to give positive results unless the bacilli are quite numerous; hence, while we can frequently obtain direct evidence that a tuberculous cow is dangerous, the failure to obtain such evidence does not prove that a tuberculous cow is safe. 3. Among tuberculous dairy cows that retain the appearance of health and are not known to be affected until they are tested with tuberculin, 40 per cent. or more actively expel tubercle bacilli from their bodies in a way dangerous to the health of other animals and persons. 4. Dairy cows that have been affected with tuberculosis three years or more, with possibly rare exceptions, are active agents for the dissemination of tubercle bacilli. 5. The general evidence justifies the conclusion that tuberculous cows do not expel tubercle bacilli until some time after they contract the affection. The practical importance of this is, that it enables us to clean herds of tuberculous cattle by the periodic application of the tuberculin test and the segregation of all reacting animals. 6. The interval of time that elapses between infection with tuberculosis and the dangerous expulsion of tubercle bacilli cannot serve as a reason for retaining a tuberculous cow in a dairy herd after the fact that she is tuberculous has been determined. The duration of the interval after infection, before the expulsion of bacilli begins, varies greatly with different animals, and it is rarely possible to ascertain how long a cow has been affected when her tuberculous condition is first discovered. 7. From the present as well as from former1 investigations we know that the commonest way for tubercle bacilli to pass from the bodies of tuberculous cows is with their fæces. This fact, together with the common presence of tuberculosis among dairy cows and the frequency with which cow fæces are found in the milk that reaches the consumer, is clear evidence that a considerable proportion of our dairy products are infected with tubercle bacilli. 8. The danger from the presence of tuberculosis among dairy cows is not confined to the use of milk as a beverage. When tubercle bacilli are present in milk they enter the various articles of diet prepared from it, and are specially numerous in butter, in which they may remain alive seven weeks or longer without showing a diminution of virulence. 9. The distribution of tubercle bacilli from tuberculous cattle in a way to endanger human health is not left to chance. It is a commercial, systematic distribution, from door to door, or rather from table to table. As long as the use of tuberculous dairy cows is permitted, the manner in which dairy products are distributed will insure that practically every member of the human family is exposed to tuberculosis. 1 Bureau of Animal Industry, Bulletin 99. This may explain why three European investigators, from their postmortem examinations of respectively 1,452, 500 and 100 bodies of persons who died from various causes found that, among this total of 2,052 bodies, no less than 91 per cent. showed lesions of tuberculosis. 10. While the danger to which public health is exposed through the use of milk from tuberculous cows is of a magnitude almost beyond conception, it is unfortunately only one among many dangers to which persons are exposed through the use of impure, infected and dirty milk. 11. If the inclination of the general public does not drive it to correct the evils to which it is exposed through the use of impure, infected and dirty milk, it should bear in mind that common humanity imposes various sacred obligations, among which pure, wholesome milk for children ranks near to the first place. We have no right to shirk this obligation, and would have no inclination to shirk or ignore it if we took the time and trouble to investigate the number of deaths, especially among infants, directly due to contaminated milk. Most intelligent persons who read have some knowledge of the fact that numerous babies die from no other cause than the use of impure milk. Unfortunately, the frequency with which milk from tuberculous cows causes tuberculosis is not so clearly apparent, because of the insidious, chronic character of the affection. 12. Our dairy herds can be cleaned of tuberculous cows by the proper application of the tuberculin test and the segregation of all reacting animals. After years of observation the tuberculin test has been found to be a more nearly infallible means for diagnosing tuberculosis than any we have for diagnosing other diseases of men and animals. OVERCROWDED DAIRY FARMS AND TUBERCULOSIS.1 Overcrowded dairy farms and tuberculosis have not often been mentioned in the present milk agitation, but it is time to take up this side of the matter. It is an axiom of biology that in every species of living. organism there is a maximum number of individuals which can exist on a given area. It is not necessarily limited by the food supply, but by self-poisonings and contagious diseases. Often the maximum is far less than the number which can find food. When food can be imported, as in the dairy farms, there is a constant temptation to overstock. The ground and buildings become infected, and the herds are ruined. The agriculturist grows better plants and makes more money by thinning out. 1 Editorial, American Medicine, December, 1907, p. 668. The coffee industry was ruined in the Philippines and Ceylon through diseases spread by crowding the tree, but success is following the opposite policy. Dairy farmers should learn this lesson, and perhaps we would then hear of fewer tuberculous herds. Since it is a question of public health, perhaps it would be wise to determine what is overcrowding, and then regulate the matter by law. It is certainly a public menace to keep a large herd in a small field or small barn yard, constantly trampling in their own excreta, and filthy beyond words. To be sure, milk is very scarce now, and with the increasing density of city populations it may become a matter of extreme difficulty to supply it, unless from very long distances. Modern transportation and cold storage are rapidly reducing the necessity of bunching the milk cattle near cities. If the conditions demand overpopulated farms, then perhaps a solution may be found in a system of drainage and removal of excreta similar to the complicated plumbing of a city. As the expense may be prohibitive, the only course to pursue is to spread out the farms over great areas, to reduce overcrowding. Something must be done, for the diseases of the crowded herds are likely to become a serious matter. The opposition of dairymen is the serious obstacle at present. In more than one part of the country they are combining to resist sanitary reforms demanded by health authorities, and in one place the president of the dairymen's association advised farmers to drive every sanitary inspector from their premises. This is a dreadful state of affairs, and it has suggested the plan of extending the authority of municipal health boards beyond city limits, as in the case of water supplies. In the case of milk sent from one State to another it has been suggested that the whole matter be placed under federal control, under the provisions of the pure food laws, as it is interstate commerce. It is merely another instance which shows that the consumers in self-protection must control the producers and dealers, who are causing sickness and death. EXCLUSION OF VERMINOUS CHILDREN FROM SCHOOLS.1 A question of considerable interest both to education authorities and the medical profession was raised in a case heard before the magistrates of the Stourbridge division on October 25 at the instance of the Worcestershire education authority. The question was whether, when a parent sends his child in such a condition that he or she brings into the school 1 The Lancet (London), Nov. 9, 1907, p. 1342. vermin, the school authorities have the right to refuse admission, and to treat the fact that the parent has not sent the child in a condition fit to be admitted as tantamount to a neglect to cause the child to attend. Several decided cases were referred to, not exactly covering the question in dispute, but where the principle of law was analogous. In Saunders v. Richardson (7 Q. B. D. 388) it was held that a parent who, under an order by a court of summary jurisdiction that his child should attend a board school, caused the child to attend the school, but without the school fees, and without having applied to the guardians for payment of such fees or to the school board for a remission of them, was liable to be convicted under the elementary education act, 1876 (now repealed), for non-compliance with the order. In Taylor v. Timson (20 Q. B. D. 671) it was held that there is no right on the part of a churchwarden forcibly to prevent an inhabitant of a parish or district from entering the church for the purpose of attending service, even though the churchwarden may be of opinion that he cannot be conveniently accommodated. The statute 5 and 6 Edw. VI., c. 1, § 2, having imposed a general duty to go to church, which is still binding upon members of the Church of England, has conferred a correlative general right to go to church on those who are so obliged to go. In Pidgeon v. Legge (21 J. P. 743) the plaintiff, a chimney-sweep, went in his working dress into the bar of an ale-house where there were several persons taking refreshment. It was after working hours, and the defendant, the landlord, recommended him to go and change his clothes; and upon his refusal to leave after request, the defendant desired two police constables to put him out. The plaintiff offered resistance to the policemen, and when outside the door still struggled, and was thrown down on the street and his leg was broken. It was held that if the plaintiff was in his clothes and person in an unfit condition to be in a public house the defendant was justified in ordering the policemen to remove him, and was not responsible for the excess of violence which they used in carrying out his command. In Tomlinson v. Ashworth (50 J. P. 164) it was held that the workman who is refused admission through failing to comply with the reasonable regulations of the works absents himself from his work. It was also contended that the education act, 1902, § 17, requires the education authorities to "maintain and keep efficient all public elementary schools;" and that, unless they have power to refuse admission to children who are suffering from vermin, they could not maintain and keep the school efficient. Medical evidence was adduced before the magistrates showing the state of the child when admittance was refused, and that the parent had been twice warned as to the state of the child, and required to cleanse her before such admittance was so refused. Further, that the parent's neglect to cleanse the child had caused the child unnecessary suffering and injury to health, and so the parent had thus failed in the performance of the duty imposed by the cruelty to children act, 1904. It was proved that the vermin would easily pass to other children and cause them discomfort, producing inattention to lessons, and possibly their withdrawal from school until their parents could properly cleanse them. The medical officer also stated that the absence of the child from school was not due to an unavoidable cause, as the vermin could easily have been removed in a few days if the parent had exercised proper care. It was proved that the child had been suffering from vermin for several months. The magistrates held that the managers were entitled to refuse admission to the child, having regard to her condition; and they fined the parent for neglecting to cause her to attend in such a condition that she would be so admitted. SCHOOL CLINICS IN POPULOUS DISTRICTS.1 Medical inspection of school children is now in force throughout England, and, though it will take a considerable time before the system will be working smoothly, it seems that a beginning is being made with a certain degree of enthusiasm. Of course, already the medical and lay journals are full of the views of faddists on the subject. It appears that there are some who believe that the rising generation of England should be fed, treated medically and educated wholly at the expense of the ratepayers. Others who do not go quite to these lengths are of the opinion that at least the medical treatment of school children is a duty of the State. A very interesting address, treating of the matter from the point of view of a London County Council medical man, was given on November 28 by Dr. A. H. Hogarth, before the Childhood Society. The speaker pointed out that it is now universally recognized that medical inspection of schools forms an integral part of every modern system of education. As long as there are in schools children suffering from preventable and remediable diseases, of which both the parents and teachers are ignorant, so long systematic medical inspection can be justified as a State institution. But, Dr. Hogarth went on to say, medical inspection by itself is insufficient; medical treatment is the natural corollary. Experience, 1 Editorial, Medical Record, Dec. 28, 1907, p. 1069. |