Milk has long been considered to be one of the most important human foods, particularly for the young, combining within itself all the essential elements necessary for the production of cell tissue and for animal vitality. In composition, it is about 87 per cent water, the remaining 13 per cent being divided between fat, casein, and sugar in equal parts, with a small addition of salt. As is well known, milk is the sole food upon which it is possible to sustain life for long periods, and while this applies directly to infants, it is by no means confined to them. Many examples can be given of men and women of mature life who, either on account of some digestive disorder or some mental bias, have confined themselves absolutely to a diet of about two quarts of milk a day and have lived thereon for months and years without suffering from lack of nutrition. In recent years, due to the advocacy of the eminent scientist, Metchnikoff, who asserts that researches in the Pasteur Institute have shown that certain diseases of advanced age are due to auto-intoxication from the larger Between these two extremes—the use of milk for the very young and for the aged and infirm—milk plays an important part as food. The consumption of milk in New York State, according to statistics, amounts to about a pint a day for each person for that part of the country. As an article of food, milk has the advantage already referred to, namely, that besides its nutritive power it has a curative effect greatly augmented by fermentation, the modification so vigorously advocated by Metchnikoff. Another advantage which milk possesses as an article of food is that, by sterilization and storage in closed vessels, it may be kept for days and even months in good condition. At the time of the Paris Exposition, milk was sent from America and exhibited alongside of French milk with no preservatives except heat used for removing the bacteria in the milk and then cold storage for keeping others out, and two weeks after the original bottling the milk was in good condition. To meet the need of ailing babies, advantage was taken of this valuable property of milk, by which it could be shipped from dairies near New York to the Isthmus of Panama, and used continually with good results although more than a week old. Bacteria in milk. The great disadvantage which milk sustains as an article of food is that the same composition that makes it so useful as a diet for man, also renders it a most admirable culture medium for the rapid development of all kinds of bacteria. Some of these bacteria are, without doubt, benign in their effect upon man; as, for example, the particular species used to produce koumiss and other varieties of fermented milk now recommended by physicians. But there are many other kinds of bacteria that find life in milk congenial, whose effect upon the human system is not salutary, and, if milk infected with those varieties is used for feeding infants, the result is quite likely to be a disturbance of their digestive system, producing diarrhea and cholera infantum and possibly death. It was at one time common to add to milk certain antiseptics for the purpose of preventing the growth of bacteria, and, except that the preservatives acted quite as injuriously upon man as upon the bacteria, the results, so far as merely keeping the milk went, were all that could be desired. The chemicals added were borax, boracic acid, salicilic acid, sodium carbonate, and other similar disinfectants. Gradually, however, it has come to be known that, inasmuch as the milk when first drawn from the cow's udder is sterile, that is, contains no bacteria, and since it is quite possible to prevent the introduction of bacteria into milk during the processes of milking, straining, and bottling, there is no need of the addition of preservatives, provided particular care is exercised in handling the milk. Effects of bacteria. Since this care involves the expenditure of both additional The second kind of bacteria are known as pathogenic; that is, are the direct cause of disease when taken into the human system. Under ordinary circumstances, this latter class will not be found in milk, since these kinds of bacteria must come from some infected person, and if no such person is in contact with the milk at any stage, then it is impossible for the milk to become so polluted. However, those interested in preventing the spread of disease through polluted milk argue that if the conditions in a stable and dairy are so unclean that large numbers of the normal milk bacteria can enter the milk and increase in numbers there, then conditions would be favorable for the introduction of pathogenic bacteria whenever the milker or bottle-washer or the strainer or any of the helpers became sick. To show the difference in the effect of a clean stable and dairy as compared with an ordinary one, it is only necessary to say that in investigating the quality of the The following example may be given to indicate the effect of impure milk upon a community. The vital statistics of the city of Rochester, including the deaths of children under five years, show that from 1889 to 1896, during the summer, infants died at the rate of 109 per 100,000 population. The health officer of the city undertook to improve the quality of the milk, and from 1896 to 1905, statistics show that the number of children dying, under five years, was only at the rate of 54 per 100,000,—a manifest saving due, without doubt, to the improvement in the quality of the milk. By repeated examinations of the dairies, by rigid enforcement of certain rules governing the distribution of milk, and by detailed lessons to The Honorable Nathan Strauss, of New York City, has taken up the same idea, and, by supplying the poor with milk properly heated so as to destroy the bacteria which may have been introduced by careless handling, has also saved hundreds of thousands of children from premature death. Diseases caused by milk. Many infectious diseases are propagated by milk, not only among children, whose chief food is found in this supply, but also among those of more mature age who, though drinking only a small quantity, are apparently more easily affected. Four diseases are particularly to be noted in connection with the consumption of milk, namely, typhoid fever, scarlet fever, diphtheria, and tuberculosis. Typhoid fever from milk. One of the most striking illustrations of the spread of typhoid fever through milk occurred this last year in the city of Ithaca, New York. The city proper lies in a valley between two hills, the milkmen having their farms on both sides of the valley to the east and west, on the hill slopes. One milkman on the west, with a large route, delivered his own milk only in part and bought an additional supply from a farmer on the east. In the family of the latter occurred a case of typhoid fever in September, pronounced by the local physician to be sunstroke, but evidently typhoid fever, since other cases of secondary infection developed in the same family and were then pronounced typhoid. The milk from this east-side farm The Reports of the Massachusetts State Board of Health give a number of cases of the same sort, all showing that milk is easily infected by persons suffering from even mild attacks of typhoid fever, attacks so slight as perhaps not to be recognized or to be worth submitting to a physician, but which are responsible for bacteria passing from the hands or mouth to a can cover or ladle, and so to the milk. Diphtheria. Diphtheria seems to be well established as a disease transmissible by milk, although its occurrence is not so frequent as that of typhoid fever. Not long since, the writer was much interested in an epidemic of this sort described by a physician who was convinced that the bacteria responsible for the mild form of the disease occurred largely in the nose and throat passages. He noted that as the result of these growths a constant exudation from both passages was present, and that a man with this disease, working over the milk, might easily allow the milk to be polluted by this exudate dropping from his nose. The result was a general distribution of a mild form of diphtheria among those using the milk. Scarlet fever. Many examples have also been given of the distribution of scarlet fever through the agency of milk, the specific contagion probably being discharged by the patient from his nostrils, mouth, or from the dry particles of skin so characteristic of this disease. Unfortunately, mild cases of scarlatina are very apt to occur, so mild that a physician is not called in, and the only positive proof of the disease consists in the subsequent "peeling," although the nasal passages may have been alive with germs. Tuberculosis. So far as tuberculosis is concerned, nothing seems to be definitely proved. There is little fear of milk becoming infected from tuberculous patients or of the disease being transmitted through milk from one person to another, as with the three other diseases mentioned. The possibility of infection here lies in the fact that a cow, like man, is susceptible to tuberculosis as a disease, and undergoes the same course of prolonged suffering and death. The interesting question is whether the disease may be transmitted from a cow to a man through the cow's milk. With all the refinements suggested by science as to the virulence of the disease thus transmitted, with a study of the comparative symptoms of the two diseases, of the progress of the disease in the cow when the germs are found in the milk, and of the possibility of eliminating these germs by heating or otherwise, the danger from diseased cows is still unsettled. So far as present knowledge goes, it is probably conservative It can only be said, therefore, that laboratory experiments have demonstrated the presence of the tuberculosis bacillus in milk from tubercular cows, and that this bacillus is known to produce tubercular lesions in man. It is wise, therefore, to eliminate the milk of tubercular cows if healthy milk is to be provided. Methods of obtaining clean milk. Aside from the infection of milk by specific disease-producing bacteria, the milkman of to-day must be very careful to avoid a milk which shall contain large numbers of bacteria of any type which, while not producing any specific disease, nevertheless causes changes in the chemical composition of the milk, which make it at the same time unfit as an article of food for individuals and shows the possibility of other kinds of infection. There are two axioms to be followed if good clean milk is to be produced, and those are that the milking and straining shall be done in clean stables, from clean cows, by clean persons; and the other that the milk shall be cooled to a temperature of fifty degrees or less as soon as received from the cow. Neither of these requirements is difficult to attain, but they constitute the sole reason why some milk contains a million or more bacteria and other milk less than a thousand; and it is quite possible by enforcing these two requirements to change the number of bacteria in milk from the large figure to the small one. Probably it is in the stable where the cows are milked that the most important factor in producing large numbers of bacteria is to be found. Not long ago the writer saw a number of stables, the ceilings of which were poles on which the winter supply of hay was stored and the atmosphere Light and air in a stable are both important, not so much for the quality of the milk as for the health of the cows that furnish the milk. Ventilation and sunlight are both excellent antiseptics. The ordinary rule for the amount of window area per cow as given by the United States Department of Agriculture is four square feet of window surface. But it is not easy to definitely state any fixed amount of window area, since the value of the window is in its disinfecting power on the bacterial life of the stable, and this is greater or less as the windows receive the direct sunlight or are hidden under eaves where no sunlight reaches them. The next factor in the production of good milk is the condition of the walls of the stable. Like the ceiling, they should be absolutely free from dust, and should be smooth, so that they may be brushed or even washed clean. For this reason, walls with ledges are objectionable, and all horizontal surfaces in a stable are undesirable. Tongue-and-groove The next factor in the production of clean milk is the condition of the cow herself, not in the matter of her actual health, but in the matter of the cleanliness of her skin at the time the milking is done. If the udder and sides of the cow have been coated with manure, it is certain that more or less will fall into the milk-pail at the time of milking, and the "cowy taste" of the milk is easily accounted for in this way. In a modern stable, the milkman is careful to clean the cow ten or fifteen minutes before the milking is done by sponging or washing her belly, sides, and udder with a damp cloth or with a cloth moistened with a disinfecting solution. In one set of experiments, for instance, 20,000 bacteria per c.c. were found in the milk when the cow was rubbed off before the milking and 170,000 when the preliminary cleaning was omitted. In another case, Only a few weeks ago, the writer watched the hired man start the milking and was disgusted to see the old-fashioned practice followed of squeezing a little milk onto the man's filthy hands and then the handful of milk rubbed around on the cow's teats to drip filthy and bacteria-laden into the milk-pail along with the milk itself. One other factor is involved which, while scoffed at by some of the old-time farmers, has nevertheless proved its value, and that is the use of the narrow-topped milk-pail. It is startling when tested by bacterial growths under the two conditions to see how many more bacteria will be found in the wide open pail than in the narrow-topped one, and while, of course, some milkers may not be able to use a pail the top of which is only six inches in diameter, it is quite worth while for milkers who do not know how to use a narrow-topped pail to learn. The size of the opening is not the whole consideration in the matter of the milk-pail. The way it is washed is even more important. If it is merely rinsed out in cold water and then washed in warm water, it is far from clean, and milk poured into such a pail and then poured out will by that process have gathered to itself thousands of bacteria. For example, some experiments have shown that milk in well-washed pails had, on the average, 28,600 Perhaps the most important factor in the care of these utensils is the necessity of killing the bacteria left in them by the milk itself. Ordinary washing will not do this. Either the washing must be done with some sterilizing agent, like strong salsoda, which must then, of course, be thoroughly rinsed out, or else the inside of the pail must be filled with absolutely boiling water or with steam. The advantage of the latter is that no contamination is possible by the water itself, whereas in washing out the disinfectant the water, unless pure, contaminates the surface again. To show the effects of clean pails, an experiment was made in which milk was drawn from a cow and found to have 6000 bacteria per c.c. It was then poured rapidly from one to another of six other apparently clean pails. At the end of the sixth pouring, the milk was found to be so changed that the number of bacteria had increased to 98,000 per c.c. The strainer for a milk-pail is preferably made of cheesecloth, since this can always be easily boiled between milkings, and so sterilized. A wire strainer through which the milk has to pass, and where the milk is often stirred by the finger of the milker to make it pass through more rapidly, is in no sense as satisfactory as cheesecloth. The straining should be performed as soon as each pail is filled with milk, and pails of milk should never be allowed to stand around in the barn back of the cows, but rather should be taken at once to the milk-room, where it can be strained before any further contamination takes place. Then the milk should be cooled, and this, to be effective, must be done in such a way that the temperature of the milk shall at once fall to fifty degrees or less. It is well known that a forty-quart can of milk lowered into spring water cools slowly on the outside, but that hours will pass before the inside of the can has its temperature lowered appreciably. Meanwhile, bacterial growth has started, and that milk can never be as good as when cooled quickly throughout. Special apparatus is made in which the milk is spread out in very thin sheets over a surface cooled by ice or cold water to a low temperature. In this way all the milk is at once lowered in temperature and may then be kept in spring water until time for shipment. Many examples can be given of the value of this kind of cooling. A few years ago, the Cornell University Agricultural Experiment Station determined that a certain milk when fresh contained, about 4000 bacteria per c.c., and fifteen hours later at room temperature had 270,000, and twenty-seven hours later had soured with an innumerable number of bacteria. Another part of the same milk, however, kept at fifty degrees Fahrenheit, showed absolutely no increase in bacteria for twenty-seven hours, and was still sweet with only 12,000 bacteria at the end of three days. City milk. The value of pure milk is not a matter of individual opinion on the part of the farmer, but it is a vital point with thousands and millions who are dependent upon the farmer for this life-giving food. Unfortunately, to-day the relation between the consumer and the milkman is so remote that it is almost lost sight of, and in place of the personal relationship which formerly existed, which made When the milk supplied to the larger cities is furnished as in New York, the impossibility of controlling the quality of the supply becomes apparent. The farmer brings to the shipping station his two or three large cans of milk, representing the night's and morning's milkings. These are loaded on a train along with hundreds of others, a few chunks of ice are thrown on top, and the train is started for New York, from points as far as two hundred and fifty miles away, reaching the city in the early evening. There it is received and hauled to milk stations, where it is distributed in different-sized cans and bottles, and the next morning, thirty-six hours old, distributed to the babies of the city as fresh milk. Thanks to the energetic inspection practiced by the officers of the Department of Health of New York City, who have emptied hundreds of quarts of milk Cleanliness and care are the two watchwords for good milk, and both practices ought to be observed faithfully by the milk producer, whether he has in mind the health of his own family or the health of the dwellers in the city hundreds of miles away. Dangers of diseased meat. Next to milk, the product of the farm which has most to do with the health of those to whom farm products are sent is the meat which comes from the cows, sheep, and pigs, and makes a large part of the farmer's produce. To be sure, the amount of meat thus sent to market from the farm is by no means as great as in former years, since even the smallest village to-day has representatives of Swift and Co., Schwartzman and Sulzenberger, Jacob Dold, and others of the great western packing houses. There is still, however, a great deal of local butchering, and it is important that the farmer himself should know the characteristics of meat and should be so impressed with the dangers of diseased meat that the temptation to unload a bad carcass on the unsuspecting public may be overcome. There is nothing more certain in sanitary science than that the application of heat destroys animal parasites and micro-organisms, so that, except for diminishing the nutritive There are two points to be noted in an animal about to be killed, namely, whether the animal is healthy, that is, free from disease,—and whether it is in proper condition, neither too young nor too old, is well-grown and well-nourished. Among the diseases to which animals are subject, some are objectionable because of the possibility of the direct transmission of their disease to those eating the flesh, while others are objectionable because the flesh is spoiled and so causes irritation in the stomach and intestines of those eating it. Among the former diseases may be mentioned trichinosis, tuberculosis, and measles of pigs. In the latter category are animals suffering from such diseases as epidemic pneumonia, foot-and-mouth disease, Texas fever, anthrax, hog cholera, and others in which a general toxic condition of the animal's system results from the disease. Toxins are thus formed in the body which may pass to the human being eating the flesh, and in this way poisons called ptomaines are produced, resulting in so-called toxic poisoning. It is not the function of this book to describe the symptoms peculiar to each of these diseases, and it is here sufficient to say that the flesh of no animal apparently suffering from any disease should be used for food. The unhealthy animal can usually be recognized by a casual examination, without undertaking to define the specific disease from which the animal is suffering, characterized by such an examination. When sick, according There is, however, one exception to this general rule, and that is in the case of tuberculosis, since the most scientific observations have failed to trace any connection between the inception of tuberculosis in man and the eating of meat from tuberculous animals, or to show any evil effects to man from eating the flesh of cows affected in the first stages of tuberculosis. The regulations of the United States Department of Agriculture on this point are as follows:—— "All carcasses affected with tuberculosis and showing emaciation shall be condemned. All other carcasses affected with tuberculosis shall be condemned, except those in which the lesions are slight, calcified, or encapsulated, and are confined to certain tissues ... and excepting also those which may ... be rendered into lard or tallow." The regulations referred to say in substance that when the lesions occur in a single part of the body, as in the neck, liver, lungs, or in certain specified combinations, the meat may be used; but that where the lesions affect more than one or two parts of the body, the carcass must be rendered This really means that an animal only slightly affected with tuberculosis, where the lesions are slight and are confined to the tissues of certain organs only, may be used for food. This has been decided only after very careful reading of all known facts, and is particularly important in view of the opposition to the use of milk of tuberculous cows. The tuberculin test, on which depends the determination of tuberculosis in cows, is so delicate that a very slight lesion is sufficient to cause a reaction. The lesions are so slight as in many cases to be entirely overlooked by the ordinary butcher. The United States regulations allow such a carcass to be butchered and used for food after the cow has been condemned by the tuberculin test as a milk-producing animal. This does not mean, of course, that those parts of the body affected by the tuberculosis lesions shall be used, but, since these lesions are usually segregated, they can readily be cut out without reference to the rest of the body. The other point to be noted in selecting or rejecting animals for slaughter is their general condition. This means that they should be of the proper weight,—that is, not emaciated, but with a proper amount of fat,—that the flesh should be firm and elastic and the skin supple. Nor should they be either too young or too old. A prominent example of the first error is in the sale of calves under three weeks old, known as "bob-veal," and while some sanitarians will not object to eating calves under three weeks old, the consensus of opinion is that to be fit for food a calf should be at least that age. Fortunately, it is for The most common example of the direct transmission of disease from animals to men is through the development of the parasite in a pig, known as "trichinosis." This disease is due to a minute worm scarcely visible to the naked eye which lives in the muscles of men, dogs, swine, and other animals, and also under other conditions in their intestines. Millions of the young trichinÆ may live in the flesh of a pig without producing any particular difference in the appearance of the flesh. After four or five weeks, they become incased in small white spherical capsules which later, after a year or so, become entirely calcified. In this form they live for years in the flesh of the pig and do no harm in that condition. If, however, this flesh be eaten by man without being cooked so thoroughly as to destroy the little worm (about one twenty-fifth of an inch long) which has been living in these capsules, then they become distributed around the stomach of the person eating that flesh, enter the intestines, and attach themselves to the membranes there. They grow very rapidly, and broods of from 500 to 1000 young worms are produced from each one of the entering worms, and, since there may be a quarter of a million or more in an ounce of pork, it is not surprising that the total number deposited in the intestines from a single meal of raw pork is enough to produce great distress, characterized by vomiting and diarrhea. Fortunately, the disease is not In general, it should be remembered that any animals dying of diseases are not fit for food, and this applies to all animals, from the largest to the smallest. Animals dying by accident, of course, are exceptions, but if diseased animals, animals dying a natural death, and animals out of condition are eliminated, the quality of food supplied from any individual farm may be approved so far as the animal itself is concerned. The slaughter-house. There is, however, the further question of the sanitary condition of the slaughter-house and the care of the meat after being dressed. It may be that one gets accustomed to the sight of the filthy barns or out-houses so often used for slaughtering. Places infected with flies and other insects, overrun with rats, and the effluvia of which is easily noticeable at a distance of half a mile, are not uncommon and suggest their own condemnation. While it is not possible to directly associate any particular disease with such a condition of the slaughter-house, yet such conditions must result in a rapid development of putrefactive bacteria, in the deposit by flies of different micro-organisms brought from the festering heaps of offal and manure in the vicinity, and must prevent the maintenance of the flesh in the clean and wholesome condition in which it may have been up to the time of hanging in such a place. A well-kept slaughter-house will have the ceilings, side walls, and partitions frequently painted, or else scrubbed and washed. The floor of the building, particularly, should be made water-tight, with proper drains so that the blood shall not remain on the floor to saturate the wood and develop decay. An abundance of clean water should be provided, so that the area may be thoroughly washed as often as used, with proper drains provided for carrying away the dirty water. The ventilation of the building should be complete, and provision should be made for lifting and moving carcasses without handling. In most small slaughter-houses, the obnoxious practice prevails of maintaining a herd of swine to consume the entrails of the slaughtered animals, and a more fearsome FOOTNOTES: |