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clared by the state board of health to be dangerous to the public health, or if one or both eyes of an infant whom or whose mother he is called to visit become inflamed, swollen and red, and show an unnatural discharge within two weeks after the birth of such infant, he shall immediately give notice thereof in writing over his own signature to the selectmen or board of health of the town; and if he refuses or neglects to give such notice, he shall forfeit not less than fifty nor more than two hundred dollars for each offence.

SECTION 52. If the board of health of a city or town has had notice of a case of smallpox, diphtheria, scarlet fever or of any other disease declared by the state board of health to be dangerous to the public health therein, it shall within twenty-four hours thereafter give notice thereof to the state board of health stating the name and the location of the patient so afflicted, and the secretary thereof shall forthwith transmit a copy of such notice to the state board of charity.

At a meeting of the State Board of Health, held Aug. 1, 1907, the following diseases were declared to be "dangerous to the public health," and hence notifiable under the provisions of the above sections:

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Chapter 183 of the Acts of 1907 directed the Board to define what diseases shall be deemed to be "dangerous to the public health," as the term is used in chapter 213 of the Acts of 1902, entitled "An Act relative to compensating cities and towns for caring for persons infected with the smallpox or other diseases dangerous to the public health." On August 1, the Board voted that the diseases above-named, with the exception of tetanus, trichinosis and varicella, should be deemed to be dangerous to the public health," as the term is employed in chapter 213, Acts of 1902.

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PASTEURIZED MILK.

Referring to the decision of the board of aldermen of the city of New York, that pasteurization of the public supply is neither necessary nor advisable, "Medical Record," (June 15, 1907) says editorially, in part:

The agitation of the subject has, however, already borne fruit in opening the eyes of the public and directing more forcibly the thoughts of the pro

fession to the vital importance of a pure milk supply. The first requisite to this is cleanliness at the source, for no amount of pasteurization or even of boiling will convert a milk full of gross impurities into an acceptable food. All that pasteurization aims to do is to destroy the germs which even the best of milk contains in greater or lesser numbers, and with which milk, carelessly handled, drawn from diseased cows, or carried in imperfectly sterilized bottles or cans, actually swarms. Therefore, if the immediate result of the agitation in and out of the public press is only a more careful inspection of the farms and creameries at the source of our milk supply, it will not have been in vain.

The opponents of pasteurization contend that the process renders milk unfit, or at least less fit, for consumption, since it destroys the contained enzymes, and so causes a deterioration in its nutritive qualities. Without attaching too much importance to this theoretical objection, it may be conceded that untreated milk, if absolutely free from the germs of tuberculosis, pus cocci and other pathogenic micro-organisms, is preferable to the sterilized (boiled) or even pasteurized fluid. Doubtless raw meat from the recently killed animal contains certain nutritive principles which are destroyed by heat, but there are advantages in cooking meat which by universal consent outweigh the loss in nutritive properties which it may sustain in the process. It is also alleged, as though this were an argument against the principle of pasteurization, that the agitation is furthered by the makers of pasteurizing apparatus. It is not unlikely that these manufacturers are alive to the possible benefit they may derive therefrom, and if they are thereby stimulated to perfect their apparatus the community will profit as well as themselves. The fundamental question is whether pasteurization does or does not prevent disease, and its determination can be arrived at only by discussion and study, so that the present agitation of the subject, even if it were of purely commercial origin, as it is not, can but be productive of good.

THE MILK SUPPLY OF COPENHAGEN.1

COPENHAGEN, May 21, 1907.

As the question of the milk supply of great cities is now being hotly discussed, not only in New York, but in many other parts of the civilized world, it may perhaps be of some interest to your readers to hear a little about the way in which this question is solved in Copenhagen.

The quantity of milk sold in Copenhagen has undergone a very considerable increase during the last half of a century. While in 1840 about 3,000 gallons of milk were sold a day, now more than 40,000 gallons are daily consumed. The daily average a head is estimated at 11 pints, or about four times the quantity consumed by a Londoner. But this increase has only been possible because, as far back as 1878, the milk trade

1 Reprinted by permission of the editor and publishers of Medical Record " (New York, June 15, 1907).

in Copenhagen was arranged according to the strict demands of hygiene. Perhaps the most remarkable fact regarding this is that private initiative has proved strong enough to revolutionize the milk supply of a great city like Copenhagen and to place it on the high level it now occupies. The merit of having accomplished this feat undoubtedly appertains to the Köbenhavns Mælkeforsyning (the Copenhagen Milk Supply Company), founded in 1878 by Mr. G. Busck in company with the late Professor Panum, Drs. Borch and Engelsted, and other prominent men. The guiding principle of the company has been from the very first " pure milk from healthy cows," and later events have proved how right it was in accepting this rule for its work. By unswerving adherence to this principle it has indirectly forced other similar enterprises, since sprung up, to follow in its wake, and has thereby conferred an incalculable benefit on the public.

Thirty years ago the milk supply of Copenhagen was in a deplorable state. The milk was furnished by farmers in the environs of the metropolis, feeding their cows on all sorts of inferior fodder, or by distillers of spirits in the city of Copenhagen itself, who kept cows in order to utilize the residual products of the distillation. If the sanitary state of the cows and the handling of the milk in the country left much to be desired, it will easily be believed that it fared far worse with the milk produced within the walls of Copenhagen, where the cows were never let out into the open air, and where some of them were kept in stables in the second stories of houses in the oldest and most crowded part of the town.

No wonder that the milk was nearly always adulterated and most often tainted and infected. In 1876, of 111 samples of cream only 2 contained the necessary amount of fat, and 24 had been adulterated by the addition of starch; of 52 samples of sweet milk only 8 turned out to be what they were sold for.

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On this dark background the milk supply of to-day stands out in a very flattering light. But I think that a perusal of the precautions taken by the Köbenhavns Mælkeforsyning will prove this contention better than many flourishes of rhetoric. All the purveyors to the company engage themselves to feed their cows on forage of only the best quality. All cows used in the production of the so-called "infants' milk are to be submitted to the tuberculin test at least once a year and must not have shown any reaction. All calves reared by the farmers with a view to milk production are also tested with tuberculin. Before the return to the stable in the fall the tail, the udder and the hind quarters of the cows have to be shaved.

Seven veterinary surgeons, appointed and paid by the company, en

sure the observance by the farmers of these regulations by visiting the farms fortnightly, and they report once a month to the company on the composition and quantity of the fodder, as on the number and state of health of the cattle. They are also empowered to examine the cows as often as they deem it desirable.

The milking has to be done with the utmost cleanliness. During this operation, therefore, every person of the milking staff must wear a special dress, exclusively reserved for this use; he is provided with water and a towel, so that he can keep his hands clean. The lighting of the stable must be so good as to permit the operator to do his work with the necessary care. Immediately after the milking the milk is strained and cooled. down to a temperature of 5° C., usually by means of the Lawrence apparatus. At this temperature it is kept until the transport to the railway station takes place.

The milk is conveyed from the farms to the factory of the company in Copenhagen in milk cans belonging to the company and returned daily to the farmers after having been cleaned and sterilized in Copenhagen. The cans hold, as a rule, 11 gallons. The consignor plumbs the cans sent by him with a seal of lead bearing the name of his farm, so that the contents cannot be tampered with. In the summer the milk vans of the farms must be provided with an awning protecting the cans against the sun during their transport to the railway station, where the milk arrives shortly before the departure of the train. The milk cans are then conveyed to the city in special cold storage vans belonging to the State or to the company. The trains arrive at Copenhagen at 10 o'clock in the morning and at the same hour in the evening, carrying about 600 cans with a content of more than 6,000 gallons of milk and cream. The cans are weighed and a sample is taken of the contents of every can. The samples are analyzed and tasted by specially trained women experts. If there is the least thing abnormal about the taste of the milk the contents of the can in question are not sold, but used for the manufacture of butter and cheese. The temperature of the milk is also measured, and if found too elevated the attention of the farmer concerned is drawn thereto.

After this first examination the milk, cream, etc., is passed through a filter of sterilized sand and gravel, cooled down, and put into cans, which are subsequently sealed by the company. From these cans the milk is later on distributed in the various parts of the town, the cream, however, being sold in stoppered bottles of a liter, half a liter, etc., as is also the so-called "infants' milk," intended for the nourishment of babies. This milk is treated with still greater precautions, the milking, for example, taking place into specially constructed milk pails containing a refrigerat

ing apparatus, whereby the temperature of the milk is already considerably reduced during the milking operation. As experiments have shown, this procedure increases very effectually the period during which the milk keeps sweet and unaltered.

The sale of most of the milk is effectuated from the milk vans of the company circulating throughout all quarters of the town and into some of the suburban districts in the vicinity of Copenhagen. With each van go a driver and from three to five boys. The latter distribute the milk in the houses, fetching and bringing the buyers' vessels, into which the desired quantity is drawn off from the cans. The cream and the infants' milk are sold, as before mentioned, in bottles sealed by the company.

In this way an excellent milk supply is furnished to the population of Copenhagen. Notwithstanding the great care given to the article it has not been necessary to raise the price above what was paid before the company came into existence. A pint of the best quality of cream, warranted to contain 29 per cent. fat, costs 15 cents, while cream with only 14 to 15 per cent. of fat may be had for 9 cents a pint. The price of a pint of sweet milk is 212 cents.

Only a minimal part of the milk is pasteurized by heating it to 85° C. for twenty minutes. Experiments have shown that milk is undoubtedly deteriorated by heating, the enzymes being destroyed, and that even if pasteurization may do away with certain bacteria, as those of typhoid, scarlet fever, diphtheria, tuberculosis and lactic acid fermentation, the bacteria of putrefaction are able to resist the procedure and multiply rapidly afterwards. Such a nimbus adhered, however, to the name of Pasteur that some years ago there was a certain amount of uncertainty whether it was not better that all milk offered for sale should be pasteurized. But as far as regards Copenhagen the contest has now come to a close, with an undoubted victory for the non-pasteurization side.

THE MILK SUPPLY OF VIENNA.1

BY ERNST J. LEDERER, M.D., VIENNA.

The dairy company of lower Austria, which supplies the greater amount of the milk consumed in Vienna, is subject to control by the provincial diet of lower Austria. The central depot in Vienna receives the milk from 76 affiliated dairies throughout the province, and these in turn receive the daily supply from a total number of 5,222 individual producers. The principal aim of the organization has been to regulate the methods of obtaining and handling the milk at the various places of production, an object which experience has shown to be especially im

1 Reprinted from "Medical Record," June 15, 1907, with the permission of the editor and publishers, who also courteously loaned the blocks for the illustrations.

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