any 
 unwholesome food " ; (l>) " Milk drawn from cows kept in a 
 crowded or unhealthy condition, or from cows suffering with 
 tuberculosis or any other contagious disease " ; (c) " Milk, 
 the temperature of which is higher than fifty degrees Fahrenheit, 
 or which shall contain more than 500,000 bacteria per cubic 
 centimeter." Milk found to be " adulterated," as defined by the 
 Ordinance, " may be seized and destroyed by an inspector or 
 other officer of the Department of Health of said city authorised 
 to inspect the same." 
 
 A point of special interest in connection with the working of 
 the Minneapolis system is that every person who sells milk 
 within the city must possess an annual State license, in addition 
 to his City license. This State license is granted by the Dairy 
 and Food Commissioner of the State of Minnesota. "No person 
 shall sell milk or cream in, or to be used in, any municipal 
 corporation, except for the purpose of supplying the same to a 
 butter or cheese factory, without being licensed by the Dairy and 
 Food Commissioner, and the fee for such license shall be $1 for 
 each place or vehicle from which sale is made. Every such 
 license shall expire May 1st, next after its issue." This method 
 of double licensing enables the city to bring the State to its aid 
 when a country producer is unsatisfactory. The city of 
 Minneapolis, for example, can inform the State Food and Dairy 
 Department that the milk coming from a particular farm is not 
 in good condition ; the State will then send one of its own 
 inspectors to examine the farm ; if reforms are needed on the 
 farm, failure to carry them out will result in the Minneapolis 
 milk-seller losing his State license, without which he cannot 
 carry on his business. 
 
 As will be seen from the regulations for the application of the 
 tuberculin test, the Health Department of Minneapolis is anxious 
 to eliminate tuberculosis from the herds supplying the city. In 
 evidence of the amount of work done in this direction it may be 
 stated that the City Veterinary Department makes a considerable 
 number of tests every year and condemns the animals found 
 tuberculous. In the year 1907 this Department inspected 384 
 dairies and tested 8,239 cows with tuberculin ; 318 of these were 
 found to be infected with tuberculosis and were immediately 
 removed from their respective herds, condemned, and killed. 
 
 In his Report for 1907 the Commissioner of Health for" 
 Minneapolis calls attention to the fact that the death rate in 
 children under five years of age has fallen from 7-73 deaths per 
 1,000 inhabitants in 1890 to 2-05 in 1907. Commenting on this 
 evidence of improved sanitation, he remarks — "An important 
 factor in the preservation of infant life is undoubtedly the exist- 
 ence of our excellent milk ordinance, which provides that milk 
 cannot be sold in the city unless coming from cows that have been 
 inspected and safely passed the tubercuhn test." An effort is 
 being made, Dr. Hall informed me, to induce the State to pass a 
 measure enacting that all cattle sold within the State, not for 
 
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IN OTHER LOCALITIES. 45 
 
 immediate slaughter, must be sold with a certificate of inspection, 
 and that this inspection must include an application of the tuber- 
 culin test. Such a measure would, he considered, greatly 
 facilitate the city's efforts to eradicate tuberculosis from milch 
 cows. 
 
 It may be worth noting that the clause in the City Ordinance 
 which requires the application of the tuberculin test dates from 
 1895. Shortly after its institution, the legality of the clause was 
 disputed, but its validity was maintained by the Supreme Court 
 of tlif State of Minnesota in 1896. 
 
 Other Localities. 
 
 Certain features of interest in the administrative work of some 
 of the other localities which I visited are "best stated in general 
 terms. 
 
 Whereas many cities are provided with a milk ordinance 
 whicli, on paper at least, furnishes the medical officer with all the 
 powers he could possibly desire, there are some cities which arc 
 by no means well equipped in this respect, but appear, so far as 
 regulations go, to be hardly any better off than English towns. 
 In cases such as these the medical officer, if enterprising enough, 
 can contrive to exercise a good deal of authority in excess of his 
 strictly legal rights. He makes the most of such statutes as are in 
 force by putting a liberal interpretation on convenient ambiguities 
 which they contain. The term " nuisance," for example, is used 
 with much elasticity ; a milk vondoi- who is not violating any 
 explicit regulation affecting the sale of milk may ho brought to 
 book by the discovery that in the (Mjuduet of his business he is 
 doing something which constitutes a " nuisance " liable to be 
 prejudicial to the public health. And in the exercise of 
 authority which might, if disputed, proTC to be illegal, full advan- 
 tage is taken of the fact that the person who wishes to resist and 
 to invoke the aid of the law is fully aware that legal proceedings 
 cost money and involve publicity. The small dealer cannot 
 afford the expense, and the big dealer who is selling unwholesome 
 milk is afraid that, though he might win his case, the publicity 
 given in the law courts to his dirty methods would ruin his 
 business. Naturally this policy of "bluff" has to be pursued 
 with caution, and the health authoi-ities do not resort to it unless 
 tlicy are confident that if the case came up for trial they could 
 produce evidenci' which would seriously damage the offender's 
 business. 
 
 Thcri' is also the policy of helping the strong and prosecuting 
 the weak. Expressed in its most favcurable light, this means 
 that the big firms often desire to keep their milk up to a 
 relatively high standard and find it commercially advantageous to 
 do sii, whilst the small traders are perhaps less enlightened and 
 perhaps cannot afford the expense of the requisite improvements. 
 Hence it may reasonably happen that the worldng criterion of 
 
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46 LOCAL REGULATIONS. 
 
 wholesome milk adopted by the local authority coincides with the 
 criterion adopted by the wealthy firms, and an advantageous 
 system of informal co-operation between the public officials and 
 the business firms results ; whilst the small dealer, who produces 
 an inferior quality of milk and has no powerful interests to 
 support him, can be successfully prosecuted with the utmost 
 rigour of the law. This happy method of combining the interests 
 of trade with those of hygiene is an important factor in the 
 working of some of the American systems of milk control. 
 
 There is, however, a reverse side of the medal. When 
 " friendly co-operation " leads to a loss of official independence, 
 when the financial and political influence of the big firms converts 
 the public authorities into their servants and tools, the system is 
 rotten with corruption and is discreditable to any community 
 which prides itself on its freedom. When a firm of milk 
 contractors, on the eve of a presidential election, finds it prudent 
 to contribute $25,000 to each political party, they naturally do 
 not intend their investment to be wasted ; and the attempt of 
 some well meaning person to prevent their distributing milk from 
 a farm where there is a case of scarlet fever may be confronted 
 with exceptional difficulties and delays. This is not a merely 
 hypothetical case. 
 
 The medical officer who, whilst able to retain his office, refuses 
 to pander to political intrigue or other unworthy influences, 
 sometimes finds that his most unpleasant difficulties are caused by 
 the political intrigues of important milk contractors. It is 
 humiliating, for example, to find that in working a system where 
 the essential control is based on the power to grant and revoke 
 permits, a wealthy contractor can continue to sell several 
 thousand quarts of milk a day after his permit has been revoked 
 for very substantial cause. In a case of this sort, when he finds 
 that it is impossible to enforce his authority, the sensible medical 
 officer, who cares more for the public welfare than his own sense 
 of injured dignity, finds it the best policy to say nothing about the 
 matter, in public. He continues to enforce observance of the 
 regulations from the less influential dealers, and devotes all his 
 surplus energies to the education of public opinion. Nothing 
 further can be done until the public learns the difference between 
 good milk and bad and exhibits a preference for the former. 
 When a general demand has been created for a better quality of 
 milk, the task is easier ; but the question of supply still requires 
 cautious consideration. A firm doing an extensive business in 
 many cities may be in a position to withdraw its supply from the 
 particular city demanding reform, with the result that a shortage 
 would be created, causing much inconvenience, an increase in 
 prices, and a general discontent. For these misfortunes the 
 niedical officer would be held to blame, if unable to solve the 
 difficult problem of finding good milk to replace the bad. The 
 education of public opinion, the elimination of unwholesome milk, 
 and its replacement by better, seem to be tasks easier of 
 accomplishment in small cities than in large, 
 
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CONCLUSIONS AXD SU( ^CiESTIOXS. 47 
 
 (3). CoXC'LUSKJNS AXlJ SlG(;ESTI(JNS. 
 
 In looking over the average "Milk Ordiiianci- " of an 
 American eity one generally finds that the regulations which it 
 contains are a mixture, capable of being roughly si^parated out 
 into three types : — (1) rules which are obviously necessary and 
 are generally enforced in most communities ; (2) rules which are 
 excellent in principle but of more or less doubtful applicability 
 in practice ; and (3) rules which, whether desirable or not in 
 theory, cannot possibly be enforced under existing conditions. 
 
 Many of the American codes are framed in too aggressive a 
 spirit. The intention is good ; they are promulgated simply and 
 solely with a view to advancing the iiiter(;sts of public health, 
 and these interests rightly claim precedence over other and merely 
 commercial ('onsiderations. But the requirements of the con- 
 sumer would be better served if it were made more clear that 
 due regard was also being paid to the actual conditions and 
 difficulties of production. American experience shows that 
 regulations demanding more than the actual producer cau reason- 
 ably perform are worse than useless ; they are alwavs evaded 
 and satisfy nobody ; by disai)pointing the consumer and exciting 
 the hostility of the produ<'er they ictard the work of milk reform 
 instead of advancing it. Af/t/re.ss/'/r jiroi/r/n/mirs of milk rrfcnii 
 hai'f iiol succeeded in Anicricd and ure nut to be recommended. 
 
 At the same time it is important to recognise that American 
 methods, at least in those instances where they are now woiking 
 well, are not, in practice, of the aggi'essive eharaeler which thev 
 may appear to present on paper. And lor two excellent reasons ; 
 the medical officer has no desire to inflict hardships on the milk 
 trade ; and, if he made the attempt, the American public would 
 not tolerate it for a moment. Such requirements of the emh' as 
 are found to be unreasonable are, as a matter of fact, not enforced. 
 With perhaps one exception, vi:., the "d\unping" of milk found 
 to be at a temperature over 55°F., the ti-eatuieut accorded in 
 America to the dealer or dairyman not guilty of sciuie flagrant 
 abuse is usually most lenient. Drastic stejis, such as the revoca- 
 tion of a permit (U' the permanent exelnsidu nf milk from a cit} "s 
 supply are only taken when the ofl:'ender refuses, after repeated 
 warnings, to obey the most elementary principles of hygiene. 
 The mere laiowledge that the authoritie- possess th<^se powers 
 and actually can exercise them, if necessary, is sufficient ; it 
 provides the re([uisite argument to convince the ofl^'ender that he 
 must make such improvements as lie within his power. More 
 than this thi' authorities ilo not expect (u- recpiire. Actual reforms 
 are maiiili/ due to the ticceptancc <f reasonable ^commendations 
 ofrreil In/ the Mrdiciil Offfcrr, and arc attrihiilidde to the recoff- 
 I'litioit rather than to the cvm-isc <;/ this ()/iirer's riijht of direct 
 intervention. 
 
 In considering the value of the 'permit" system^ it is 
 essential to take into account the difterenee. frankly ailmitted by 
 
 •112?-. U :' 
 
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48 LOCAL REGULATIONS. 
 
 the Americans themselves, between paper regulations and 
 regulations actually enforced. Theoretically, a permit is only 
 issued to such persons as satisfy the medical officer that they are 
 capable of complying with the city's regulations, and is cancelled 
 by the officer's own authority if any of these regulations are 
 violated. If one takes the text of a municipal milk code as it 
 actually stands, and asks, is it possible or rea,sonable to restrict 
 the milk trade to persons who comply with all these con- 
 ditions ? the answer must undoubtedly be in the negative. It 
 is obvious that the officer cannot insist on implicit obedience to 
 all the rules. He must necessarily make a selection, and decide 
 for himself what are the actual rules upon obedience to which 
 the tenure of a permit shall in fact depend. This introduces an 
 element of arbitary choice, and affords ground for the objection 
 that the right to deal in milk should not be made dependent on 
 the personal opinion and judgment of one man. The theoretical 
 right of the medical officer to withhold or revoke a permit for any 
 and every breach of the municipal regulations may he questionable. 
 
 But in actual practice the medical officer cannot revoke or 
 withhold a permit except for persistent refusal to conform to those 
 regulations which are admitted by all except the most unscrupulous 
 members of the milk trade to be just and reasonable, i.e., rules 
 requiring that milk shall not be kept or produced under obviously 
 unsanitary conditions and that it shall not be adulterated by the 
 abstraction of cream, the addition of water, or the introduction 
 of preservatives. The medical officer, to quote the words of the 
 Supreme Court of the United States, does not in fact exceed 
 " a fair and reasonable exercise of that discretion which the law 
 reposes in the Board of Health " for the purposes of controlling 
 a business " which, unless controlled, may be highly dangerous 
 to the health of the community." In practice the permit system 
 ivories well and involves no hardships or injustice to the honest dealer. 
 
 Assuming that the powers conferred by the permit system 
 are only exercised in a just and temperate manner, the question 
 may be raised whether the evils which this system is intended- to 
 correct could not be dealt with equally well by prosecuting actual 
 offenders in the courts. Theoretically, perhaps ; but practically, 
 no. When a man proves himseM by his conduct, his tempera- 
 ment, and his surroundings to be a person who cannot be safely 
 entrusted with the care of milk, the imposition of fines will 
 never reform him. Apart from the fact that fines for adultera- 
 tion are usually paid for him by the man from whom he obtains 
 his milk, the only way which proves effective in dealing with 
 these people is to make it plain to them that if they cannot sell 
 milk in accordance with the minimum requirements of the law 
 they cannot sell it at all. The direct control eu erdsed by the permit 
 system is an effective instrument of reform ; p7'osecvtions in the law 
 courts are not. 
 
 Closely connected with the permit system is the right of 
 imposing conditions which must be fulfilled before milk can be 
 permitted to enter the city. Here again one must distinguish 
 
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CONCLUSIONS AND SUGGESTIONS. 49 
 
 between theoretical rights and rights actually enforced. If milk 
 were excluded merely because it came from a dairy unable to 
 conform to some ideal standard of dairy perfection which happened 
 to be placed in the " ordinances," the right of exclusion would 
 undoubtedly be exercised in an arbitrary and unjustifiable manner. 
 But it is well-known, and the trade is not prepared to deny, that 
 some dairies are so abominable that they are a disgrace to the 
 agiicultural interests as well as a danger to human health. The 
 exclusion of milk from places such as these is obviously reason- 
 able. It is all a question of where to draw the line. The 
 exclusion f rum a city of milk whrh is not provided with a reasonable 
 (juarantee that it has been produced under irholesome conditions is 
 justifiable. 
 
 The objections to the American system of controlling the milk 
 trade by means of " penults " and by prohibiting the sale, within 
 the area of the local authority, of milk not produced under certain 
 conditions, would disappear if the right entrusted to the local 
 medical authorities were defined with sufficient precision to make 
 it impossible for such povveis to be exercised arbitrarily uv to the 
 detriment of legitimate trade interests. In America perhaps this 
 objection cannot be easily overcome, because the people have an 
 affection for rules embellished with vigorous ideals of what ought 
 to be, and therefore they are compelled to uphold the theory that 
 their medical officer is vested with the power of enfocing the 
 regulations en hloc But in other countries thci'C seems to be no 
 reason why this obstacle sliould arise, and it ought to be po-sible 
 to secure the advantages of the American systt'ui without its 
 defects. There sei'nis, for exiiniple, nothing unreasonable in 
 demanding that a standard of efficient veterinary and sanitary 
 inspecticn should be established, and that milk should not be 
 accepted at the railwa} stations unless it came from farms which 
 had passed this standard. It woald be an iidriintiit/c to eiifrnst to 
 the local health authorUics rcasoiKihle <ind le//alli/ dejincd /mirrrs of 
 direct control over the [irodiution and sale of milh. 
 
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50 PA8TEURISKD MILK. 
 
 B. SPECIAL ASPECTS OF THE MILK PROBLEM. 
 (1.) Pasteurised Mii.k. 
 
 The theoretical aspects of the question wh-ether milk ought to 
 be pasteurised are largely discussed in America ; but it seems 
 advantageous in dealing with this subject to consider what 
 actually is being done before entering into theories. 
 
 In all the large cities which I visited I found that the custom 
 of pasteurising milk is common, particularly amongst the large 
 dealers. In Minneapolis I was told that about 40 per cent, of 
 the city's supply is pasteurised ; in New York the percentage is ^ 
 said to be 25 and in Philadelphia 75. Boston, in 1906, received 
 368,849 quarts of milk daily, and of these, 123,250 quarts were 
 pasteurised. 
 
 Dealers pasteurise their milk in order to make it keep longer. 
 This is the main and generally the only reason. Some of them 
 may be also influenced by the knowledge that the germs of 
 infectious diseases are liable to be conveyed by raw milk, and 
 that their presence, if detected or suspected, is likely to cause 
 trouble. In some cities, for example, the health authorities keep 
 careful records of the number of cases of infectious disease which 
 occur amongst each dealer's customers. If a particular dealer 
 happens to have a heavy score against him, an inquiry is 
 instituted which may cause serious interference with that dealer's 
 trade. So pasteurisation is employed as a commercial safeguard, 
 to prevent loss from sour milk or from the interference of the 
 health ofKcer. 
 
 The methods of pasteurisation vary. In Washington I 
 visited an excellent firm, where the milk is heated to 1-18° F. and 
 by an automatic arrangement is held at that temperature for half 
 an hoiu' before being discharged into the cooling apparatus. But 
 in many places very much less care is taken about exposing the 
 milk to an adequate temperature for a proper length of time. 
 Pasteurisation by " the rapid method " is popular, the principle 
 of this system being to cause the milk to flow in a thin stream 
 exposed for a brief period to a fairly high temperature. In an 
 apparatus of this kind which I saw at Washington the milk 
 flowed between an outer and an inner metal coil heated with 
 water to 185° F., and was exposed to this temperature for one 
 minute. The milk inspector of Boston says " commercial pasteur- 
 isation means the heating of milk to varying temperatures, 
 usually from 155" to 170" F , for a short time, usually a matter 
 
 of seconds, and then suddenly cooling Oftentimes this 
 
 pasteurisation means that filthy milk which would under ordinary 
 conditions be unsaleable, because of souring, is given a new lease 
 of life and becomes a marketable commodity." 
 
 The first mentioned Washington firm, though working as a 
 purely business concern and showing a reasonable profit, conducts 
 its pasteurising under ideal conditions. The work is under the 
 constant supervision of a bacteriologist who makes bacterial 
 
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PASTKUKISKD _MILK. 
 
 51 
 
 counts oi the milk as it is received and during each stage of the 
 pasteurising process down to the final bottling. He also inspects 
 the cleaning of the apparatus and makes cultures from any part 
 of the machinery which he suspects have not been adequately 
 cleansed. The workmen appreciate this control and take a pride 
 in getting good results as judged by the bacterial test. 7 he milk 
 purchased by the firm is the best procurable from the Washington 
 district and is by no means " filthy," but the firm considers that 
 it is commercially advantageous to resort to efficient pasteurisa- 
 tion in order to bring about a large reduction in the bacterial 
 count and to eliminate any pathogenic bacteria which possibly 
 may be present. 
 
 As examples of pasteurising in Philadelphia, some of them 
 less satisfactory than the above, I quote the following case> 
 investigated by Drs. Pennington and McClintock : — 
 
 Material examined. 
 
 Cuuat per c.o. 
 
 Twenty-four 
 
 hours la' or. 
 
 count per c.c. 
 
 Milk from first tank 
 
 „ „ second tank 
 
 ., „ Pasteurising coil, 155° F. 
 
 „ „ first cooling coil, 75° F. 
 
 „ „ second cooling coil, 64° F. 
 
 „ after bottlinn^, ready for consumer ... 
 
 1,504,000 
 2,250,000 
 18,000 
 33,000 
 2,160,000 
 :i,K8(),U00 
 
 25,380,000 
 
 37,800,000 
 
 36(1,000 
 
 1,02(1,(100 
 
 3,7H( 1,000 
 
 45,9UO,00(J 
 
 II. 
 
 Material examined. 
 
 Milk from original can 
 „ „ first tank 
 ., „ second tank 
 „ „ Pasteurising coil, 158-160° F. 
 „ „ first cooling coil, 78° F. 
 :, „ second cooling coil, 34° F. 
 
 „ bottled, ready for consumer ... 
 
 III. 
 
 
 Twenty-four 
 
 at i-ur c.u. 
 
 hours Liter, 
 
 
 count per c.c. 
 
 4-_',66(.; 
 
 300,(JOO 
 
 340,000 
 
 7(10,000 
 
 (■.20,000 
 
 3,420,0(J0 
 
 16,80(J 
 
 240,000 
 
 l'.),6G6 
 
 42(J,(J(.)(_I 
 
 178;C66 
 
 1 ,560,(.)00 
 
 446,000 
 
 2,880,00(1 
 
 Material examined. 
 
 Count per c.c. 
 
 Twenty-four 
 hours later, 
 count per c.c. 
 
 Jl 
 
 Ik from first reservoir 
 „ second tank 
 
 „ first Pasteurising i.oil, 160^ F. 
 „ serond coil, 70"^ F 
 „ third coil, 42° F. 
 
 pipe cntcr'ng bottlini: tank 
 bottled, ready tor couMimer ... 
 
 1,140,000 
 
 2,1(10,0(30 
 
 1,000 
 
 1,933 
 
 63,666 
 
 86,000 
 
 138,000 
 
 4,406,0110 
 
 4,^60,000 
 
 1.266 
 
 3,166 
 
 88,666 
 
 360,000 
 
 :-!.280,o(Xt 
 
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52 
 
 PA8TEUBISED MILK. 
 IV. 
 
 Material examined. 
 
 Milk before placing in tank 
 „ after placing in tank ... 
 „ after leaving cooling tank 
 „ from pipe to bottling tank 
 ,, ready for the consumer 
 
 Count per c.c. 
 
 Twenty-four 
 
 hours later, count 
 
 per c.c. 
 
 7,680,000 
 
 7,140,000 
 
 3,000 
 
 3,333 
 
 744,000 
 
 13,800,000 
 
 12,600,000 
 
 6,000 
 
 6,000 
 
 785,000 
 
 I and II, where the milk was in a worse condition at the end 
 of pasteurisation than at the beginning, afford excellent examples 
 of dirty machinery. In III and IV the bacterial content shows 
 a numerical reduction, but the diminution in III is only slight at 
 the end of 24 hours. In IV, though the number of living 
 bacteria has been greatly reduced, the initial count was 
 very high and the undesirable and probably unwholesome 
 material associated with this bacterial content would still be 
 present after pasteurisation. 
 
 From the Boston Milk Inspector's Report for the year 1907-8, 
 i quote the following statistics bearing on the same subject. 
 
 Bacteriological Examination or Pastedrissd Milk from Store?. 
 
 Bacteria per cubic centimetre. 
 
 Number of 
 Samples. 
 
 Percentage. 
 
 Under 50,000 
 
 50,000 to 100,000 
 
 100,000 to 200,000 
 
 200,000 to .300,000 
 
 300,000 to 400,000 
 
 400,000 to 500,000 
 
 3 
 7 
 1 
 3 
 5 
 6 
 
 4-12 
 9-59 
 1-36 
 4-11 
 6-85 
 8-22 
 
 Total samples under 500,000 
 
 25 
 
 34-25 
 
 600,000 to 609,000 
 
 600,000 to 1,000,000 , 
 
 1,000,000 to 3,000,000 
 
 3,000,000 to 5,000,000 
 
 Above 10,000,000 
 
 5 
 13 
 25 
 
 3 
 
 2 
 
 6-85 
 
 17-82 
 
 34-24 
 
 412 
 
 2-72 
 
 Total samples above 500,000 
 
 48 
 
 65-75 
 
 Total 
 
 73 
 
 100-00 
 
 The bacteriological data which I have quoted are sufficient to 
 show that pasteurisation, as a commercial process, is conducted 
 with varying degrees of inadequacy or adequacy. From 
 inquiries made in various cities I formed the general opinion 
 that if the firms were grouped, according to their manner of 
 conducting this business, into the three classes of (1) good, (2) 
 
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Pasteurised milk. 53 
 
 bad, and (3) indifferent, the majority, probably a large majority, 
 would come under (2), and there would be many more in group 
 (3) than in group (1). 
 
 Some reformers consider that pasteurisation is radically bad in 
 principle, and strongly disapprove of it. But is it possible 
 to obtain and enforce a law pi'ohibiting firms from resorting to 
 this process ? The answer seems to be definitely. No. It has 
 taken a strong hold on the trade ; trade interests arc very power- 
 ful and the effective influence of the reformers who dislike the 
 process is relatively slight ; it is necessary to recognise that, as 
 a matter of fact, the abolition of pasteurisation is impossible. 
 
 More importance attaches to proposals which, recognising 
 conditions as they are, aim at improving the way in which the 
 business is at present being conducted. The best effort towards 
 practical reform which I have been able to discover comes from 
 the City of New York. On April 22nd, 1908, the following 
 rules were added to their Sanitary Code. 
 
 " 1. Pasteurisation of milk must be carried out under a permit 
 therefor issued by the Board of Health, in addition to the usual 
 ])crmit for milk required by Section 56 of the Sanitary Code. 
 2. The milk after pasteurisation must be at once codleil and 
 placed in sterilised containers, and the containers sealed. 3. All 
 pasteurised milk must be delivered to the consumer in sealed 
 containers which are plainly labelled ' pasteurised.' The labels 
 nuisl also bear thedate and hour when the pasteurisation of the milk 
 was completed, the degree of the heat employed, the length of 
 time exposed to the heat, and the number of the pasteurisation 
 permit issued by the Board of Health, 4. Pasteurised milk 
 must be delivered to the consumer within twenty-four hours of 
 the j)asteurisation. 5. No milk shall be pasteurised a second time" 
 The value of these regulations uuist be judged by their results, 
 and as they had not been in force for more than a few months 
 when I visited New York, it was not possible for me to form an 
 opinion as to their actual working. 
 
 In the interests of the producer, as well as in those of the 
 consumer, the princij)le that pasteurisation should be subject to 
 official inspection seems to be excellent. The best class of firm, 
 as 1 know from personal observations and inquiries both in 
 Washington and in London, obtains the best milk procurable at 
 the ordinary trade rates and does not resort to pasteurisation as 
 a means of "doctoring" inferior and cheaper stuff ; these firms 
 recognise the importance of conducting the process thoroughly 
 and of keeping their machinery clean ; their milk is delivered to 
 the consumer well within twenty-four hours after pasteurisation, 
 and they do not distrilmte milk which has been pasteurised a 
 second time. Such firm> have nothing to fear fi-om official 
 inspection governed by rules framed according to the reasonable 
 requirements of the trade, whereas they would indirectly benefit 
 from the application of similar inspection to the inferior firms 
 whose methods are unreliable, dirty, and unscrupulous. With 
 one exception, the requirement that all pasteurised milk mu^t be 
 
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54 PASTEURISED MILK. 
 
 delivered to the consumer in sealed containers, the New York 
 rules seem capable of application to other communities without 
 the infliction of hardship or injustice upon legitimate trade 
 interests ; and as the consumer may properly ask to be pro- 
 tected against the dangers of stale pasteurised milk or of milk 
 passed through such dirty machinery as to become richer in 
 bacteria at the end of the end of the process than it was in the 
 beginning, official intervention with a view to the prevention of 
 such practices ought to meet with general approval. 
 
 There are many American authorities who advocate compulsory 
 pasteurisation, not because they think pasteurised milk is better 
 than clean raw milk, but because they consider that the bulk of 
 raw milk, as at present produced, is liable to contain pathogenic 
 bacteria. Is it possible to establish compulsory pasteurisation ? 
 In legislating for swine this actually has been done. It is the 
 custom in Minnesota for the farmers to send their milk to 
 factories where the cream is removed and the skim milk returned 
 to them for the purpose of feeding their pigs. It was found 
 that the milk frequently contained tubercle bacilh which set up 
 tuberculosis in the pigs and gave rise to a serious economic loss ; 
 consequently a law has been passed requiring the pasteurisation 
 of all factory skim milk. This law has been in effect for 
 several years and has given general satisfaction. But the State 
 is unable to pass a law preventing the feeding of babies with 
 milk containing, or likely to contain, living tubercle baciUi. 
 The reasons why pigs are better protected by the legislature 
 than children appear to be — (1) pigs have a definite market 
 value, and it is recognised that economic interests must be 
 protected ; (2) the need for legislation to protect the health of 
 human beings is less well established ; (3) the agricultural 
 interest carries votes at an election ; (4) public health interests 
 carry little or no political weight. Pigs in Minnesota are better 
 protected than in some of the other States ; but, so far as my 
 experience goes, it is true of all the States which I visited that, 
 for the purpose of effective legislation, economic considerations 
 outweigh considerations of human health. It seems that those 
 who advocate compulsory pasteurisation of milk intended for 
 hmnan food must acquire more influence than they at present 
 possess before they can carry their point, even if then- views be 
 accepted as sound. 
 
 _ Since it appears impossible, at least under present conditions, 
 either to abolish pasteurisation or to estabHsh compulsory 
 pasteurisation for all milk intended as human food, it does not 
 seem of interest, in connection with this Report, to recapitulate 
 the arguments employed for and against this process. From 
 what I have observed in America, where the pasteurisers and 
 anti-pasteurisers are about equally divided, the more immediate 
 object of reform should be to give both sides a better oppor- 
 tunity of propagating their views than they possess at present. 
 This could be accomplished by compelling 'the dealer to sell all 
 pasteurised milk as such. The customer would then know 
 
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PASTEUIil.SED MILK. 55 
 
 whether he was getting pasteurised milk or raw milk ; he \vould 
 be able to weigh for himself the arguments of the pasteuriser;; 
 against those of the anti-pasteurisers, and would select his 
 milkman in accordance with the opinion which he formed. 
 
 Commercial pasteurisation is firmly established and cannot be 
 abolished ; but it seems both possible and desirable to institute a 
 Si/stem of inspection which shall provide a guarantee that the work 
 is done eficiently, icith regard to the interests of the consumer and in 
 accoi'dance with the standard of skill, care, and cleanliness already 
 observed Jiy the belter class of firniH. 
 
 Whilst official encouragement or enforcement of pasteurisation 
 might be objectionable, it would appear useful and reasonable to 
 insist that pasteurised milk shall be sold as such, in order to enable 
 tlie consumer to choose for himself between the pasteurised and the 
 raw article. 
 
 (2). Bacterial Standards. 
 
 Before discussing technical details, I propose to give an 
 example of a bacterial standard which is really useful. At 
 Washington I visited a firm, conducted on strictly business lines, 
 which employs a bacteriologist to examine the milk from ever}- 
 farm with which the company deals. Culture plates representing 
 the bacterial growth of milk derived from each of the farms are 
 fixed with formalin and kept for reference. Fresh cultures of 
 each milk supply are made periodically and the later lesiilts are 
 compared with the earlier. Sample cultures are arranged on 
 shelves in the office, with the farmers' names attached to them. 
 When a culture shows an excessive number of bacteria, the 
 farmer concerned is asked to call at the office ; the masses of 
 white specks on the culture plate are pointed out to him and he is 
 told that they mean dirty milking. As examples of clean or 
 relatively clean milking, he is shown culture plates, prepared 
 with milk from other farms, where the white specks ;ire obviously 
 much less numerous. He is told that what is accumplished on 
 other farms ought to be accomplished on his, and that if it is not 
 his contract will not be renewed. The ordinary requirements of 
 cleanliness are discussed and practical suggestions for improve- 
 ment are made. With the exercise of patience and the repetition 
 of this warning, when necessary, the desired object is generally 
 attained ; when it is found impossible to efi'ect any improvement, 
 as indicated by the bacterial standard, the contractor ceases to 
 do business with the farm in question. This firm's " bacterial 
 standard " is not a certain number of bacteria per cubic centi- 
 metre ; it is a row of culture plates, arranged on shelves, with the 
 fanners' names attached to them. It is a standard adopted for 
 trade purposes and works well. 
 
 As additional examples of firms which appreciate bacterial 
 standards, I quote the following from the Boston Milk Inspector's 
 Report for 1907-8. " During the year the various contracting 
 firms made 29,208 bacteriological examinations of milk in the 
 endeavour to ascertain the quahty of their supplies. Of this 
 
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56 BACTERIAL STANDARDS. 
 
 number, 928, or 3'17 per cent., were classified as containmg 
 pus or streptococci. Where the milk was found to have 
 a high bacterial content, notices stating that fact were sent 
 to producers, and the latter were also notified of the 
 necessity of having their milk comply with the requirements 
 of the Board of Health. One concern sends notices to farmers 
 where the numbers of bacteria reach 250,000 per cubic centi- 
 meter, and all milk found by this firm to have above 100,000 
 bacteria per cubic centimetre is pasteurised and used for cream 
 and butter. In instances where pus and streptococci were present 
 in milk, the progressive concerns procure samples from the 
 individual cows in each herd, and in this manner locate the cause 
 of the trouble. The milk from the cows at fault is withheld 
 
 until such time as the milk appears normal AU of the 
 
 contracting firms agree that the bacteriological work of the last 
 three years in connection with the milk supply has resulted in a 
 marked improvement. One firm states that the amount of sour 
 milk has been reduced 70 per cent." 
 
 The above examples serve to show that bacteriological 
 standards are useful, when properly applied, and advantageous to 
 the trade as well as to the consumer. 
 
 Various local authorities have attempted to establish a 
 numerical bacterial standard for ordinary market milk. 
 
 According to the latest copy of the Chicago rules (April 13th, 
 1908), "milk on arrival in the city must not contain mare than 
 1,000,000 bacteria per cubic centimetre from May 1st to 
 September 30th, and not over 500,000 bacteria per cubic centi- 
 metre between October 1st to April 30th. MUk for- delivery to 
 the consumer shall not contain an excessive number of bacteria. 
 The sale of milk containing over 3,000,000 bacteria per cubic 
 centimetre is prohibited, and the dealer selling or ofiering for sale 
 svich milk shall, after three examinations of his milk on successive 
 days by the bacteriologist and showing bacterial counts above 
 3,000,000, be prohibited from selling milk until the method of 
 production and handling of his milk supply has been properly 
 regulated by the department." 
 
 New York, in 1900, attempted to establish a bacterial standard 
 of 1,000,000. 
 
 In Minneapolis and in Boston the legal standard is 500,000. In 
 Montclair, ISew Jersey, the standard is 100,000. 
 
 Dr. Groler, the Health OfiScer of Eochester, New York State, 
 says " for several years we have endeavoured to insist upon a 
 municipal standard of 100,000 bacteria per c.c. No ordinance 
 provides for this standard, nor do we attempt, save through 
 notifications, to punish the vendor who submits a sample containing 
 a greater number of bacteria per c.c. If a sample contains over 
 500,000 bacteria, we send the man a notice warning him that his 
 licence will be revoked if he again has such a large count. If 
 such a number is found on a subsequent examination, the licence 
 is revoked as a still further warning, though he is permitted to 
 renew it if he promises to pursue more cleanly methods." 
 
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BACTERIAL STANDARDS. 57 
 
 Some of these bactorial standards look excellent, on paper ; 
 but are they really enforced ? My experience in America leads 
 me to believe that they are not ; and in several instances I found 
 that the efforts which had at first been made to enforce them had 
 failed, and that further attempts to prosecute dealers or revoke 
 their licences, on the ground that they had exceeded the limit 
 imposed by the bacterial standard, had been abandoned. This 
 was almost to be expected, owing to the obvious difficulties of 
 enforcing the standard. In illustration of these difficulties I 
 quote a few of the statistics which have been collected 
 by Dr. Eosenau, Director of the Hygienic Laboratory at 
 Washington. In his own laboratory an extensive investigation 
 has been made of the Washington milk during the summer 
 months of the years 1906 and 1907. In 1906 the average number 
 of bacteria per c.c. was found to be 22,134,000 ; in 1907 it was 
 1 1,270,000. Amongst the investigations of other observers, quoted 
 by Rosenau, I note the following : — Bergey, in 1904, reported 
 the average bacterial content of milk in certain American cities 
 as follows : — 
 
 Bacteria per c.c. 
 
 New York 4,000,000 
 
 Boston 2,300,000 
 
 Chicago 2,350,000 
 
 Baltimore 4,000,000 
 
 Wilmington 7,000,000 
 
 In the same year Jordan found that tli(> market milk of 
 Chicago contained an average of 9,361,000 bacteria per c.r. 
 in April, 10,071,000 in May, and 18,924,000 in June; 
 sixteen per cent, of the samples contained over 2'-J million bacteria 
 per c.c. Byrnes, also in 1904, found that in the milk supply of 
 Philadelphia the bacteria per c.c. varied from 1,600 to 21,00i',000. 
 The results of investigations made in Europe show that in most 
 European towns the bacterial content of milk is quite as high as 
 in American cities, or even higher. 
 
 In considering these statistics too much stress must not be laid 
 on the precise figiu-es quoted, because different investigators 
 employed different methods of working and their results are not 
 strictly comparable. The main point is that, where the ordinary 
 city milk contains as a matter of fact several million bacteria 
 per C.C., the bacterial standards laid down in some of the 
 American ordinances are not likely to be enforced. 
 
 It would, however, be a serious mistake to suppose that the 
 American bacterial standards are useless. Against the medical 
 officer who finds himself unable to enforce direct compliance with 
 his city's " bacterial standard " it is easy to direct obvious 
 criticisms of an adverse nature ; but it is more usefvil to appreciate 
 the fact that, in spite of this disadvantage, the information 
 obtained by bacteriological examinations is of great value to him 
 asaguido"to the control nf the milk supply, and has already 
 been turned to excellent account. The practical importance of 
 the work is well put by Rosenau. " The activities of our health 
 
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58 
 
 BACTERIAL STANDARDS. 
 
 officers were at first directed almost exclusively to the prevention 
 of sophistication of milk, detected by chemical methods, to the 
 neglect of the valuable information obtained from bacterial 
 examinations. The addition of water to milk and the extraction 
 of cream are fraudulent practices, but, as a rule, have only a 
 secondary bearing upon the public health. I'he bacteriological 
 examination of milk gives us a clue to the cleanliness of the 
 methods employed, the temperature, and the age of the milk. 
 The health officer who has the advantage of bacteriological 
 assistance knows that the milk of dairies containing excessive 
 numbers of bacteria is dirty, old, or warm. With a bacteriological 
 count as a guide it is comparatively easy to determine the cause 
 of the trouble and to institute proper means to correct it. The 
 enumeration of bacteria in milk is, therefore, one of the readiest 
 and cheapest methods at the disposal of health ofiScers to 
 determine the general sanitary quality of the market milk supply. 
 The laboratory results serve not only as a guide to direct the 
 efforts of the health officer, but confirm the conclusions arrived 
 at from an inspection of the dairies and dairy farms." I consider 
 that Eosenau's statements are fully justified by what has already 
 been accomplished in America. 
 
 The bacteriological work done in Boston by the health 
 authorities affords a good example. The following tables, which 
 I obtained from Dr. Eickards, Director of the Bacteriological 
 Laboratory, illustrate the nature and extent of the routine milk 
 investigations. 
 
 Bacteriological Examinations of Boston Milk 
 
 IN 1907. 
 
 Total number of samples examined 
 
 No. of samples showing over 500,000 
 bacteria per c.c... 
 
 No. of samples passed by microscopic 
 method alone 
 
 No. of samples showing presence of 
 pus 
 
 No. of samples showing streptococci 
 
 No of samples showing both strepto- 
 cocci and pus 
 
 4,681 
 
 1,307 = 
 
 = 1%% 
 
 1,404= 
 
 -- m% 
 
 16 = 
 35 = 
 
 = 0-34^ 
 =0-75^ 
 
 Bacterial Content of Boston Milk in 1907. 
 
 Where obtained. 
 
 Number of 
 Samples. 
 
 Percentage of 
 
 conats above 
 
 500,000 per c.c. 
 
 Contractors 
 
 Wagons 
 
 Stores 
 
 Unclassified ... 
 
 2,947 
 978 
 643 
 113 
 
 17 
 
 39 
 
 • 59 
 
 31 
 
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BACTERIAL STANDARDS. 59 
 
 Philiulclphia is anothci' city where frrcat importance is attached 
 to bacteriological investigations of a practical nature. The 
 Health Officer, Dr. AMjott, and his assistants kindl) explained 
 their methods to me. Special importance is attached to the 
 microscopical examination of the deposit after centrifngalisation. 
 In 1904, for instance, d,H'^l samples of milk were bacteriologically 
 examined ; 1,219 of these were condemned ; 292 contained pns ; 
 254 contained pus organisms ; and 673 contained both pus and 
 pus organisms. Veterinarians, sent to inspect the herds from 
 which the condemned samples came, reported as follows : — 
 
 Conditions and diseases reported. 
 
 Mai<titis 
 Septicsemia 
 
 Pustular dermatitis 
 
 Cowpox 
 Parturient paresis 
 
 Milking too close to parturition 
 
 Out of condition 
 
 Total number of a^^normal conditions 
 
 Number of cases where no disease could be detected 
 
 Total number of cases examined 
 
 Xumber of reports 
 received from 
 veterinarians 
 
 .883 
 1 
 5 
 4 
 1 
 17 
 
 9 
 
 413 
 
 103 
 
 516 
 
 )y 
 
 ire 
 
 The same report also states : — " l^he later reports received I 
 the chief milk inspector, Mr. Cik^gg, fi'om the v(terinari:i,n 
 called to inspect the herds when milk has been condetniied 
 as follows : — Per cent, of inspection in which disease was found 
 when milk was condemned because it contained pus, 97-1. Per 
 cent, of inspection in which disease was found when milk was 
 condemned because it contained pus-producing organisms, 74-3. 
 Per cent, of inspections in which disease was found when milk 
 contained both pus and pus-producing organisms, 90'3." In 
 Philadelphia, Dr. Abbott informed me, bacterial counts have 
 been abandoned, and reliance is placed solely on the microscopic 
 examination of the deposit. 
 
 In New York City, Dr. Park, who makes the bacteriological 
 examinations for the Board of Health, informed me that he 
 makes 100 bacterial counts per week of milk samples taken fi-om 
 the railway platforms and the cans or bottles in stores and 
 wagons. He finds the counts are usefid as an indication of 
 dirtiness or high temperature, and time of keeping. Since the 
 rule that the temperature of milk must not exceed 50'' F. has 
 been enforced, there has been a marked diminution in the figures 
 yielded by the summer bacterial coimts. In former times these 
 often gave from 4(1 to 500 million bacteria per c.c. : now. the 
 woist coiuits are generally under 10 million. 
 
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60 BACTERIAL STANDARDS. 
 
 In many parts of the United States which I visited I was 
 strongly advised to study the work done by Dr. Goler, Health 
 Officer of Rochester, N.Y., in improving the milk supply. 
 When I visited Rochester, Dr Goler informed me that the city 
 contains 200,000 inhabitants and uses 70,000 quarts of milk 
 daily. Every year, bacterial counts of 1,000 samples are made ; 
 fifty per cent, of these now yield less than 100,000 bacteria per 
 c.c. There are 170 retailers in the city, and counts of the milk 
 from each of these are made at least four times in the course of 
 the year. The yearly cost of the milk work in Rochester is 
 $6,000. This sum includes the salaries of the bacteriologist and 
 chemist and three inspectors, together with the salaries and 
 travelling expenses of six nurses who are employed for eight 
 weeks for work at the summer municipal mUk stations. 
 Dr. Groler is a strong believer in the value of the bacterial count, 
 and considers that the reduction which he has effected in the 
 bacterial content of Rochester milk is one of the causes which 
 have brought about a diminution of infantile mortality. The 
 work commenced in 1900, when the systematic collection of 
 samples to determine the bacterial content of milk was instituted. 
 
 The above data are sufficient to show that bacteriological 
 knowledge actually is being applied to the control of the milk 
 supply with good results. The routine work of preparing and 
 counting culture plates and examining microscopic preparations 
 is neither costly nor difficult. To prepare and count a culture 
 obviously takes much longer than to examine a film, and as it is 
 desirable to make as many examinations as possible and to do 
 them as rapidly as possible, it is interesting to find that in some 
 cities, e.g., Boston and Philadelphia, much useful information is 
 obtained by the microscopic examination alone. In Philadelphia 
 they rely on this method entirely ; in Boston a film is examined 
 first and only the suspicious samples are plated. 
 
 Special attention may be called to the fact that microscopic 
 examination, in addition to affording evidence of the relative 
 abundance of bacteria {i.e., evidence that the milk has been 
 handled or produced in a dirty way, or is old, or has been 
 exposed to an unduly high temperature) sometimes gives a useful 
 indication that the animal yielding the milk is actually diseased, 
 the microscopic diagnosis being confirmed by subsequent 
 veterinary examination. I quote an example of the prompt 
 efficacy of this method from one of the Philadelphia reports. 
 " Recently a child was made sick by the use of milk, the sample, 
 which was sent to the laboratory, was found to contain pus and 
 streptococci in large numbers. The dairyman was notified, his 
 herd inspected, and the infected cows excluded within six hours." 
 
 The results already obtained in America by the use of 
 bacteriological methods are worthy of admiration. Much more 
 remains to be done towards perfecting these methods, and, in 
 particular, the practical problems of differentiating pathogenic 
 from non-pathogenic bacteria present in milk are still far from 
 
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BACTERIAL STANDARDS. 61 
 
 being solved ; they oifer a wide and important field for future 
 inquiry. 
 
 Routine bacteriological examinations of samples, for the f/uidanct 
 of 4hc milk inspection sercice, are valuable, and should be adopted. 
 They afford the most reliable, the cheapest, and often the quickest 
 means of discovering when milk has been improperly handled. 
 
 I'pon the pathogenic effects of many of the bacteria commonly 
 present in milk further research is needed. 
 
 (3.) The Cooling of Milk. 
 
 Closely allied with the questions of bacterial standards is the 
 problem of temperature, since it is known that temperatures 
 above SO^F. favour the rapid multiplication of the majority of 
 Ijacteria present. In America great stress is laid on this factor, 
 and most of the cities which I visited have an ordinance, 
 reasonably well enforced, prohibiting the sale of milk found to 
 be at a higher temperature than 50°F. 
 
 In the following respects American conditions are difFfrent 
 from those which obtain in England. (1 ) It is the general 
 custom to collect ice in winter and store it in ice-houses ; and 
 the winters arc so severe that the ice produced and readily 
 obtainable is sufficient to last through even the liottcst summer. 
 (2) The summers are so hot that the use of ic'c is abscilutely 
 necessary to protect many of the more jjciisliabk' foods ; the 
 addition of milk to this numbci' tht'refore doc-; not appear to the 
 people to be an unreasonable or remarkable innovation. (3) In 
 the case of many of the larger cities tlic time occupii'd in 
 transferring the greater part of the milk from the farm to tlic 
 city contractor, and thenco to thr consumer, is much longci' than 
 in England ; and as the dealer cannot sell milk unless it kcc])s 
 sweet, the use of ice is often a matter of commercial necessity. 
 (4) The American habit of demanding iced di-inks makes it 
 natural for them to expect that milk shall be treatod, as far as 
 possible, like other liquids intended for consumption. 
 
 For these reasons the health authorities have had a relatively 
 easy, or at least a reasonable possible, task in keeping down the 
 temperature of milk during tlie summer months. They have 
 had to fight for it : compelling railway companies to put on 
 refrigerator cars, and enforcing the use of ice at other stages 
 during transit and storage are matters which cannot be accom- 
 plished without a struggle. And nnuli still remains to be done. 
 In Washington, for example. l\o>(Miau gives the average tempera- 
 ture of milk during the summer of 1906 a- lfi-,5°C. (61'7°F.) ; 
 in 1907 the average was brouglit down to 14-2^C. (.57|6°F.), a 
 great improvement, but >till short of the ideal. And in other 
 cities I have foxmd, by examining the records which inspectors 
 have kindly shown to me, that summer temperatures of 60^F. and 
 over are vi'rv common indeed. Nevertheless, taking the result-: 
 
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62 THE COOLING OF MILK. 
 
 as a whole, there is substantial evidence that America has already 
 made solid progress towards reducing milk temperatures, and is 
 evidently gaining ground year by year. 
 
 In England some of the main obstacles are : — (1) the cost of 
 ice, which in America, I was told, can be manufactured at from 
 75 cents, to one dollar per ton ; (2) the absence of effective 
 demand for cool milk ; (3) the objection of the railway companies 
 to provide suitable vans ; (4) the difficulty of obtaining ice at 
 the farms. At present (2) seems to be the most serious of these 
 difficulties. If the better class consumer, who ought to know the 
 advantages of properly cooled milk in hot weather and can well 
 afford to pay a little extra for it, would insist on demanding it, 
 the problem would at once become a suitable matter for practical 
 discussion. 
 
 At present it seems impossible to compel English milk-sellers to 
 keep milk at a temperature not exceeding 50°F. in hot weather. 
 
 (4.) Trade Standards for Milk Values. 
 
 Though it is impossible to make all marketable milk good by 
 Act of Parliament, it is both possible and desirable to obtain wider 
 recognition, from producer and consumer alike, that the value of 
 milk ought to depend upon its quality. 
 
 In the latest amendments (April 22nd, 1908) to their Sanitary 
 Code, the Board of Health of the City of New York is 
 endeavouring to establish this principle. Milk is graded as 
 follows : — (i) " Milk," i.e., cow's milk which conforms to the 
 ordinary requirements of the code. (2) " Selected " or " in- 
 spected " milk. The minimimi requirements for milk so designated 
 are : — " 1. Only such cows shall be admitted to the herd as are 
 free from all diseases of the udder, and from clinically manifest 
 tuberculosis. 2. That all the cows be examined clinically each 
 year by a veterinarian of "the Department of Health ; all cows 
 with any disease of the udder, or with clinically manifest tuber- 
 culosis, to be excluded from the herd and farm. It shall be 
 unlawful to sell or use the milk from such cows for food purposes. 
 
 3. That the milk shall never contain more than 60,000 germs 
 per c.c. in winter, nor more than 100,000 germs per c.c. in summer. 
 
 4. That such milk be delivered to the consumer only in sealed 
 bottles, which shall have been filled at the dairy or creamery and 
 shall be labelled with the date of the earliest milking whose milk 
 forms part of the contents of the bottle. 5. That such milk be 
 delivered to the consumer within thirty-six hours after milking." 
 (3) " Guaranteed " or " certified " milk. The minimum require- 
 ments for this are : — " 1 . That only such cows be admitted to 
 the herd as have not reacted to a diagnostic injection of tuberculin. 
 2. That all cows be tested annually with tuberculin, and all 
 reacting animals be excluded from the herd. 3. That the milk 
 shall not contain more than 30,000 germs per c.c. when delivered 
 to the consumer. 4. That the milk be delivered to the consumer 
 
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TRADE STANDARDS FOR MILK VALUES. 63 
 
 only in sealed bottles whidi shall have been filled at the dairy, 
 and shall bear a label giving the name of the dairy, and the date 
 of the earliest milking at which the milk forming part of the 
 contents was drawn. 5. That such milk be deUvered to the 
 consumer within thirty-six hours." (4) " Pasteurised " milk. 
 The regulations for this elass of milk have been quoted above. 
 
 In 1907 a conference appointed by the Commissioners of the 
 District of Columbia recommended that thi"ee grades of milk 
 should be recognised by law, riz., (1) certified milk, (2) inspected 
 milk, and (3) pasteurised milk. The requirements specified for 
 (1) may be summarised briefiy as ideal conditions, including a 
 maximum count of 10,000 bacteria per c.c, and delivery to the 
 consumer within 12 hours. (2) " Insjiccted milk" is to be 
 " clean raw milk from healthy cows, as determined by the tuber- 
 culin test and physical examination 1)y a qualified veterinary 
 surgeon." (.5) is to be "milk from the dairies not able to 
 comply with the requirements specified for the production of 
 milk of classes 1 and 2 "; it is to be pasteurised before being 
 sold, and must be sold under tiie designation " ))astcurised milk." 
 Before being pasteurised it " shall be kept at all times at a 
 temperature not exceeding 60° F." ; and after pasteurising it 
 " shall be placed in sterilised containers and delivered to the 
 consumer at a temperature not exceeding od^ F." The recom- 
 mendation also requires that "all inilk of an unknown origin 
 shall be placed in class 3 and subjected to clarification and 
 pasteurisation." Cows "in any way unfit for the ))roduction of 
 milk for use by mail, as (leternuncd upon physical examination 
 by an authorised veterinarian " are not to lie jiermitted to 
 produce milk even for class (3), but cows which have reacted to 
 tuberculin but do not show ])hysical signs of tuberculosis may be 
 used for milk of this class. Pasteurising is defined as "the 
 heating of milk to a temperature of l"in" F. or 65- C. for 
 20 minutes, or 160° F. or 70° C. for 10 minutes, as soon a- 
 practicable after milking, in inclosed vessels, preferaMy the final 
 containers, and after such heating immediate codling tn a 
 temperature not exceeding ,30° F. or 10° C." The pasteurising 
 plant must be " under the personal supervision of an officer or 
 oflficers of the Health Department." 
 
 It will be observed that the Washington recommendations are 
 of a distinctly coercive character. All dealers not able to cm- 
 form to the high standards of classes 1 and 2 are to be compelled 
 to pasteurise, under official supervision. "Whether or no such 
 stringent requirements can be enforced must depend upon local 
 conditions. In England, at the present day, such drastic 
 proposals hardly seem Ukely to meet with acceptance. 
 
 The >'ew York reuulations, on the other hand, do not interfere 
 with ordinary raw market milk, and therefore the dealers in this 
 conunoditv cannot complain of any harJship. But unles- the 
 dealer conforms to special retiuirements he is prohibited fi-om 
 misleading his customers by the use of fancy terms such as 
 " guaranteed," " selected." &c. This regulation has been made 
 
 :n22o ^■- 
 
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64 TRADE STANDARDS FOR MILK VALUES. 
 
 in order to protect the firms which are doing genuine business in 
 the better qualities of milk. This certainly seems a step in the 
 right direction, and, I was informed at the Board of Health, 
 these requirements are being actively enforced. 
 
 In view of the arbitrary and misleading application to milk 
 sold in this country of such terms as " pure," " nursery," 
 " medically inspected," " from tuberculin tested cows," and the 
 like, it seems desirable that the use of such designations should 
 be officially restricted. I offer the following suggestions :— (1) 
 Ordinary milk which has not been subjected to heat or been 
 tampered with in any way should be sold as " raw milk." (2) 
 Milk which has been heated should be kept separate from raw 
 milk and should be sold as " pasteurised milk," with a statement 
 of the date and hour of heating, the temperature to which it was 
 exposed, and the duration of such exposure. (3) Milk obtained 
 exclusively from herds guaranteed (not more than six months 
 previously), by official inspection, including the application of 
 the tuberculin test, to be entirely free from disease should be 
 allowed to bear the title of " officially certified milk." In more 
 general terms, my suggestion is that milk which, from the stand- 
 point of medical knowledge, possesses certain important and 
 distinctive features, should be " hall-marked " as such, and that 
 concealment or misrepresentation in regard to these features 
 should be treated as fraudulent. This would be the first step 
 towards affording the purchaser reliable information as to the 
 nature of the article he is buying. 
 
 FoT the purpose of controlling the producer and enlightening the 
 consumer, a regulation requiring all milk to be sold under one of 
 three designations, viz., "raw," "pasteurised," or "officially cer- 
 tified," icould he helpful. 
 
 (5.) American Certified Milk. 
 
 In 1892, Dr. Henry L. Coit initiated a movement for the 
 production of what he termed "certified milk" under the control 
 of "medical milk commissions." From BuUetin 41 of the 
 Washington Hygienic Laboratory, I quote the following outline 
 of Dr. Coit's proposals : — 
 
 " First, that physicians give their practical support to an 
 effiDrt conducted by a medical milk commission selected by a 
 medical society, which shall endeavour to bring to the city a 
 supply of milk produced under such regulations that purity shall 
 be assured. 
 
 " Second, that approved and trustworthy dairymen possessing 
 honour, financial ability, and dairy facilities shall be induced by 
 reason of promised medical support and the increased price of 
 their milk to conduct their dairies, collect, and handle the 
 product in conformity with the code of requirements made by the 
 aforesaid medical commission and imposed by it in due leo-al 
 form, ^ 
 
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CERTIFIED MILK. 65 
 
 •' Third, that the duties of the commission shall be, first, to 
 estabhsh correct clinical standards of purity for cows' milk; 
 second, be responsible for a periodical and personal inspection of 
 the dairy or dailies imder its patronage ; third, to provide for 
 bi-monthly expert examination of the dairy stock by competent 
 and approved veterinarians and for medical supervision of the 
 employees by competent physicians. 
 
 " The milk produced shall also be subject to periodical chemical 
 analysis and to bacterial counts made under the direction of the 
 commission as often as in its judgment is desirable. The 
 experts employed by the commission shall render their reports to 
 this body, which constitute the basis of its certification of the 
 product. 
 
 " The expense of examinations and inspections shall be defi-ayed 
 by the dairymen, but the members of the commission shall 
 receive no pay for their services. 
 
 " The findings of the commission shall be published to the 
 profession only, and the milk thus produced shall be known as 
 ' certified milk ' and be sold in quart containers bearing t\n- date 
 of milking and the seal of the commission." 
 
 This plan has met with success, and tweuty-eij^ht milk com- 
 missions have already been established on these lines in various 
 parts of the United States. The conditions for the production 
 of milk which the contractors are required to observe are 
 specified in elaborate detail but may be sunuiuirisL'tl briefly 
 as consisting of perfect hygienic conditions and scrupulous 
 cleanliness. The milk must be promptly cooleil after milking, 
 and kept at a temperature not exceeding .50°F. luitil it reaches 
 the consumer. The bacterial count ought not to exceed 10,000 
 organisms per c.c. 
 
 Certified milk is not expected to eonipete with ordinary 
 commercial milk. The price is much higher, and the supply is 
 necessarily very limited. The milk is primarily intended for 
 medical purposes where a thoroughly reliable suppl>- is required. 
 For example, in the contract signed with the first producer of 
 certified milk it was stipulated that the milk " shall be designed 
 especially for clinical purposes, and when at any time the 
 demand shall be greater than the supply and is required by a 
 physician, either for infant feeding or the diet of the sick, it is 
 hereby agreed that such shall be the preferred purchaser." 
 
 Unfortunately people do not always appreciate the physician's 
 advice. Dr. Wesbrook, of Minneapolis, in discussing this 
 question with me, put the ease in a nutshell. " They will pay 
 for it as a remedy but not as a prophylactic." Parents willing 
 to incur heavy expenditure for the general welfare of their 
 children do not, except in ease of actual illness see the desira- 
 bility of paying a few cents a day more for milk, when ordinary 
 market milk is, in appearance, "just as good." In fact the slight 
 faecal odour often detected in common milk seems to be attractive. 
 In several cities, producers and other persons interested in the 
 production of certified milk informed me that temporary 
 
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66 cbeTtfied milk. 
 
 customers not infrequently gave them up on the ground that 
 their milk was " tasteless." 
 
 In addition to the certified milk bought under medical advice, 
 there is a small but apparently uncertain demand for absolutely 
 pure milk as an ordinary article of diet amongst the better 
 classes in several of the American cities. In Baltimore a firm 
 which has made a very heavy financial outlay and produces milk 
 under ideal conditions informed me that they used to sell 1,200 
 quart bottles a day of " table milk." Finding that they were 
 losing heavily at the price charged, 15 cents a quart, they raised 
 their terms to 18 cents. In consequence of this change their 
 sales have fallen to 900 quarts a day. From the business point 
 of view it seems to me possible that the certified milk producers 
 would do better if they charged much higher prices, and expended 
 some capital in creating and developing a demand for the milk as 
 a popular fashion. Forty cents a quart, for example, ought to 
 show them a good return. There is nothing impossible about 
 obtaining such a price ; it is actually being done. In Philadelphia 
 some of the certified milk is put up in half-pint bottles which are 
 sold at 10 cents each to business men requiring a " rapid lunch." 
 A glass of certified milk for lunch is also popular with New York 
 business men. 1 mention these details because doubt is frequently 
 raised as to the possibility of producing " certified " milk on terms 
 terms compatible with financial success. Persons seriously engaged 
 in the sale of other drinks of various kinds usually consider it 
 their first business, whenever introducing a novelty, to find their 
 custom ; they do not expect either doctors or the general public 
 to bring it to them. Before deciding that the sale of " certified " 
 milk is not " good business," one must consider whether it has 
 been "pushed" with the intelligence of the average business 
 man. 
 
 The production of certified milk has been undertaken in several 
 instances by gentlemen of independent means who have become 
 personally interested in the milk problem and are determined to 
 bring their product up to the standard of perfection, no matter 
 how much it may cost. Their model cowsheds and expensive 
 apparatus are quite beyond the reach of the ordinary farmer 
 who has to earn his living. They have- no particular desire to 
 make money out of the business and often run the concern at a 
 loss. Two of these model dairies which I visited were certainly 
 a great pleasure to see, but I attached greater importance to the 
 ordinary, unpretentious and inexpensive dairies of farmers con- 
 ducting this business on strictly commercial lines. I visited a 
 farmer of the latter type who is producing certified milk for 
 Philadelphia, His place was in excellent order, but the feature 
 he was_ most proud of was his crop of " alfalfa," which meant 
 a plentiful supply of green fodder at low cost. He produces 400 
 quarts a day of certified milk and obtains 7^ cents a quart for it 
 from_ the retailer, who sells it at 16 cents a quart. The retailer 
 provides the bottles, which is an expensive item. The selling 
 price of ordinary milk in Philadelphia is eight cents a quart. 
 
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CERTIFIED MILK. 67 
 
 The farnuT informed me that he « as making the business pay, 
 but that his profit was small, and the business was more trouble- 
 some than that of the ordinary dairyman, owing to the difficulty 
 of seeing that the farmhands observed the necessary requirements 
 of cleanliness. The equipment necessary to satisfy the demands 
 of the society which certifies him involved an outlay of S5,000 : 
 out of this sum iJGOO went to the purchase of an autoclave 
 for sterilising his bottles. Everything I saw gave me the 
 impression that this farmer is doing reliable work ; and his 
 reputation, as I learnt afterwards from the secretary of the milk 
 commission, is excellent. Two things, however, seemed to me 
 peculiar : (1) The farmer had a pasteurising apparatus which 
 would take about 80 bottles at a time ; he told me that he 
 pasteurised a small amount of his milk, " because there was a 
 demand for it." This was afterwards corrcjborated by the 
 secretary, who told me that this milk was specially certified as 
 " pasteurised " and commanded a higher price than the raw 
 certified milk. That there should be any demand for the 
 pasteurisation of milk produced under such stringent cunditions 
 is not easy to understand. (2) The fai-nier did not date his 
 bottles. 
 
 I hold the opinion that on a farm producing certified milk no 
 pasteurisation should be allowed, and that the date of bottling 
 should be stamped on the label of every bottle. The particular 
 farmer I saw was not the sort of person likely to rescjrt U> dis- 
 honest methods, but one must consider this possibility in the ease 
 of others. The most important means of controlling certified 
 milk is by means of the bacterial rcjiuits, generally made once a 
 week. If, as is not unconnnonly the case, the farmer receives 
 official complaints that his counts are exceednig 10,000 and that 
 therefore he must insist on greater cleanliness in milking, it is 
 not at all desirable that the farmei- should be teuqjted to solve 
 the difficulty by pasteurising liis milk and bottling it as raw milk. 
 And, with regard to the dating of bottles, though it is not to the 
 interest of the fai-nier to retain filled bottles on his premises, 
 when bottles are undated there is an obvious temptation for the 
 rctaUer to add unsold bottles to his next day's supply. 
 
 The number of "medical milk commissions" is ,-luwly 
 increasing, but several of the farms are not conducting their 
 business at a profit and would not contmue the work if they were 
 not owned by men ui independent means who are more interested 
 in the production of thoroughly reliable milk than in making 
 money out of it. In some cases the work has been commenced 
 but has been abandoned owing to the financial loss involved. 
 This loss may have been due partly to lack of public support, but 
 another and more important reason is that unnecessarily large 
 sums have often been expended on buildings and eqmpment. 
 Clean stables are not necessarily costly stables ; a small amount 
 of labour is sufficient to keep cows clean ; and cleanly milkmg 
 and handling of the milk until it is sealed in bottles needs 
 vigilant supervision but no large expenditure of money. Failure 
 
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68 CEKTiriED MILK. 
 
 due to lavish expenditure of capital in establishing a " show 
 place" is no argument against the possibility of producing 
 certified milk, by reliable methods, with a reasonable margin 
 of profit. 
 
 Certified milk never amounts to more than a minute fraction 
 of the total supply of a city ; but its production is a valuable 
 object lesson ; by showing what milk ought to be, it tends to 
 raise the standard for the general supply. And by teaching the 
 people that the first requirement for the production of sound 
 milk is the possession of a herd entirely free from tuberculosis, 
 it helps, or ought to help, in the movement towards the 
 elimination of bovine tuberculosis. It was suggested to me in 
 Minneapolis that though the production of certified milk might 
 be unprofitable in itself, the enterprise could be made to pay if 
 combined with the business of raising pedigree stock, and I was 
 told at the Health Oflfice that a local farmer who was combining 
 the two pursuits was doing well. The project of combining 
 the trades of certified milk production and the raising of non- 
 tuberculous stock seems worthy of consideration. Both objects, 
 the increase in the supply of thoroughly reliable milk, and the 
 increase in the number of non-tuberculous herds, are difficult of 
 attainment ; but they are of such high importance to the com- 
 munity and are so closely connected, that any plausible scheme 
 for working the two together is deserving of a trial. 
 
 Two further points may be mentioned. (1) Certified milk is 
 naturally the best material for the preparation of " humanised " 
 milk. But this process involves additional cost, particularly if 
 the milk is put up in small bottles each containing a single feed, 
 Certified milk concerns, particularly those run on philanthropic 
 lines, often take up this latter business. But in considering the 
 financial possibilities of certified milk production, it must not be 
 forgotten that the cost of turning out the mUk in quart bottles, 
 or other sizes convenient for general use, must be estimated on a 
 different basis from the cost of turning out humanised milk. 
 The latter is more expensive, and if such milk be sold at a loss 
 it may involve the failure of a firm which might hold its own if 
 limited to the supply of unmodified milk. (2) The poor cannot 
 aflford to pay for certified milk at commercial rates. But the 
 production of this article does nothing to increase the price of 
 such milk as the poor are able to buy ; and the opportunity is 
 open for municipal or private philanthropic enterprise to provide 
 certified milk for sale to the poor at reduced rates. 
 
 The American " Medical Milk Commissions,'" ivhich aim at the 
 production of thoroughly wholesome milk, are making slow hit 
 appreciable progress, and are loorthy of imitation. 
 
 Tlie possibilities of producing "certified" milk on a financially 
 successful basis have not yet been fully exploited. 
 
 Municipal enterprise in the production of certified milk for the 
 purpose of improving the pbysiq^ie, and therefore increasing the 
 wage-earning capacity, of the poorest classes, is also icortk 
 considering' 
 
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score caed system. 69 
 
 (6.) The Score Card System. 
 
 Most of the cities which I visited have adopted the score card 
 system of inspection. When examining a place where milk is 
 produced, handled, or sold, the inspector fills up a card containing 
 a printed list of the details on which he is required to report. 
 For each detail a maximum score of a certain number of points 
 is assigned, the maximum for each detail being proportionate to 
 its importance. The total maximum score amounts to some 
 convenient figure such as 100. Printed instructions on the score 
 card define for each detail the condition for which full marks 
 must be given, and specify the defects for which deductions 
 must be made, and the number of marks to be deducted for each. 
 There is also a space for " remarks " opposite each item, in 
 order that the inspector may explain more precisely his reasons 
 for making any particular deduction. The total number of 
 marks assigned to the place inspected is added up ; compiirison 
 of this number with the maximum possible score gives a good 
 idea of the general condition of the place. The person in charge 
 of the place is given a copy of the score, and, if he is not 
 satisfied with its fairness, is ex[)eeted to complain at once to the 
 Health Department. The score cards arc filed at the ntficc, and 
 fresh score cards giving the results of reinspectioiis arc added to 
 their number. 
 
 In all the places where this system is employed, the authoritic-; 
 told me that it is of great utility. \\'hene\ er a questftju arises 
 about any particular farm or milk shop, tliey at once turn t<i the 
 score. This gives a convenient numerical exjjressiou tui- the 
 general status of the place and indicates at a glance the nature 
 and degree of particular defects. It hel])s to make the inspectors 
 do their work thoroughly, because the tilliiii^- up of a score eanl 
 necessitates attention to every detail which a e(}mpletc inspection 
 ought to take into account. It is a guide to the farmer or dealer 
 because it informs him precisely how he stands, and indicates 
 more clearly than verbal descriptions the relative importance of 
 the defects which he ought to remedy. The score cards are also 
 intended to be of service to the consumer ; if he wants to satisfy 
 himself about the quality of the milk he is buyiui;-, he may call 
 at the health office and inspect the score cards of the concern 
 with which he is dealing. In some of the smaller towns it Is the 
 custom to publish periodically a list of all the firms supplying 
 milk, together with the score of each. The town of Montclair, 
 N.J., is a good example of enterprise in this direction. The 
 report of their Board of Health for 1907 contains a list of all 
 the dairymen and dealers supplying milk to the town, and 
 opposite to each name is given the score, under the foUowing 
 headings :— cows (maximrun score, 2ii) ; stables (25) ; milk house 
 (20); milking (Id); handling of milk (20): total 100. The 
 best firm in the list scored a total of 99 and the lowest obtained 62. 
 Appended to their scores is a series of short comments on aU the 
 firms, each of which Is mentioned by name. Praise is freely 
 
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70 
 
 SCORE CARD SYSTEM. 
 
 given, but when the authorities wish to find fault they do not 
 mince matters. " This supply cannot he recommended " is the 
 comment attached to one of the best known and biggest firms in 
 the district. Of two other firms it is said — " the milk is rich 
 but the bacterial count is above the average." 
 
 Whilst appreciating the importance of the favourable opinions 
 which various authorities expressed regarding the score card 
 system, I endeavoured to obtain evidence of a statistical nature 
 in support of this view. A particularly interesting instance was 
 brought to my notice by Professor A. C. Lane, of Washington. 
 The town of Richmond, Va.., commenced the scoring of dairies 
 at the beginning of May, 1907. The following are the 
 tabulated results of their first year's work. 
 
 Classification of Dairies. 
 
 
 
 Percentage of all dairies inspected for the month 
 
 
 
 which tell la each class. 
 
 
 Class. 
 
 1907. 
 
 1908. 
 
 
 >> 
 
 a 
 
 3 
 
 l-s 
 
 3 
 
 
 
 t 
 
 o 
 
 > 
 o 
 'A 
 
 
 1 
 
 1 
 
 1 
 
 1 
 
 < 
 
 Scoring below 30 . . 
 
 13-8 
 
 26-5 
 
 3-9 
 
 4 
 
 
 
 
 
 
 
 
 
 between 30 and 40 
 
 3I)-H 
 
 4a-n 
 
 ai-0 
 
 III-'/ 
 
 
 
 
 
 
 
 
 
 40 „ 50 
 
 a6-a 
 
 22'4 
 
 3«-2 
 
 Hit-'i 
 
 40-0 
 
 23-7 
 
 14-K 
 
 l.l-K 
 
 2-8 
 
 
 
 
 50 „ 60 
 
 IH-H 
 
 «-a 
 
 aa-4 
 
 33-H 
 
 45'(l 
 
 35-(i 
 
 45-9 
 
 36-8 
 
 11-3 
 
 13-H 
 
 H-8 
 
 57 
 
 60 „ 70 
 
 iirK 
 
 
 is-2 
 
 a:i-« 
 
 la-o 
 
 33-9 
 
 29-5 
 
 23-0 
 
 35-2 
 
 44-1 
 
 39-8 
 
 34-3 
 
 70 „ 80 
 
 it, 
 
 
 1-3 
 
 
 a-.i 
 
 ()•« 
 
 8-2 
 
 18-4 
 
 3|-(l 
 
 25-4 
 
 34-2 
 
 42-9 
 
 80 „ 90 
 
 
 
 
 
 51-4 
 
 570 
 
 1-0 
 
 58-4 
 
 5-4 
 60-5 
 
 197 
 70-4 
 
 16-9 
 69-6 
 
 19-2 
 71-5 
 
 17-1 
 
 Average oE all scores for 
 
 41-5 
 
 S6-4 
 
 47-5 
 
 50-5 
 
 72-0 
 
 month. 
 
 
 
 
 
 
 
 
 
 
 
 
 An excellent illustration of the progressive improvement of the 
 fit and elimination of the unfit. 
 
 The actual working of the score card system may be considered 
 under three aspects, the efficiency of the inspectors who do the 
 scoring, the influence of the system on the producer, and its 
 influence on the consumer. 
 
 The system will not work well if the inspectors are unreliable. 
 In one of the larger cities which I visited, the Health Officer told 
 me that he believed in the score card system in theory, but had 
 not adopted it because he did not think his inspectors were a 
 sui3&ciently reliable class of men to be trusted to do the work 
 properly. It will be agreed that untrustworthy or inefficient 
 inspectors will not make out reliable score sheets, and it is true 
 that men capable of doing the work properly may not be easy to 
 find ; but with inefficient inspectors no system of inspection can 
 be good ; the fault lies with the men and not with the system. 
 In some of the cities where the score card is used, I got into 
 conversation with inspectors and endeavoured to form my own 
 opinion as to their reliability. In two instances I thought the 
 men were distinctly careless. Some of the score cards were filled 
 
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SCORE CARD SYSTEM. 71 
 
 up in a slovenly manner and contained oln-ious inaccuracies. One 
 inspector who was showing me a bundle of his score cards 
 happened to mention a particular place, the owner of which had 
 been warned for dirtiness. I asked to see the score card and 
 found that the maximum for cleanliness was KJ, but this parti- 
 cular individual's score was a sort of hieroglyphic which might 
 Lij anything ; the inspector, who wrote it, thought it was probably 
 either seven or one, but could not make up his mind which. I 
 also formed the suspicion that in cases of re-inspection, where the 
 inspector has not got his original score card at hand or where the 
 re-inspection is being made by another man, things get a Uttle 
 mixed up occasionally and require manipulation. Oceasiunallr, 
 I was told, the inspector armed with a score sheet assumed an 
 officious and dictatorial manner which the owner of the premises 
 was apt to resent, and if the owner happened to be a short- 
 tempered country farmer the inspector might meet with some dis- 
 comfiture. In short, I met with little indications every now and 
 again that some inspectors were notquite all that they should be, and 
 these observations impressed me with the importance of having a 
 vigilant chief inspector who should he capable of keeping his men 
 under proper control and should be allowed to spend a larj;e 
 amount of his time in supervising the accuracy of the score cards 
 by actual visits to the places reported on. But after making due 
 allowance for such indications as I obstrved that the score card 
 system may be abused and may work imperfectly, I found that 
 the preponderance of evidence was strongly in favour of the 
 system. The method is working well, the authorities are 
 obtaining a more intelligent and reliable class of men for the 
 work, and a better understanding is being established between the 
 inspectors and the trade. 
 
 The small country town of Ithaca, N.Y., affords a good 
 example of the score card system at its best. The dairy 
 inspection is in charge of Mr. Ferguson, of Cornell University, 
 who personally inspects about 120 farms, liefore filling up a 
 score sheet he makes the farmer fill in answers to a long series 
 of printed questions, covering every detail to be investigated at 
 the subsequent inspection. The farmer is thus compelled to 
 criticise himself, and to make acquaintance with his own 
 shortcomings, before receiving any adverse criticism from the 
 inspector. And as the farmer knows that he wiU be required to 
 verify his statements, he has good reason to examine his dairy 
 equipment \vith a critical eye. This makes the inspector's duty 
 of fault rinding much easier. Questions of fact being more 
 readily agreed to, the score card can be filled up without causing 
 resentment ; the inspector then proceeds to ofi'er friendly 
 suggestions of remedies and improvements, and is soon able to 
 convince the farmei- that the object of his visit is to help rather 
 than to interfere. The work of education has to be done 
 gradually. When the inspector finds a tumble-down cowshed 
 with a low roof laden with di]-t and cobwebs, a leaking wooden 
 drain, bad light, no system of ventilation, a ramshackle outhouse 
 
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72 SCOEE CARD SYSTEM. 
 
 for cooling and bottling, and defective cleansing apparatus, he 
 does not talk about model cowsheds and ideal dairy equipments, 
 but points out obvious improvements which can be made readily 
 and without any expenditure which is beyond the farmer's 
 means. At each subsequent visit he praises auch improvements 
 as have been made and suggests something further. 
 
 Mr. Ferguson took me on a tour of inspection to several farms 
 in the neighbourhood of Ithaca. One of them was a model 
 dairy owned by a man who aimed at perfection regardless of 
 expense. He complained that his score card had been marked 
 too liberally. The other places were small farms, each with 
 about a dozen cows, owned by men of very limited means. The 
 cowsheds were badly constructed and the milk rooms were too 
 small to allow of the work being done properly ; but from the 
 various improvements which had been made and were pointed 
 out to me it could be seen that the farmers were doing their 
 best. The influence of the scoring system was shown by the 
 eagerness of the farmers to learn how they could obtain more 
 marks. The competitive element appealed to them ; the addition 
 of a few more marks here and there by more attention to details 
 would enable them to equal or excel a neighbour whose score at 
 present stood above theirs. The scores are published periodically 
 in the local paper, are keenly discussed, and stimulate the rivalry 
 of the farmers. The prospect of scoring more marks will induce 
 a farmer to keep his cows clean, clip the hair about the 
 udder, and attend to other details, far more effectively than dis- 
 cussions of bacterial content or the general requirements of a pure 
 milk supply. The special feature of the system is that it stimu- 
 lates improvement by voluntary enterprise and without resort to 
 coercion. When the inspector knows his business and gains the 
 confidence of the farmer he rarely has to resort to the threat 
 that the licence will be withdrawn unless improvements are 
 effected. The farmer endeavours to reform because a bigger 
 score means an increase of his reputation amongst his neighbours 
 and a possible expansion of his custom. 
 
 The influence of the score card on the consumer is difficult to 
 estimate. A definition of the quality of a milk supply based on 
 an objective statement, such as the score card provides, ought to 
 be appreciated, but the average consumer is often influenced by 
 some purely capricious reason in the choice of his milkman. 
 The main fact which is emphasised by American experience is 
 that the score cards have more influence on the farmer when he 
 knows that their contents are accessible to the consumer. This 
 element of publicity is recognised as important even in cases 
 where scoring by marks is not resorted to. When in Boston I 
 was informed by the oflicials of the State Board of Health that 
 the score card system had not been adopted by Massachusetts, 
 but the dairies were officially divided into two categories — (1) 
 " commendable " and (2) "those having objectionable conditions." 
 This classification is based on oflficial inspection by a trained 
 veterinarian specially appointed for the purpose. Every month 
 
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SCORE CAHD 8Y8TEML, 73 
 
 le Official Monthly Bulletin of the State publishes a statement 
 : the uuniber of dairies examined during the mouth and the 
 imbei- fouud " commeudable." The names and Idealities of all 
 le " commeudable " dairies are given, but, acting on the advice 
 : their Attorney General, the State does not publish the names 
 'the "objectionable" places. Tn the case of 'these latter the 
 ecretary of the State Board of Health sends a letter to the 
 irmer, caUrng attention to the defects revealed by inspection 
 id concluding with the sentence — " If, on second inspection, 
 le same condition of affairs is found to obtain, it will be 
 jcessary to take steps leading to the exclusion of your milk 
 ■om public sale." The health authority in the town receiving the 
 lilk is also notified, and when the milk is being sold to a large 
 jntractor he is advised of the unwholesome conditions, and 
 enerally, I was told, finds it to his advantage to exclude such 
 lilk from his supply. During the period from July, 1905 to 
 Lpril, 1908 the State Inspector examined 8,340 dairies and 
 3und 2,665 of these "commendable." To what extent the 
 Dnsumer exhibits a preference for milk coming from " cora- 
 lendable " dairies I was not able to ascertain. 
 
 In several places where the score card system exists and seems 
 3 be working well, I suggested that the system might be made 
 bill more effective by requiring the milk dealer to exhibit along 
 dth his permit, which he is compelled to post up in his shop or 
 n his wagon, a copy of the latest scores relating to his milk, 
 ly suggestion was not cordially received, though I wa^ unable 
 3 discover any insuperable objection to it ; it ap])ears to me 
 liat if the right of the pulilic to know the contents of a score 
 ard be recognised, as it is in many places, the mo;-t ettective 
 Ian would be to make the dealer exhibit his score to his 
 ustomers. There is, of course, the possibility that if this plan 
 rere adopted, careless work on the part of an inspector would 
 ome to light in a rather inconvenient fashion, and the health 
 uthorities might consequently get into difficulties ; the tempta- 
 ion for an inspector to accept bribes might also be increased. 
 
 Given competent, honest, and taetful inspectors, the scan- card 
 ystem loorks well and is advantcu/tons (tlihe to the health authoriti/, 
 he producer, and the cinsMnier. Its most important service is that 
 ) provides a steadihi applied stimulus to voluntary improvement, 
 ^here the conditions fall far short of the ideal but do not lend 
 ^lemselves to correction hy coercive measures. 
 
 (7). From Cow to Consumer. 
 
 In all the places which I visited I endeavoured to ascertain 
 rom the authoritiis how far they were able to trace milk back 
 rom the consumer to its source. One of the conditions on which 
 lie milk sellers hold their license is that they must keep the 
 uthorities informed of the place or places from which they 
 btain the milk. If the milk seller obtains all his supply from 
 nc farm, the task of tracing it back is easy : the difficulty aiises 
 
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74 FBOM COW TO CONSTTMBE. 
 
 from the bigger concerns who receive their milk from a large 
 number of sources. In Philadelphia, I was told, the dealers who 
 send out a large number of milk wagons keep a record- of the 
 source supplying each wagon and generally supply each wagon 
 from the same one or two dairies. But the answer which my 
 enquiries usually elicited was to the effect that the identity of 
 the milk was lost when it arrived at the city contractor, and that 
 the only thing to do when dealing with a case of infectious' 
 disease possibly due to milk was to take up the contractor's list 
 of farms supplying him and investigate all of them. In the case 
 of big contractors selling unpasteurised milk, I expressed the 
 opinion that this must be a very formidable task. Whilst not 
 disputing my view, the authorities generally pointed out that 
 they took elaborate precautions to secure early notification of 
 infectious disease arising on any of the farms supplying the con- 
 tractors ; it was better to prevent infective bacteria, e.g., 
 typhoid iDacilli, from getting into the milk at the source than to 
 wait for them to reach the consumer, where there would be the 
 long delay of the incubation period before they manifested their 
 presence. This line of argument did not satisfy me, because I 
 was aware of the importance of early notification of disease in 
 dairies and regarded this as a question distinct from the problem 
 of tracing milk from the consumer back to the herd. For this 
 latter problem, it appears to me, the American authorities have 
 not been able to provide a satisfactory solution. In fact the 
 difficulty arising from the trade custom of mixing milk appears 
 to be as great in America as in England, possibly greater. In a 
 country district I visited a small farmer who bottled and sold 
 milk ; his total output was only 100 quarts a day but this was a 
 mixture from five different sources, his own cows and the cows 
 belonging to four farmers in the neighbourhood. In the larger 
 businesses, where the milk before commencing its transit by rail 
 is mixed at a country creamery or collecting station supplied by 
 various farms, the diflficulty of tracing back from consumer to 
 cow is obviously much greater. 
 
 In America, as in England, one meets with the trade objection 
 that mixing is necessary in order to average the qualities of milk 
 obtained from various sources. Whatever may be the importance 
 of this requirement, to the trade, it is certainly not greater than 
 the importance, to the general public, of enabling the health 
 officer to trace back to its source milk which is suspected of 
 conveying infectious disease. It is no excuse to say, as has been 
 said to me in America, that the mixing of milk dilutes the infec- 
 tive material and thus reduces the dangers which might arise 
 from it. On the contrary, the mixture of milk containing 
 pathogenic bacteria with wholesome milk makes the whole of the 
 mixture infective. When the swine of Minnesota were fed with 
 a mixture of wholesome skim milk and skim milk containing 
 living tubercle bacilli, they become infected with tuberculosis ; 
 the dilution of the pathogenic material with innocuous material 
 did not prevent them from acquiring the disease. The disease 
 
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PROM COW TO CONSUMER. 75 
 
 continued to .ipread, and, being associated with financial loss, 
 necessitated the passing oi. a law prohibiting the feeding of swine 
 with factory sjcim milk containing any living tubercle bacilli, no 
 matter how few in number. And with regard to pathogenic 
 bacteria in general, it must not be forgotten that milk is an 
 excellent nutrient medium, and that therefore the number of such 
 bacteria present when the milk reaches the consumer may be 
 much greater than the number immediately after mixing. 
 
 In order to meet the difficulty arising from this trade custom, 
 I suggest that action might be taken in accordance with the 
 following principles. When a case of infectious disease arises 
 where the milk is suspected and where it is known that the milk 
 lias not been pasteurised, the ultimate source of the supply 
 ought to be immediately inspected. If the dealer can satisfy 
 the medical officer that the milk in question is derived entirely 
 from one farm, the expense of inspecting that farm ought to be 
 borne by the public authorities. If there are several possible 
 sources, the expense of inspecting all except one ought to be 
 borne by the dealer. The matter might be simplified and made 
 easier for the dealer by putting a limit on the amount of mixing. 
 Assuming that the dealer receives milk of threr qualities ri:., 
 (1) average, (2) above average, (3) below average, he might 
 send out ( I') imaltered, and limit his mixing to (2) and (3), by 
 adding a particular lot of (2) to a particular lot of (3) and 
 labelling the mixture with the names of the two som-ces. Ik'fore 
 I sailed for America Dr Manby took me to Paddington Station 
 and showed me the mixing process as it is conducted on the platform. 
 The contractor's foreman grades tlic milk by sumc rapid 
 empirical method best known to himself. What one actually sees 
 is that he opens several churns, removes a gallon or more from 
 each, and fills u]) thc^ ])artially emptied churns with mOk diftcrent 
 from that which they originally contained. Here it seems 
 reasonable and very desirable that the law should step in and 
 insist that after the mixuig is over the churns should be 
 re-labelled. If they originally contained milk, respeitively, from 
 farmers A, B, and C, they should be re-labellcd, t:(/., mixture of 
 A + B, B h C, or, if requisite, A + B + C. As the business 
 is at present conducted, it is impossible to trace milk back to the 
 herd ; the expenditure of a few minutes in re-labeUing the 
 churns would at least remove one obstacle which now stands in 
 the way. 
 
 The American cans used for the transit of milk are smaller 
 than the English churn. They differ in size in different districts. 
 In Minnesota, I was told, cans of 5, 10, and 15 gallons capacity 
 are used. I do not remember seeing any cans so large as 15 
 gallons in any of the States through which I travelled ; 10 
 gallons and 5 gallons, or thereabouts, are the sizes usually found. 
 Some of the 6-gallon cans which I saw in Baltimore were placed 
 within an outer can, the space between the two being packed 
 with ice. In New York City the cans which I saw arriving by 
 train were of 10 gallons capacity ; lumps of ice were placed 
 
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76 PROM cow TO CONSUMER, 
 
 between the cans and generally res'ted on ' tlie shoulders of 
 adjacent cans. 
 
 The particular size of the cans does not seem to be a matter 
 of much importance, but it is an obvious advantage to have a 
 uniform size for all cans travelling by a particular route. It is 
 also an advantage to have all the cans completely filled. If 
 however a very large size such as the English 17 gallon churn 
 is used, it may frequently happen that one of the cans sent from 
 an individual farm is only partially filled ; hence the custom of 
 filling up such cans with milk obtained from another source, with 
 its attendant evils of promiscuous mixing, unsealed cans, and the 
 impossibility of tracing milk back to the farm. But as the 
 avoidance of these evils is of greater importance than the 
 observance of absolute uniformity in the size of cans, the 
 simplest way out of the difficulty would be to make the farmer 
 use a can of smaller size, e.g., 5 or 10 gallons, for the milk left 
 over after he has filled all his churns. The additional incon- 
 venience caused by the haulage of a few of these smaller cans 
 would be trifling as compared with the advantage of preserving 
 the identity of all the milk arriving by rail. 
 
 All the American cans I saw were covered with a closely 
 fitting metal lid (the Boston wooden plug seems to be going out 
 of fashion). The upper surface of the lid was generally convex-, 
 with the rim slightly projecting beyond the mouth of the can. 
 None of the lids were perforated. In only a few instances did I 
 find the cans sealed. 
 
 Whilst feeling that the Americans might with advantage 
 attach more importance to the sealing of cans, I freely admit 
 that they are greatly in advance of the old country in the matter 
 of protecting milk from contamination by dirt during transit. 
 . At the first half-dozen places I visited, I volunteered the informa- 
 tion that many English dealers thought that the presence of holes 
 in the lid of a milk churn was necessary in order to make the 
 milk "keep." My statement was always received with an 
 outburst of laughter, and I was usually told that it was just the 
 funniest thing ever heard. It is quite common in America for 
 the milk dealer to consider that " aeration " of milk in the 
 milk room is necessary in order to get rid of the " cow smell," 
 but the idea that milk should be exposed to the contamina- 
 tion of the dirt which accumulates during railroad transit is 
 regarded in America, and very properly, as simply disgusting. 
 Feeling somewhat ashamed of my countrymen, I abandoned this 
 subject, after the first fortnight. All I can say by way of 
 rejoinder is that in one of the largest cities in the Eastern States 
 I elucidated from an inspector a remarkable suggestion. We 
 were going round on night work, and it was part of his duty to 
 ascertain that the empty milk cans sent to the station for return 
 to the farmer had been properly cleansed. I tipped up several 
 lids, and, as it was too dark to see, relied on the sense of smell. 
 The odour of putrid milk was unmistakable, close proximity being 
 both unnecessary and undesirable. The inspector admitted that 
 
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FROM COW TO CONSUMER. 77 
 
 there was " a slight stuffy odour," but explained that this was 
 usual in empty can* and that a ventilation hole ought to be 
 perforated in the lid, "in order to let out the smell." It is only 
 fair to add that his suggestion has not been officially adopted. 
 
 Bottled milk is sold in much larger quantities in America than 
 in England. When the empty bottles are, after washing, 
 sterilised in an autoclave, when the Jjottling apparatus is 
 hacteriologically clean, and when the filled bottles are dated, 
 bottled milk is decidedly better than the same, milk sold " loose." 
 But these precautions are very far from bein;; universal ; in fact, 
 the observation of all three of them is the exception rather than 
 the rule. Without these precautions, bottled milk is an article 
 of doubtful reliability. Amongst the lower classes empty milk 
 bottles are frequently used for disgusting purposes ; and even 
 the better class of consumer frequently returns the bottles in a 
 state which makes them very difficult to cleanse properly with 
 the aid of a brush, alkaline solution, and hot water. These 
 difficulties, and the imperfect way in which they are often met, 
 were impressed on me by a farmer's wife, who was responsible 
 for the bottle-cleansing part of the business. Failing to recog- 
 nise my friend as an inspector, and mistaking us both for 
 ■' gentlemen at large," she talked freely on the subject. Her 
 revelations were somewhat disquieting. No bottle seems as yet 
 to have been invented which is both satisfactory and cheap 
 enough to be discarded after once being used. Paper bottles, 
 saturated with paraffin, have been tried, but I have not found 
 any instance of their successful adoption. In one place I was 
 told that the fatal objection was that the customer would not buy 
 them because the cream layer could not be seen ; the American 
 housewife seems to attach more importance to the presence of a 
 deep cream liiyer on the top of the milk bottle than to the date 
 of bottling. In another place the objection W!is that some of the 
 paper bottles leaked ; and in a third I was told that the disposal 
 of the waste paper, if the bottles came into general use, would 
 become a serious nuisance. 
 
 Whilst the various difficulties which I have mentioned diifer 
 in importance, the conclusion seems to be warranted that the 
 bottling of milk requires careful supei-vision and demands 
 official attention. 
 
 The fact that, in the American trade, mill: is hauled in dust-proof 
 receptacles denumstrafes the absurdity of the notion that rentilation 
 holes arc ncccssanj. 
 
 On arrival at its destination by rail, milk should be in sealed 
 cans hearing the name of the farm where it teas produced. 
 
 Promiscuous mixiuq of milk intended for sale without pasteurisa- 
 tion is undesirable. If some mixing be necessary for the purpose of 
 areraaiiia the (juality of milk stdd as raw milk, the dealer should be 
 saddled irifh the responsibility of labelling the mixture with the 
 names of the tico or more sources from which it was obtained. 
 
 fVhen milk is sold in bottles, orfcial supervision is desirable, to 
 , nsure the bacteriological cleanliness of the bottles and bottling 
 apparatus. 
 
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78 SUMMARY. 
 
 PART III. 
 
 Summary. 
 
 Througliout the above Keport I have called attention to certain 
 salient points by the use of italics. The following is a summary 
 of the statements thus emphasised. 
 
 1. It is, so far as my observations enable me to speak, useless 
 to attempt the formulation of any general plan for the complete 
 eradication of bovine tuberculosis throughout this country within 
 a limited period. 
 
 2. It is imperative, in the interests of agriculture, that dairy 
 cows with advanced or generalised tuberculosis, or with tuber- 
 culosis of the udder, should be destroyed. 
 
 3. The public must be prepared to meet all the cost of 
 adequately inspecting the condition of dairy cattle. 
 
 4. It is essential, in the interests of agriculture, that compen- 
 sation should not be paid out of the public funds for slaughtered 
 cattle showing advanced or generalised tuberculosis, or tuber- 
 culosis of the udder. 
 
 5. The testing of entire herds with tuberculin should be 
 encouraged, and for this purpose the assistance of public money 
 is requisite and desirable. 
 
 6. Public money spent on re-testing, with a view to establish- 
 ing thoroughly the soundness of herds giving on the first test 
 either no reactions or only a small percentage of reactions, would 
 be money well spent. 
 
 7. Reacting animals possessing a market value might under 
 special circumstances be taken over by the community at a price 
 exceeding their market value ; but with this limited exception, 
 compensation out of the public funds does not appear to be 
 justifiable. 
 
 8. Local authorities, by establishing and maintaining clean 
 herds for the supply of public institutions, would provide a 
 valuable means of educating the farmer. 
 
 9. The difficulty at present seems to lie not so much in th° lack 
 of public support, of a financial nature, as in the lack of evidence 
 that the agricultural interest is prepared to turn to good 
 advantage such effective public support as might be offered. 
 
 10. It is true in fact that in America the local sanitary 
 authority enforces regulations for the control of the milk supply 
 by the exercise of its own unaided powers, and that the exercise 
 of such powers is sanctioned both by law and by public opinion. 
 
 11. Aggressive programmes of milk reform have not succeeded 
 in America and are not to be recommended. 
 
 12. Actual reforms are mainly due to the acceptance of 
 reasonable recommendations offered by the medical officer, and 
 are attributable to the recognition rather than to the exercise of 
 this officer's right of direct intervention. 
 
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SUMMARY. 79 
 
 13. The theoretical right of the medical officer to withhold or 
 revoke a permit for any and every breach of the municipal 
 regulations may be questionable. 
 
 14. In practice the permit systemi works well and involves no 
 hardship or injustice to the honest dealer. 
 
 15. The direct control exercised by the permit system is an 
 effective instrument of reform ; prosecutions in the law coiirts 
 are not. 
 
 16. The exclusion from a city of milk which is not provided 
 with a reasonable guarantee that it has been produced under 
 wholesome conditions is justifiable. 
 
 17. It would be an advantage to entrust to the local health 
 authorities reasonable and legally defined powers of dii-ect 
 control over the production and sale of milk. 
 
 18. Commercial pasteurisation is firmly established and cannot 
 be abolished ; but it seems both possible and de^^irable to 
 institute a system of inspection which shall provide a guarantee 
 that the work is done efficiently, with regard to the interests of 
 the consumer and in accordance with the standard of skill, care, 
 and cleanliness already observed by the better class of firms. 
 
 1 9. Whilst official encouragement or enforcement of pasteuri- 
 sation might be objectionable, it would appear useful and reason- 
 able to insist that pasteurised milk shall be sold as such, in order 
 to enable the consumer to choose for himself between the 
 pasteurised and the raw article. 
 
 20. Routine bacteriological examinations of samples, for the 
 guidance of the milk inspection service, are valuable and should 
 be adopted. They afford the most reliable, the cheapest, and 
 often the quickest means of discovering when milk lias been 
 improperly handled. 
 
 21. Upon the pathogenic effects of many of the bacteria 
 commonly present in milk further research is needed. 
 
 22. At present it seems impossible to compel English milk- 
 sellers to keep milk at a temperature not exceeding 50°F. in hot 
 weather. 
 
 23. For the purpose of controUing the producer and 
 enlightening the consumer, a regulation requiring all milk to be 
 sold under one of three designations, r/r., " raw," " pasteurised," 
 or " officially certified," would be helpful. 
 
 24. The American " medical milk commissions," which aim 
 at the production of thoroughly wholesome milk, are making 
 slow but appreciable progress, and are worthy of imitation. 
 
 2 j. The possibilities of producing " certified " milk on a 
 financially successful basis have not yet been fully exploited. 
 
 26. Municipal enterprise in the production of " certified " 
 milk for tlie purpose of improving the physique, and therefore 
 increasing the wage-earning capacity, of the poorest classes is 
 also worth considering. 
 
 27. Given competent, honest, and tactful inspectors, the score 
 card system works well and is advantageous alike to the health 
 authoritv, the producer, and the consumer. Its most important 
 
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service lis -tjiat it provides a. steadily appjied stimulus to voluntary 
 improvement, where the conditions fall far short of the ideal but 
 do not lend themselves to correction by coercive measiires; ; 
 
 28. T^e fact that, in the American trade, milk is hauled m 
 dust-proof receptacles demonstrates the absurdity of the.notioii 
 that ventilation holes are necessary. ' j.? 
 
 29. On arrival at its destination by rail, milk should be, in 
 sealed cans bearing the name of the farm where it was produced. 
 
 30. Promiscuous mixing of milk intended for sale without 
 pasteurisation is undesirable. If some mixing be necessary' fb]f 
 the purpose of averaging the quajlty of^milk, sold as raw mUk, 
 the dealer should be saddled with the responsibility of labelling 
 the mixture with the names of the two or more sources frona- 
 which it was obtained. 
 
 31. When milk is sold in bottles, official supervision is desir- 
 able, to ensure the bacteriological cleanliness of the bottles and 
 bottling apparatus. 
 
 ARTHUR EASTWOOD. , 
 
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Mtmm/actattJ iy 
 
 GAYLORD BROS. Ik. 
 
 Srr«u», N. Y. 
 
 Stoclitoil, Cali(. 
 
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