[Reports and Appendices] of the Irish Milk Commission, 1911.

  • Great Britain. [Royal] Commission on the Irish Milk Supply.
Date:
1913
Catalogue details

Licence: In copyright

Credit: [Reports and Appendices] of the Irish Milk Commission, 1911. Source: Wellcome Collection.

Provider: This material has been provided by London School of Hygiene & Tropical Medicine Library & Archives Service. The original may be consulted at London School of Hygiene & Tropical Medicine Library & Archives Service.

    1076/1108 (page 194)
    express object of elucidating the problem, whether butter could serve as a medium of infection, but this was not followed up. No case has come to the knowledge of the Local Government Board in which creamery butter has been ascertained to be the vehicle of infection of enteric fever. This is the more surprising in face of the numerous instances in which creameries are known to ■liave been associated with extensive outbreaks arising ifrom the consumption of separated milk. These ■creameries were, no doubt, at the same time, dispos- ing of their butter products, and although in the \\ ide distribution of butter, there is doubtless greater diffi- ■culty in tracing out the relation of cause and effect, it is difficult to believe that, assuming that enteric fever is transmitted by butter, no positive instance should have come on record in this country. In the 'early part of last year, a case was brought under the -Board's notice in which there were prima facie grounds for supposing that the consumption of creamery butter was accountable for a group of enteric fever cases in the North of Ireland. On inquiry, however, it was ascertained that the patients in the creamery area, from whom infection Avas believed to have spread, con- tracted and, in fact, developed the disease while absent at a holiday resort, and that the supply of milk from their residence to the local creamery had been discon- tinued two days before their return to the creamery urea. Conclusion. The foregoing summary ftf the experience of the past nineteen years shows that the creamery system is capable of acting, and continues to act, as a source of danger to the public health which cannot be disre- garded. That danger primarily has its origin at the premises of individual creamery suppliers through concealment of disease or non-observance of essential principles of cleanliness and hygiene. Secondarily, the danger arises at the creamery premises through the failure to provide or make effec- tive use of a pasteurising plant for the destruction of pathogenic germs in milk received for butter-making. The remedies and preventive measures which should be generally adopted are :— (1) . Careful and systematic inspection of the pre- mises of creamery suppliers in accordance with the terms of the Dairies, Cowsheds and Milkshops (Ire- land) Order of 1908. (2) . Exclusion from the creamery supply of all milk from infected households, unless and until ])roper precautions are observed. (3) . The compulsory provision and use of pasteuris- ing plant at all creameries. (4) . Power to close a creamery when found to be associated with an epidemic outbreak of disease. Local Government Board, Dublin, December, 1912. Supplemental statement handed in by Mr. J. L. Smith. Milk Supply and Infectious Disease. Appended is a list of recent outbreaks of enteric fever which have with more or less certainty been attributed to an infected milk supply. 'The following points may be noted :— Frequency.—The rate of occurrence is about three per annum. Incidence.—Greater in urban districts. Camtation.—Unreported or unrecognised cases on dairy premises ... ... 7 Typhoid carriers ... ... 3 Polluted water supply ... 1 Obscure, ... ... ... 10 This summary indicates the great importance of notification in the prevention of milk-borne epidemics of enteric fever. Notification is enjoined under the Infectious Disease Notification Act, but this is an adoptive Act, and does not apply universally to every sanitary district The obligation to notify infectious disease is specifi- cally imposed on purveyors of milk by Article 14 of the Dairies, Cowsheds and Milkshops Order. A similar duty is prescribed by Section 54 of the Public Health Act Amendment Act, 1907, but with wider scope, as it extends to every dairyman supplying milk within the district of the sanitary authority, and requires the notice to be given to the Medical Officer of Health of the district in which milk is supplied from the dairy. The Act, however, is an adoptive one. The main obstacle to the enforcement of the above- mentioned provisions lies in the circumstance that knowledge of the existence of infectious disease on the part of the dairyman, &c., is necessary to impose liability. There must therefore be wilful concealment in order to involve a penalty, and guilty knowledge is not easily proved in evidence. Typhoid carriers present a problem of considerable difficulty. Under the existing law they are not sub- ject to any disability, although they no doubt consti- tute a serious source of danger to public health, espe- cially when engaged in the milk trade or the handling or preparation of food. The number of outbreaks in which the primary source of infection cannot be satisfactorily traced illustrates the limited effectual operation of Section 4 of the Infectious Disease Prevention Act. That Sec- tion presupposes, as a condition of the prohibition of the milk supply from a dairy, the possession of evidence of infection obtained on an inspection of the dairy, but it will be seen that even after all practicable investigation the original cause cannot, in many instances, be positively determined. It might be a solution of this difficulty if in any amending legislation power were given to a sanitary authority to suspend the milk supply from a dairy upon reasonable circumstantial evidence of infection arising therefrom. Occasionally outbreaks of scarlatina and diphtheria, traceable to the milk supply, come under notice; they would average not more than two in the year. [TABLE