1735

THE LANCET.

LONDON: SATURDAY, DECEMBER 21, 1912.

The New Pure Milk Bill.

THE NEW PURE MILK BILL.

THE Milk and Dairies Bill which has so long been expectedhas now been introduced into the House of Commons by thePresident of the Local Government Board. The main

objects of the Bill are stated in a memorandum issued withit. They include provision for more effective registrationand inspection of premises used by milk traders ; the pro-hibition of the supply of milk which has caused, or is likelyto cause, infectious disease, including tuberculosis ; the

prevention of the sale of tuberculous milk, and the

issue of regulations to secure the supply of "pureand wholesome" milk. It is also proposed to empower

local authorities in populous places to establish depotsfor the sale of milk specially prepared for infants,and to remove one of the principal abuses of the Sale of

Food and Drugs Acts by abolishing what is known as

the warranty defence" where milk is the article in

respect of which the proceedings are taken. At presentthe only requirements as to registration of milk traders arethe very imperfect provisions contained in the old Con-

tagious Diseases of Animals Acts and the Dairies, Cowsheds,and Milkshops Orders. Under Mr. BURNS’s Bill these are

to be superseded ; registration is to be made compulsory, andit will be possible to remove a dairyman from the registerin consequence of serious or continuing offences.The general effect of the clauses relating to the inspec-

tion of premises, and stopping the supply of infected

milk, is to apply in England and Wales methods similarto those which have for many years been adopted withsuccessful results in Scotland under the Public Health

(Scotland) Act, 1897. In respect of tuberculosis, the

memorandum to the Bill shows that the Board of Agri-culture and Fisheries intend to revive the Order, whichwas issued in draft form two years ago, enabling countiesand boroughs to apply the Diseases of Animals Act, 1894,to cows which have tuberculous udders or are otherwise

seriously affected by tuberculosis, and to pay compensation incertain cases of compulsory slaughter. When this Order

formerly appeared, objection was taken to it on the groundthat the cost of measures which were required chiefly for the

protection of town populations was being thrown mainly on therural rates, but it is now announced that the Treasury is pre-pared, subject to the assent of Parliament, to sanction for a

period of five years an exchequer payment of one half the netamount of compensation paid by local authorities after theOrder has taken effect. Under the Order of the Board of

Agriculture it will be necessary for counties and boroughs to

possess official veterinary surgeons, and this is also providedfor in the Bill, which requires the appointment of local

veterinary officers who will cooperate with the medical

officer of health in the detection of cows suffering from tuber-culosis of the udder, or tuberculosis with emaciation, or givingtuberculous milk. Other clauses aim at preventing the milkof such cows from being sold or offered for sale, or used inthe manufacture of products intended for human consumption,and powers are given to medical officers of health for this

purpose. At present, under the "model milk clauses" ofthe local Acts possessed by several cities, it rests with the

city authorities, after they have established the presence oftubercle bacilli in a sample of milk, to trace back the impli-cated milk, if they can, to the farm in the country districtwhence it came. Should the farm or offending animal bediscovered, the milk in question can only be excluded fromthe city supply and cannot otherwise be dealt with. This

proceeding has often been objected to, particularly by dairyfarmers, and the Bill, instead of extending these powers of"invasion," authorises notific:ttion from the district of

delivery to the district of production, and then places the

responsibility for dealing with the infectious milk at its

source definitely on the authority of the district in which

the dairy farm concerned is situated.

Many suggestions have been made for the prevention ofthe c)ntaminations and objectionable manipulations to

which milk is under present conditions so commonlyexposed during various stages of its course from cow to

consumer. From time to time schemes are put forwardfor certification, on American lines, of milk which hasbeen obtained with exceptional care and has been treated

throughout with special precautions under adequate super-vision. An excellent illustration of what may be done in

this direction has lately been given in the report of the

London committee on certified milk of which Sir THOMAS

BARLOW is president. Well-contrived schemes such as

these deserve every encouragement from the public, whichshould be prepared to pay the higher price necessitated bythe elaborate precautions that the certificate guarantees, butit hardly seems probable that certified milk of this kind

will ever have more than a limited sale in this countryor form a large proportion of the total milk-supply.The very popularity of " certified milk," if it should come to

be an article in large general demand throughout the

country, would most likely operate against the effectivenessof the systems attested by the various certificates employed,while there would be some risk that the association of puremilk with certification would result in the residual uncertified

milk, sold at prices within reach of the poorest classes,

becoming worse instead of better in quality. Whatever maybe voluntarily done by the milk trade in following the leadof Sir THOMAS BARLOW’S committee, and supplyingsuper- milk "-if the word may be forgiven-it is still of

the utmost importance that the legislature should replacethe uncertain and inadequate requirements of the present law

by a simple and practical code of precautions to be taken inall cases by those engaged in every branch of the milk trade.And from this point of view it is satisfactory to find that theBill proposes to confer on the Local Government Board

wide general powers of making regulations, after consulta-tion with the Board of Agriculture, for the prevention ofthe contamination of milk.

It is evident that on a number of controversial questions,

1736 THE NATIONAL INSURANCE ACT.

such as that of compensation for slaughter of tuberculouscows to which we have already referred, the Bill representsa good deal of compromise between public health ad-

ministration and the interests of the milk industry.Although the measure is on this account open to some

criticism from a doctrinaire point of view, it is, on

the other hand, more likely to meet the practicalrequirements of the case by giving the milk trade the meansof cooperating with the public health authorities instead of

placing the two interests in antagonism at every point. We

are confident that the Bill will receive cordial support fromthose who have been dismayed at the long inactivity whichParliament has shown in dealing with this question, in faceof the evidence furnished from so many sources-and

particularly by the elaborate scientific investigations of

the recent Royal Commission-of the extent to which

tuberculosis and other diseases are at present spread throughlack of precautions in regard to the milk-supply. Only alittle thought and organisation are needed for proper safe-

guards to become generally adopted. Mr. BURNS’S zeal on

these matters is well known, and we trust that he will

successfully maintain his Bill in the coming year againstcompeting claims on Parliamentary time, and secure a

substantial benefit to the health of the whole country, and

particularly to its child population.

The National Insurance Act.DURING the past week the divisional voting upon the

question of refusal or acceptance of service under the

Insurance Act has been completed, and as we go to

press the combined result of the plebiscite is announcedfrom the headquarters of the British Medical Associa-

tion. As had been confidently predicted, the return of

the voting shows a great majority against taking serviceunder the final terms and conditions offered by the Govern-ment, and an analysis of the votes recorded by practi-tioners attending the meetings indicates that members

and non-members of the Association in much the same

proportion are unwilling to - work the Act. The cor-

rected returns will be placed before the special meetingof the Representative Body to-day. The figures implythat five-sixths of the profession are determined to

stand aside from the Act until it is so modified as

to meet medical requirements ; and it should be added

that, as we write, there is no evidence to suggest that

many of those who have voted in favour of working theAct will not accept in the circumstances the verdict of

the majority. But the question has been asked how far

this voting truly represents the views and intentions of the

profession as a whole. It was alleged at a meeting of

medical practitioners avowedly favourable to the Act thatthe recorded decision would not reflect the real feelingof the profession, and that the great majority of those

not voting wished to undertake service, but had been

intimidated into silence. This is a very grave allega-tion, and its truth is no more to be relied upon than

is the opposite supposition that the figures of the

voting reveal the wish of the whole profession. The

one inference is supported by the imagining of an

enthusiastic solidarity that cannot be shown to exist ;the other by suggestions of intimidation that cannot be

maintained. It is true that the total number of votes is a

little less than half the number of medical practitioners inGreat Britain, but it must not be forgotten that the circum-stances of their work, especially in rural districts, make

it impossible for all the medical men in a given area tomeet together at a given time; while many members of

our profession have abstained from voting, not because

they differ from the majority, but because their work

lies outside the’ insured class, and they hold that the

decision should be given by those only whom the Act

directly affects.

By the time these words reach many of our readers the

Representative Body of the British Medical Association

may have confirmed the verdict of the majority and

issued it as a binding decision of the Association ;but before the meeting of that body is held it is im-

possible for anyone to forecast with certainty the out-

come of the proceedings. Whatever the decision, we feelsure that it will not be given lightly or without due

appreciation of what it will lead to and how it will be

interpreted. Those in whose hands this grave and far-

reaching issue now lies will not overlook the dangerof embarking the profession upon a merely destructive

policy which, incidentally, may not destroy its objects.If the Representative Body of the British Medical Associa-tion declares for refusal of service under the National

Insurance Act, an alternative provision of medical service,appropriate to the changed conditions brought about by theAct, will be expected of the Association.

ROYAL FREE HOSPITAL AND LONDON SCHOOLOF MEDICINE FOR WOMEN.-The eleventh annual dinnerof this hospital was held at the Trocadero Restaurant onDec. llth, Mr. Stanley Boyd, F.R.C.S., in the chair.There was a good attendance, the number present being 195.Amongst the guests were included Sir John Rose and LadyBradford, Lady (Almroth) Wright, Admiral Pelham Aldrich,Professor and Mrs. W. E. Dixon, and Major and Mrs.Scharlieb. In proposing the toast of the evening, "TheRoyal Free Hospital and London School of Medicine forWomen," the chairman announced that progress and in-

creasing prosperity were the signs of the times, andthat the present position of the school was a cause of

deep satisfaction to those who, like himself, had knownthe school from its early days. He referred to thosewho had worked so enthusiastically to create ’a medicalschool for women, among whom the name of Mrs. GarrettAnderson, the president of the school, stood foremost. Forthe first time for many years the school stood free of debt,and in spite of increasing expenditure in all directions, thefinances might be said to be satisfactory. The entry inOctober last of 37 new students, making a total of 180students in the school, was the largest for many years. The

hospital, by the generous gift of a considerable piece of free-hold land adjoining the present buildings, was about tobegin a much needed extension of premises, which wouldinclude a new out-patient department and maternity wards.Several valuable scholarships, bursaries, and prizes had beenendowed during the past year, and many generous gifts forspecial purposes had been received from friends of theschool. Dr. J. Walter Carr and Dr. May Thorne responded,and the toast of " The Guests was proposed by Dr. W.d’Este Emery, and responded to by Sir John Rose Bradfordand Admiral Pelham Aldrich. Dr. H. Sainsbury proposed thehealth of "The Chairman," who briefly replied. Songs byMiss Graham and Mr. Louis Godfrey terminated a successfulgathering.

1737THE CARRIER PROBLEM IN DIPHTHERIA.

Annotations.

THE CARRIER PROBLEM IN DIPHTHERIA.

Ne quid nimif,.

WE publish in our columns this week a letter from Mr.Horace A. Debenham drawing attention to some of the

difficulties met with in practice in connexion with diphtheriacarriers and the methods of dealing with them. The

whole question is discussed in a clear. and interestingmanner in a monograph, entitled The Carrier Problem inInfectious Diseases," by Dr. J. C. G. Ledingham and Dr.J. A.’ Arkwright. I They point out that carriers may be

divided into three classes-convalescent carriers, healthycarriers, and chronic carriers, the latter being defined asthose who have harboured the bacillus for more than three

months. They describe the routine of methods for the

differentiation of virulent strains from non-virulent, and of

diphtheroid organisms, such as Hofmann’s bacillus, from truediphtheria bacilli. The morphological and cultural pecu-liarities of these are briefly reviewed, and the method oftesting virulence by means of guinea-pigs is referred to.

They conclude that the differential diagnosis of the bacillus

diphtherias by its morphology is chiefly directed against thebacillus of Hofmann, and that certain other diphtheroidorganisms, such as bacillus xerosis, are much less easilyexcluded, but that fortunately they are rare in the throat.The chance of error is, however, greater in the nose, sincecertain diphtheroid organisms occur more frequently in thissituation than in the throat. Dr. Ledingham and Dr.

Arkwright discuss in detail many of the problems con-

nected with the carrier state, including the percentage ofcarriers, the significance of non-virulent strains, and theirrelation to virulent ones. The persistence of the bacilli inthe fauces or nose is carefully described. It appears that

50 per cent. of patients who have had diphtheria lose thebacilli by the time the local membrane has disappeared, andthose in whom the bacillus persists for one month are 7 percent. of the whole. It is also stated that "healthycarriers" retain the bacillus on an average for as long a

period as convalescents. In regard to "chronic carriers" "

it appears from statistics that not more than 1 or 2 percent. continue to be carriers after 90 days from the onset,and if only virulent bacilli are taken into considera-

tion the number of chronic carriers would be reduced.The treatment of carriers is not at present very satisfactory.Carbolic acid, iodine, alcohol, chlorine, menthol, thymol,and pyocyanase have all been used locally without success.Antitoxin injections also do not appear to accelerate the

disappearance of the bacilli. Some reports of vaccine treat-ment are encouraging, and the spraying of living cultures ofstaphylococcus aureus has also been regarded as valuable.If the fauces only are infected extirpation of the tonsils hasbeen recommended. The public health measures recom-

mended by Dr. Ledingham and Dr. Arkwright are the dis-covery and isolation or supervision of convalescents and

healthy carriers as long as they harbour the organism.

MERCURY IN THE HAIR.

IT is possible by a refinement of analysis to detect

mercury in the hair of persons who have undergonemercurial treatment. It is said that the process is capableof detecting 1 part of mercury in 90,000,000 parts of

hair, while only from 2 to 10 grammes of the hair are

necessary for the purpose. After removal of greasy sub-stances by washing with ether, alcohol, and water, the

1 London: Edward Arnold. 1912. Pp. 319. Price 12s. 6d. net.

hair is digested in hydrochloric acid, potassium perman-ganate being added to destroy organic matters. Completesolution takes place eventually, and the fluid which containsmercuric chloride, if mercury is present in the hair, is filtered.Sulphuretted hydrogen is then passed through the clear solu-tion and the precipitated mercuric sulphide collected. The

sulphide is then treated with hydrochloric acid and potassiumchlorate and the solution filtered and evaporated to a smallbulk. A strip of copper foil is then placed in the solution,which is gently boiled. Mercury, if present, is depositedupon the copper. The copper foil is dried and placed in atube, one end of which terminates in a capillary form. The

tube is exhausted of air and sealed. The part in which thecopper slip is situated is then heated over a flame, which willcause the mercury to volatilise and condense in the capillaryportion of the tube. Microscopical examination will then

show any globules of mercury which have been expelled fromthe copper foil. When these are treated with a little iodineon a glass slide and examined under the microscope theformation of red iodide of mercury may readily be observed.The hair would appear to have a curious selective action for

poisonous metals, for, as is well known, arsenic was foundin the hair of persons who had consumed beer contaminatedwith small quantities of arsenic.

DOCTOR JOHNSON AND THE DOCTORS.

" Dr. Johnson," says Boswell, writing under date 1784, theyear of Johnson’s death, "had in general a peculiar pleasurein the company of physicians, and this was certainly notabated when he took tea at Oxford in the company of Dr.

Wall, a ,. learned, ingenious, and pleasing gentleman." It

was on this occasion that the great moralist prophesied, insome sort, the necessity for research into the diseases

of the East and of warm climates. He fell foul of

the Radcliffe Travelling Fellowship, and averred that

the Fellows had done very little good. "I I know nothingthat has been imported by them; yet many additions

to our medical knowledge might be got in foreigncountries." And he cited inoculation as having saved morelives than war destroys, and the unnumbered cures per-formed by Peruvian bark. 11 I would send the Radcliffe

Fellows," he cried, "out of Christendom ; I’d send them

among barbarous nations." Johnson’s kindness to poor old

Dr. Robert Levett, his pensioner, is, of course, famous, andequally so are the lines he wrote on the doctor’s death at theage of 80 in 1782. Goldsmith, also a physician, wasamong his intimates, and the chaff bestowed on his new

plum-coloured coat has become immortal. The coat,

terribly worn and threadbare, is now in the London

Museum, and suggests the pathetic supposition that the

spendthrift poet-physician wore it till it was almost

unpresentable. At the time of Goldsmith’s death in 1774Johnson wrote, "Of poor dear Dr. Goldsmith there is little

to be told." Goldsmith probably owed E2000, not less, andthis preyed on his mind and heightened a fever, which hefurther complicated by an excessive use of James’s powders.Referring to the debt Johnson humorously asks : " Wasever poet so trusted before?"

"

Later, writing to Bennet

Langton, he says, Let not his frailties be remembered ; hewas a very great man." If Goldsmith by his over-medica-tion hastened his own death, Johnson by dint of amateursurgery did likewise. Shortly before his death he inflictedsuch wounds upon himself, in the hope of obtaining relief,as to suggest the idea of suicide. He used a pair ofscissors in an endeavour to void the water of dropsy.Johnson’s last words were many. To the faithful Langtonl said tenderly: "Te teneam moriens deficiente manu."Of his man nurse he said, with a flash of the old humour :"Sir, the fellow’s an idiot ; he’s as awkward as a turnspit