RAW MILK MENACE 
IN KANSAS CITY SPECIAL REPORT 
on 
RAW MILK MENACE 
IN KANSAS CITY, KANSAS 
AUGUST, 1941 
by the 
DEPARTMENT OF HEALTH 
KANSAS CITY, KANSAS 
GEO. T. DARBY 
COMMISSIONER OF FINANCE, 
HEALTH AND PUBLIC PROPERTY 
RAGNAR T. WESTMAN, M. D., DR. P. H., F. A.P.RA. 
DIRECTOR OF HEALTH TABLE OP CONTENTS 
Page 
1. "A special Report on the Raw Milk Menace in 
Kansas City, Kansas/' By Ragnar T. Westman, 
M.D., Dr. P.K; Director of Health, Kansas 
City, Kansas. 1 
2. "The Raw Milk Menace"; By Harold J. Harris, ' 
M.D.; Health Officer, Westport', N. Y. 13 
3. "Brucella Abortus In Milk and Its Relation 
To Undulant Fever"; By C. M.-Carpenter, Ph.D., 
and M. J. King, M.D.; Hew York Veterinary 
College and Metropolitan Life Insurance Sana- 
torium, Respectively. 19 
4. "Brucellosis In and Around Vancouver"; By 
C. E. Dolman and Vivienne G. Hudson; Provincial 
Board of Health, Vancouver, B. c. 29 
5. "Further Observations On Brucellosis In and 
Around Vancouver"; By C. E. Dolman, Vivienne 
Hudson, and D. G. B. Mathias; Provincial Board 
of Health, Vancouver, b. C. 41 
6. "Excerpts From the TMilk Problem1 In the 
Bulletin of The Health Organization of The 
LEAGUE OF NATIONS;" By a Committee of Authors. 47 
7. "Milk and Its xRelation To Disease;" By 
A* W. Fuchs; UNITED STATES PUBLIC HEALTH 
SERVICE. 55 
8. "What Every Person Should Know About Milk;" 
By Leslie C. Frank; UNITED STATES PUBLIC 
HEALTH SERVICE. 65 
9. "A Study of Milkborne Epidemics;" By Paul B. 
Brooks, M.D.; New York State Department of 
Health. 77 
10. "A Scarlet Fever Outbreak Due to Raw Milk;" 
By Roy F. Feemster, M.D., Dr. P.H., and 
J. M. Kingston, V.M.D.; Massachusetts 
Department of Health. 85 
11. "Experience With An Epidemic," By A Dairyman 93 
12. "Excerpts From The Textbook Preventive 
Medicine and Hygiene"; By Milton J. Rosenau; 
Harvard Medical School and United States 
Public Health Service 95 
(Table of Contents Continued on Next Pago) TABLE OF CONTENTS (Continued) 
Page 
13. "The Pasteurization of Milk;" By C. J. . . 
Babcock; Bureau of Dairy Industry, UNITED 
STATES DEPARTMENT OF AGRICULTURE. 99 
14. "Should All Public Milk Supplies Be 
Pasteurized?" By Prof. R. M. Washburn; 
Director, Dairy Products Institute. 105 
15. "Excerpts From ’The Nutritional Aspects of 
Milk Pasteurization;’" By Dr. E. V. McCollum, 
Johns Hopkins School of Hygiene and Public 
Health, and an International Authority on 
Nutrition. 113 
16. "Jug Station Milk;" An Editorial In The Journal 
of the American Medical Association. 115 
17. "Dairymen, Distributors, Grocers and Restaurant 
Owners May Bo Hold Liable For Undulant Fever;" 
An Opinion of The Supremo Court of Washington. 117 
18. "To The Health Commissioners of the City of 
Los Angelos—A Report on the Local Milk ’ 
Situation;" By George Parrish, M.D.; Health 
Officer, Los Angeles, California. 121 
19. "Pasteurization of Milk." By Thomas Parran, Jr. 
M.D., SURGEON GENERAL 0F THE UNITED STATES 
PUBLIC HEALTH SERVICE, and Edward S. Godfrey, Jr. 
M.D., Commissioner, New York State Department 
of Health. 145 
20. "Undulant Fever;" By Fred P. Helm, M.D.; 
Secretary, KANSAS STATE BOARD OP HEALTH. 159 1 
To the Honorable Board of City Commissioners, 
Kansas City, Kansas - 
A SPECIAL REPORT ON 
THE RAW Mil# MENACE 
IN KANSAS CITY, KANSAS 
. , By 
Ragnar T. Westman, S.B.,M.B.,M.D.,M.P.H.;Dr .P.H. jP.A.P.H.A* 
Director of Health, Kansas City, Kansas 
People' are becoming sick with undulant fever from raw 
milk being sold in this city. The Kansas State Board of^Health 
Laboratory continues to find the germ of undulant fever in raw 
milk from producers serving our community. Eighty-two cases 
of undulant fever were reported to our. department of health 
in 1940, and already fifteen additional cases have been report- 
ed in 1941. We certainly have the duty of at least safeguard- 
ing the milk supply for the protection of our own residents. 
The responsibility of providing a safe, pure milk has 
been increased, now that Kansas City, Kansas has been declared 
a Defense Area, and awaits an influx of new defense workers. 
The United States Public Health Service cannot condone such a 
dangerous condition in a defense area. One Public Health 
Service physician went so far as to say, (!It is actually 
criminal negligence to allow people to become ill with undulant 
fever, especially since it can be so easily prevented by safe- 
guarding the milk supply.,f 
As the Board of Commissioners knows, the Department of 
Health has been endeavoring to improve the milk supply for some 
time. We have not been entirely unsuccessful, for wo have 
induced seventeen dairies to insta.ll pasteurizers, thereby 
increasing the percentage of safe pasteurized milk sold in the 
city from fifty per cent a year ago to almost ninety per cent 
today. But so far wo have been unsuccessful in safeguarding 
'the remaining ten per cent of milk sold in the city, because 
a handful of raw milk dairymen refused to protect the public 
health by either testing their herds and removing their infect- 
ed cows, or pasteurizing their milk. Indeed, they started 
law-suits and initiated a 'restraining order against the city 
to stop the milk improvement program. 
The city won when the restraining order against it was 
dissolved in February, 1941, but the Court cast some doubt on 
the phraseology of one clause in the milk ordinance. The milk 
ordinance must be amended before jfc may be properly enforced. 
The amendment has been drawn and approved by the city Legal 
Department, ’ and awaits presentation to your Honorable Board. 
This special report is being presented in order that the Board 
may have the true facts when considering the proposed amendment. 
It is moreover the duty of the Director of Health to call this 
unhoalthful condition to your attention. Of course the average citizen, no matter how intelli- 
gent he may he, is not in a position to clearly understand the 
true situation. He is naturally confused when^he hears a di- 
vergence of opinion which he cannot test for himself. The 
Department of Health has repeatedly warned that raw milk^in this 
city is spreading undulant fever, and advises that raw milk 
should he hoiled until such time as'it can he reasonably safe- 
guarded. . But. the raw milk dairymen, naturally anxious to sell 
their product without added expense, counter hy saying that- 
the health department is politically controlled to drive the 
email dairyman out of business. They even go so far as to 
deny that there is such a thing as undulant fever, or at least 
that it may he spread hy raw milk scientific proof to the con- 
trary notwithstanding* Whom shall the milk consumer believe? 
It is not until his raw milk consuming neighbor contracts^undu- 
lant fever that ho realizes the truth. And hy that time it may 
ho too late to prevent the disease in his own family. To corro- 
borate our stand we arc reproducing hero articles from the scien- 
tific literature. This literature is very voluminous and so we- 
can include only a few articles which wo happen to have in our 
library, 
. Those cases of undulant fever which have been reported 
occurred in persons who either had never hoard of the disease, or 
believed that it could not happen to them* But it did. Wo hu- 
mans are prone to believe that it will always bo the other follow 
who will be affected, and not us. 
Imagine how they must have felt when they got it. 
Consider the prominent attorney whose daughter had undulant 
fever for three years. Ho didn’t half believe that she had 
it, but since the family' physician said it was due to using 
raw milk ho stopped buying raw milk for his family. But ho 
continued to buy raw cream from the same dairyman, not knowing 
that raw cream carries oven more undulant fever germs than 
raw milk. Anyhow, he didn't believe it could happen to him. 
But it did. Imagine how ho felt lying there in the hospital 
with severe headache, backache, high fever, severe chills, * 
profuse perspiration, great fatigue and nervousness. Laborat- 
ory .tests showed that he, too, had undulant fever. Ho really 
hadn’t thought much about undulant fever before. 
You see, ho was an educated man. He v/as always 
careful^about himself and family, always used the best of 
everything. But he listened to the propaganda of the raw 
milk dairyman who said that raw milk was better because it 
was "natural”, and unchanged. That sounded logical. Ho 
didn’t know that about fifty epidemics of disease are report- 
ed every year in the. United States, duo to using raw milk. 
Many more occur which are not reported. Not only undulant 
fever, “but typhoid' fever, scarlet fever, diphtheria, dysentery, 
food poisoning, and even infantile paralysis have been spread 
by raw milk. More diseases are spread by using raw milk than 
y any other food. And ho didn’t know that pasteurization of milk not only completely safeguards milk against these milk- ' 
borne diseases,’but it does so without being changed in taste* 
cream-line, vitamin or food value. And so he got undulant 
fever from using raw milk. The disease settled in the valves 
of his heart, and he died July 13, 1940. 
The State Board of H ealth investigated the dairy 
which sold him the raw cream. Out of fourteen cows in the 
dairy, eight wore found to be infected with Bang's disease, 
the disease in cows which is spread by raw milk to cause human 
undulant fever. Even the germ itself which causes this con- 
dition, known as the Brucella abortus, was found in the milk 
from four of these cows.. 
Consider now the music teacher in one of our high 
schools. Imagine how he must have felt when he lay in the 
hospital;,with high fever, chills, profuse perspiration, aches 
and pains, groat prostration. Imagine how he felt when the 
undulant fever became complicated with pneumonia and it looked 
as though ho were going to die. The laboratory found the germ 
of undulant fever in his blood, the germ being the typo that 
comes only from Bang's infected cows. Investigation revealed 
three Bang's Infected cows at the dairy from which ho obtained 
his raw milk* The music teacher didn’t die, but ho is still 
so sick that ho cannot return to work* Ho hasn't worked for 
a year. Think how expensive undulant fever was to him with 
hospital bills and everything* 
Consider now the business college student who a 
few years ago became ill with sore throat, chills, high fever, 
drenching sweats, and delirium. He became mentally unbal- 
anced, becoming excited, violent, and noisy, completely dis- 
oriented as to whore or who ho was. Finally he became so 
bad that ho had to be admitted to the state hospital for the 
insane. He was hallucinated and destructive of clothing and 
bedding, and was frequently nude. The laboratory tests for 
undulant fever were extraordinarily strong, and tests for 
other diseases were negative. His lnsanitcy\. was duo to 
undulant fever. Fortunately, ho recovered mentally when his 
undulant fever was treated. He was a heavy drinker of raw 
milk. The raw milk dairy from which he obtained his milk 
was shown to have Bang's infected cows in the herd. ‘Imagine 
how this young man felt going through all this terrible ill- 
ness. Consider the three year old boy who became so vio- 
lently ill with undulant fever that it was first thought that 
ho had the dreaded disease> acute leukemia,* Laboratory tests 
were exceedingly strong for undulant fever. When specific 
anti-undulant fever serum was injected into him, ho became 
well almost over night. Imagine how..his. parents must have 
felt, watching him, thinking that he might die, knowing that 
this could have been prevented had they used pasteurized 
milk instead of raw milk. Two Bangfs infected cows wore 
found in the herd supplying raw mij-k to this boy. This dairy 
also sold milk in Kansas City, Missouri, Testing tho cows 
at intervals, as required by that city, was hot enough pro- 
tection. 
And consider tho hundreds of cases, both reported 
and not reported to us, who continue tohavo chronic undulant 
fever for years, becoming semi-invalids, continuing to work 
only with difficulty. Undulant fever is not a pleasant disease Any 
person who has it will toll you that ho would not wish it on 
his worst enemies. Many cases of arthritis are in reality duo 
to undulant fever. Hodgkins- disease, a cancer-like condition, 
may bo duo to chronic undulant fever for tho germ of undulant 
fever has been repeatedly found in tho enlarged lymph nodes of 
Hodgkin's disease. 
There can be no doubt that all these cases of undulant 
fever were duo to raw milk, with tho possible exception of a 
daily man's v/ife, two veterinarians, and a moat packing worker 
who, though they used raw milk, might have acquired their in- 
fections directly from cows or hogs. It is certainly no coin- 
cidence that all of tho cases used .raw milk. This Department 
of Health, in cooperation with the Kansas State Board of*H ealth, 
.tested tho 74 raw milk dairies serving this city in 1940, and 
among this number found that 72 dairies had Bang's infected 
coy;s in their herds, ,Somo herds had as high as 60 per cent 
of tho cows infected. Of tho total number of cows tested, an 
average of twenty per cent ‘wore infected. Nor is this all, 
for tho State ’ Board of H ealth frequently found the germ 
itself of undulant fever in the raw milk from those dairies. 
And it is continuing to find tho germ in raw milk in this 
city today, 
‘ Undulant fever is not a now disease in this state 
or city, Tho first cases in the state were reported in. 1927 
k? Hillman of tho United States Army Medical Corps 
at Port Riley, since that time a total of more than eleven 
feaR^rg^...9.a3G3 forty-five deaths, attributed to the" disease 
Have boon reported in this state. This is an average of eighty 
thp ddaat1?? a ?oar* But the r°P°rted incidence of 
the diocese h<*s steadily increased so that one hundred sixty- 
five cases were reported in 1940. Undulant fever is an import- 
cint disease in Kansas largely because wo arc a dairy state in 
ltC^n°h PaW la However, not all these cases In 
directly f"om°antaaL°.raW mUk’ Sin°° S°m° °f th0m TOro ao<^cd The first recorded mention of the existence of 
undulant fever in Kansas City, Kansas, appeared in an article 
by Dr. Fred E. Angle of this city in the Jounral of the Kansas 
Medical Society of October, 1929, when ten cases were reported. 
Six years later the same physician reported in the Journal of 
the American Medical Association of September 2, 1935 that he 
had treated one hundred cases of undulant fever# Some of these 
cases were non-residents. In the Annals of Internal Medicine 
of June, 1937, Drs. Angle and Algie describe how a Kansas City 
resident became insane from his undulant fever infection and 
had to be admitted to the insane asylum. These physicians 
noted that their cases were users of raw milk, m the Annals 
of Internal Medicine of October, 1938, Drs. Angle, Algie, Baum- 
gartner, and Lunsford gave the results of a skin testing survey 
for undulant fever done on Kansas City, Kansas, school children. 
It should bo noted that Dr. Baumgartner represented the United 
States Public H ealth Service, and that Dr. Lunsford was then 
the Director of Health of Kansas City, Kansas. It was found 
that nine per cent of the children reacted positively to the 
test and subsequent investigations revealed that many of them 
actually had some of the manifest symptoms of the disease# 
Investigation further showed that those positive reactors wore 
using raw milk or had used it in the past. Routine blood tests 
on adult patients in this city show that about seven per cent 
of adults have a positive reaction for undulant fever to some 
degree. Undulant fever is therefore neither a now or a rare 
disease in Kansas City. 
One can only wonder at the audacity and stone- 
hoartedness of the handful of raw milk men who see undulant 
fever cases develop on their milk routes, yet refuse to tost 
their herds and remove their positive reactors. How these 
non-resident, non-voting, non-tax-paying raw milk men have the 
nerve to continue to distribute the stuff in our city is more 
thn the average citizen can understand. 
To further confuse the issue some of those raw milk 
men have deliberately vaccinated their entire herds against 
Bang's disease, adult cows as well as calves, despite the fact 
that the United States Department of Agriculture, the Kansas 
State Livestock Sanitary Commissioner, and this Department of 
Health have repeatedly stated that vaccination of adult cows 
is of no valuo in safeguarding milk, and have advised against 
it. The vaccination of adult cows causes the blood tost for 
Bang's disease to become positive so that one can not tell 
whether the animal is infected with Bang's disease, and therefore 
dangerous, or whether it is only a vaccination reaction. Some 
of those vaccinated animals continue to have a positive tost 
for Bang»s disease for life# Thoso raw milk men, contrary to 
our advice, have boon deliberately contacting other raw milk 
men urging them to vaccinate their herds also# Their hope has 
been to have so many vaccinated herds with positive tests for 
Bang s disease that v/e would not dare to enforce the milk ordi- 
nance. But in this attempt they were unsuccessful since only a 
few other dairymen vaccinated their herds. On-March 8, 1941 w© wrote to;*Dr• John R. Mohler, 
Chief of the Bureau".of Animal Industry, united States Depart- 
ment of Agriculture*- briefly ‘ out lining our testing requirements* 
and asking his official opinion of’the value-of‘.vaccination of 
calves and adult cows against Bang’s disease • ?• .We quote the 
reply in full as follows:, 
"UNITED STATES DEPARTMENT'OP AGRICULTURE 
BUREAU OP ANIMAL INDUSTRY 
Dear Sir; 
This will acknowledge your letter of March 8, 
requesting information relative, to the part that vaccina- 
tion of cattle may play in connection with providing a safe 
milk supply for your city. 
It is believed that your ordinance is reasonable 
and should not work an undue hardship on the cattle owners. 
It would, no doubt, be beneficial as a public health measure 
in the elimination of animals that react to the Bang’s di- 
sease test, as quite a number of such animals frequently 
expel Brucella abortus from their udders during their 
lactation period. 
The Bureau does not recognize the use of Bru- 
cella abortus vaccine in animals more than eight months 
of age and considers it of no value in treating animals 
affected with Bang’s disease.. 
There is enclosed a copy of a paper delivered ' 
by Dr. John R. Mohler, Chief of Bureau, on December 5 
before the United States Livestock Sanitary Association 
meeting in Chicago,. Illinois,, from which it is thought 
you will be able to obtain a great deal of valuable in- 
formation concerning Bang1s.disease and the use of Bru- 
cella abortus vaccine. . • u 
. : Very, truly yours, 
(Signed) A. W. Miller 
Acting Chief of Bureau.’* 
Wo quote a few pertinent passages from this paper; 
11 It was found that vaccines of no kind had any 
curative effect in infected cattle...... 
” ’’Later studios by the Bureau of vaccination with 
virulent cultures in open adult animals showed that in many in- 
stances the vaccine localized in the.udder and that such animals 
wore made chronic carriers of the organism.” "Dairymen who seek the vaccination of their adult 
cattle with or without vaccination of their calves should be 
warned that the number of city and town health officers who 
are requiring milk from non-reacting cattle for their citizens 
is constantly on the increase. Too frequently have we learned 
that such owners have been deprived of their markets because 
their vaccinated'cows had continued to react following vaccin- 
ation. Moreover, regulations in a number of States require 
that cattle destined to such States must not be reactors to 
the blood test. Therefore, shippers of both dairy and beef 
dattlQ dhduld be properly advised against promiscuous vaccin- 
ation wilhoul supervision, before they risk shipments in 
violence to the regulations of the State at destination." 
"The vaccination of all animals should bo confined 
to calves between four and eight months of age and this should 
be accomplished aa nearly as possible during the sixth month 
of the animals life," 
"An animal in a herd whore vaccination is practiced 
should not bo disposed of for any purpose other than immediate 
slaughter while revealing a positive titer, except upon written 
permission by the cooperating State or Bureau officials." 
"A herd under the vaccinal plan may bo certified as 
a HERD FREE OP BRUCELLOSIS for a period of one year when all 
animals in the herd over two years of age reveal at least two 
negative reactions to official blood agglutination tests properly 
spaced, when non-vaccinatod heifers under two years shall sim- 
ilarly bo proved negative to the test, and when vaccinated 
heifers under two years either show a satisfactory decline in 
titer or are removed for slaughter." 
Vaccination of calves is not a method of safeguarding 
milk, Calfhood vaccination appears to bo of some value in 
preventing abortions when the calf becomes an adult, but does 
not prevent Bang»s disease infection and contamination of milk 
with undulant fever germs. Calfhood vaccination is, therefore , 
chiefly of value to the dairyman himself because more calf 
offsprings will be obtained. 
We asked the Kansas office of the United States De- 
partment of Agriculture for'advice on our undulant fever problem. 
Dr. Ralph Graham, in charge, visited our city, talked to Raw 
milk dairymen hero, examined our milk ordinance, and analyzed 
ouf milk improvement program. We quote his report in full as 
follows; ’’UNITED STATES DEPARTMENT OP AGRICULTURE 
BUREAU OP ANIMAL INDUSTRY 
LOCAL OFFICE 
204 Federal Building 
.•••. . ■' Topeka, Kansas 
May 8,1941 
Mr. George T. Darby 
Commissioner of Finance, Health and Public Property 
Kansas City, Kansas 
■Sir; 
* In reply to your request for information and 
advice regarding the Bang’s disease control .program--;: 
of your city. I should like to state that I believe 
your program'is reasonable and'practicable for the 
da irymen and, ah the same time, it offers a re a so nab 1 e 
protection ~bo "the public health of your community/" 
Under your City Milk Ordinance the dairymen 
have a choice of two procedures, either test their 
herds and remove all cows which react to the aggluti- 
nation tost for Bang’s disease or, pasteurize all the 
milk. It appears as if it would bo reasonable to re- 
quire the dairymen who desire to supply raw milk to 
revest their herds every tHroo months . They will find 
that this is also profitable from a production standpoint 
as, reacting cows do not produce as much as those v/hich 
are negative to the test. It is impossible to distin- 
fulsh by the agglutination test between the naturally 
nfoctod, cattle and those which have boon vaccinated, 
against Bang’ s disease . Therefore, in order to' protect 
health, raw milk from such reactors should not be mar- 
keted. 
ft 
A practical solution in your community would 
appear to bo to permit the vaccination of calves between 
the ages of 4 and 8 months (preferably during the' .sixth 
month) to be raised as replacements of the older cows. 
It is not recommended to vaccinate any cattle more than 
6 months of ageV ■ “ T 
I might suggest a plan as adopted by some other 
dairy localities to handle similar situations. Due to 
the.fact that infected herds do not produce sufficient 
calves to make a rapid replacement of the old herd, some 
dairymen have adopted the plan of buying heifer calves 
from 4 to 8 months of ago and having them vaccinated. 
In this manner it does not take long to build up their 
herds as, sufficient calves can be purchased during the 
first and second year to replace the entire old herd. 
Those calves, of course, to be tested at the age of 18 
months and any showing a positive reaction to the agglu- 
tination test to bo eliminated before the y ar o pa ’€ into 
the hi ilk lino. This appears to me to ho the most prac't ical 
method of handling such a situation. 
rj/-i „ „ . , „ Respectfully 
RG‘S l»sGE5fcMnS8fi$?8i»in chars° 9 
The proposed amendment to the milk ordinance embodies 
the suggestions made by Dr.Ralph Graham in his letter. The 
highest authorities in the land on undulanV fever and BangTs 
disease are the United States Public Health Service and the 
United States Department of Agriculture. The State Board of 
Health and the State Livestock Sanitary Commission are guided 
by them in this matter. Hence we know that we are doing the 
right thing in adopting this amendment to the milk ordinance. 
It will be noted that Dr. Graham states that it is im- 
possible to distinguish by the agglutination test between the 
naturally infected cattle and those which have been vaccinated 
against Bang’s disease, and therefore, in order to protect the 
public health, raw milk from such reactors should not be mar- 
keted. The cattle which have been vaccinated may be naturally 
infected with Bang’s disease even though vaccinated. 
The concensus of opinion is that testing for various 
diseases in cows, though helpful, is hot a complete protection, 
no matter how often tests are made. Tests often do not detect 
disease in cattle actually present. Disease may bo spread be- 
tween tests. Diseases not tested for may bo transmitted. 
Numerous authorities have stated that raw milk is never safe, 
and that pasteurization is the only complete safeguard. Very 
occasionally a pasteurizer may brea£ down, for nothing in'this 
world is perfect, but by comparison with other safeguards, 
pasteurization is the best safeguard against all milk-borne 
diseases. This is the conclusion of epidemiologists, public 
health loaders, and physicians everywhere. The United States 
Government permits only pasteurized milk to be served to its 
Army, Navy, and other armed forces. 
The idea still prevails among the laity that when a 
dairyman has a clean looking dairy and is apparently careful 
to produce his product in a clean manner it will be safe. 
This idea arose from the old belief that disease v/as spread 
through filth. Among health officials it has been recognized 
for more than a quarter century that diseases are spread mainly 
through material from previous cases in the form of living 
germs. It is not a question of nfilthn at all. The repeated 
spread of epidemics through raw certified milk, is the best 
evidence that the extreme care and cleanliness used in the 
production of certified milk \vill not alone make raw milk, 
safe. Today Medical Milk Commissions are urging that even 
certified milk be-given the added protection of pasteurization. 
No one can tell by just looking at'a bottle of milk if 
it is safe to use. Just as an experiment, try mixing a teas- 
poonful of cow manure in a bottle of milk and see if you can 
detect any difference. Nor will there be any appreciable dif- 
ference in taste, for the milk will only have thatMgood old 
raw milk flavor "you were used to as a child on the farm. 
The gems of disease are invisible and require practically 
no space at all. A teaspoonful of disease germs would most 
cartainly prove fatal. There is only one sure safeguard for all 
milk, and that is to produce it as clean and pure as possible 
and then pasteurize it. Even in this enlightened day of science, producers 
and distributors of rawimllk are hammering at the credulous 
public with a propaganda designed to m&ke-one believer .that 
raw milk is somehow betterj'tt^n...pasteurized' * Of course... 
the purpose-of this" propagancjg, raw milk without the 
added expense of pasteurization< If a pasteurization apparatus 
were to cost only'ten dollars*' the raw milk industry would not 
fight pasteurization, hut,would Itself adopt it. The fact that 
seventeen raw milk producers were able to install pasteurizing 
plants at their farm dairies indicates that the expense of such 
plants is not prohibitive# If the dairyman could not afford 
to install his'own pasteurizer, he could at least have someone 
else pasteurize for him at low-cost* 
But we are not attempting to force the raw milk man 
to pasteurize his milk. According to our milk ordinance he has 
the choice of either testing his cattle and removing the positive 
reactors, or of pasteurizing his milk. The proposed amendment 
clearly provides that he may continue to sell tqw milk, provided 
only that it be shown that he has no cattle on his dairy which 
react positively to the test for Bang’s disease. Nob ody is 
forcing anyone out of business. Surety the dairyman owes it 
to the public to provide a safe, pure milk. 
The Wyandotte County Medical Sod ioty has by resolu- 
tion approved our milk improvement program, has endorsed our 
efforts to require that cows bo tested and. shown to be free from 
Bang’s disease, and recommends pasteurization of all milk as 
the best safeguard* 
The vested interests of the raw milk industry are by 
law-suits, scandalous unscientific articles, and even political 
pressure attempting to intimidate public officials so .that they 
will not do their duty to the public. As public o fficials wo 
are sworn to protect the health and welfare of our community 
and must therefore stand up against such intimidation. Have 
wo the fortitude to withstand such pressure, knowing that we 
are right, and follow the dictates of our consciences? Wo 
must if we arc to do our duty and fulfill our responsibilities 
to the community. 
In former years epidemics of diseases carried by 
water and milk were more frequently spread by water. But today 
no city would think of pumping raw river water with its con- 
taminating sov/age into the water mains of the city without 
first safeguarding it by a treatment process analogous to 
pasteurization. But that is just v/hat cities used to do, and 
they had terrific epidemics of typhoid fever. But now water- 
borne epidemics are exceedingly rare, and occur usually in 
small communities from small individual untreated supplies, 
analogous to the numerous small untreated rav/ milk supplies 
wo have today. More outbreaks'today arc duo to raw milk than 
to water. Among all the foods* raw milk carries mpro outbreaks 
of disease than does any other single food. It bo unthink- 
able for a progressive city not to protect its water supply by modern scientific treatment; indeed, it would be criminal. 
Likewise, the time is rapidly approaching when no city will 
allow its milk supply to stand unguarded. 
We know that raw milk now being sold in the city 
is a menace to health. The State Board of Health continues 
to find the germ of undulant fever in raw milk, and people 
arc getting sick from it. It is obviously air duty until such 
time as the milk can be safeguarded to warn the public and 
advise that the raw milk should bo boiled before using, or 
use pasteurized milk instead. It is our duty to warn residents 
of surrounding cities, soldiers from nearby military encamp- 
ments, defense workers, tourists, and others who may visit our 
city. As public officials it is our duty to give this warning. 
The public has the right to expect it. 
But wo hope that this will not bo necessary much 
longer. Wo hope that your Honorable Board will adopt the 
amendment to the milk ordinance and give us your full support 
in enforcing it. 
The United States Public Health Service no longer 
includes Kansas City, Kansas, on its list of cities having an 
approved milk supply. Adoption of the amendment to the milk 
ordinance and its enforcement are necessary before we may once 
more be approved. 
On the following pages are reproduced articles by 
authorities on milk and milk-borne diseases. These articles 
prove that wo are not alone in our stand. "re say that raw 
milk is never truly safe, and should be pasteurized. So do 
they. Reprinted from HYGEIA, The Health Magazine, March 1941 
Copyright, 1941, by American Medical Association 
Underwood &■ Underwood 
The RAW MILK MENACE 
A malevolent masquerader like syphilis, 
brucellosis appears under many guises. 
Like syphilis, too, its incidence rate 
is unusually high—occurring in an es- 
timated 10 per cent of our population. 
By HAROLD J. HARRIS Printed and Published in the United States of America The RAW MILK MENACE 
By HAROLD J. HARRIS 
THE CONQUEST of disease during the com- 
paratively short history of modern medi- 
cine has been largely a matter of learning 
how to ward off death in some of its more 
violent forms. Epidemics of virulent disease 
were a ghastly but effective kind of population 
control in the old days; they are rare now, 
fortunately, and limited in their effect. Scien- 
tists now have time to turn their attention to 
keeping the human race well, rather than just 
alive. 
In recent years a disease little known and 
difficult to understand has begun to attract 
widespread attention. Not a new malady, its 
acute form was probably referred to by Hip- 
pocrates in his classical descriptions of disease 
written in the fourth century B. C. This dis- 
ease took a real place in medical history when 
it swept through the ranks of the British army 
during the Crimean War, breaking out on the 
Island of Malta among soldiers who drank raw 
goats’ milk. Sir David Bruce isolated the germ 
of “Malta Fever” in 1886, and countless other 
names were given it in an attempt to describe 
its locality, its nature or its course, among them 
Mediterranean fever, goat fever, dust fever. 
In 1895 British army doctor M. L. Hughes, 
noting how temperatures and other symptoms 
came and went, called it “undulant fever,” a 
name still often used despite the scientists’ 
more recent and descriptive term, “brucel- 
losis.” 
The disease was studied in animals before 
its effect on man was fully understood. Not 
only goats, but cattle, pigs, horses and sheep 
were subject to it. The first human case was 
recognized in this country in 1904. It was not 
until the World War that Alice Evans, Senior 
Bacteriologist, Public Health Service, found 
that the germ as found in goat’s milk was 
similar to that causing a widespread epidemic 
of contagious abortion in cattle and prophesied 
that it would prove dangerous to human 
beings. Nine years later Richard Kern, one 
of the few investigators then impressed by the 
importance of this disease, noted that thirty-six 
cases of human illness due to the abortus strain 
had been reported from widely scattered sec- 
tions of the United States. He predicted more 
cases and a major public health problem aris- 
ing from the disease. Within two years there 
were 2,365 cases and six years later, 9,965. 
Statistics do not tell all the story, for cases 
were reported only from regions where there 
chanced to be doctors who understood and 
could diagnose the disease. Even now, ade- 
quate research is being carried on in hut a 
few widely separated areas scattered over the 
country. Sample group testing seems to indi- 
cate that about 10 per cent of the population 
has become infected with the germ and cases 
have been reported from all over the civilized 
world. Of those infected about 1 per cent are 
actively ill; the rest, while harboring the germ 
in their tissues, may never develop serious ill- 
ness, or if they do, it may be only evanescently 
following some depleting, resistance-destroying 
experience. 
The disease occurs more frequently among 
country people than among city dwellers, 
and is contracted from the use of infected, 
raw milk or by handling infected animals or 
carcasses. Veterinarians, slaughter house 
employees and laboratory workers are grossly 
exposed to infection. It is reliably estimated 
that 20 per cent of the cattle of America, dis- 
tributed among 46 per cent of the herds are 
now infected. Sheep, goats, horses, hogs and 
other domestic animals as well as wild rats 
are known to carry the infection, but it does 
not seem to be transmitted from one human 
to another. In the experience of a doctor with 
patients from farming regions, 51 per cent of 
150 cases of arthritis reacted to the tests for 
brucellosis and 90 per cent of those treated 
recovered from their arthritis with undulant 
fever vaccine. The milk supply of cities may 
be protected by pasteurizing regulations, but 
people who drink raw milk while vacationing 
in the country are not protected. Even if the 
exposure from raw milk was years before, the 
disease still must be suspected for the body 
may harbor the germ for years. 
Like syphilis, it is a great masquerader, 
appearing under many guises. Scarlet fever, 
measles, whooping cough and most other infec- 
tious diseases have a more or less typical mode 
of onset and group of symptoms. But two 
cases of brucellosis rarely act alike. Until 
quite recently only the acute form was recog- nized. Since the introduction of more accurate 
tests, the chronic form is known to be far more 
common than the acute. 
Usually the acute infection begins with a 
grip-like illness, of slow or rapid onset, with 
fever, chills, backache, headache, pains in 
joints and muscles, prostration, possibly sore 
throat, cough and even pleurisy, or with pro- 
fuse sweating, often of unpleasant odor. Fever 
continuing beyond that of ordinary grip may 
suggest brucellosis, but early agglutination 
tests may be negative or weakly positive. 
Usually, in the acute illness, the blood reaction 
becomes positive within two weeks but may 
remain negative indefinitely. The illness may 
last ten days to six weeks or more, with fever 
bobbing up and down and relapses occurring 
at any time. Usually it tapers off and may 
never recur, but repeated relapse is common. 
If, as often happens, the joints are swollen or 
excrutiatingly painful, rheumatism may be 
diagnosed. 
Fever may be out of all proportion to the 
severity of the illness, even in patients not con- 
fined to bed. Some have a severe illness resem- 
bling typhoid and are often so diagnosed. One 
patient, a nurse, had frequently recurring 
attacks over a period of seven years. At times 
her fever reached 107.2 degrees. Finally in a 
chronic interval she had vaccine treatment. 
She has been well for the past four years and 
doing twenty-four hour special duty. 
The importance of the chronic phase of 
brucellosis became increasingly apparent dur- 
ing the study of two young farm hands in 1932. 
One complained that for four years he had 
had upper abdominal pain after meals, sug- 
gesting peptic ulcer; the other had suffered 
profuse nose-bleeds, weakness and backache 
for the past nine years. Both had been 
examined repeatedly without diagnosis or 
relief. Both became acutely ill with high fever 
and typhoid-like states while their cases were 
being studied, one for eight, the other for 
twelve weeks. One young man developed what 
seemed to be perforation of the ulcer and 
peritonitis, hut lacked abdominal rigidity, so 
he was spared unnecessary operation. The 
other patient just went on with chills, aches 
and fever for twelve wearisome, pain-racked 
weeks. Agglutination tests, tried on a hunch, 
were strongly positive. These young men con- 
tributed much to knowledge of the disease 
that was to benefit patients who came after 
them. They recovered from the acute phase 
of their illness, but then lapsed into the chronic 
phase with the same symptoms that had 
plagued them for years. Botli ultimately 
recovered under vaccine treatment and have 
been well ever since. Their cases suggested 
that other patients with various ambulant 
illnesses might have a chronic brucellosis 
infection. 
Later, a young farmer’s wife came under 
observation because she had lost her baby in 
the third month of pregnancy and failed to 
regain her health. There were two subsequent 
miscarriages with unhealthy afterbirths, and 
then an inspiration came. Perhaps this woman 
was going through the same hopeless process 
as had her husband’s and neighbors’ cows. In 
1917 another physician had described repeated 
miscarriages in women on farms where cows 
had recently aborted, but without laboratory 
proof of the identical nature of the infection. 
This woman might have brucellosis without 
fever and perhaps she could be cured. Her 
blood agglutination test was strongly positive 
and the germ of brucellosis was cultured from 
her uterine discharge. Treatment with vaccine 
and pelvic diathermy restored her to perfect 
health, but she has waited for five years for a 
baby that has never come. 
Abortion in women is but one of the serious 
possibilities. How many women are sterile, 
how many premature and stillborn babies are 
deprived of their chance for life by this infec- 
tion cannot yet be estimated. 
Coexistence with other diseases may bring 
serious results. A farmer with slight tubercu- 
lar infection also had brucellosis. He was not 
very ill and early x-rays showed no lung 
involvement. Attacks and remissions alter- 
nated, and despite the best of specialized care 
within a year he was dead. Tubercle bacilli 
had run their most destructive course, aided 
and abetted by the undermining influence of 
brucellosis. 
The germ of brucellosis has been shown to 
cause infection in practically every tissue in 
the body. It may be the infecting organism in 
pyelitis, arthritis, meningitis, and even in mas- 
toiditis; it may complicate convalescence from 
measles or pneumonia to the confusion of the 
doctor and detriment of the patient. 
Happier outcomes may now become possi- 
ble. Good results have been reported from 
vaccine treatment, though not in all instances. 
A woman of middle age, surrounded all her 
life by the utmost comfort and protection, 
became ill near one of America’s great medi- 
cal centers. An abrupt, night attack of con- 
vulsions, fever and coma resulted only in 
a diagnosis of colitis. Three months later a second similar episode was nearly 
fatal. She rallied and sought the 
cause from the country’s leading 
doctors. She continued to be weak, 
pale, anemic and to have distressing 
abdominal symptoms, but no fur- 
ther diagnosis was made. Twenty- 
eight apparently sound teeth were 
found abscessed and removed, but 
recovery did not follow. Returning 
to her summer home, resigned to 
death, she was for the first time 
given the diagnostic tests for bru- 
cellosis. Vaccine brought improve- 
ment, and when her gallbladder was 
shown, under x-ray, to be infected, 
short wave diathermy was added. 
Recovery followed although there 
are still occasional mild recurrences 
of anemia, fatigue and distention, 
which yield to resumption of vac- 
cine. The germ is probably still 
with her, but her resistance has the 
upper hand. 
In the chronic form, the one 
symptom common to all patients is 
fatigue. Other signs and symptoms 
of this strange disease may occur 
alone or in any combination. A 
composite case history may serve 
to illustrate the chronic illness. 
The patient is most likely to be 
an adult resident of a rural com- 
munity, where raw milk has been 
consumed throughout his life. He 
may be a farmer or a farm laborer 
engaged in milking and general 
care of cows, a butcher or slaughter 
house employee, a veterinarian or 
laboratory worker. Not infrequently 
the patient is a city dweller and 
has never had raw milk except dur- 
ing summer months spent in the 
country. He may not recall ever 
having had raw milk or cream or 
having come in contact with cattle 
except for a single instance. Per- 
haps a soda fountain drink in some 
small community in the course of 
a motor trip may have been the 
only source of exposure, or cream 
in coffee at a resort hotel. 
His reason for consulting a phy- 
sician is that he does not feel well, 
that he has been losing weight and 
is tired for a part or all of each 
day. Backache, pain and lameness 
in joints and muscles have appeared 
and disappeared. His appetite is 
poor. Headache and mental con- 
fusion have worried and depressed 
him. Glasses have been fitted with 
no improvement. Skin eruptions, 
of several confusing types, have 
appeared at intervals, once closely 
resembling multiple patches of ery- 
sipelas. He has had cystitis and 
has been told that there was pus 
in his urine at times and none at 
others. He has been constipated 
and has had gas and indigestion. 
Neuritis of various parts of the 
body has led to re-investigation of 
teeth and removal of one or more 
found to be infected or dead. Nose- 
bleeds have been an irregularly 
occurring source of annoyance. He 
has been examined at one or more 
of the leading clinics and has been 
assured that there is nothing seri- 
ously wrong, that he needs a change 
and rest. He has tried these meth- 
ods, as well as tonics, ultraviolet 
light, vitamins and many other 
things, with little or no effect. He 
is discouraged by his alternations 
of apparent improvement and re- 
lapse; his hopes have been raised 
and dashed repeatedly. Diseased 
tonsils have been removed, w.ith no 
noticeable effect. He is worried 
about his lungs because he has 
heard that his tendency to tire, lose 
weight and sweat may be caused 
by tuberculosis or even by cancer. 
Low-grade afternoon temperature 
and moderate anemia have added 
to this worry, although he has no 
fever at times (if mouth tempera- 
ture is taken for less than 5 min- 
utes, a low-grade fever will be 
missed). His chest has been 
x-rayed, with no definite findings. 
In the background there may be 
a story of unexplained illness sev- 
eral years before with fever which 
was called influenza or paratyphoid 
or tuberculosis. Both he and his 
doctors have dismissed it as an un- 
related thing of the past. Or the 
present condition may have fol- 
lowed an actual influenza or pneu- 
monia, his failure to convalesce 
normally being the only indication 
that a latent brucellosis had flared 
up following the other illness. Or 
there may have been no history of 
any acute illness preceding the com- 
plaints which brought him to a 
physician, but just a story of the 
gradual onset of symptoms which 
were weakening him physically and 
mentally. 
The doctor who examined him is 
surprised that there can be so many 
complaints in a patient who is only 
slightly anemic and with no other 
physical findings. Small wonder, 
then, that brucellosis is so often 
wrongly diagnosed as neurasthenia, 
for it follows a textbook picture 
exactly. 
Doctors do not depend on a single 
test to diagnose or rule out tuber- 
culosis. Multiple sputum tests, re- 
peated x-rays, blood and skin tests, 
together with temperature records 
and careful physical examination 
must all be used. Similarly, not one 
but a combination of four labora- 
tory procedures may be necessary 
in patients suspected of brucellosis. 
The cooperation of the patient in 
the often long drawn out study of 
the symptoms and history necessary 
to rule out all other disease is an 
essential. 
The agglutination test, commonly 
considered sufficient alone for diag- 
nosis, is used to discover what 
proportion of defensive substance 
called agglutinins the blood has pro- 
duced to defend the body against 
this particular germ. Each of sev- 
eral germs produces its own spe- 
cific agglutinins in the blood. If 
that germ were not present, the 
agglutinins would not be there 
either. Agglutinins are easy to find, 
but culturing the germ of undulant 
fever from blood, body fluid or 
organs, while a sure test when posi- 
tive, is a long drawn out and 
technically complicated process, 
done only when essential. If posi- 
tive, the agglutination test proves 
the presence of infection against 
which the body is struggling, but 
agglutinins may never appear in 
some cases of brucellosis, even after 
weeks of illness. 
The skin test is made, like the 
tuberculin test for tuberculosis, by 
injecting a small quantity of vac- 
cine between the layers of the skin 
on the forearm. Reaction proves 
that the body is sensitive to the pro- 
tein of that particular germ, that 
it has at some time been infected, 
although the patient may have since 
recovered. A positive reaction may 
produce within a week anything 
from a small red lump to a sore 
which develops a scab, though 
strength of reaction does not neces- 
sarily indicate degree of infection. 
The fourth or opsonocytophagic 
test gets its rather impressive name 
from the tendency of certain white 
corpuscles, stimulated by another 
blood by-product called opsonins to 
phagocyte or surround and digest 
the live germs. A small amount 
of fresh blood combined with germs 
from a live culture under a micro- 
scope shows how well they are 
doing their job. White cells stuffed 
with germs show that the body is 
well able to defend itself, even 
when a positive skin test shows that 
it has been infected. White cells with languid appetites are poor pro- 
tectors and indicate a low opsonic 
index. The complexities of this test 
are almost too much even for the 
experts, for it is a perfect example 
of the fact that the practice of medi- 
cine is no foolproof affair, but a 
matter of continuously balancing 
theory, observation and deductive 
reasoning. 
Mortality in acute cases was for- 
merly about 2 per cent, but this 
has been greatly lowered by modern 
methods. Bed rest, nursing care 
and the use of one of the newly dis- 
covered “miracle drugs,” such as 
sulfanilamide, have been effective 
in stopping an acute attack or ac- 
complishing cure in an impressive 
number of cases. Modified vaccines, 
blood transfusions, serums and arti- 
ficial fever are also used with suc- 
cess. In the chronic phase most 
authorities agree that vaccine treat- 
ment is best, although fever ther- 
apy may also be of great value. 
Until the medical profession and 
the public are aware of the serious- 
ness of this situation, preventive 
measures will continue to be in- 
adequate. One simple precaution 
which every one can observe is to 
be sure that all milk and milk prod- 
ucts he uses are pasteurized. No 
vague assurance that the herd has 
been tested should be enough. The 
test may have been for tubercu- 
losis, not for contagious abortion. 
Herds free of infection for years 
may suddenly develop infection. 
The label on the bottle from a re- 
liable dairy stating that the milk 
is pasteurized is the only safe 
guarantee. It has been conclusively 
shown that only a small percentage 
of vitamins are destroyed by pas- 
teurization and that digestibility, 
mineral content and caloric value 
are unimpaired. 
The following quotation from 
Public Health Reports, United 
States Public Health Service, ade- 
quately and authoritatively sums 
up the case for pasteurization: “If 
all milk were efficiently pasteurized 
or boiled before being consumed, 
there would be no brucellosis ex- 
cept in those occupational groups 
whose work brings them in contact 
with infected animals or infected 
carcasses.” 
232b4hlel 19 
BRUCELLA ABORTUS IN MILK AND ITS 
RELATION TO UNDULANT FEVER 
C. M. Carpenter, Ph. D. 
(Diagnostic Laboratory, New York State Veterinary College, 
Cornell University, Ithaca, N. Y.) 
and 
M. J. King, M. D. 
(Hegemon Memorial Research Laboratory, Metropolitan Life 
Insurance Company Sanatorium, ‘Mt. McGregor, N. Y.) 
(Printed by the American Public Health Association 
New York, N. Y.) 
The specific etiology of the undulant fever which 
occurs in North America, as woll as its source, necessitates a 
most thorough study. There are 3 possible factors to be con- 
sidered—Br. molitonsis, Br. abortus of porcino origin, and Br. 
abortus of bovine origin. 
Br. molitonsis, the infective agent of true Malta 
fever, should bo considered first as a possible cause, since 
cases of this disease have boon described as occurring in the 
sputhom United States. There is positive evidence that goats 
in the extreme South are infected with Bp. molitonsis. Craig 
reported the first case of Malta fever in the United States in 
1905. Later Gentry and Poronbaugh and Yount and Looney reported 
.similar cases. Very recently Watkins and Lake reviewed the 
literature on Malta fever in this country and have reported 
additional cases. The danger to man and to the dairy industry 
from the presence of this infection must not bo underestimated 
by public health officials and sanitary live stock officers. 
The. time to control molitonsis infection is before it becomes 
widespread. 
Several investigators believe that our cattle may now 
bo infected from this source and that because of the groat 
traffic in the dairy industry it has spread to other parts of 
the country. The Isolation of Br. molitonsis from one bovino 
fetus collected at Gambrills, Md., by the U. S. Bureau of 
Animal Industry, has boon reported by Evans. There is a possi- 
bility that certain individuals may have contracted the disease 
from dairy products produced in the South and distributed to 
other parts of the United States. .Another suggested source of 
Br. molitonsis in this country is its Introduction from Europe 
with dairy products, principally choose made from milk of shoop 
and goats whore Malta fever exists. 
•» 
A few observers report that Br. abortus of porcino 
origin is the cause of undulant fever in America. Wo designate 
as of porcino origin a culture of Br. abortus isolated directly 
from swine. It is difficult to determine whether abortion 
disease spreads from cattle to swine or from swine to cattle. However, it may bo stated that infoctlous abortion in cattlo was 
doscribod many years before it was reported in swine*. In general 
it may bo stated that porcino strains of Br. abortus arc more 
virulent for guinea pigs than are bovine strains* Yet thorc is 
considerable evidence Indicating that this hypothesis cannot 
always bo accepted. A, study of the virulence of cultures of 
Br. abortus isolated'from various sources is always difficult 
because of,the rapid change in virulence under artificial 
cultivation which may bo duo,to the microaorophillc tendencies 
of the organism. There is- no doubt that animal passage from 
one species to another or oven among animals of the same spocios 
effects a gradual change of virulence* 
Many of the cultures of Br. abortus isolated 
from cases of undulant fever in man arc as infectious for 
guinea pigs as are certain porcino typos. McAlpine and Slonotz 
have reported that carbon dioxide causes a partial inhibition 
of the growth of porcino and human strains while ..the growth 
of the bovine strains is stimulated by it. They state further 
that the human and porcino cultures utilize *from 4 per cent 
to 18 per cent glucose, increase the non-protoin nitrogen and 
produce very little free ammonia, while those of bovine origin 
utilize practically no glucose, decrease slightly the non- 
protein nitrogen and produce largo amounts of free ammonia. 
Because of such' similarities between the human and swine 
cultures of Br. abortus, the infection in man has boon ascribed 
to the latter typo. However, wo have recently recovered from 
milk a culture of abortus that utilizes 12 ,pcr cent glucose. 
In a few instances, cases ,of undulant fever have 
occurred in meat inspectors or butchers who have boon in contact 
with swine, but possible contact with carcasses of cows that 
have aborted or milk that might have contained the infection 
has not alv/ays boon considered. Without doubt a small percent- 
age of the cases occurring in the United States may bo traced 
to the porcino strain as a result of wound infection. 
Some of the biological characters of tho bovine 
typo of Br. abortus have boon discussed above in comparing it 
with that’ of porcino origin. Serologically the 2 spocios can- 
not bo differentiated. The so-called typical bovine typo, 
according to Smith, will not produce abscess formation of tho 
lymph nodes and spleens of guinea‘pigs whereas tho majority 
of porcino strains will produce such lesions. Olafson, how- 
ever, has observed that certain strains of abortus isolated 
from cattlo will produce abscess formation of tho lymph nodes, 
spleens and livers of guinea pigs. Tho incidence of abortion 
disease in cattlo and tho virulence of tho causative agent are 
extremely variable in different herds. Br. abortus is dis- 
charged from the uterus and mammary gland, and at tho. time of 
abortion the placenta and uterine exudate are teeming with tho 
organisms. The infection in the uterus usually disappears 
within a few weeks after tho expulsion of the fetus. A largo 
percentage of cattlo that abort show this infection in tho 
colostrum, but it may disappear soon after the normal milk is 
secreted. However, 20 per cent to 80 per cent of this group 
continue to harbor tho infection in their mammary glands throughout thoir lifetime and eliminate it with the milk* It 
often happens that many herds that do not show clinical evi- 
dence of the disease are infected with Br. abortus. The herds- 
man will state that the animals arc free from abortion but 
frequently several carriers can bo detected by the blood tost* 
Br. abortus was first reported in milk by Smith and 
Fabyan ‘and Schro’odor and Cotton In 1912. Since those observa- 
tions extensive studios have boon made on the prevalence of this 
organism in milk. One of the most important contributions 
was made in 1918 by Evans while studying this problem. She 
demonstrated the very close biological relationship that exists 
between Bp* molitonsis and Br. abortus*. As a rule, only a 
comparatively few (20-500) abortus organisms can bo cultivated 
from 1 c*c*. of milk. It has boon observed that after milk has 
stood or has been centrifuged the greatest numbers of Br* 
abortus are found in the cream content of the sample, having 
boon carried up with the fat globules. Carpenter and Book have 
found Br. Abortus to remain viable in cream from 8 to 10 days at 
ordinary refrigerator temperatures (8 dogroos-10 degrees C.) 
and to live in butter 142 days under similar conditions when 
the butter had boon made from unpastourizod sweet cream. 
In 1925 the senior author reported 2 cases of un- 
dulant fever in Cornell University students at Ithaca, for which 
there could bo found no possible source of infection except 
the raw milk that the patients had drunk. A careful investi- 
gation was made of abortion disease in the herd sup dying this 
milk. The mixed milk was examined for 30 days, and daily was 
found to bo infected. A blood tost showed that 10 of 16 animals 
comprising the herd were positive and the infection of the 
milk from those 10 into guinea pigs showed 9 to bo discharging 
Br. abortus. The guinea pigs became emaciated and showed 
lesions described as typical of those produced by Br. abortus 
of porcine origin. An epidemiological study of undiagnosod 
fevers in this community revealed that several cases of a typhoid- 
like disease had occurred on this same milk route but no defi- 
nite diagnoses had been male previous to our examinations. The 
milk from a second small herd in this vicinity, consisting of 
3 cows, was carefully stLidiod because it was supplied to a 
university instructor who has boon incapacitated with undulant 
fever for approximately 18 months. The mixed milk showed the 
presence of abortus infection for 7 of the 13 days upon v/hich 
examinations wore made. A history of the herd revealed that 
1 of the animals had aborted 2 years in succession and her milk 
v/as heavily infected. The other 2 cows wore normal. 
Wo have thoroughly investigated 52 other cases of 
undulant fever that have boon diagnosed in our laboratories, have 
studied the histories and sources of infection, and have examined 
tho milk consumed by them in all but 6 instances. Seventeen 
cases have occurred in Ith&ca, N. Y., since tho work on this 
disease was undertaken. Eleven of those wore university students; 
3, housewives; 1, a high school student; 2, university in- 
structors, 1 of whom was a bacteriologist. Because of the 
proximity of those cases to one of our laboratories, wo have 
had an excellent opportunity to make a thorough study of tho disoaso in this community as wo 11 as of tho .pr oval one o of Br. 
abortus in tho milk supply.: Carpontor and Bakor have roportod 
tho results of tho examinations of 50 herds of cattlo that wore 
supplying most of tho raw nilk in this aroa. They found that 
tho milk from 9, or 18 por cent, contained Br. abortus. 
It is vory interesting to noto that, with tho 
exception of tho bacteriologist, fcho othor pationts wore 
porsistont drinkors of raw milk or croam. Tho bacteriologist 
who had tho disoaso had boon working with cultures of Br. 
abortus of bovino origin.at this time and had nevor had in 
his laboratory, to his knowledge, any porcino strains of Br. 
abortus or cultures of Br. nolitonsis. Tho gf tho 
casos at Ithaca, N, Y., showod that nono of thorn had boon in 
contact with swino, cattlo or goats and tho only manner in 
which thoy could havo acquired tho infection, in so far as wo 
could dotormlno, was from tho raw milk which thoy had drunk* 
A study was mado of tho milk supplied to a caso 
of undulant fovor roportod by Flshor and Garon of Oloan, N, Y. 
This caso was that of a young man living on a farm whoro 13 
cows woro kopt* Twolvo of thoso animals woro positive to tho 
blood tost for infectious abortion but only 1 was eliminating 
Br. abortus in hor milk. Tho milk from from this cow was 
savod for homo uso andkdrunk by this man* 
Tho milk from a farm noar Marathon, N. Y., whoso 
owner was suffering from undulant fovor, wps also oxaminod. 
Tho hord consisted' of 10 cows. Tho agglutination tost on tho 
blood sorum of thoso animals showod 4 to bo dofinitoly infoctod 
and a fifth ono suspicious. Guinea pigs injoctod w£th tho 
milk from thoso infoctod cows showod only 1 to bo eliminating 
Br. abortus at tho time of examination. 
A survey was mado of tho raw milk supply of 
Newark, N. Y., whoro 4 casos of undulant fovor had,boon diag- 
nosed. Wo had an opportunity to got blood samples' from all 
tho cows supplying milk to this village. Tho milk from ovory 
cow whoso sorum contained abortus agglutinins was oxaminod 
for Br. abortus by animal inoculation. The data showod that 
Br. abortus was prosont in tho mlxod. milk from only 3 of 15 
hords. In studying tho histories of tho, 4 casos of undulant 
fovor it was found that tho mixod milk from 2 of thoso 3 infoctod 
dairios was boing supplied to thorn. In tfyoso 2 hords 94 per 
cont and 63 por cent of tho animals woro positive to tho blood 
tost for infectious abortion. Whon examinations woro mado of 
tho milk from tho infoctod cows in thoso 2 dairios showing 
ovldonco of tho disoaso, 25 por cont and 36 por cont, respec- 
tively woro discharging Br. abortus. 
* 
At Utica, N.. Y., 4 cases qf undulant fovor 
occurred oh ono milk routo. Wo oxaminod tho blood sorum from 
37 cows comprising this hord and found 12, or 32*4 por cont, 
of tho animals to bo infoctod. Tho milk from tho cows was 
oxaminod with nogatlvo results but only l/2 ounco was collected 
from each animal, which amount wo consider insufficlont• Wo 
boliovo, howovor, that could we havo had l/2 or 1 pint samples. 23 
which is tho customary amount tested, Bp. abortus would havo 
boon found* Tho milk contained a high antibody content and wo 
havo obsorvod that in 95 per cont of such samples Br. abortus is 
prosont in comparatively largo numbers. 
Approximately 90 por cont of *'tho milk consumed in 
Syracuse, N, Y*, is pasteurized and therefore there should bo 
very few cases of undulant fever if milk is tho source of tho 
infection. < Wo examined tho mixed milk from 2 dairies that wore 
distributing raw milk. One herd supplied certified milk while 
tho second sold grade A raw. Br. abortus was recovered from 
both samples. Tho total amount of milk from those 2 herds, 
however, comprised only a very small percentage of tho milk sold 
in this city* . 
Those findings correspond remarkably well with tho 
results obtained on 4,050 routine Wassormanji samples collected 
by tho Bureau of Health Laboratories at Syracuse and tested for 
abortus agglutinins by Carpenter and Chapman. Seven and throe- 
tenths por cont of tho samples contained those antibodies. A 
study of tho histories of tho patients with a positive serum 
showed that tho majority wore living outside tho city of Syra- 
cuse in smaller towns and villages whore there was a raw milk 
supply. 
Dr. King observed a caso of undulant fovor at tho 
Motropolitan Lifo Insurance sanatorium at Mt. McGrogor, 
N. Y. This prompted an investigation of abortion disease in 
tho sanatorium herd as well as a routine examination of tho 
serum from all patients and tho staff at this institution. Tho 
hord consisted at this timo of 150 cows. A blood tost of this 
group showod 82, or 54.6 per cont, of tho animals to bo infoctod 
with Br. abortus. Tho milk from tho infoctod animals was thon 
examined and 24, or 29.2 per cont, of them wore found to bo 
.eliminating tho organism. 
A routine tost on tho serum from tho 530 patients and 
staff showed 69, or 13 per cent, to have abortus agglutinins. 
Eight of these had shown definite symptoms of undulant fever. 
Many others had a history 'of symptoms suggestive of the milder 
form of the disease. All of the patients' had been drinking 
large amounts of the raw milk and cream from this herd. Because 
of these findings the infected cows were segregated and the milk 
from the cows discharging abortus was pasteurized. We then 
considered tho milk supply to be free from living abortus in- 
fection. The routine serum examinations on 448 now patients 
and employes was continued after tho milk was supposedly 
abortus free. The results of those tests have shown only 6 
of the 448 to havo a few abortus agglutinins. Tho 6 serums 
produced only sedimentation of tho antigen when tho sorum was 
diluted 1;15. At tho time wo obsorvod those 6 serums wo dis- 
covered that 1 cow, whoso milk had boon negative ropoatodly, 
began to discharge Br. abortus aftor a normal gestation period* 
Unknowingly, her infoctod milk was mixod with tho raw abortus- 
froo milk for approximately 6 wooks before it was dotoctod. Tho 
examination of sorums from approximately 100 pationts for a por** 
iod of 3 months sinco tho pasteurization of her milk has given 
negative results. Nono of tho individuals in tho negative group of 
tho first 530 tostod has shown abortus agglutinins sinco tho 
elimination of Br. abortus in tho milk. Bocauso 44*9 por cont 
of tho patients at tho Metropolitan Lifo Insurance Company 
Sanatorium with sorum containing abortus agglutinins wero 
as tuberculous, it occurrod to us that tho aggluti- 
nation of tho abortus antigon might bo duo to agglutinins 
produced by tho tuborclo bacillus* Thoroforo we docidod to 
mako further observations on tho sorum from patients in various 
tuberculosis sanatoriums whoro in somo tho milk supply was 
pastourizod and in others raw milk containing Br. abortus v/as 
usod. 
Blood was collected from 42 patients at tho 
Saratoga County Sanatorium and oxaminod for abortus agglutinins# 
Two of those serums showed abortus antibodies# An examination 
of tho blood serum from 12 cows supplying milk to this sana- 
torium showed that 3, or 25 per cent, wore infected with Br# 
abortus. Guinea pigs injected with tho milk from tho entire 
group showed none of tho animals to bo discharging Br. abortus 
at the time tho examination was mado. 
Through tho cooperation of Dr. Goorgo Bigolow, 
Commissioner of Health of Massachusetts, and with laboratory 
facilities offered to Dr, King by Dr* Hans Zinsser of tho 
Harvard Medical School, tho sorums from 690 pationts in 3 
stato sanatoriums in Massachusetts woro oxaminod for abortus 
agglutinins. Not a singlo sorum showod agglutinins for this 
organism. Tho milk supply for each of thoso institutions is 
carofully pastourizod. 
To obtain data on tho amount of Bp* abortus 
infection in milk in a comparatively largo territory, a survey 
of tho raw milk supply of 3 counties in central Now York was 
made# Tho territory included 67 towns and villages, 2 cities 
with an approximate population of 20,000, and 1 city of 200,000* 
Samples from 122 distributors wore collected, which represented 
approximately 95 per cent of tho raw milk sold and consumed 
in t£is area* 
Guinea pigs woro injoctod with 2 c.c. of tho 
mixed croam and sodimont after a 500 c.c. sample had boon 
contrlfugod at high spood for 15 rainutos. Tho guinea pigs 
wore autopsiod from 25 to 35 days aftor injection and oxaminod 
for losions of abortion disoaso. Tho sploons wore culturod 
for ovidonco of Br. abortus infection. Twonty-fivo, or 20.4 
por cont, of tho samples showod tho prosonco of this infection. 
Tho milk sorum from oach samplo was oxaminod for abortus ag- 
glutinins and 18 of tho samples showod thoso antlbodios. Tho 
biological characters of tho various strains isolated aro boing 
studied to dotormino whether any of tho cultures may bo Br, 
molitonsls rathor than Br. abortus. Thoir virulence for 
guinoa pigs is boing determined as v/oll as thoir biochomical 
actlvitios. Wo havo obsorvod a raarkod difforonco from tho 
typical bovino strain of Br* abortus in 3 of tho cultures 
rocovorod, which grow roadily on slanted nutriont agar in un- 
soalod tubos. DISCUSSION 
A roviow of publlshod caso reports of undulant 
fovor in the United.States and of our, own cases gives a total 
of 155 which have "boon diagnosed as definitely duo to Br. abor- 
tus. Fifty-two cases have boon reported as Malta fovor caused 
by Br. molitonsis infection, although in some instances very 
meager information concerning the bacteriology of the cases is 
given and in our opinion such a diagnosis 'is somotimos question- 
able. The first reported caso of undulant fever was that of 
Keefer in 1924, and the groat increase in the number of reported 
cases during a period of 4 years emphasizes the importance of 
this disease as a public health problem. A recent epidemiologi- 
cal report from the Health Section of the League of Nations has 
called attention to the prevalence of the disease in Europe, 
particularly in those countries where Malta fever does not occur. 
Undulant fever became a reportable disease in Denmark in 1927. 
During the first 3 months of 1928, 62 cases of undulant fever 
were diagnosed in that country. Last year in a discussion on 
Br. abortus infection in man. Prof. Bernard Bang of Copenhagen 
stated that this was not suspected in Denmark until reports of 
the disease came from America. 
An analysis of the possible sources Of the infection 
of the reported cases gives evidence of the danger of raw milk 
containing Br* abortus. One hundred and nine of the 155 cases 
have a history of drinking various amounts of raw milk from 
which, in the majority of instances, Br. abortus was isolated. 
In 35 cases no information was obtained as to whether or not 
the patients had been drinking raw milk. Only 7 of the cases 
of undulant fever had been directly in contact with swine or 
had boon on farms whoro abortion, disease in swine had occurred. 
Four laboratory infections with Br. abortus have boon reported. 
It would seem that if the porcino strain of Br. abor- 
tus in man is largely responsible for undulant fovor in the 
United States, there would bo more evidence of a closer relation- 
ship between this disease and abortion in swine. Of course it 
may bo argued that the infection in swine has boon transmitted 
to cattle. Some experiments have boon reported indicating that 
the bovine typo is not pathogenic for swine and that the porcino 
typo is not pathogenic for cattle. However, by the injection of 
a limited number of cattle with porcino cultures, wo have demon- 
strated that porcino strains readily infect the cattle and 
become established in the mammary gland. In Now York State the 
incidence of undulant fovor is approximately the same as in other 
sections of the United States but porcino abortion is compara- 
tively rare. In so far as wo can ascertain, only 1 culture of 
Br. abortus has boon isolated from a porcine fetus during the 
last 10 years. Inasmuch as the data show that about 20 per cent 
of the samples of raw milk from a comparatively largo territory 
aro infected with Bang’s bacillus, it cannot bo supposed that 
all of those cultures have the same virulence. 
Our study of the disease shows clearly that Br. abor- 
tus is only slightly pathogenic for man and it must bo that 
only the most virulent strains in milk aro of danger to him. It may bo that an accumulative infection in the tonsils, lymph' 
nodes or other tissues is necessary, and at some time when 
tho individual is fatigued, convalescing•or suffering from 
some other disease, Br.'abortus may invade tho blood stream, 
causing tho disease or sotting up an intorcurront infection* 
Wo know of only 2 cases of undulant fever in children under 
6 years of ago, tho majority of cases occurring botwoon tho 
yoars 15 to 45. Tho fact that children aro not so susceptible 
as adults cannot bo explained at this time because children 
consistently drink more milk than adults. However, when 
calvos aro fod infected milk wo have found that as a rule 
tho organism will not remain permanently in thoir tissuos 
after tho source of infection has boon removed. 
Ploischnor and Moyer havo shown that agglutinins 
are dovolopod in tho blood sorum of monkoys following tho 
intravenous injection of cultures of Br* abortus isolated from 
milk and that later tho organism may bo rocovorod from the 
spleen, lymph nodos, liver and kidneys. This was also- accom- 
plished by feeding monkoys broad and carrots upon which bovine 
cultures of Br. abortus had boon spread. When such experi- 
mental animals wore fod tho milk from a goat infectod with 
Br. abortus, tho same results wore obtained. Unpublished 
work by King, on fooding monkoys bovine cultures isolated 
from* milk, shows tho invasivonoss of tho organism from tho 
gastrointestinal tract. That a marked diffcronco exists among 
such cultures is indicated by the fact that 2 of 13 failed to 
produce any evidence of infection. Such data load us to 
believe that tho organism can invade a normal mucous membrane 
and gain entrance to tho circulating blood. Since approxi- 
mately 7 per cent of tho routine Wassormann samples showed 
abortus agglutinins, wo believe that this suggests a greater 
incidence of tho invasion of Br. abortus in man than case 
reports at present indicate. The presence of specific agglu- 
tinins is evidently a result of an active infection instead of 
a passive absorption of such antibodies from drinking milk 
containing them. In fooding experiments that havo boon con- 
ducted with adults drinking pasteurized milk with a'sorum 
titer of from 1:400 to 1:1,200 wo havo failed to find agglu- 
tinins in their blood sorum following tho consumption of a 
liter of such^miIk daily, for a period of 10 days. Undoubtedly 
some agglutinins from tho milk sorum aro absorbed, but because 
of tho groat dilution factor duo to the amount of blood in 
tho tissuos they cannot bo demonstrated. Wo rarely find tho 
mixed milk from 1 herd or from several to have a sorum-titer 
greater than 1:45. Wo havo observed, however, that when milk 
from an individual cow has a serum titer- greater than 1:45, Br. 
abortus can usually bo isolated from it. 
Studios of tho thermal death point of Br. abortus 
in milk show that our present methods of pasteurization aro 
effective. In no instance have cases of undulant fever 
dovolopod from a pasteurized milk supply, with tho exception 
of 2 cases that clearly seemed to bo duo to a wound infection 
resulting from contact with swine and a third case of a 
veterinarian who had manually removed tho placenta from a 
cow that had aborted and died later from metritis. Prom the data submitted we believe that milk is the 
logical source of Br. abortus infection in man. Whether the 
origin of the strains that are pathogenic for man are from 
cattle or swine we are unable to state at this time. There 
seems to be no reason why cattle cannot become infected with 
the swine strains if the two species are in close contact with 
each others. However, in Now York State we have failed to 
observe porcine abortion though our observations and inquiries 
have been extensive. 
CONCLUSIONS 
An examination for Br. abortus has boon made of the 
milk supplied to several communities whore cases of undulant 
fever have occurred, as well as of that drunk by individuals 
suffering from the disease. The results have shown that the 
milk contained comparatively largo numbers of the organisms 
and was produced by herds extensively infected with Br. abortus. 
An examination of the serum from 530 individuals known 
to have drunk raw milk containing living Br. abortus from a 
single herd in which 54.6 per cent of the animals wore infected, 
showed 13 per cent to contain agglutinins specific for this 
organism. Eight from this group wore showing definite symptoms 
of undulant fever at the time the examinations wore made, while 
others gave a history of symptoms suggestive of the disease. 
The serums from a group of 690 individuals known to have drunk 
raw milk free from abortus infection or milk carefully pasteur- 
ized have shown no agglutinins, nor have any cases of undulant 
fever occurred in the group. 
A survey of the raw milk supplied to 67 towns, 2 
small cities and 1 city of 200,000 showed the presence of Br. 
abortus in 20.4 per cent of the samples examined. 
A review of 155 case reports of undulant fever duo 
to Br. abortus showed that 109, or 70.3 per cent, had boon 
drinking raw milk which in the majority of cases was proved 
to bo infected with Br- abortus. No information concerning 
the source of the disease could bo obtained in 35, or 22.6 per 
cent, of the cases; 7, or 4.5 per cent, had either boon directly 
in contact with swine or had lived on farms whore porcino abor- 
tions had occurred; 4, or 2.6 per cent, wore considered to bo 
laboratory infection. 
Evidence has boon submitted that suggests raw milk, 
unpastourizod cream, or butter made from unpastourizod sweet 
cream, to bo the source of undulant fever in the United States. 29 
BRUCELLOSIS IN AND AROUND VANCOUVER 
C. E. Dolman and Vivienne G, Hudson 
Division of Laboratories, Provincial Board of Health 
Vancouver, B*C. 
(Reprinted from The Canadian Public Health Journal, May, 1938) 
Tho veterinarians and dairy farmers of tho lower 
mainland of British Columbia concur in acknowledging that bovino 
contagious abortion is very prevalent throughout tho Fraser 
River valloy, the sole source of tho fluid milk supply for 
Vancouver and tho neighbouring munlcipalitlos. Unfortunately 
no authoritative surveys of tho incidonco of tho disease among 
local herds havo boon recorded, nor is ‘it possible to* state 
whothor* tho situation is Improving or otherwise. But tho 
-stringent regulations enforced at tho international border, 
whereby Bang roactors (or cattlo showing blood scrum agglutinins 
against a Brucella suspension) are forbidden entry into, tho 
western States, must tend to an accumulation of infected cattlo 
on this side of tho border. 
In view of this situation, and of the then apparently 
increasing percentage of raw milk distributed in Vancouver, a 
survey was begun two years ago in this laboratory of tho 
Brucella agglutinin titro of tho whey in raw milk samples 
brought in by sanitary inspectors for bacterial plate counts. 
Moreover, for tho past six years, all blood specimens sent 
to tho Provincial Board of Health Laboratories in Vancouver 
for Widal tests have boon examined for tho presence of Brucella 
agglutinins. In this communication tho results of those two 
surveys will bo recorded and their significance discussed and 
illustrated by reference to tho main clinical, aotiological, 
and bacteriological features of a group of 15 recent cases of 
severe undulant fever occurring in or near Vancouver. 
Jordan (1), Johns, Campbell, and Tonnant (2), Hall 
and Loarmouth (3), and others havo reported thoir laboratory 
and clinical findings among relatively small groups of in- 
stitutionalized patients known to havo boon exposed to a Bru- 
colla-infoctod milk supply. But wo havo found no record of any 
investigation in Canada comparable, in rospoct of tho numbers 
and typos of specimens involved, to that which forms tho sub- 
ject of this report. 
BRUCELLA AGGLUTININS' IN WHEY FROM RAW-MILK SAMPLES' 
In partial fulfilment of tho regulations governing the 
bacterial standards of raw milk purveyed within tho city, tho 
Provincial Laboratories perform tho coliaorogcnos tost, and 
total colony counts, on samples secured by sanitary inspectors 
at least -once monthly from each of tho 55 licensed raw-milk 
distributors in Vancouver, A portion of every sample thus 
received has boon treated with rennet according to TorroyTs 
method (after tho cream layer formed on overnight standing has 
boon pipetted off) and tho Brucella agglutinin titro of tho 
whey determined as follows* Tho antigon used was an 0.5 por cent. phono- 
lizod saline suspension (standardized to the oquivalont of 
MacParland No. 2) of four strains of Br. abortus, one strain 
of which came sovoral yoars ago from tho Ontario Department 
of Health Laboratories, while tho other throo wore obtained 
from Dr. Huddleson about two years ago. All four strains 
had become adapted to growth in ordinary atmospheres on 
liver infusion agar, but conformed in all other 
respects, including their susceptibility to various aniline 
dyes, to tho generally accepted criteria for Br. abortus. 
Suspensions prepared thorofrom showed no tendency to non- 
specific agglutination. A semi-dilution series of 0..5 cc. 
volumes of whey, extending over a range from 1:12.5 to 1:100, 
was distributed into agglutination tubes. To each tube 
0.5 cc. of antigen was added, thus giving a range from 1:25 
to 1:200 of whey in tho final mixtures. Tubes wore incubatod 
at 37 degrees C. for 48 hours, and road after standing an 
additional 24 hours at room temperature. No inhibitory zones 
wore notod in this survey of whey agglutinins. Readings 
wore classified as follows: 
i. No agglutination, or only slight, 
in 1:25 * Negative 
il. Partial agglutination in 1:25, with 
slight agglutination up to 1:50. Doubtful 
iii. Complete agglutination in 1:25 only 4- 
iv. Complete agglutination up to 1*50.. *4- 
v. Complete agglutination up to 1:100* +4*4* 
vl* Complete agglutination to 1:200 or 
over i... Hff 
Prom March, 1936, to March, 1938, inclusive, a 
total of 1,296 separate raw milk samples was received and 
examined for Brucella agglutinins by the method described. 
Of this total, 704 samples (54.3 per cent.) showed complete 
agglutination in one or more tubes of the range adopted; while 
a further 168 (13 per cent.) gave a doubtful reading. Thus 
less than 33 per cent, of samples were completely negative 
for Brucella agglutinins. Submitting results on the 704 
positive samples to further analysis, 186 (26.4 per cent, of 
the positive group) gave a 4- readings; 275 (39.0 per cent.) 
gave 4-4*; 173 (24.6 per cent.) gave 4-44; and 70 (10 per cent.) 
gave 4-444* readings. 
When the results arc analyzed according to 
dairies, they assume a yet more serious potential significance. 
In table I the raw milk dairies of Vancouver have been classi- 
fied in throe categories according to the types of result 
given by their respective samples. Category 1 includes 9 
dairies, among whose 213 samples no negative specimen was 
found. Category 3, on the other hand, covering dairies 
which yielded no positive specimens, includes only 60 samples 
from 3 dairies. Category 2, into which fell roughly four- 
fifths of the dairies and their specimens, shows a groat 
preponderance of positive and doubtful results. Wo would emphasize that the foregoing findings relate 
to bottled milk samples, taken as sold, and therefore containing 
the pooled milk of several cows. In a few instances wo have 
had the opportunity of determining the effect of pooling upon 
the agglutinin titre of the composite sample. 
For example, among 21 samples of bottled milk received 
at monthly intervals from dairy A, Vancouver, the result was 
never negative; was doubtful on three occasions; J- on six 
occasions; 44 on eleven occasions; and 4-44 once. On no occasion 
was a 4444 reading (complete agglutination in 1:200 or over) 
obtained. However, when an opportunity came to examine milk 
samples from 29 individual cows in this dairy’s herd, the find- 
ings wore as follows: nineteen samples gave a negative result; 
four samples gave a 4- result; one gave a *4; one gave a 4*44; 
and four samples gave a 4444 result. Among this last group 
of four, the limiting titre proved to bo 1:200 in one sample, 
1:400 in another, and 1:800 in the two remaining samples. From 
each of the two latter samples, Br. abortus was isolated on 
Huddloson’s liver-infusion gentian-violet agar (4). 
TABLE I 
BRUCELLA AGGLUTININS IN RAW-MILK SAMPLES FROM DAIRIES DISTRIBUTING IN 
VANCOUVER (MARCH 1936-MARCH 1937) 
Category 
No. 
of Dairies 
Total No. 
of Tests 
Positive 
Doubtful 
Negative 
1. 
9 
213 
203 
10 
0 
2. 
43 
1,023 
501 
157 
365 
3. 
3 
60 
0 
1 
59 
Totals 
55 
1,296 
. 
704 
168 
424 
Neg. a no agglutination, or only- 
slight, in 1:25 whey 
4 — complete agglutination in 
1:25. 
++ — complete agglutination in 
1:50. 
D, - partial agglutination in 
1:25, with slight in 1:50 
+-H- s complete agglutination in 
1:100. 
4+++ - complete agglutination in 
1:200, 
The agglutination reactions given by the monthly 
pooled samples from each dairy are listed on charts in the 
laboratory. Not infrequently, those charts have shown a sudden 
marked change in the whey agglutinin titre of a given herd. 
Such changes, as is evident from the following examples, may 
bo of considerable public health significance. TABLE It 
INFLUENCE OF ONE INFECTED COW UPON AGGLUTINATION REACTIONS OF POOLED 
MILK SAMPLES 
Dates of tests 
on pooled 
s amples 
Total No. of 
monthly test* 
4444 
++4 
44 
4 
D. 
Neg 
. Comments 
Mar. 1936- 
Jan. 1937 
“■ 
11 
3 
3 
2 
0 
0 
0 
• • • • 
Feb. 1937- 
Aug. 1937 
7 
0 
0 
0 
0 
2 
5 
Cow "XM removed from herd 
early in February 
Sept. 1937- 
Nov. 1937 
3 
0 
1 
2 
0 
0 
0 
Cow "X" returned to herd 
early in September 
Keg. at no agglutination, or only 
slight, in 1:25 -whey 
4 a complete agglutination in 
‘ 1:25. 
44 - complete agglutination in 
1:50# 
D. s partial agglutination in 
1:25, with slight in 1:50 
444 — coranlete agglutination in 
moo. 
4444 is complete agglutination in 
1:200. 
. For* oxamplo, dairy B, Vancouver, ovor tho five- 
months* period April-August, 1936, yielded three negative and 
two doubtful samples of pooled milk. Tho laboratory findings 
then suddenly changed. From September, 1936-Novombor, 1937, 
no negative or doubtful samples wore received; but of a total 
of 14 monthly pooled samples, six gave a 4 result; six gave a 
44; and two gave a fff result. Throe months after- our labora- 
tory findings had so markedly changed, patient no. 3 in our 
series, who received his milk supply from this dairy, foil 
ill and took to bod. Shortly afterwards wo readily isolated * 
Br. abortus, not only by blood culture from this patient, but 
also from a composite milk sample from this dairy. Incidentally 
tho particular 9.ample of milk from which Br, abortus was grown, 
showed only a 44 agglutination reaction (i*o. complete ag- 
glutination up to I;50 whey dilution)* 
Dairy C, Vancouver,'''also provides an instructive 
oxamplo. Tho herd contained 9 cows. Tho agglutinin reactions 
of monthly pooled milk samples aro shown in tablo II. In 
February, cow X, with a history of previous abortion, being 
about to calvo again, was segregated. In tho ensuing seven 
months, during which tho milk from cow X was not included in 
the herd samples (which had previously boon 
always positive) gave either negative or doubtful reactions. 
Meanwhile, Br. abortus was isolated on four separate monthly 
occasions from tho milk of cow X. Tho agglutination titro of 
its colostrum was as high as 1:25,600, and Br. abortus was 
grown therefrom; but tho titro of its milk subsequently ranged 
botwocn 1:800 and 1:1,600 ovor a period of eight months, 
irrospoctivo of whothor or not Br. abortus was isolated, 
Aftor only ono or two succossivo monthly milk samples had 
had proved negative on culture, cow X was returned to tho 
herd. The inclusion of its milk in tho next throe pooled 
■samples is clearly shown by their agglutination reactions. On ono occasion, undulant fever in a dairy farmor!s 
wifo (pationt no, 4 in our sorios) afforded' an opportunity of 
performing parallel agglutination tests upon the blood scrum 
and whey of individual cows in the herd. The results are shown 
in table III, With only one exception, the blood serum titros 
proved higher than those of the corresponding whey specimens. 
Despite the agglutination titro of the whey being only 1:50, 
Bp, abortus was isolated from,the milk of cow no, 8, 
TABLE III 
COMPARISON OP AGGLUTININ TITHES IN BLOOD SERUM AND IN WHEY FROM 
INDIVIDUAL COWS OF AN INFECTED HERD 
(Dairy Abbotsford) 
1 
Blood serum; 
Whey; 
Cow No. 
agglutination complete to 
agglutination complete to 
4 
1;100 
Negative 
5 
1:1600 
Specimen unsatisfactory 
6 
1:5000 
1:200 
8 
1:1200 
1:50’ 
9 
1:50 
Negative 
10 
1:400 
1:500 
11 
1:200 
1:200 
12 
1:25 
Negative 
13 
1:200 
Negative 
17 
1:400 
1:200 
1-3,7,14-16 
Negative 
Negative 
Negative—no agglutination detectable in 1:25 dilution. 
N.B.—Br. abortus isolated from milk of cow no 
• 8. 
BRUCELLA AGGLUTININS IN HUMAN BLOOD SERUM SAMPLES 
Blood serum samples*sent to those laboratories for 
Widal tests during the past six years from some 5,420 persons 
have boon routinely tested for Brucella agglutinins. The re- 
sults obtained with one group of 5,068 specimens, sent in by 
physicians of Vancouver and adjacent municipalities, are set 
forth in table IV. 
In connection with those results, a minor complication 
arises from the fact that lack of facilities prevented, until 
August, 1936, replacement of the rapid microscopic method of 
performing the Brucella agglutination test by the more satisfac- 
tory macroscopic method similar to that already described for the 
whey tost. Complete macroscopic agglutination in a scrum dilu- 
tion cf 1:20 or higher was thereafter termed a positive result, 
whereas previously definite microscopic agglutination in a sorum 
dilution of 1:120 or higher had been reported as positive. A 
series of parallel titrations on a number of specimens verified' 
the general validity of adopting a 6:1 ratio of sensitivity as 
between the two methods; but the microscopic method proved 
rather inconsistent, and often gave titros more nearly approxi- 
mating those obtained on the same specimen by the macroscopic 
method . table iv 
BRUCELLA AGGLUTININS IN HUMAN BLOOD SERA FROM RESIDENTS OF VANCOUVER 
AND ADJACENT DISTRICTS 
Year 
Total nos. of j 
Specimens tested ! 
Nos. positive for 
Brucella agglutinins 
Per cent, positive 
for Brucella agglutinins- 
1932 
376 
10 
2.7 
1933 
427 
11 
2.5 
1934 
428 j 
18 
4,2 
1935 
725 
66 
9.1 
1936 
1,209 
41 
3.4 
1937 
1,538 
68 
4.4 
1938 
(3mo.) 365 
14 
3.8 
Total 
5,068 ' , | 
228 
4.5 
To Aug, 1936, positive a definite microscopic agglutination to 1:120 dilution 
of serum or higher. 
Subsequently, positive = complete macroscopic agglutination to 1:20 dilution 
of serum or higher. 
Over the whole six-year period, tho incidence of 
positive samples among a total of over 5,000 sera tested, was 
4.5 per cent. Very few of those specimens were sent in under 
a provisional diagnosis of brucellosis, and wo have no infor- 
mation regarding the clinical signs and symptoms from which 
the majority of the 228 persons with positive sera may have 
been suffering. However, tho further analysis of their limit- 
ing agglutination titres, made in table V, suggests that about 
42 of this group probably had an acute attack of brucellosis at 
the time; while at least 64 must have had a fairly recent 
attack of brucellosis. 
TABLE V 
LIMITING BRUCELLA AGGLUTININ TITRES OF 228 POSITIVE HUMAN SERA 
Titre limits 
for 
c omplete 
No, of 
specimens i 
macrosoropic• 
agglutinations 
positive 
1:20 
or higher 
228 
1:40 
« 
If 
147 
1:80 
« 
If 
101 
1:200 
It 
n 
64 
1:500 
» 
n 
48 
1:1,000 
II 
n 
42 
1:2,000 
n 
n 
21 
1:5,000 
n 
n 
7 
1:10,000 
n 
n 
3 
1:20,000 
n 
w 
1 
Note; Where a 
microscopic test was actually 
done on 
the specimen. 
the titre then 
shown 
by the serum has 
been divided 
by six. 
to ensure a 
conservative macroscopic equivalent being assigned 
to it ( 
of. text). 
Of the group of 5,068 specimens, over 90 per cent, 
are known to have come from patients living in or immediately 
adjacent to Vancouver. The results shown by this group may be 
contrasted with thes o given by a group of 352 BDocimens re- 
ceived from employees of a logging camp and from residents of 
a paper-pulp-company town, living remote from Vancouver and 
its milk supply. In this group, only 2 specimens, or 0.57 por cent., were positive, and gave complete agglutination in 
scrum dilutions no higher than 1:40 and 1:80 respectively. Al- 
though there is admittedly a marked difference in the size of 
the two groups of sera under consideration, the smaller group 
includes a sufficiently largo number for the contrast in find- 
ings to be deemed statistically significant. The incidence of 
Brucella agglutinins in the sera of the Vancouver group is 
roughly eight-fold that in the other group. 
ACUTE BRUCELLOSIS ATTRIBUTABLE TO RA’/Z-MILK CONSUMPTION 
No attempt was made to trace the clinical history of 
every patient with a positive scrum in the above groups, but in 
recent months wo have telephoned to all city physicians sending 
in specimens which gave complete agglutination in scrum dilutions 
of 1:1,000 or higher. With the ready co-operation of the physi- 
cians concerned, fifteen cases of undoubted acute brucellosis 
have thus boon diagnosed on both laboratory and clinical grounds* 
In every case, the evidence has pointed to raw-milk consumption 
as the primary aotiological factor# 
CLINICAL FINDINGS 
The characteristic symptomatology of acute brucellosis 
has been too well recorded in the literature to need further 
elaboration. But a striking uniformity of clinical signs and 
symptoms was shown by our group, despite £hc age range being 
from 14 to 66 years. Eleven patients wore male and four female. 
General weakness and depression, with fever lasting from several 
days to a few week's at a level of 103 degrees P. or oven higher, 
and associated with drenching night sweats, muscle and joint 
pains, and headache, were typical of the onset. Six patients 
in the group had an acute sore throat in the early stages of 
the disease, and in this connection it is of interest to note 
that Poilma and Pickens (5), and Carpenter and Boak (6) reported 
the isolation of Br. abortus from tonsils . A leucoponia (total 
W.B.C. 4,000 to 6,000 per cmm.), with a relative lymphocytosis 
(38 to 63 per cent.), was present throughout the acute phase 
of the disease in every patient tested. Splenic enlargement 
was not a conspicuous feature, but a big loss in weight was 
characteristic. Three of the now convalescent patients show 
respectively the following neurological or psychological 
sequelae: partial deafness and ataxia; intermittent paralysis 
of an arm with migraine-like headaches; and marked emotional 
depression. In almost every case the original diagnosis was 
influenza. In four of the patients, this diagnosis was sub- 
sequently changed to rheumatic fever, septic arthritis, para- 
typhoid fever and -appendicitis, respectively. When the fever 
persisted, or returned after a brief remission, the diagnosis 
for the rest of the group was changed to pyrexia of unknown 
origin. In only one instance had the doctor either enquired 
into the milk supply, or made a provisional diagnosis of undu- 
land fever, prior to our laboratory reports on the Brucella 
agglutinin titre of the patient’s scrum. LABORATORY FINDINGS IN 15 HUMAN CASES O-F ACUTE BRUCELLOSIS 
TABLE VI 
Patient 
No. 
Age 
Sex 
Agglutination litre 
of first specimen 
received 
1 
Results of Blood 
Culture 
Comments 
1 
17 
M 
1:10,000 
. 
4 positive speci- 
mens at 2, 5, 8 
and 12 weeks 
Drank raw milk for 9 
months prior to onset 
Fair recovery with 
neurological compli- 
cations after six 
months* illness. 
2 
' 
. • 
38 
1 
F 
1:2500 
2 positive speci- 
mens at 1 and 3 
weeks 
Drank raw milk for 
seven months prior to 
onset. Good recovery 
after 7 months’ ill- 
ness. 
3 
55 
M 
1:500 
4 positive speci- 
mens: concurrently 
and at 4, 9 and 18 
weeks 
Br* abortus isolated 
from his milk supply. 
Unable to work for 1 
year. Poor recovery. 
Ataxic and deaf. 
4 
40 
F 
1:2000 
One negative 
specimen at 1 
week 
Dairy farmer’s wife. 
Br. abortus isolated 
from her milk supply. 
Incapacitated for 
several weeks. 
5 
17 
M 
“1:1200 
6 positive speci- 
mens; concurrently 
‘and at 1, 3, 7, 26 
land 41 weeks 
I 
! 
Very serious case 
with several relapses 
Temperature contin- 
uously over 104 de- 
grees for 10 days at 
one period. Now get- 
ting better after 1 
year’s illness. Sup- 
plied with "preferred 
raw" milk by a dairy 
of high repute. 
6 
28 
M 
1:4800 
j4 negative speci- 
mens at 1, 2, 7 
land 38 weeks 
Moderately ill and 
unable to work for 
several months. 
7 
59 
. - 
M 
. 
1:2000 jOne positive 
(specimen at 4 
(days 
Not yet recovered. 
Ill 13 weeks to date. 
Keeps own cows. 
8 
55 
1 F 
1:2000 
!2 negative speci- 
mens; concurrently 
land at 6 weeks 
Not yet recovered, 
111 6 weeks to date. 
Supplied with raw milk 
from patient No. 7’s 
o ows . 
9 
27 
M 
1:2000 
|1 negative speci- 
men at 7 weeks 
Not yet recovered but 
now ambulatory. Ill 
12 weeks. 
10 
14 
..-.J 
F 
1:1600 
'No specimen ob— 
taine d 
1 
Had relapse after 1 
year interval. At 
first attack had gen- 
eralized rash and 
acute sore throat. 
11 
44 
, 
M 
1:3200 
. 
,4 negative speci- 
mens at 4 days 
Keeps own cows. 
12 
30 
M 
1:2560 
2 positive speci- 
mens at 5 days and 
■ 1 week 
i 
Policeman. Suffered 
with sweats on night 
duty. Finally had to 
report sick. 
~13 
66 
• ■ i 
M 
1:6400 
!l positive speci- 
imen at 1 week 
.. .' 
Supplied with "prefer- 
red raw" milk by same 
dairy as No. 5. Ill 
10 weeks. 
14 
45 
M 
Ts 2*560 
1 positive speci- 
men at 4 weeks 
Br. abortus isolated 
twice from his milk 
supply. (Bottles pur- 
chased over shop coun- 
ter.) 
15 
20 
( 
M 
1:3200 
2 positive speci- 
mens; concurrently 
and at 2 weeks 
Ill several weeks. 
At present free from 
symptoms. AETIOLOGY 
Every one of the foregoing patients had regularly con- 
sumod raw milk prio'F~ tb~ the on s e t ~~ o f i 1 iness . Except for' three 
persons, who contracted their infection outside this city, all in 
the group obtained milk from dairies distributing in Vancouver. 
None of the patients had any concern with the slaughtering of 
cattle or hogs, although two kept their own cows, and another 
was a dairy farmer’s wife. Our laboratory charts showed the 
dairies supplying those patients to have poor rebords in respect 
of the Brucella agglutinin titros of pooled whey samples. More- 
over Br. abortus was isolated from the milk supplies of throe 
of these patients. 
In one instance (case no. 14, table VI) the micro- 
organism isolated from the patient’s blood grew initially in air 
without added carbon dioxide. No other strain isolated by us 
from milk, or by blood culture, has grown in atmospheric air 
except after repeated subculture on artificial media. Except 
for this peculiarity, the strain in question conformed (in 
respect of its reactions to basic fuchsin, pyronin, and thionin) 
to the accepted criteria for Er. abortus rather than Br. suis. 
Morphologically and serologically, the strain fell definitely 
in the Brucella group. On two occasions, separated by an inter- 
val of several days, a bottle of milk from the dairy which had 
recently supplied this patient, was purchased over a shop coun- 
ter. A micro-organism was readily isolated from each sample, 
having the identical characteristics of the strain isolated from 
the patient. Apart from the deliberate addition of a Brucella 
culture to previously sterilized milk, and the administration of 
milk so infected to healthy volunteers, it would be hard to 
secure a more convincing item of epidemiological evidence than 
this . 
BACTERIOLOGICAL FINDINGS 
In several of these cases, both patient and physician 
were so co-operative that repeated blood cultures could be made 
during the course of the disease. In six patients, Br. abortus 
v/as readily isolated (using the currently-approved techniques) 
from two or more successive blood specimens taken at irregular 
intervals. In three other cases, a positive culture was obtained 
from the single blood specimen received. One moderately ill 
patient, from whom four blood samples were obtained, gave nega- 
tive cultures on each occasion. Pour other acute cases, from 
each of whom only one blood sample was obtained, gave a negative 
culture, although their Brucella agglutinin titres wore high. 
No blood sample was obtained from the one remaining patient. 
The laboratory findings and commentary notes on those patients 
are set forth in table VI. 
DISCUSSION 
The purpose of this paper has neither been to record 
special cultural and .diagnostic methods, nor to report observa- 
tions throwing new light upon the aetiology of brucellosis in 
man. Our intention has rather boon to show how, within the serious limitations of its working conditions, a public health 
laboratory can accumulate data bearing significantly upon tho 
relationship of an infected milk supply to tho incidence of 
brucellosis in the community. According to the latest official 
estimate (7), 78 per cent, of the milk distributed in Vancourvor 
is pasteurized; but that 22 per cent, of the milk should be 
consumed raw was believed likely to occasion a high incidence 
of human brucellosis, in view of the local prevalence of con- 
tagious bovine abortion. 
That local raw-milk consumers undergo no small 
risk of contracting Brucella infection is evident from the 
results of the specific agglutinin survey, carried out on the 
whey from monthly pooled-milk samples received from the 55 
raw milk distributors in the city. In view of the difficulties 
anticipated in the isolation of Br. abortus from pooled milk, 
and of. the fact that the micro-organism is in any event prob- 
ably excreted intermittently by infected cows, no special ef- 
forts were made to determine the frequency with which the 
actual presence of living Brucella might bo demonstrated in 
these milk'samples• But when some unusual circumstance oc- 
casioned the attempt, Br. abortus v/as readily isolated from 
the milk of 6 dairies, of which 4 wore city distributors. 
Culturally positive samples were obtained in two instances from 
.milk showing complete agglutination in no higher than a 1:50 
dilution of whey; while we have recently isolated Br. abortus 
from a local raw milk sample giving incomplete specific ag- 
glutination in a whey dilution of 1:25. Veterinarians are 
now learning to bo suspicious of cattle showing Brucella ag- 
glutinins in a 1:25 dilution of blood serum; and our own 
findings on one small herd (table III) confirm the view 
generally held, that the Brucella-agglutinin titre of a cow’s 
blood scrum is usually higher than that of its milk serum. 
Hence, a whey agglutinin titre of only 1:25 is believed to bo 
significant as an index of the possible presence of living Br. 
abortus in the milk; particularly when (as occurs with a 
pooled sample) a largo dilution factor may mask the inclusion 
of milk from one or more severely infected cows in the sample. 
There would appear to bo no immunological principle to prevent 
secretion of Br. abortus in milk having an agglutinin titre of 
loss than 1:25, but none of the recorded cases of acute 
brucellosis v/as supplied with milk by any of the group of 3 
dairies (table I) from which agglutinin-positive pooled milk 
samples had never been obtained. 
In surveying tho Brucella-agglutinin titres of 
human blood sera, wo were not attempting to determine trends 
of inoidenco of brucellosis. Wo cannot, for instance, explain 
the especially high percentage of positive samples in 1935. 
The emphasis should be laid upon tho finding, in one group, of 
4.5 per cent, of positive sera over the whole six-year period, 
among a total of over 5,000 specimens tested. The choice of a 
1:20 dilution of scrum giving complete agglutination, may bo 
questioned as a valid criterion of positivity. This dilution 
was arbitrarily chosen, and no claim is made that positivity 
(complete agglutination) at this dilution level necessarily 
indicates past or present Brucella infection. Before any 39 
such claim could be considered, the effect of continued investi- 
gation of pasteurized milk containing large doses of dead Br. 
abortus upon the development of specific serum agglutinins, 
would clearly first need to be determined. Admittedly, neither 
experimental evidence nor clinical information is available to 
indicate what percentage of the 228 persons whoso specific 
agglutinin titro we have termed positive, actually suffered 
past or present disability from Brucella infection. However, 
the fact remains that whereas only 0.57 per cent, of positive 
scrum specimens wero found among a group of persons living 
remote from Vancouver and its milk supply, the incidence of posi- 
tive scrum specimens was eight times as high among a large group 
of Vancouver residents who visited their physicians for one 
reason or another. The conclusion seems inescapable that the 
Vancouver group had been more exposed to Brucella agglutinogens 
than had the other group. Moreover, since the Vancouver speci- 
mens came from persons who had sought medical attention, it 
would seem justifiable to presume that the symptoms, in many 
at least of the 4.5 per cent, of persons showing Brucella ag- 
glutinins, were attributable to brucellosis. This presumption 
is strongly supported by the identification of 15 typical 
cases of acute brucellosis among persons drinking the local 
raw milk. Since such acute cases arc as a rule more readily 
diagnosed than the subacute and chronic types of brucellosis, 
the clinically milder varieties of the disease wore probably 
not identified. It may relevantly bo stated that any com- 
munity exposed to a raw milk supply from Erucclla-infected herds, 
is likely to suffer a high incidence of vague illness, charac- 
terised by persistent slight fevers, recurrent headaches, 
neurasthenia, and rheumatic pains. Incrasod use of the intra- 
dermal (brucollcrgin) and phagocytic (opsono-cytophagic) tests 
for Brucella infection, as recommended by Huddloson (8), should 
lead to a specific diagnosis being more frequently made in many 
instances of this type. 
The fact that many of the milder cases of brucellosis 
do not visit a doctor, and then when they do seek medical care 
their complaints are rarely attributed to this infection, has 
encouraged the raw-milk interests of Vancouver to minimize, and 
oven to ridicule, the risk of contracting brucellosis by con- 
sumption of raw milk from infected herds. But the information 
herein recorded has already provided the basis for effective 
counter-propaganda. There has boon no contention that the 
brucellosis hazard is the major argument for compulsory pasteur- 
ization of all milk; but wo have lost no opportunity of reiterat- 
ing to practising physicians, health officers, sanitary inspcc*. 
tors, public health nurses, bactoriolog5r students, and welfare 
groups, that locally this disease ha.s always appeared to be 
milk-borne. Some of the most effective proponents of pasteur- 
ization have proved to be former sufferers from acute brucellosis. 
Several local raw milk dairies have recently installed a 
pasteurizing plant, and the loss of former customers who had 
learned the aetiology of undulant fever from a friend or relative 
of a patient with this disease, is believed to have played no 
small part in bringing about this conversion. Finally, it scorns 
pertinent to note that the findings recorded in this paper have 
undoubtedly helped to accelerate the formulation, by the local racdical and health organizations, of resolutions in favour 
of the compulsory pasteurization of all milk sold in Van- 
couver . 
SUMMARY 
Of 1,296 samples of pooled raw milk received at 
the Provincial Laboratories from 55 dairies distributing in 
Vancouver, 54.3 per cent, showed complete agglutination of a 
standardized Br. abortus suspension in whey dilutions of 1:25 
or higher. Only 2 of the dairies (no longer in business) 
yielded whey samples which wore consistently negative, ac- 
cording to this criterion; while from 9 dairies negative whey 
samples were never obtained. 
The significance of those results is discussed 
and illustrated by reference to the isolation of Br. abortus 
from 6 local raw milk supplies, and also from the blood of 9 
persons with acute brucellosis of apparently milk-borne origin. 
Over a six-year period, a Brucella .agglutinin 
survey was made, covering one group of 5,068 blood specimens 
sent in by Vancouver physicians for Widal tests. Of this 
group, 4.5 per cent, gave a complete agglutination of a Br. 
abortus suspension in a scrum dilution of 1:20 or higher. 
By contrast, among blood specimens from an analogous group 
of 352 persons living remote from Vancouver, only 0,57 per 
cent, shewed agglutinins in equivalent titre. 
The main clinical findings in 15 typical cases of 
acute brucellosis were protracted fever, loss in weight, 
joint and muscle pains, headache, and depression. Loucopenia, 
with a relative lymphocytosis, was present in all cases. The 
final diagnosis was invariably made as'a result of laboratory 
findings• 
ACKNOWLEDGMENTS 
We desire to record our appreciation of the kind 
co-operation received from various physicians whose patients 
arc referred to in this paper; from the sanitary inspectors 
who have collected the raw milk samples; and from our labora- 
tory colleagues, especially Miss E. M. Allan, who performed 
the agglutination tests on the human blood sera. 
REFERENCES 
1. Jordan, E. 0.: J. Infect. Dis., 1931, 48, 526. 
2. Johns, E. P., Campbell, P. J. H., & Tennant, C. S.: Canad. 
M. A. J., 1932, 27, 400. 
3. Hall, I. C., c°: Lcarmonth, R.: J. Infoc . Dis., 1934, 55, 184. 
4. Kuddloson, I. F.i "Brucella Infections in Animals & Man", 
Commonwealth Fund Monograph, Now York, 1934. 
5. ( Poclma, L. J., and Pickens, E. M.: J. Bact., 1932, 23, 112.. 
6. Carpenter, C. M., and Boak, H.A.: J.A.i .A. 1932, 99,296. 
7. Report of Committee on Milk Control, Canad. Public Health J., 
1937, 28, 459. 
8. Huddle son, I.P., Johnson, H.W., and Beattie, C.P.; Techni- 
cal Bulletin No. 149, Michigan Agricultural Experiment Sta- 
tion, 1936, p.35. FURTHER OBSERVATIONS ON BRUCELLOSIS 
IN AND AROUND VANCOUVER 
C. E* Dolman, Vivienne Hudson, and 
D.G.B. Mathias 
’(Reprinted from the Canadian Public Health Journal, 
February, 1939) 
In a former paper (1) ovidpnco was presented bearing upon ,.. 
the brucellosis hazard entailed by the consumption of raw milk 
in and around Vancouver* Over a two-year period, fifteen local 
oases of clinically-acuto brucellosis wore shown serological, 
cultural, and epidemiological methods, to have boon milk-bomo 
and duo to Br* abortus. During this same period, milk samples 
taken monthly from'ovory distributor of raw milk within the 
city, and brought to the laboratories by sanitary inspectors for 
routine cbll-aorogonos tests and total colony counts, wore also 
examined for whey agglutinins against a standardized suspension 
of Br. abortus. Of a group of 1,296 samples, 704, or 54 per 
cent., showed complete agglutination in whey titros of 1:25 or 
higher. Of 5,068 blood samples received over a six-year period 
from Vancouver/physicians for Widal tests, 4.5 per cent, gave 
complete agglutinations of a Br. abortus suspension in a serum 
dilution of 1:20 or higher. A comparable group of sorum speci- 
mens from persons in two communities remote from Vancouver 
showed only one-eighth as high an incidence of Brucella agglu- 
tinins. 
No special efforts wore made, in the above investigation, 
to isolate Br. abortus from '‘routine " milk samples from dairies 
which had supplied patients who developed acute brucellosis. 
Those findings led us, shortly, after their publication; to 
begin attempts to isolate Br. abortus from pooled raw milk 
samples, collected officially by sanitary inspectors and brought 
by them to the laboratories for routine coli-aorogonos tests 
and tot&l colony counts. At the outset (April-May, 1938) one 
pooled-milk sample was cultured from each of 32 dairies whoso 
herds wore adjudged to bo the most heavily infected on the 
basis of consistently high-titro whey agglutinin records. Eight 
samples, or 25 per cent., yielded Bp. abortus. Such a finding 
lent further weight to our uncompromising advocacy of compulsory 
pasteurization; but instead of adopting this measure, tho^local 
authorities decided that the human brucellosis hazard could bo~ 
yroctivoly controlled by the elimination of individual 'Voactors 
from ovary herd supplying raw milk to the city. Advantago was 
taken of the opportunity afforded by this decision. Cultural 
and agglutinin surveys wore carried out over tho ensuing months, 
and tho extent to which the local brucellosis hazard was dimin- 
ished by tho ostensible withholding from city distribution of 
raw milk from “reacting w cows,could thus bo estimated.* This 
communication records our findings over tho eight months which 
have elapsed since tho policy of 1* elimination was 
adopted, rather than that pf_ enforced pasteurization. 42 
METHOD ’OP ISOLATING BR. ABORTUS-FROM MILK 
Tho medium usod in culturing milk f;or Br. abortus was 
HuddlosonTs liver infusion agar containing 1:200,000 crystal 
violet. Plates of this medium wore spread with a few loopfuls 
of 24-hour standing cream, centrifuged cream, and centrifuged 
deposit respectively, obtained from 15 oc. of tho milk sample, 
seven to nine plates being usod in all for tho sample. Plates 
wore incubated for six days at 37°c, in'an atmosphere containing 
1-12 per cent, carbon dioxide* Suspicious colonies wore then 
picked, their identity being confirmed by microscopic examina- 
tion, their carbon dioxide requirements, their specific aggluti- 
nability in tho presence of an anti-abortus serum of high tltro, 
and by’their susceptibility to fuchsin, thlonln, and pyronin. 
Tho findings are sot forth in table 1. 
TABLE 1 
. ISOLATION OF BR. ABORTUS FROM POOLED RAW- 
MILE SAMPLES 
MONTHS 
NUMBER OF SAM PIE S 
.GIVING; ‘SATISFACTORY 
NUMBER OF 
PLATES YIELDING 
DAIRIES 
Br.abortus 
April-May, 1938 
32 
8 
June-August, 1938 
90 
5 
November, 1938, January, 1939 
49 
9 
When more than half tho plates spread with tho various 
fractions of any one milk sample wore too overgrown for satis- 
factory examination, tho sample was excluded from considered ion. 
In tho April-May survey, tho remarkably high percentage of pos- 
itive cultures was no doubt duo in part to tho deliberate sel- 
ection of samples among which the likelihood of successful iso- 
lation seemed greater. Over the period November, 1938-January, 
1939, one sample was cultured from every raw milk distributor, 
irrespective of. tho whey agglutinin records of tho dairies con- 
cerned* During tho period Juno-August, on tho other hand, tvo 
samples wore ’cultured from every raw milk distributor. The lower 
incidence of positive cultures obtained throughout this latter 
period must in part bo attributed to smaller inocula being spread 
on tho plates to compensate for tho higher total colony counts/ 
obtained during those hotter months; and in part to tho recently- 
noted fact, that a slightly changed method of preparation of tho 
medium, ‘in use at that time, rendered it loss satisfactory for tho 
Isolation of Br. abortus. Bearing those points in mind, tho 
cultural findings indicate that no significant reduction in tho 
brucellosis hazard was brought about by the measures adopted. 
It should bo added that in several instances more than one pos- 
itive milk sample, was obtained from tho same dairy during the 
periods under review and that such findings are not recorded 
in the* table. One dairy yielded positive cultures ever the 
eleven-months * period March, 1938,-January, 1939, from ton 
samples out of thirteen tested. Determination of the whey agglutinin titres of routine 
samples taken at monthly intervals from all city raw milk 
distributors, suggests further that the attempts to eliminate 
reacting cattle failed almost entirely to accomplish their 
objective* In table 11 the whey agglutinin findings are 
grouped into various periods. Ovor the two-year period, 
March 1936-1938, during which no official efforts were made 
to identify "reactors” with a view to their enforced segre- 
gation, only 592 samples among a total of 1,296 (45.7 per 
cent.) failed to show comploto agglutination, in 1:25 or highor 
dilutions of whey# Identification and segregation of reactors 
officially began late in May, 1938. It is apparent from the 
table that no significant improvement in the agglutinin 
situation took place ovor the successively ensuing periods; 
for during the eight months elapsing since control measures 
wore put into effect, 199 samples among a total of 425 tested, 
or 46*9 per cent*, failed to show comploto agglutination in 
1:25 dilution of whey. During this period, only six raw 
milk dairies, among a total of 53, showed definite improvement 
in their monthly whey agglutinin records; while throe dairies 
whoso records hnd previously been fairly good, began to show 
consistently high whey agglutinin titres* 
(Continued next page) In tho past eight months, at loast fire cases of acute 
human brucellosis have occurred In tho city, of whom throo 
had regularly consumed raw milk from dairies with had records 
In respect of either cultural on agglutination findings* A 
positive blood culture was obtained from one of those cases, 
a child of six years, whoso raw milk supply had roc-ontly 
yielded a culture of Br. abortus, the apparent in- 
cidonco of tho loss acute typos 6f brucellosis showed no sig- 
nificant r oduc tTbn • Of SIX samel os of blo'od received tot' 
routine Widal tests during tho past eight months, 32 or 3*5 
per cent., completely agglutinated a standardized Br* abortus 
suspension in serum dilutions of lf£0 or higher: whereas in 
tho preceding five-months* period the corresponding figures 
wore 21 out of 576 specimens, or 3.7 per cent* 
Incidentally, tho possibility that specific serum 
agglutinin titros of 1:20 or higher might bo provoked in man 
by consumption of pastourizod milk containing dead brucollsqo, 
was shown to bo very, unlikely by tho following experiment* \ 
Eight healthy volunteers drank increasing doses of a heafc* '• 
killed suspension of a strain of Br. abprtus recently isolate 
by blood culture from an actitoly ill patient* Over a six 
weeks’ period, a total of 23*6 cc* of st suspension corres- 
ponding to MacParland No .6 turbidity standard, or tho equiva- 
lent of over 210 billion Br. abortus, was taken by mouth* 
Doses wore taken at weekly intervals, tho initial dose being 
roughly equivalent to 500 million brucollao, and tho final 
dose 60 billion brucollao. None of tho volunteers showed any 
detectable increase in serum agglutinin titro* 
DISCUSSION 
Tho forogoina findings are presented not with any intent 
to embarrass authorities who doubtless acted in good faith in 
choosing reactor elimination as a possible means of reducing 
tho local human brucellosis hazard; but rather so that other 
similarly-situated authorities may perhaps bo spared from at- 
tempting a costly, dilatory, impracticable, and _at best only 
partially-offactive control measure. "The plan original ly ad- 
opted was that veterinarians should do a blood serum aggluti- 
nation tost on all cows in dairy herds distributing raw milk 
in Vancouver. Those tests wore to bo done twice monthly for 
throo months, and subsequently at longer intervals, until all 
cows showing agglutination in serum titros of 1:100 or high*©? 
had boon eliminated. But tho tests wore performed in many 
instances by quite inexperienced persons, and no standardiza- 
tion of antigen was attempted. Occasionally, a farmer would 
insist on unfavourable reports being chocked in another labor- 
atory, which might issue an entirely contrary report. Some 
dairies refused to cooperate from the beginning, while others 
which initially cooperated lost interest when they learned 
that their reacting cows had boon bought by loss scrupulous 
competitors. Again, it was only to bo expected that a herd 
■*0loaned upn following one survey, should show additional reactors at a subsequent survey; but such experiences 
proved highly discouraging to farmers whoso understand- 
ing of the principles underlying the tests was very 
slight. 
Even if all the laboratories involved could have boon 
rolled upon to do satisfactory tests, using a standardized 
antigen, and oven if farmers wore then forced to sogrogato 
or slaughter tholr 11, brief consideration of the 
immunological principles involved loads to the conclusion 
that in dairying districts such as the Fraser Valley, whore 
tho incidence of bovine contagious abortion is extremely 
high, herds not bo thus freed from tho infection ex- 
cept over a period of many years, and at groat expense. 
Clearly, a cow may theoretically acquire tho infection, 
excrete Br. abortus in tho milk, and prove infective not 
only to other cows in tho herd, but also to man, before blood 
or milk serum agglutinins have developed. Such a contingency 
is accepted by Immunologists, but is not yet apparently re- 
cognized by the majority of veterinarians. Wo have ourselves 
isolated Br. abortus on a few occasions from tho individual 
raw milk samples from cows having no specific agglutinins 
in 1:100 dilutions of either blood serum or v/hoy. 
Perhaps it is not surprising, in tho light of the above 
findings, that a majority of tho raw milk distributors them- 
selves are now convinced that compulsory pasteurization of all 
city milk is tho only moans of offodtlvoly controlling tho 
human brucellosis hazard. 
(1) Dolman, C»E., and Hudson, V., Canad. Pub. Health J. 
1938, 29: 236. 
REFERENCE 
TABLE 11 
WHEY AGGLUTININ FINDINGS 4 
MONG R0UTI1 
tfE POOLED-MILK SAM PIE S 
PERIOD COVERED 
BY TESTS 
NUMBER OF 
SPECIMENS 
TESTED 
NUMBER OF 
POSITIVE 
SEE CIMENS 
NUMBER AND PERCENTAGES OF 
POSITIVE SPECIMENS AT INCREASING 
TITRES 
£ 
4 
4 + 4 
4-444 
March,193 6-Maroh,lS38 
1,296 
704 
186 
(26.4$) 
275 
(39.0$) 
173 
(24.5$) 
70 
(10.0$) 
Aprilp 1938-May, 1938 
107 
62 
19 
30,7$) 
30 
(48,4$) 
11 
(17.7$) 
2 
(3.2$) 
June, 1938—July, 1938 
107 
59 
24 
[40.7$) 
19 
(32.2$) 
10 
(16.9$) 
6 
(10.2$) 
August,1938-Jan,1939 
318 
140 
44 
[31.4$) 
54 
(38.6$) 
31 
11 
(7,9$). .. 
* m complete agglutination in 1:25 only 
++ s complete agglutination up to 1;50 
444. - " K " " 1:100 
j.j.i.4. * " " « « i;200 or over EXCERPTS FROM THE 11 MILK PROBLEM1' IN THE 
BULLETIN OP THE HEALTH ORGANIZATION OP THE 
LEAGUE OF NATIONS, VOLUME VI, EXTRACT NO. ELEVEN 
AUTHORS; 
1) Professor H. C. Bendixen 
Royal Veterinary and Agricultural College, 
Copenhagen 
2) Mr. G. J. Blink 
Union for Dairy Industry and Milk Hygiene, 
The Hague 
3) Professor J. C. Drummond 
University College, London 
4) Professor A. M. Leroy 
National Institute of Agronomy, Paris 
5) Professor G. S. Yiilson 
London School of Hygiene and Tropical Medicine, 
London 
FREQUENCY OF' MILK-BORNE DISEASE IN HUMAN BEINGS 
("Pag0""422-4'J4) 
Milk-home disease is rarely obtrusive; unless it is 
looked for* it will not usually be found* To ascertain,its 
true frequency in any country would require a combined epi- 
demiological and bacteriological investigation covering every 
town and village and paying attention to practically every case 
of infectious bacterial disease. Needless to say, no such 
investigation has ever been undertaken* and our knowledge of 
milk-borne disease is therefore fragmentary and incomplete. 
There are several reasons why this should be so. 
(1) No disease is exclusively milk-borne. All the 
diseases that may be carried by milk may also bo carried by 
other moans, such as air, food, or water. In any particular 
disease, milk may bo, and often is, an unusual source of 
infection, and the occurrence of cases of tho disease in ques- 
tion does not therefore arouse an immediate suspicion that tho 
milk is at fault. Too often, tho common method of infection is 
taken for granted, and tho possibility that tho milk supply is 
infected is not oven envisaged. Perhaps one of tho most 
striking examples of this is afforded by tho outbreak of septic 
sore-throat in August 1935 in Copenhagen. In spite of tho 
magnitude of this epidemic. Involving as it did about 10,000 
persons, no suspicion of its milk-borne origin was aroused 
tint 11 attention was drawn to it by a careful epidemiological 
enquiry. 
(2) Somo typos of pathogenic organisms in milk, 
particularly tho tuborclo bacillus and Brucolla abortus, givo 
riso to clinically dotoctablc disease in only a very small 
minority of persons consuming tho milk. This circumstance 
has led many ill-educated members of the laity, and even of tho 
non-medical scientific professions, to ocpross a doubt whether 
those organisms are in fact responsible for disease at all. Such a doubt might have boon justifiable fifty years ago, whon 
current, bacteriological teaching on tho causation of disoaso 
laid undue stress on t.ho organism .and practically neglected tho 
reaction of tho host. It was then assumed that tho more access 
of tho organism to the tissues would result in an attack of tho 
corresponding disoaso. Since then, we have learned a groat deal 
about abortive attacks, sub-clinical infections, latent infections, 
healthy carriers, and so on, and wo now know what many of tho 
older epidemiologists realised long ago, that tho occurrence of 
disease is only possible whon accessary factors arc at work to 
lower tho resistance of tho tissues, and hence permit tho 
in vivo proliferation of tho invading organism. Since tho 
roslstonco of tho tissues is determined in any individual by a 
multiplicity of factors of which wo have at present only very 
imperfect knowledge, and since it varies from one individual 
to another, and oven from time to time in tho same individual, 
it follows that tho reaction 6f any individual to infection 
with a particular bacterium is generally quite impossible to 
predict. When tho bacterium is highly virulent, and gains 
access to a non-immuno population, tho majority of those ex- 
posed to risk will probably develop a typical attack of tho 
disease. When, on tho other hand, the bacterium is loss viru- 
lent and is circulating in a population a largo proportion of 
which is protectod by a latently or overtly acquired immunity, 
only isolated persons, hero and there, whoso resistance for 
some reason or other is at a low ebb, are likely to suffer from 
tho disoaso in its characteristic form. When it is further 
roalis od that tho outcome of any bacterial onslaught is deter- 
mined not only by tho virulence of tho organism and tho rests- , 
tanco of tho tissues but also by the numbers of tho organisms 
in tho infocting.dose and tho frequency with which tho doses 
are repeated, some idea will be gained of tho complexity of tho 
equilibrium that exists between any given parasite and any 
given host. 
(3) The occurrence of a long incubation period 
and a gradual onset in s omo mi Ik- b o rn o~ dl sea s o~s, “such as tuber - 
culosl s ancFundulant“Tbv”or, *“s6rvo”To“ mask' any ' afire*eF^bTatfbn- “ 
ship between tHo~~TnToctlon and ‘r£ITc vbhicTo "T5y whTcE"Tt~"was~ borne• 
It is, in fact> only within recent"year th c~ “vcTby~*oxistonccP 
of undulaht fever'has boon recognized,"and thalT~its 
rallk-borno origin has boon proved. 
(4) When a largo epidemic of an infectious 
disoaso occurs with explosive suddenness, attention is very 
often directed to the milk supply. But when the disoaso is 
limited to a few families, particularly if they ore scattered 
over a wide area or aro attended by different doctors, or when 
it affects only one or two persons, the probability that milk 
will receive oven a passing thought is very small. 
(5) Sporadic casos and small outbreaks of mllk- 
borno disoaso aro often not reported at all, or are published 
only in the local medical officer of health’s annual report* 
Without going through every such report in detail, the majority 
of those smaller outbreaks will bo overlooked and will never be 
brought to the notice of the central authorities* For those reasons, therefore, our knowledge of milk- 
borne disease is very defective, and wo may confidently assume 
that the few figures we have got. underestimate—sometimes grossly— 
its true frequency. 
UNDULANT FEVER (Pago 426-428) 
Like tuberculosis of bovine origin, the existence of 
this disease can bo proved only by bacteriological examination. 
Since many clinicians arc still unaware of the role played by 
Brucolla abortus in the causation of disease in man, and since 
the diaoasc, when it does occur, is often so protean in its 
manifestations that a diagnosis of active Brucolla infection is 
never oven considered, any attempt to assess its frequency from 
clinical records is bound to load to a gross underestimate. 
Moreover, in some countries, the disease is not reportable, 
and private enquiry can bring to light only a proportion of 
the total cases. The only satisfactory method is that which 
has been used with such conspicuous success in Denmark--namely, 
to estimate the number of active infections from the frequency 
distribution of agglutinins to Brucella abortus in the blood 
serum of pyrexial patients. To be completely satisfactory, this 
method requires that the sera of all patients suffering from 
pyrexia of doubtful origin should bo tested against Brucolla 
abortus, and that a record should bo available of the results 
so obtained. In Denmark, whore the general practitioner has 
been educated to use laboratory facilities, and where all sera 
are examined at one central laboratory, those two requisites 
are fairly well complied with* But in other countries, partly 
through the practitioner*s failure to make full use of the 
laboratory, and partly on account of the existence of multiple 
laboratories which are under no obligation to examine blood 
sora for agglutinins to Brucolla abortus or to report their 
results to any central authority, the difficulties of obtaining 
satisfactory figures are very much greater. What figures are 
available arc given in Table 10. 
Table 10*—Proportion of Sora from Febrile Patients 
Agglutinating Brucolla abortus to 1/80 or over, 
and Estimated Annual Number of Undulant Fever 
Cases about 1930 (taken from Toploy and Wilson, 1936), 
Country 
No, of Sera 
Examined 
Number 
Positive 
Percentage 
Positive 
Estimated 
Annual No. 
of Undulant 
Fever Cases 
Number of 
Cases per 
1,000,000 
Population 
Groat Britain 
3,175 
101 
3.18 
440 
11 
Germany 
9,397 
323 
3.44 
600 
10 , 
Austria 
9,693 
177 
1.83 
50 
8 
Switzerland 
1,503 
91 
6.1 
340 
84 
Netherlands 
4,500 
50 
1.11 
90 
12 
Denmark 
4,623 
500 
10.82 
500 
147 
Sweden 
• • • 
120 
20 . v It will bo scon that Denmark has much the highest 
incidence per 1,000,000 of the population. To what extent this 
is duo to the factors wo have just considered it is impossible 
to say, but it seems doubtful whether bettor diagnosis can 
account for such a big discrepancy between the'figures for Den- 
mark and those for Groat Britain, Germany,•Austria, the Nether- 
lands and Sweden. The high incidence of undulant fever in 
Switzerland is of special interest, and suggests that the 
boiling of milk in the homo is not as widely practised as it is 
sometimes stated to bo. 
Though it is probablo that practically all infec- 
tion of man with Brucella abortus is derived from the cow, not 
all ’of it is duo to tho consumption of raw milk. Some of it 
undoubtedly follows dlroct contact infection with diseased cows. 
This mode of infection is particularly likely to occur in 
veterinarians, farm workers and slaughterers. Apart from those 
throe occupations, it would appear that practically all other 
classes of tho population are infected by milk. The importance 
of milk-borne infection is further borne out by the fact that 
in Groat Britain, for example, tho majority of recognized cases 
have occurred in town workers who have never had any dlroct 
contact with sick animals. Moroovor--and this is a very striking 
piece of cvidonco--in cities like London, whore over 90$ of 
tho milk supply is heat-treated, tho few cases of undulant fever 
that have occurred have boon in patients who havo consumed 
certified, grade A, or other typos of raw milk. 
In this connection, wo may point out that neither 
butter nor choose appears to bo of any considerable importance 
in the causation of tuberculosis or undulant fever. Except on 
farms, butter is. almost Invariably made from pasteurised cream, 
while, in hard choose, both the tubercle bacillus and Brucella 
abortus are usually dead some considerable time before the 
ripening process is complete. Only in'farm-made butter and in 
soft cheese are those organisms likely to bo found, alive. The 
vast majority of milk-borne tuberculosis and undulant fovor~Ts 
undoubtedly due to the consumption of raw milk or cream. 
TtfREE OBJECTIONS TO PASTEURISATION PROPOUNDED BY RAW MILK MEN 
. (Page 447-451) 
(1) That Compulsory Pasteurisation would adversely 
affect the Producer's Price.—.This argument has been carefully 
examined by Wright (1933) who concludes that, so, far as Great 
Britain is concerned, it ip without foundation. In fact, there 
is no evidence to show that pasteurisation per se has any effect 
on tho producer's price. The same likewise appears to hold for 
Canada and the United States, where pasteurisation has been 
enforced in many cities for some years. It is true that the 
producer—retailer may stuffer, because tho necessity of 
pasteurising his milk will diminish his not profit. But we 
can see no reason why he should obtain a greater romunoratlon 
for selling raw milk"~Th a potentially dangerous state "than tEe 
large dairy’ companies a considerable' expenditure" in 
order to render it~ safeT Even in Groat BrlEainT tHe producer- retailors contribute only about Y1% of the milk sold for liquid 
consumption, while in Scandinavia, the Netherlands and Switzer- 
land they hardly exist at all. It is difficult to understand 
why the public health of the nation should bo sacrificed to the 
economic interests of a small section of the farming community. 
(2) That Compulsory Pasteurisation would remove the 
Stimulus to the Eradication of Diseased Animals from Milking 
Herds,--This argument is based on a fundamental confusion of 
the veterinary and medical aspects of the milk problem. It 
endeavors to place the whole onus of paying for disease 
eradication in the herds on the consumer of liquid milk, 
assuming—quite erronoously--that milk from disease-free herds 
can safely bo drunk in the raw condition. In certain countries, 
the veterinarian trios to dictate to the public health official, 
to toll him what milk is safe for human consumption, and to in*» 
sist that the consumer should pay a higher price for milk from 
disease-free herds. Instead of demanding directly that the 
herds should bo freed from disease for their own sake, ho endeav- 
ors to shift this responsibility to the public health service, 
which is no more directly concerned with animal health than 
the veterinary service is with human health.* The public health 
official knows perfectly well that milk from disease-free herds 
is open to contamination from human carriers and cases of 
disease, from water and possibly other sources, and cannot bo 
regarded as safe for distribution in the raw state. Even if 
the herds of Europe wore completely freed from tuberculosis, 
contagious abortion and mastitis—a prospect that cannot 
possibly bo envisaged in our lifetime—it would still bo 
necessary to pasteurise all milk that was to bo suppllod to a 
population of any sizoT The public health official, if ho is 
honest, tolls the consumer that milk from tuberculin-tested 
herds cannot bo regarded as completely safe, and that ho had 
much bettor buy pasteurised milk at a lower price that raw 
milk from tuberculin-tested herds at a higher price. The 
problem of supplying the-public with a safe milk is not de- 
pendent on the eradication of disease from the milking herds, 
however much this may bo desirable on other grounds. This 
does not, of course, moan to say that if milk is to bo drunk 
raw, milk from disease-free herds is not to bo preferred to 
milk from ordinary herds, but it does moan to say that pasteurised 
or boiled milk from ordinary herds is safer than raw milk from 
disease-free herds. The ideal is obviously pasteurised milk 
from herds that are free from disease. With water, milk or any 
other article of food, the stringency of the precautions taken 
to ensure the safety of the supply must depend on the size of 
tho population exposed to risk. So far as milk is concerned, 
pasteurisation of tho supply to any urban population must bo 
regarded as indispensable. 
It is high time that tho confusion of thought 
existing, for example, in Groat Britain was cleared up. Tho 
eradication of disease from tho milking herds must bo justified 
on agricultural and veterinary grounds alone. If it can bo 
shown that animals are free from disease are healthier, 
more fertile, produce more milk, ' and fetch a higher price in 
tho market or tho slaughter house than animals affected with 
tuberculosis, contagious abortion, mastitis otf JohrioTs disease, 
then tho eradication of those diseases is economically desirable. 52 
altogether irrespective of whether or not the milk is to ho con- 
sumed in the liquid state hy the human population* 
...... Summarising, wo £iay say that the iradicatlon of 
disease from the hords is'■essentially an agricultural and veteri- 
nary problem and should ho undertaken on economic and not public 
health grounds* The provision of a safe milk supply, to the human 
population is essentially a public health problem and can ho 
s olved satisfact orily only by c ompul3 ory past ouri sat ion* fHo 
two problems should bo kept distinct, and 'the or adl c at ion of 
animal disease should not bo made contingent on the payment by 
the consumer of a higher price for milk from disoaso-froo hords. 
It is interesting to note that the samo conclusion is roachod 
in tho report of the Milk Reorganisation Commission (1936b). 
(3) That Pasteurisation diminishes tho Nutritive 
Value of tho Milk.—This statement continues to bo made in 
spite of any adequate scientific evidence to support it. Tho 
very thorough examination by Stirling and Blackwood (1933) of 
tho literature dealing with this subject' failed to reveal any 
significant difference between the nutritive value of raw and 
pasteurised milk. It is true that pasteurisation frequently 
causes a diminution in tho vitamin C Content, but this sub- 
stance is, as wo now know, very unstable and disappears spon- 
taneously from raw milk under tho influence of light and ©ora- 
tion. Paediatricians are agreed that neither tho vitamin C, 
nor, in’Winter, tho vitamin D, content of cow’s milk is suf- 
ficient to satisfy tho requirements of the growing infant, and 
that whether milk is given raw, pasteurised, boiled or dried, 
an extra source of vitamins C and D must bo provided. 
Considering the extensive use that has boon made 
for several years of pasteurised milk in tho feeding of infants, 
it would bo surprising if any inferiority in tho nutritive 
value of this typo of milk had not become evident by now* No 
such evidence, however, is available. On tho contrary, Frank 
and his colleagues (1932), who enquired into tho histories 
of over 3,700 children in tho United States, failed to find 
any significant difference in tho height or weight of children 
who had received heated, and children who had received raw milk. 
If pasteurisation did produce any real diminution 
in the nutritive value of tho milk, this fact should bo rendered 
evident more easily by feeding experiments on calves than in 
any other way. M’Candlish and Black in 1935 and Wilson, 
Minott, and Carling in 1937, did such experiments. There was 
a slight advantage in favour of the animals fed on pasteurised 
milk. 
Taken separately pr in conjunction there is 
nothing in those two experiments to suggest that tho nutritive 
value for calves of holder milk is in any way in- 
ferior to that of raw milk. - The fear that pasteurisation was 
detrimental to tho food value of the milk has undoubtedly 
-deterred many doctors in tho past £rom supporting compulsory 
pasteurisation. This fear appears,to bo entirely groundless 
and should now be removed to tho limbo of disproved and forgotten 
prtxjudi-oos« RAW MILK NEVER SAFE 
—[Tag’e'm-TgTJ 
No raw milk can ever be regarded as completely safe 
for human consumptionT Sven if produced from healthy animals, 
milk is so subject to contamination from human and other sources 
that it must always be regarded in the raw state as a potentially 
dangerous article of food. The only satisfactory method of 
ensuring the final safety of the product is to submit it to some 
form of heat treatment that can be relied on to destroy any 
pathogenic organisms that may be present. It is our considered 
and emphatic opinion that all liquid milk for human consumption 
should bo adequately pasteurised or boiledT 
Though many pseudo-scientific objections havo been 
advanced against pasteurisation, wo havo boon unable to find any 
that is supported by adequate evidence. On the other hand, there 
is a considorablo amount of ovidonco to show that, when pasteuri- 
sation has boon introduced on a largo scale, milk-borne disoaso 
has boon practically abolished. There is roason to believe that, 
if pasteurisation wore rendered compulsory for all towns, 
infection derived from milk would bo completely prevented. In 
country districts, whore compulsory pasteurisation is impractic- 
able, insistence should bo laid on the necessity of boiling 
milk prior to consumption. U. S. Public Health Service 
Sanitation Section 
MILK AND ITS RELATION TO DISEASE 
.... by 
A. W. Fuchs, Senior Sanitary Engineer, U. S, Public Health Service 
(Delivered before Philadelphia College 
of Physicians, Feb. 5, 1940) 
Incidence of Milk-Borne Disease 
Each year between 30 and 50 outbreaks of milk-borne disease 
have been reported to the Public Health Service by State and 
local health authorities in the United States. For the 15-year 
period from 1923-1937 inclusive, 039 milk-borne outbreaks were 
reported, involving 25, 863 cases and 709 deaths. In the Order 
of their importance the diseases included were; (l) typhoid 
fever, with 369 outbreaks, 6,461 cases, and 486 deaths 5 (2) 
septic sore throat, with 75 outbreaks, 9,467 cases, and 117 
deaths; (3)scarlet fever, v/ith 84 outbreaks, 5,725 cases, 52 
deaths; (4) dysentery and enteritis, with 34 outbreaks, 1,506 
cases, and 26 deaths; (5) paratyphoid fever, with 23 outbreaks, 
1,029 cases, and 22 deaths; (6) diphtheria, v/ith 13 outbreaks, 
179 cases, and 4 deaths; and (7) miscellaneous diseases, inclu- 
ding food poisoning, with 41 outbreaks, 1,496 cases, and 2 deaths. 
It should be noted that this compilation does not include 
sporadic cases of typhoid fever, scarlet fever, septic sore 
throat, etc., since sporadic cases have rarely been given suffi- 
cient epidemiologic study to determine the role of milk and milk 
products in their causation. 
Nor does this compilation take any note of such diseases as 
bovine tuberculosis, undulant fever, or infantile diarrhea, which 
arc largely milk-borne, but which generally occur as sporadic 
cases rather than in epidemic form. Park and Krumwiodc’s (l) 
figures indicated that in 1913 in some regions about one-fourth 
of all cases of tuberculosis in children under 16 years of ago 
wore of bovine origin; and Rosonau (2) estimated that perhaps 7‘ 
percent of all tuberculoslsin man was of bovine origin. Today, 
as a result of widespread tuberculin testing of cattle and in- 
creased use of pasteurized milk, these figures arc undoubtly no 
longer applicable to the United States. 
As for undulant fever, or brucellosis, it is difficult to 
estimate the incidence. In 1937 about 2,500 cases were reported 
in the United States. Evans (3) states: nWe do not know what percentage of the total 
number of acute eases the reported cases represent. The data on 
which the number of chronic cases in this country might bo esti- 
mated is very meagre. We only know that the chronic disease 
rarely receives the correct diagnosis. If all milk were effl- 
ciently or boiled before being consumed, there 
would~b“iho brucellosis except in those occupational groups 
wnoso worK brings them into contac.t v/lth infected animals or in- 
rectea carcasses.” . 
Milk is especially adapted to the needs of the young and 
growing individual, and has come to bo looked upon as the ideal 
food from the standpoint of completeness, digestibility, and cost. 
Any teaching that might curtail the consumption of milk or its 
products would result in more injury than benefit. The reason for 
discussing milk-borne disease at this time is not to discourage 
milk consumption btit rather to create in the milk-consuming public 
the milk produce rs,* and the medical profession a proper apprecla-** 
tion and demand for an adequately safeguarded milk supply. 
Why No Haw Milk Can Be Guaranteed As Safe 
Why cannot raw milk be guaranteed as safe? The answer is, 
first, that eve'n frequent sanita ry inspections of dairies will 
not Insure that infected bottles have been properly sterilized, 
that a safe water supply is used for cleansing milk utensils, and 
that milk containers have not been contaminated by flics. And, 
secondly, the answerr is that frequent health examinations of herds 
and of milk handlers sometimes'fail to disclose disease or carrier 
conditions that may bo present. 
It may bo of interest to outline the mode of transmission of 
three types of milk-borne disease -— undulant fever, typhoid fever, 
and septic sore throat. What precautions, short of pasteuriza- 
tion, can -a dairyman take to Insure that none of his customers 
will ever contract any of these diseases by drinking his milk? 
In the case of undulant fever, the only recourse open to the 
dairyman is to have his cows tested for Bang!s disease and to 
slaughter the reactors. Certainly- the slaughtered cows will no 
longer bo a menace to his customers. Since repeated testing is 
required to maintain a herd free from Bang*s disease, the dairy- 
man will restest his cows six months or a year later, and it 
would be not at all unusual if he discovered another reactor. 
Ho would then be faced with.some very serious questions: How 
long had the cow been discharging the Brucellosis organisms in 
the milk? How many of his customers had consumed his milk sup- 
ply raw and had' contracted the disease? How could he bo certain 
that the same menace would not bo disclosed at the next retest? Turning now to typhoid fever, if on© of the milkers contracts 
this disease, the dairyman will at once have him quarantined or 
sent to a hospital. Even if this were done as soon as the dlseo.se 
was properly diagnosed there is no assurance that the milker had 
not in the meanwhile infoctod the milk. The fact that milk-borne 
outbreaks of typhoid fover aro sometimes traced to a case on the 
farm indicates that'the infection may actually follow this path. 
More often, however, milk-borne typhoid fever epidemics are caused 
by carriers rather than by cases. Such a carrier is an individual 
y/ho has had typhoid fever perhaps many years ago and who, though 
exhibiting no symptoms of illness, still carries typhoid fever 
organisms in his gall bladder or elsewhere, from which they arc 
occasionally discharged with his feces or urine. The organisms 
may thus accidentally find their way to his hands, his clothing, 
and eventually to the dairy equipment and to the milk supply. 
Perhaps the most dangerous feature is that the typhoid carrier is 
often unaware of his condition and may continue to work at the 
dairy until irreparable damage has been done*. 
In view of those facts, what can a raw-mlIk dairyman do to 
keep typhoid fever out of his milk supply? His most promising 
course is to send samples of the fecos and urine of all employees 
to the health department laboratory, as required by the Public 
Health Service milk ordinance for all handlers of gro.de A raw 
milk who give a history of typhoid fever. If the laboratory finds 
any positive specimens, the solution is obvious. If, however, 
the specimens are negative for typhoid fever, as is usually the 
case, the dairyman can not be certain that none of his employees 
is a carrier, as it is a well-known fact that many typhoid fever 
carriers discharge the organisms intermittently only and at irre- 
gular intervals. Even if samples are taken and examined on throe 
separate days, the carrier condition can easily be missed until 
it is dramatically disclosed by a typhoid fover outbreak among 
the dairyman1s’ customers. 
In the casef of the third type of milk-borne disease—septic 
sore throat— steps can a raw-milk distributor take to pre- 
vent its transmission through his milk supply? is no satis- 
factory answer, A milker with a common cold may later prove to 
have septic sore throat. Until his illness is properly diagnosed 
he may remain at work and infect the milk supply directly, or he 
may infect a cow*s udder during milking. In the latter case the 
cow may develop an apparently ordinary case of mastitis, but her 
milk may bo teeming with hemolytic streptococci long after the 
milker has recovered. Even if every milker*s throat and every 
cov/’s udder were examined and cultures taken daily (a procedure 
which would, of course, be impracticable because of the expense 
entailed), the danger could not bo averted because by the time 
the report came back from the laboratory somo of the milk would 
have been consumed. 
The three diseases just discussed Illustrate throe different 
modes pf transmission of milk-borne disease, as described by 
Prank (4)., Brucellosis is a disease of cattle as well as of 
humans; the typhoid fever enters the milk from human cases or 
carriers; the organisms of septic sore throat originate in humans 
and may-enter the milk directly, or they may cause mastitis in cattle and enter the milk indirectly* These are not theoretical 
descriptions* Epidemics of the types outlined recur year after 
year, oven from certified and grade A raw milk. Slaughtering 
the diseased cows, discharging the employee v/ho is a typhoid 
carrier, oven frequent examinations of milkers andof herds, can 
not unde the damage already done, These measures may reduce the 
hazard but cannot eliminate it# 
It seems impossible, then, to escape the conclusion that all 
milk sTiould bo either pasteurized.1 or boiled to aake it safe. 
Proper Pasteurization Protects against All Milk-Borne 
Disease 
Pasteurization is usually done at 143 degrees F# for 30 
minutes, sometimes at 160 degrees F, for 15 seconds. Both of 
these methods are recognized by the milk ordinance recommended 
by the U. S, Public Health Service (5) for local adoption. 
That raw milk can and does transmit disease and that proper 
pasteurization prevents such transmission has been proved to the 
satisfaction of health authorities by laboratory and commercial 
scale experimental work, by epidemiologic methods, by statis- 
tical methods, and by animal experimentation# 
All milk-borne pathogens arc killed at 143 degrees F, for 
30 minutes and at 160 degrees F, for 15 seconds, The following 
thermal death, points of various pathogens in milk taken from tne . 
literature. B. tuberculosis; at 155 degrees F, in 1 minute and 
at 142 degrees P# in 10 minutes (6), B, typhosus; at 142 degrees 
P, in 7 minutes (6)# B, diphtheria©: at 140 degrees F, in 10 
minutes (7).Streptococci; all of 200 strains of hemolytic strep- 
tococci from septic sore throat and scarlet fever were killed at 
140 degrees F, in 30 minutes, most of then at 136 degrees P# or 
loss (8), Br, melitensis and Br, abortus: 13 strains of human, 
bovine, and swine origin were all killed at 140 degrees P# in 10 
minutes (8), B, dysentoriae: killed at 140 degrees P# within 10 
minutes (9), 
It is difficult to determine the reduction in milk-borne 
disease due to pasteurization as distinguished from other con- 
current public health measures, but a number of examples may 
bo cited# 
A classical illustration, and perhaps the most striking 
example of the immediate effect in the reduction of diarrheal 
diseases of infants by the pasteurization of milk, is that which 
occured in a institution on Randall!s Island, New 
York where a mortality rate of 44 was promptly reduced to 
19 with no hygienic measures put into operation other than the 
pasteurization of all milk (10), In 1921 a family in a northern county of Illinois with 4 cases 
of typhoid fever sold milk to 5 neighbors, all of whom developed 
the disease# same milk was shipped to Chicago, whore it was 
pasteurized, and no cases are known to hat/o resulted* In an 
outbreak at Richmond, California, in 1915, 12 cases occurred on 
a route soiling 90 gallons of milk daily# During the same 
period this dairy shipped 600 gallons daily to Berkeley, where it 
was pasteurized, and no typhoid occurred. Similar examples of 
part of an infected supply being rendered harmless through pas- 
teurization are noted in' the outbreaks at St# Gharloe Township 
in Kane County, Illinois, in 1921, also in central Now *ork State 
in 1922, and at Denver, Colorado, in 1926 (11)# 
Dr# John L. (12) reports that “more than 4,000 children 
under 5 years of age died each year in Now York uity from Infant 
diarrhea in the early 1900!s -- about one child in every 100 of 
that age group; but now this scourge of childhood is a thing of 
.the past# In 1934 there were only 142 deaths from infant dia- 
rrhea in New City# Had the rate of 1901 continued to pre- 
vail in 1934 there would havo been 4,790 deaths. This remarka- 
ble decrease began as soon as the department of health in 1912 
made the pasteurization of the city milk supply compulsory.” 
In 1907 when pasteurization by the holding method was first 
set up in Boston, there wore 760 deaths of children under 2 yrs 
of age due to diarrhea and gastroenteritis# In 1935, with 99.8$ 
of the milk supply pasteurized there were only 49 such deaths(13)# 
The Public Health Service compilation of milk-borne disease 
outbreaks for the 16 year period 1923-1938 indicates that about 
95 percent of the outbreaks and of the cases involved wore from 
raw milk and milkproducts.' Since about 30$ of the milk used 
during this period was raw, the risk from contracting disease 
from’raw milk was about 50 times as groat as from pasteurized 
milk*—hven certirlecl ‘raw mTTk has been responsible ‘for outbreaks 
It is a most significant fact, however, that no outbreak has 
ever Peon reported as duo to grade A~ pasTourized milk"in any city 
operating under the milk ordinance rocommendod by the Fublic 
health Service, in outbreaks attributed to Trpastcur 1 zcd,r 
supplies the evidence points to breakdown of the pasteurizer, or 
bypassing of raw milk, or inadequate temperature'or time of 
pasteurization, or post-pasteurization infection# 
That the value of pasteurization is being Increasingly 
recognized by the milk-consuming public is shown by the progress 
made in the percentage of the milk supply that is pasteurized# 
A survey made by the Public Health Service showed that, in 1936, 
75$ of the total milk supply of all municipalities of over 1,000 
population in the United States was protected by pasteurization 
(14)# For the largest cities, those over 500,000, the percentage 
v/as 97.5; for the smallest municipalities, those between 1,000 
and 2,500, the percentage pasteurized was less than 25# In ' 135 municipalities all market milk was pasteurized in 1936, 
including 65 in which pasteurization was compulsory. There were 
41 additional municipalities in which all market milk was pas- 
teurized except certified milk, was a steady increase in 
the percentage 'of pasteurization between 1923 and 1936, parti- 
cularly in the smaller communities, but most of the milk in the 
smaller communities is still raw, and it is almost entirely from 
small towns and from Institutions that milk-borne disease out- 
breaksarc reported. 
Objections to Pasteurization Arc Unsound 
Various objections have been raised to pasteurization. 
One argument is that pasteurized milk is poor milk that has * 
been rescued by pasteurization. This was probably true in the 
early days of pasteurization, but it is not true in the many 
communities operating under the Public Health Service milk ordi- 
nance or under the ordinances which have set high sanitary■stan- 
dards for the production of milk to be used for grade A pasteu- 
rized milk. 
The next argument against pasteurization is that the process 
impairs the flavor of the milk. This can be easily disproved (15). 
In order to disprove this claim the health officer should first 
satisfy himself that the local pasteurization plants arc strictly 
observing the Grade nAfr pasteurized milk requirements of the Public 
Health Service Milk Ordinance and Code, and that the milk is being 
neither over-pasteurized nor exposed to copper, cither of which 
sometimes produces off flavors. Then he may break down the flavor 
prejudice against'pasteurization by arranging for flavor deter- 
mination contests. One of the local pasteurization plants may 
furnish both raw and pasteurized milk in quart bottles to the 
Rotary, Kiwanis, or other civic luncheon clubs, the bottles be- 
ing marked with distinguishing marks unknown to the drinkers. 
Each member should bo provided with six glasses, placed in a 
row in front of him.- A small portion of pasteurized milk should 
be placed in three of the glasses and a small portion of raw milk 
should be in the other three in an order unknovm to any one.but 
the health officer. The members should not bo told-how many 
glasses contain pasteurized milk. Then each member should be 
asked to tell by tasting which of the six glasses contained the 
pasteurized milk. It is fundamentally important that the raw 
and the pasteurized milks be identically the same milk except 
for the fact of pasteurization. This condition is best accomp- 
lished by obtaining the raw milk directly from the pasteurizer 
just prior to the pasteurization process, but after thorough 
mixing, and then obtaining the pasteurized milk from the same 
batch of milk after the pasteurization process has been completed. 
If pasteurization really Imparted an undesirable flavor td 
milk a large proportion of the members should be able to give 
aorroct ansv/ers. The speaker should ask all members who really 
believe they can. distinguish the flavor to rise and state their 
opini on. There will be only a few members who will make this claim, 
since the flavors are really indistinguishable; and since 
those members will be merely guessing, the number of them 
who will guess correctly will depend purely on the laws of 
chance. The mathematical chance of guessing correctly in 
this case is about throe or four out of one hundred. 
It v/ill‘ thus become apparent to all of the membership 
that pasteurisation really' docs not impart an undesirable 
flavor to milk, and the- results of the tost may then be 
published in the newspapers. 
The remaining argument i's that pasteurization impairs 
the food value of milk. Most of us have known that the 
pasteurization temperature is destructive to vitamin C, 
though wo have insisted that this vitamin is present in 
undependable and irregular quantities in milk anyway, and 
that orange juice is a much better source of vitamin C 
than milk. 
But there has been a widely distributed attempt to 
convince the consumer that heating milk seriously affects 
its wholesomcncss and growth-promoting power. 
In order to test this out, the Public Health Service a 
few years ago studied the history of over 3,700 children, 
1,921 of which had received no milk except heated milk, 
and 1,836 of which had received raw milk for more than the 
latter half of their lives (16). It was shown that over 
a considerable part of the ago-weight curves tho heated milk 
group of children- shows'a slightly greater average weight 
than tho ray/ milk group, tho average ‘weight of tho children 
receiving raw milk being 53.2 pounds, whereas the average 
weight' cf the, children receiving heated milk is 33.6 pounds, 
a difference of 1.2$ in favor of the heated milk group. 
A study of the. age-height curves- showed that the curves 
of the two groups arc practically identical. The raw milk 
group allows an average height of 37.4 inches, while the 
heated milk group shows an average height of 37.5 inches, 
a difference of loss than, throe-tenths of.one percent, again 
in favor* of the hoatod/miIk group.. 
Studios of race, financial status, and supplementary 
foods shewed practically no difference between the two 
groups of children except in the case .of cod liver oil 
-feeding. Hie raw milk group received cod liver oil 
cluring only 27.6$ of the average child life, whereas 
the heated milk group received cod- liver oil during 41.6$ 
of the average child life. As thi's might have obscured 
a real difference in favor of raw milk in the preceding 
curves, the children who had received heated milk were 
regrouped into two sub-groups, namely, one group which 
had received cod liver oil fbr more than half of their 
lives, and tie other group which had received no cod liver 
oil at all• , As a result of these supplementary studios it was found that the 
former group gave, an average weight of 33,8 pounds, too slight a 
difference to depress the former heated milk curve below the raw 
milk curve• 
One other important bit of information was secured from the 
studies’,' namely, tEat the parents of the children receiving 
prodeminently raw milk roportod a higher meidbnco of clTpiftHcrla, 
scarlet fever, IntostTnaT'TtTHtur bancos,' and rickets thah~7Ticr~tHb~~ 
parents of chiIdron recolying" heated milk only* "The respective' 
case rates For diphtheria v/cre" 17*1 and 22.7 per * thousand, for 
scarlet fever 23.0 and 41.4 por thousand, for Intestinal dis- 
turbances, exclusive of diarrhea, 11.0 and*196.0 per thousand, 
and for rickets 31.5 and 51.1 per thousand. 
From the above studies it may bo stated emphatically, thcre- 
fore, that there is no foundation"to the argument that"'the pasteu- 
rization of milk impairs its growth-promoTIng proper tic's. 
All Milk Should be Pasteurized Or Boiled 
It may bo asked, if pasteurization is really so desirable, 
why the Public Health Service .Milk Ordinance, which is now in 
effect in over 2,200 communities (17), permits each community , 
to decide' for itself which grades of milk it will permit to bo 
sold, instead of requiring the pasteurization of all milk. The 
answer is simply that if the ordinance were so worded only a 
small percentage of cities could be induced to adopt it. It was 
considered v/isor to frame the ordinance so as to make it adaptable 
not only to cities which wore ready for tho pasteurization of all 
milk but also to the many other communities in which there still 
persists* a strong sentiment again,st pasteurizations. In tho lat- 
ter group this ordinance will at least provide the maximum pro- 
tection afforded by the raw milk precautions alone. Pending the 
timo who n' the pasteurization of all milk can be required by 
ordinance, health officers should persistently urge tho consump- 
tion of pasteurized or boilod milk only. 
In closing may I again point out that every sanitary precau- 
tion with which milk is surrounded, including pasteurization, is 
of course subject to slips in operation. Health examinations of 
herds and employees occasionally fail to disclose existing disease 
or carrier conditions., and even froquont sanitary inspections do 
not prevent occasional violations, both at producing farms and at 
pasteurization plants. However, tho one thing which differenti- 
ates pasteurization from all other protective measures is that 
while all other measures may fail to protect completely oven if 
they are properly applied/ pastourization will always protect 
if it is properly applied. References 
(1) Park and Krumwioclo« Tbo relative Importance of the 
Bovine and Human Typos of Tubercle Bacilli in the Different Forms 
of Tuberculosis. Collected Studies from the Research Laboratory, 
Department of Health of New York City, Vol.7, pp.88-92, 1912-1913. 
(2) Roscnau. Preventive Medicine and Hygiene. 
(3) Alice Evans. Brucellosis (Undulant Fever). Prepared 
for U. S. Public Health Service (multigraphod release) July,1938. 
(4) Leslie C, Frank, What Every Person Should Know About 
MiIk.Supplement No, 150 to the Public Health Reports, 1939, 
(5) Milk Ordinance and Code Recommended by the United 
States Public Service, Public Health Bulletin No, 220, 
1939 edition. 
(6) W. H. Park, '%ormal Death Points of Pathogenic Bacteria 
in Milk, A.J.P.H., XVII, 1:36, Jan. 1927, 
(7) Park and Williams, Pathogenic Microorganisms, 
(8) W. H. Park Thermal Death Points of Streptococci, A.J.P.H. 
XVIII, 10:1259, Oct. 1928, and XX, 5:503, May 1930, 
(6) Zlnnser and Bayne-Jones, Textbook of Bacteriology, 7th 
edition. 
(10) Report of the Committee on Milk Production and Control, 
White House Conference on Chilf Health and Protection, p. 13, 
(11) Armstrong and Parran, Further Studios on the Importance 
of Milk and Milk Products as a Factor in the Causation of Out- 
breaks of disease in the U. S, Supplement No, 2 Public Health 
Reports, 1927, p, 8, 
(12) 1935 Annual Report of the Nov/ York State Association of 
Dairy and Milk Inspectors, 
(13) Report of Committee on Milk Plant Practices, Jl, of Milk 
Technology, 1:38-43, Sept., 1938, 
(14) Fuchs and Frank, Milk Supplies and Their Control in 
American Urban Communities, Pub, Health Bulletin No, 245, 1938, 
p. 25, 
(15) Leslie C# Frank, The responsibilities of Health Authori- 
ties & Physicians with Reference to the Pasteurization of Milk in 
Communities in Which Pasteurization is Not Compulsory, Mimeo- 
graphed publication, U,S,P.H,S,, Nov, 1932, 
(16) Frank, Clark, Haskell, Miller, Moss, and Thomas, Do 
Children Who Drink Raw Milk Thrive Bettor Than Children Who Drink 
Pasteurized Milk? Reprint No, 1549 from tho P. H. Reports of 
Sept. 23, 1932, 
(17) List of American Communities in Which the Public Health 
Service Is in Effect, Multipraghed publication, U,S,P.H.S, 
(4057) 65 
WHAT. EVERY PERSON SHOULD KNOW ABOUT MILK 
By Leslie C, Frank 
Senior Sanitary Engineer in Charge, Sanitation Section 
United States Public Health Service 
(Reprinted from Public Health Reports of Doc, 14, 1934; 
revised Jan. 1940.) 
Of all thing's of life which affect human welfare none 
is more Important than food* Pood is to man what coal is to 
the furnace or gasoline to the automobile* Food furnishes man 
with internal heat, without which oven overcoats would not 
keep him warm. Properly selected food provides mankind with 
the mental and physical energy which has been the mainspring of 
all civilization, it repairs the structural damage which the 
wear tear of life inflict upon our bodies, and it helps 
make us resistant to disease. On the other hand, improperly 
selected food is responsible for a large proportion of human 
ills, from a simple stomachache to the shortening of life it- 
self. In short, food is all-important in the human economy. 
Of all of tho kinds of food none is more Important 
than milk, the principal food of infants and small children. 
There are throe important questions about milk which every 
person should bo able to answer. They are: 
* (1) Why is milk such an excellent food, and how much 
of it should bo included in tho diet? 
(2) How can milk bo safeguarded to prevent it from 
transmitting disease? 
(3) How can consumers bo certain that tho milk they 
drink has boon.thus safeguarded? 
(1) WHt ‘IS MILK SUCH AN EXCELLENT POOD, AND HOW MUCH 
OP IT SHOULD BE INCLUDED IN THE DIET? 
In the first place milk is the only food specifically 
prepared by nature for the young of mammals. Nearly everyone 
will immediately agree that a substance specifically prepared 
by nature for no other purpose than for food is most likely to 
contain the food elements needed to sustain life and justly 
deserves the title recently conferred upon it, namely, 11 the 
most nearly perfect food.11 
It is by no means sure that wo know all of the at- 
tributes which the perfect food should have, but wo can at least 
discuss some of them. 
It will bo obvious that ono of tho most important 
attributes which a food should possess is that it bo a good 
source of energy, since every’ living thing needs a fresh supply 
of energy every day. Milk is such a food and, furthermore, is 
a cheap form of energy, Tho equivalent energy value in tho 
form of certain other widely used foods is more expensive. 
Milk is also a good muscle builder. It is rich in 
protein, which is required for muscle building. A child cannot 
grow and form strong muscles without protein. A full-grown adult cannot koop in health without it. As to tho quantity 
of protoin available in milk. Rose statos: TfA quart of milk 
yields more than an ounce of pure protein of tho highest 
quality," that is, more than one-third of tho total dally 
protein requirement of an adult. 
Again, milk is a good tooth and bone builder, 
for it contains plenty of lime. Children particularly need 
lino, and tho lime should bo in a form which is easily util- 
ized by tho body. This is above all true of tho lime in milk. 
One cup of milk contains as much lime as cups of carrots, 
7 eggs, or 42 slices of broad. 
Milk is a far noro concontratod food from tho 
standpoint of solids than most of us imagine. Wo think of 
milk as a liquid not much aboyo tho consistency of wator; but 
it contains 13 percent of solids by woight, which is moro than 
is contained in onions, boots, carrots, squash, pinoapplo, 
turnips, oystors, cabbago, radishes, cauliflower, spinach, 
watermelon, pumpkin, tomatoes, asparagus, colory, lottuco, 
or cucumbors. When wo buy 1 pint or 1 pound of milk, thoroforo, 
wo buy moro actual dry solid food than when wo buy 1 pound of 
any of tho other above-nontionod foods. 
Milk is also an excellent sourco of fat. This, 
of course, is obviously in tho fora of croon, which, with tho 
milk sugar, is diroctly rolatod to its fuel valuo. 
Milk is an excellent source of vitamin A. Profes- 
sor Sherman, of Columbia University, one of tho outstanding 
diet specialists of tho world, has stated, as a result of 
his own extensive research, that "milk is tho most important 
of all foods as a source of vitamin A.” Tho same author has 
stated, in his book on "Chemistry Of Pood and Nutrition": 
"Of tho throe vitamins A, B, and C, vitamin A is tho factor 
of greatest practical importance to nutrition and health, 
because so many of our staple foods are poor in vitamin A, 
and because a dietary poor in this vitamin causes such 
wide-spread weakening of the body and increases its suscep- 
tibility to.so many infectious diseases." 
In tho January 1932 issue of tho American Jour- 
nal of Public Health, the work, of Professor Mellonby and his 
wife on vitamin A (British Modical Journal, Oct. 3, 1931) 
was discussed. As a result of their work with 550 pregnant 
women, those authors reported a significant reduction in 
morbidity following the administration of a preparation 
containing vitamins A and D; and tho authors conclude, on 
tho experimental evidence, that the vltamin-D fraction had 
little to do with the results. 
Again, Professor Mellonby and his wife have for 
some 5 years taken cod-liver oil (a rich source of vitamin A) 
dally and report that during this time they have boon prac- 
tically free from ordinary colds. 'This latter, as tho editor 
of tho Journal says, is of course not a controlled experiment; 
but tho work on pregnant women was controlled, as 275 of tho womon received tho vitamin A preparation and tho remaining 275 
did not* Those statements are very interesting in view of tho 
widespread fooling that vitamin A gives protection against 
infection* 
Milk seems also to bo a good source of vitamin G. 
This vitamin, as tho result of tho ronownod work of tho late 
Surg* Joseph Goldborgor, of tho Public Health Service, has boon 
found to bo valuable both in preventing and in curing pollagra, 
a dietary doficioncy disease. Sinco milk contains vitamin G, 
tho consumption of milk has boon stressed by Goldborgor and 
others as one important measure for combating pollagra. 
Finally, milk is one of tho most digestible of foods. 
It is easily digested by most persons. Sherman states that tho 
coefficient of digestibility of milk protein is from 97 to 98 
percent. 
It may bo asked why milk was called tho most nearly 
perfect food rather than utho perfect food.11 This is bocauso, 
while it is tho most nearly perfect food, it is not absolutely 
perfect, and what has boon said would not bo complete without 
rcforonco to its shortcomings. Milk doos not seem to bo an 
entirely dependable source of tho other vitamins, nor doos it 
contain sufficient iron, and experiments have shown that in- 
fants and young animals restricted entirely to milk over con- 
siderable periods of time develop anemia. 
For this reason, and also bocauso variety in tho diet 
stimulates tho appetite, wo should not try to live on milk alone. 
Tho diet of normal children should include a quart of milk 
daily,.supplemented.with a wise selection of other foods, among 
which should bo included orange juice, cod-liver oil, and green 
vegetables. Normal adults may wisely include at least a pint 
of milk in their daily diet. Of course, abnormal adults or 
children should receive and follow competent medical advice. 
I scorns reasonable to bcliovo that in tho futuro 
public-health officials will not always grade milk on tho basis 
of its cloanlinoss and safety alone, but will also grade it 
with roforonco to its nutritive value. Recently it has become 
quite apparent that tho kind of food a cow gets very much 
affects tho nutritive value of tho milk she gives. Therefore 
it may bo anticipated that some time in tho futuro grade L 
milk may bo required to have boon produced 'by cows which re- 
ceive at least a standard balanced ration so that their milk 
may-possess tho maximum food value for human beings. 
(2) HOW CAM MILK BE SAFEGUARDED TO PREVENT IT PROM 
TRANSMITTING DISEASE? 
It seems a pity'that milk can bo such an excellent 
food and at tho same time so dangerous if not properly safe- 
guarded. But it is unfortunatoly true that milk is not only 
a good food for human beings, but also a good food for certain 
typos of disease organisms, such as those causing typhoid fever 
and diphtheria. Then, again, milk may sometimes, without our knowledge, come from sick cows. In such cases their milk 
may at the time of milking contain large numbers of the 
organisms of such diseases as septic sore throat, undulant 
fever, and tuberculosis. 
Occasionally there occur milk-bome outbreaks 
of appalling magnitude. Only a few years ago a milk-borne 
outbreak in Montreal caused over 5,100 persons to be stricken 
with typhoid fever, and killed over 500 of them. Fortunately 
most disease outbreaks caused by unsafe milk are not nearly 
so serious as the Montreal outbreak, but tho United States 
Public Health Sorvlco receives reports each year of from 30 
to 50 outbreaks. 
This fact is tremendously significant to all of 
us who drink milk—AND ESPECIALLY TO ALL OP US WHO HAVE 
CHILDREN. 
Among tho diseases which may be transmitted 
through milk are tuberculosis, typhoid fever, scarlet fever, 
diphtheria, septic sore throat, and undulant fevor. Lot us 
confine ourselves for the moment to but throe of them—tuber- 
culosis, typhoid fever, and septic sore throat. 
SUPPOSE YOU WERE A DAIRYMAN. WHAT WOULD YOU 
DO, SHORT OF PASTEURIZATION, TO MAKE SURE THAT NONE OP YOUR 
CUSTOMERS WOULD EVER CONTRACT ANY OP THESE DISEASES BY DRINK- 
ING YOUR MILK? 
Well, in tho case of tuberculosis, almost the 
only thing you could do would bo to have your cows tested 
for tuberculosis and kill those that showed they had it. 
Suppose you did that. Suppose you had a herd of 
50 spondid, puro-brod cattle, that you had them all tested, 
found 5 or 4 of them to bo tuberculous, had those 3 or 4 
slaughtered, and then continued with your business. Would 
you havo protected your customers from contracting bovine 
tuberculosis? If I wore one of your customers, could you 
give mo real assurance that I would never regret having 
permitted my children to drink the milk from your dairy? 
Certainly the four you had slaughtered would no 
longer bo a menace* But suppose that a year later, when you 
came to tost again, you found another cow to bo tuberculous* 
Then you would face a very serious question* You would wonder 
how many months it had boon tuberculous. You would bo as- 
sailed by the disturbing thought that perhaps some innocent 
child had received through your milk supply the germs of 
tuberculosis, an infection which might not disclose itself 
until considerable time had elapsed, until, perhaps, the 
child and the parents had forgotten that you had over been 
their dairyman. 
Do not lot anyone benumb your conscionco into 
believing that this doos not happen* It does happen, again 
and again, oven at certified and grade A raw-milk dairies. and slaughtering tho infoctod cows does not undo tho damage 
they have already done. 
Now lot us pass on to typhoid fever. If you wore tho 
owner of a raw-milk dairy, what would ho tho most effective 
thing you could do, short of pasteurization, to make suro that 
your milk supply would not carry typhoid fovor to your cus- 
tomers? 
Of, course, if one of your milkers or other helpers 
contracted typhoid fever, you would at once have him quarantined 
or sent to a hospital; and if you woro prompt and careful, 
there would probably bo very little danger. But, unfortunately, 
that is not usually tho way epidemics of typhoid fever are 
caused by milk. When milk becomes infected with typhoid fever 
it is usually not a sick person who is at fault, but, instead, 
a perfectly well individual, one who had had typhoid fever 
perhaps years ago and who possibly did not oven know that what 
ho had was typhoid fever. Nevertheless, ho has, as a result of 
this possibly unrecognized sickness, become what is known as 
a typhoid carrier. Such a man is, so far as wo know, a perfectly 
well individual. Ho doosnft look sick and ho doesnft fool 
sick. But, unfortunately, ho still carries typhoid fever germs, 
either in his gall bladder or elsewhere, from which they are 
discharged with his feces or urine, and thus accidentally now 
and then find their way to his hands, his clothing, and 
eventually to tho dairy equipment and to tho milk supply. 
Of course, the typhoid-fever carrier is not av/arc of 
his condition. If ho were, ho would, in most cases, bo honest 
enough to refuse to imperil tho lives of his follow beings by 
continuing to work at a dairy. But that is tho dangerous thing 
about it. The typhoid carrier is usually ignorant of tho fact 
that ho is a menace, a carrier of disease and death. 
Knowing thoso facts, then, what would you do if you 
woro tho owner of a raw-milk dairy? Possibly you would do what 
is required by tho Public Health Service milk ordinance for 
grado A raw-milk employees who have at any previous time had 
typhoid fever. You would have everyone at your dairy send 
samples of their feces and urine to tho health department 
laboratory so that it could bo determined whether they contained 
any typhoid organisms. Fortunately scientists have discovered 
an excellent^.method of recognizing typhoid fever germs, ' 
Now suppose you took this precaution and tho labora- 
tory reported that so far as it could determine none of tho 
specimens of feces or urine contained the germs of typhoid 
fovor. Could you then rest assured that none.of your employees 
is a typhoid-fever carrier, and that none of your customers 
would over contract typhoid fovor from tho milk you sold thorn? 
Unfortunately, tho answer must bo no. Many typhoid- 
fever carriers do not discharge tho typhoid-fever germs every 
day, and on tho day tho specimens wore .collected and sent to 
tho laboratory tho carrier, if there had boon one at your dairy, 
may or may not have boon discharging tho organisms. If he was discharging them, the chance that the laboratory would find 
them is excellent; but if he was not discharging them the 
laboratory could not, of course, find them. 
There is, therefore, no way to make absolutely 
sure that raw milk will never contain the germs of typhoid 
fever; and if you knew as much about the danger as the health 
officer does, you, as a dairyman, would live constantly in fear 
lest some morning you awaken to find the newspapers pointing 
the finger of accusation at you and your milk supply. 
We have now discussed 2 of the 3 diseases we 
intended to discuss. 
How about the third-*-septic sore throat? What 
could you, if you wore a producer of high-grade raw milk, do 
to prevent the transmission of this disease through your milk 
supply to your customers? 
Frankly, I do not know. A milker may think he 
has an ordinary cold, when really it is septic sore throat. 
He may then infect the milk supply directly, or ho may infect 
a cow!s udder during the milking process, and the milk from 
that cow may later bo simply teeming with the organisms of the 
disease. 
Suppose we wore to examine every milkor*s 
throat every day and every cow’s udder every day. Even then 
wo would not havo .done away with the danger, because by the 
time the report came back from the laboratory some of the 
milk would have boon consumed. Of course, I need not tell 
you that a dally examination would bo out of the question, 
if for no other reason than the expense entailed. 
A septic sore throat outbreak can be very serious. 
In Portland, Orog., several years ago, a milker infected a 
cowTs udder; and before the resulting epidemic was quelled, 
487 persons sickened and 22 died. 
To repeat, I do not know of any way in which you 
could guarantee that septic sore throat would not bo spread 
through your row-milk supply. 
IT SEEMS IMPOSSIBLE, THEN, TO ESCAPE THE CON- 
CLUSION THAT-ALL MILK SHOULD BE EITHER PASTEURIZED OR BOILED 
TO MAKE IT SAFE. 
Should wo roly upon boiling? That is what is 
dono in many parts of Europe and South .America, and, as a 
result, thoy havo in thoso places practically no milk-borne 
disease. But with thoso pooplo boiling milk is a matter of 
daily habit. In most of the areas in question, the house- 
wife does not have icq, and milk is boiled to keep it from 
souring. k ... • 
In this country wo have to deal with two factors: 
First, that most families do have ice or electric refrigerators 
and can keep milk sweet; and second, that many people do not 
like the taste of boiled milk. If health officers simply said to all of the people, 
uBoil your milk,11 they could not depend upon a sufficient num- 
ber doing it to prevent epidemics. Again, the adults and chil- 
dren who now drink raw milk because they like its flavor would 
not drink so much milk if it had to bo boiled, and wo must, 
by all moans, encourage people to grink enough milk. It is 
just as important to do this as it is to make milk safe. 
There is, then, only one other thing wo can do (short 
of putting chemicals into tho milk, and nobody wants to do that), 
and that is to pasteurize tho milk. That is why most health 
authorities today fool that ALL milk should be pasteurized. 
Tho most common method of pasteurizing milk commercially is to 
heat it to 143 degrees P. and hold it at that temperature for 
30 minutes. This treatment kills or renders harmless all 
disease organisms which may bo transmitted through milk. Higher 
temperatures for shorter periods are also effective. 
You need not bo worried about the effect of heating 
milk upon its food value. The vast majority of health officers 
and physicians today believe that pasteurizing milk has no 
significant effect upon its food value, especially whon it is 
remembered that all children should receive a supplementary diet 
in addition to milk. Vitamin G is affected by heat, but this is 
not significant, since the amount of this vitamin present oven 
in raw milk is frequently insufficient, and it is therefore 
necessary to food children orange or tomato juice or some other 
high-boaring, source of vitamin C, regardless of whether the 
milk they drink is raw or pasteurized. Therefore, since the 
child will got all the vitamin C it needs anyway, why take a 
chance on disease by insisting upon giving it raw milk? 
Several years ago tho Public Health Service conducted 
an intensive study of about 3,700 children to determine whether 
those who drank heated milk actually throve loss well than 
those who drank raw milk. Tho results of tho studios showed 
that tho average weight of tho children receiving raw milk was 
33.2 pounds, whereas tho average weight of tho children receiving 
heated milk was 33.6 pounds; also tho average height of tho 
children receiving raw milk was 37.4 inches, whereas tho average 
height of tho children receiving heated milk was 37.5 inches. 
Furthermore, from tho parents’ reports it was found that tho 
children who drank raw milk suffered with communicable diseases 
more frequently than did tho children who drank heated milk 
only. The final conclusion of tho study was that, taking into 
account the average supplementary American child diet, children 
who are fed pasteurized or other heat od milk thrive as well as 
children who are fed raw milk, and contract certain communicable 
diseases loss frequently. 
you may say, llmany people do not like tho 
flavor of pasteurized milk, and I am one of them.” 
That nay bo quito truo; but it is true only whon a 
low-grade, unclear nilk is used for pasteurization or whon a 
high-grade milk is improperly pasteurized. Pasteurization will 
not remove the bad flavor from bad milk, and oven good milk can bo damagod by pasteurizing it improperly. But if high-grade 
milk is properly pasteurized, there is no change in the flavor. 
To prove this, your health officer may conduct the following 
demonstration: 
Ho himself that the local pasteur- 
ization plants are strictly observing the grade A requirements 
and that there is no real flavor difference, such as might 
result from the use of a hlghor pasteurizing temperature than 
is required or from exposure of the milk to copper. Then one 
of the local pasteurization plants may furnish both raw and 
pasteurized milk in quart bottles to the Rotary and other 
civic .luncheons, the bottles being marked with distinguishing 
marks unknown to the drinkers. Each member should bo provided 
with six glasses, placed in a row in front of him. A small 
portion of pasteurized milk should bo placed in 3 of the glasses 
and a small portion of raw milk in the other 3 in an order 
unknown ’to anyone but the health officer. The members should 
not bo told‘how many glasses contain pasteurized milk. Then 
each member should bo asked to tell by tasting which of the 
six glasses contain passtourizod milk. (It is fundamentally 
important that the raw and pasteurized milk bo identically 
the same milk, except for the fact of pasteurization. This 
condition is accomplished best by obtaining the raw milk 
directly from the pasteurizer just prior to the pasteurization 
process, after thorough mixing, and then obtaining the pasteur- 
ized milk from the same batch of milk.) 
Each guest should bo provided with a small card. 
The glasses should bo considered as being, numbered from loft 
to right and each guest should bo asked to write on tho card 
tho numbers representing tho glasses containing pasteurized 
milk. Then someone from tho speaker’s table should announce 
tho true content of each of the six glasses, and all of tho 
members who guess correctly may bo awarded a prize of some 
sort • 
If pasteurization roally imparted an “undesirable 
flavor to milk, most of the guests should give correct answers 
for all six glasses. If pasteurized milk really cannot be 
detected by flavor, most of the members should fail in re- 
porting all six glasses correctly. In tabulating the answers, 
each guest who fails to foport all six glasses correctly* 
should bo listed as ’’wrong.11 A very few may guoss correctly 
just by chance. This chance is the samo as that of throwing 
all 6 heads when pitching 6 pennies at a time, usually not 
more than 1 or 2 times in 100 throws (p-0.0156). 
After this guessing contest has boon tried upon 
at least 100 persons in the city, tho results may bo published 
in tho newspapers as evidence of tho fact that proper pasteur- 
ization roally does not affect th.0 flavor of milk. 
Of course wo should not roly upon pasteurization 
as a cure-all and nogloct all precautions at tho farm, ovon 
if tho flavor problem did not exist. Tho pasteurization pro- 
cess Is operated by human beings and thoroforo is not entirely foolprpof, though it is nearly so. Wo should firmly insist that 
tho milk wo drink bo not only properly pastourizod but also 
carefully produced, so that wo will have tho maximum practicable 
protection all along tho lino from tho cow to tho consumer. 
(3)‘ HOW CAN CONSUMERS BE CERTAIN THAT THE MILK THEY 
DRINK HAS BEEN THUS SAFEGUARDED? 
As abovo stated, milk which has boon properly safe- 
guarded must have boon both carefully produced and properly 
pastourizod. Is the milk you buy such milk? Tho first thing 
you must know boforo you can bo sure of this is whothor tho 
milk regulations in forco in your city correctly proscribe tho 
methods of production and pasteurization. There has boon much 
disagreement on this point among health officers in tho past, 
and obviously not all health officers have boon correct. In 
some citios tho milk is not carefully produced boforo pasteur- 
ization, and in others important pasteurization principles aro 
ignored or faulty pasteurization machines usod, and yot tho milk 
may bo sold as grade A or otherwise designated as safe. 
To remedy this situation tho Public Health Service 
has for a number of years been urging American States and citios 
to adopt one uniform system of effective control. Tho model 
uniform regulations are carefully reviewed annually by a 
National Advisory Board, composed of 16 exports in milk-control 
work. 
Under tho regulations approved by this board, grade A 
pastourizod milk is milk which has boon both carefully produced 
and properly pastourizod and is as safe as any milk can bo made. 
Grade A raw and certified milks aro raw milks which aro as safe 
as ANY RAW MILK can practicably bo made. If you prefer to buy 
either of those raw grades, you can secure tho added protection 
of pasteurization as homo as follows; Place tho milk in an 
aluminum vessel on a hot flame and heat to 155 degrees P., 
stirring .constantly; immediately sot the vessel in cold 
water and continue stirring until cool. 
, If you buy grade A pastourizod milk, however, no 
additional homo treatment is necessary. 
Ovor 2,200 American communities have already put 
thoso uniform milk regulations into effect and arc grading milk 
in accordance therewith. In such cities a milk distributor who 
is found to violate any grade A requirement is denoted or de- 
graded by tho health officer, and must remove tho grade A caps 
and substitute lower grade caps, depending upon tho nature of 
tho violation. This attracts your attention if your milk dis- 
tributor becomes careless. Finally, tho health officer may 
revoke the permit of such a distributor if ho persists in -fail- 
ure to safeguard tho milk ho sells. 
You may wish to know what you should do if your 
municipality has not as yot adopted those nationally recommended 
uniform milk regulations. Tho host thing to do is to call on 
your health officer and discuss the matter with him* In most 
cases he will appreciate that and welcome your assistance in urging the city authorities to adopt the ordinance and provide 
the necessary inspectors* 
However, your health officer may have already 
worked out a good milk ordinance of his own and he may be 
justly proud of the results he has accomplished. If he is 
in doubt as to whether the .local ordinance is in all respects 
the equivalent of tho United States Public Health Service 
ordinance, he may consult the State milk-control authority or 
the Public Health Service. Even if your local milk ordinance 
is a good one, however, your health officer and you may agree 
that there are advantages of economy and efficiency in tho 
adoption of a standard. There is no profit in difference for 
differenced sake. Of course, if your local ordinance is 
really better than tho nationally recommended standard, your 
city should not drop tho improvements; but it should bo made 
quite certain that they are real improvements. If so, they 
should bo brought to the attention of the Public Health Ser- 
vice, which should incorporate them in its standard. 
One final doubt may still assail you. You may 
want to know how you can be sure that the local milk inspectors 
do not give a dairy a grade A rating when it does not deserve 
it. This is a very real problem which is taken care of by 
another part of the general national milk sanitation program 
of the United States Public Health Service. It recommends 
that the State milk control authority in each State should 
periodically measure the excellence of the milk sanitation 
work done in each municipality in the State by moans of a 
rating method devised by the Public Health Service, and 
award ratings. If the city milk-control work is found to 
rate•90 percent or more, the name of that city is included 
in a list published periodically by the Public Health Service. 
A copy of this list may bo secured by addressing the Public 
Health Service. You and your follow milk consumers should 
leave no stone Unturned in helping your health officer 
qualify your city for inclusion in this list. 
Last of all, the Public Health Service itself 
occasionally rates cities in the various States and thus 
standardizes the State rating work. This gives you the 
assurance that the ratings awarded by the State department 
are comparable with similar ratings in other States. 
SUMMARY 
(1) Milk is an excellent food because (a) it 
is a natural food, (b) it is a cheap source of energy, (c) it 
is a good muscle builder, (d) it is a good tooth and bone 
builder, (o) it is a highly concentrated food, (f) it is an 
excellent source of vitamins A and G, and (g) it is highly 
digestible. 
Normal children should consume a quart of milk 
a day, normal adults a pint, together with a well-balanced 
supplementary diet, which in the case of children should in- 
clude such foods as orange juice, cod-livor oil, and groon vogotablos. Abnormal children or adults should rocoivc and 
follow competent medical advice. 
(2) Milk may bo safeguarded so as to prevent it from 
transmitting such diseases as tuberculosis, typhoid fever, scar- 
let fever, diphtheria, septic sore throat, and undulant fever 
by careful production and proper pasteurization. Neither 
production precautions alone nor pasteurization alone are ade- 
quate. Both are necessary to assure the maximum protection 
from cov/ to consumer. 
(3) Consumers may assuro thornsolvos that tho milk 
they drink has boon thus properly safeguarded by purchasing only 
grade A pasteurized milk as defined by tho United States Public 
Health Service milk ordinance, or by pasteurizing at homo 
certified or grade A raw milk as defined by this ordinance. 
Consumers should ascertain whether tho local milk ordinance 
is equivalent to tho uniform milk ordinance recommended by the 
Public Health Service, and if not, they should offer to assist 
tho local health officer in having all of its provisions incor- 
porated in tho local milk ordinance, or, bettor still, in having 
tho present ordinance repealed and tho recommended uniform or- 
dinance adopted outright. 
To insure that the ordinance is strictly enforced, 
the local milk control work should bo rated at least biennially 
by the State milk control authority, and the rating should bo 
not loss than 90 percent, based upon the standard rating method 
recommended by the Public Health Service. Cities with 90 per- 
cent ratings arc listed semi-annually by the United States 
Public Health Service. Copies of the list and of the recommended 
uniform milk ordinance may bo secured by addressing the Public 
Health Service at Washington. A STUDY OF MILKBORNE EPIDEMICS 
Paul B. Brooks, M. D. 
Stato Department of Health, Albany, N. Y. 
(Hoprintod from Journal of Milk Technology, 2 (4) 168 (1939). 
Published by the International Association of Milk Sanitarians, 
29 N. Day St,, Orange, N, J.) 
EPIDEMIOLOGY 
In tho twenty-two year period 1917-1938 inclusive. 
Now York State, recorded 151 milkborno outbreaks of sickness. 
Noy/ York City, with no raw milk other than a relatively small 
amount of certified milk, recorded none® Of tho diseases in- 
volved, typhoid and paratyphoid fever contributed the largest 
number of outbreaks (75) but in two-thirds as many outbreaks 
of streptococcus infoction--scarlot fever and septic sore 
throat—tho total number of victims v/as nearly five times as 
great. Tho other diseases were diphtheria, poliomyelitis, 
bacillary dysentery, and gastroenteritis. 
Sixty-nine of thoso outbreaks occurred during the 
last twelve yoars of tho period, and a study of the data on thoso 
has rovoalod some interesting and significant .facts. All ex- 
cepting four occurred in rural towns and villages. The source 
of infection in eight was not determined but the other sixty- 
ono originated at tho farm. This illustrates tho fallacy of 
tho still popular idea that milk is safe -if it comes directly 
from tho farm to tho consumer. 
Direct contamination by cases or carriers on the farms 
appears to have boon responsible for about half of the sixty- 
nine outbreaks, if wo include a few in which the opportunity for 
such contamination was suspected but not proven. Responsible 
cases of mastitis were located in twenty-four other outbreaks 
of septic sore throat, scarlet fovor, and gastroenteritis. 
Considering as one group the thirty-nine outbreaks of 
scarlet fovor and septic sore throat occurring in the twelve- 
year period, responsible cases of mastitis wore discovered in 
eighteen. It is almost certain that some wore missed, duo to 
the investigators getting on the job too late and to reticence 
or actual concealment' on the part of dairymen. In eleven of 
the eighteen, the probable human sources of infection of the 
cows’ udders wore located. Wo believe, of course, that there 
wore human sources in the other seven. The conditions from which 
the eleven infected persons suffered wore about evenly divided 
between throat and wound infections, the latter most often on 
the hands. 
ADMINISTRATIVE QUESTIONS RAISED BY EPIDEMICS 
Twenty-five of the more important outbreaks of which 
a majority were of scarlet fovor and septic sore throat, wore 
selected as the basis of an inquiry designed to find the answers 
to some questions of interest primarily from an administrative 
standpoint. This revealed, among other things, that in only 
five of sixteen outbreaks did physicians attending cases report thor.1 promptly, to tho local health officers, as thoy arc legally 
required to do.- In only ton out of nineteen instances did 
local health officers report to tho State Department of H0alth 
without serious delay. In many of tho outbreaks of strepto- 
coccus infection in which bovine.udders wore infected by milkers 
having sore throat or discharging sores or wounds, tho dairy- 
men apparently know of tho condition of the milkers before 
tho bovine infection occurred. In connection with eighteen 
outbreaks, it was reported that dealers whoso milk was respons- 
ible wont out of business in eight instances, in throe tho 
dealers lost some of their trade, and in seven their business 
apparently was not affected. In one of tho latter instances 
it was reported that gross negligence on tho part of tho 
dealer was responsible for tho outbreak—one or our most serious. 
Indeed, it is a regrettable fact that there is 
evidence in our files which forces us to tho conclusions that 
ignorance of facts which should bo common knowledge among 
intelligent dairymen and dealers, failure to conform to commonly 
recognized standards of practice in tho milk business and to 
legal requirements, carelessness, or nogligonoo--ono or all 
have boon factors in tho causation of many if not most of 
our outbreaks* 
Reference has boon made to tho after-effect, if 
any, on tho business of dealers whoso milk was responsible for 
eighteen epidemics. Through tho cooperation of tho secretary 
of the local Chamber of Commerce, wo wore able to got some 
interesting data on the effect of one of those on business in 
general. This was an epidemic of 511 cases of scarlet fever 
in a village with a population of 4742; about 1 in 9 of tho 
population having boon ill. A canvass was made of two manu- 
facturing plants and sixteen other places of business. Tho 
estimated aggregate loss from falling off of business and tho 
closing of one of tho manufacturing plants was §149,721. Con- 
sidering that tho canvass did not include all places of business 
and that no attempt was made to determine tho cost of families 
of victims of tho epidemic this figure would seem sufficiently 
impressive to convince business men, not otherwise convinced, 
of tho importance of preventing such epidemics. 
ILLUSTRATIVE OUTBREAK FROM STAPHYLOCOCCI 
A brief reference to two outbreaks will illustrate 
tho possibility of trouble from carelessness and disregard of 
legal requirements, and will bring out some other points. One 
was an outbreak of 75 cases of gastroenteritis in two asso- 
ciated private summer camps, one for boys, tho other for girls. 
These camps received daily about 240 quarts of supposedly 
pasteurized milk, in cans, from a producer-dealer who also sold 
about 220 quarts daily to other customers. Tho cases in tho 
two camps occurred, at different times on tho some day, 
about five hours after consumption of milk. At tho time of 
investigation some of this milk remained in one can and, when 
tho phosphatase tost was applied, gave a complete raw reaction. 
Tho laboratory reported both Staphylococcus aureus and hemolytic 
streptococci in samples•from tho■can. At tho dairy ton cows woro found to havo mastitis. Tho usual practice was to cool 
tho raw milk in a vat at tho farm milkhousc and to store tho 
cans of bulk pasteurized milk in a vat off tho pasteurizing 
room. Tho investigation report indicated that the milk-house 
vat had boon out of commission because of a leak; and'all of 
tho cans, unlabolod, wore cooled in one vat, tho raw milk at 
one end, pasteurized at tho other. An employee at tho plant 
agreed that on tho day of tho outbreak ho may havo gotten two 
cons of raw milk by nistako--as ho apparently did. When I say 
tho milk was cooled, I say it with reservations; tho temper- . 
aturo of milk in tho vat at one visit was 70 degrees P. Counts 
on two bottles of pasteurized milk from tho plant wore 150,000 
and 360,000 colonies per ml. Tho sanitary code limit for tho ; 
grade is 30,000. 
This outbreak, presumably due to consumption of 
Staphylococcus aureus toxin, quite evidently was the result 
of inadequate supervision by the proprietor and of careless 
methods both at the farm and in the plant; milk from cows with 
mastitis being used, cans not properly labeled and separated, 
and inadequate cooling giving opportunity for pathogenic organ- 
isms to multiply and develop toxin. This producer-dealer is 
said to have lost considerable business and appears to have 
learned his lesson. 
OUTBREAK OP TYPHOID FEVER 
An outbreak of seven cases of typhoid fever in a 
small city demonstrates the weakness of control measures when 
we are dealing with unreliable individuals. Tho patients' wore 
Italian and Polish and their infection was traced to milk, 
supposedly pasteurized, from a Polish dealer. Ho served about 
780 patrons daily. It developed that at tho time when tho 
infection presumably occurred, ho was buying twelve to fifteen 
quarts of milk dally from a four-cow dairy on which there was a 
Polish woman, known and registered as a typhoid carrier under 
tho supervision of tho health officer' of tho township in which 
tho farm was located. Previously, on tho carrier agreeing to 
havo no contact with milk or utensils, tho dairyman had boon 
authorized to send his milk to another city for pasteurization. 
Instead of this, it had gono, at least for a time, to tho local 
doalor. Both tho dairyman and .dealer denied this until con- 
fronted with proof. The carrier had boon washing utensils 
on tho farm. Tho doalor was reported finally to have admitted 
that, on some occasion when ho ran short of pasteurized milk, 
ho might havo bottled this raw milk. This presumably was what 
happened. Tho doalor paid a penalty of fifty dollars. Tho 
dairyman was forbidden to keep cows on tho farm as long as tho 
carrier remained and eventually sold out. 
Whilo wo have had a fow milkborho outbreaks tracoablo 
to known typhoid carriers, tho unrocognizod carrier naturally 
is a greater sourco of danger when milk is not pastourizod. An 
outbreak of thirtoon eases of typhoid fovor a year ago in a 
small village illustrates what may happen. A small raw milk 
producor-doalor noodod moro milk and without authorization from 
the health officer, got fifty quarts daily from a relative*s farm which was conveniently located. Tho casos began developing 
shortly after this milk was added. Tho relative turned out 
to ho a typhoid carrier who had had typhoid fever eighteen 
years before. For several years his milk had boon going to 
a city pasteurizing plant and nothing had happened. 
In this outbreak it was the people who used the 
most milk, generally speaking, who became infected. Among 
141 v/ho used the milk and wore not infected, the average 
amount consumer dally per person was 0.98 pint. The average 
among those who contracted the disease was 2.2 pints dally. 
This outbreak also illustrates the point that the extent of 
an outbreak is not the only measure of its seriousnessi Among 
the thirteen victims there wore throe deaths {a fatality 
rate of 23 percent): a girl of thirteen, a boy of eighteen 
and a man of sovonty-*thr eo. The wife also had the 
disease but survived. 
OUTBREAK OP SEPTIC SORE THROAT 
An outbreak of 33 eases of septic sore throat 
in a small village had some interesting features. This was 
an explosive outbreak limited to employees of a milk col- 
lecting plant, their families, and a few intimate friends. 
The plant was shipping raw milk to a large city for pasteur- 
ization, The employees wore permitted to take milk from the 
plant, in their own containers, for family use. Ordinarily 
this milk was drawn from the cooler into a can at about the 
same time each day and later was measured into the employees1 
pails. This milk was the one thing in common among the plant 
employees and there had boon no previous illness among them. 
Milk came to this plant from 199 herds, representing about 
3600 cows. Trying to find the ultimate source of infection 
seemed like T,,looking for a noodle in a haystack11. Neverthe- 
less, one of our optimistic milk sanitarians began making 
Brood smears of milk from each dairy, as it arrived at the 
plant. uLady Luck” was on his side; ho had examined only a 
few smears when ho found one in which there wore largo numbers 
of streptococci and leucocytes. A ”Brood smear11 of a similar 
sample is shown in Figure 1, A visit to this farm revealed 
a cow with mastitis, from whoso milk hemolytic streptococci 
of Lancofiold’s Group A wore later isolated. The. milk from 
this farm usually reached the plant at about the time the 
omployo.es* supply was being taken out. 
Further investigation revealed tho probable source 
of infection of tho cow*s udder. She had come from another 
farm. Late in December (the epidemic was in April) tho man 
who milked her had wa severe sore throat” as his mother also 
did. Later in tho winter, tho cow freshened and developed 
v/hat was described as a severe 11 caked udder”. At tho time of 
tho epidemic, this man still had hemolytic streptococci in 
his throat and there is little doubt but that ho v/as the 
ultimate source of tho epidemic. And hero lot mo repeat v/hat 
can not bo repeated too ofton: tho only casos of mastitis 
responsible for septic sore throat or scarlet fever, so far 
as wo know, are those arising from infection with hemolytic 
stroptoaoevei from a human source. Throo of tho four outbreaks thus far nontionod wore 
from nilk intondod to bo pastourizod boforo boing used* This 
observation, plus the fact that in NqW York Stato in at loast 
fiftoon yoars wo havo discovorod no outbreaks from milk oven 
partially pastourizod, gives us some idea as to what oven im- 
perfect pasteurization saves us from* It suggests, also, 
that failure to pasteurize (tho ’’human element”) is, in general, 
a much greater source of danger than defective pasteurizing 
apparatus* It does not minimize -tho importance of efficient 
apparatus but it supports tho belief that there is a consider- 
able margin of safety in tho standard procedures* 
Associated outbreaks of scarlet 
FEVER AND SEPTIC SORE THROAT 
Now, in order to bring out some special points, I 
want to make brief referoneos to two associated small outbreaks 
of scarlet fever and two much larger ones of septic sore throat. 
Tho two scarlet fever outbreaks* one of sixteen 
cases, tho other of nine, although they occurred in different 
counties eight months apart, wore traced to tho infected udder 
of one cow—or, to go back a little further, to a milker who, 
several weeks before'tho first outbreak, had what was evidently 
milk scarlet fever* At tho time of this first outbreak tho cow 
was found to havo mastitis; and Beta-hemolytic streptococci of 
Lancefioldfs group A, corresponding to those on patient cultures, 
wore isolated. Tho cow "dried off'* and, duo to an unfortunate 
combination of circumstances, instead of being slaughtered, 
was sold, changed hands several times, and eight months after 
tho first outbreak, arrived on a farm in an adjoining county* 
There she freshened, her mastitis recurred, and tho second out- 
break followed* Nine persons, all members of the families of 
tho proprietor and hired man, usod the milk, and all dovolopod 
scarlet fever. Tho same organisms wore again isolated from tho 
milk* Tho photomicrographs shown in Figure 2 (for which I am 
indebted to Dr. J*. I. Schloifstein of our laboratory staff) 
arc unique: tho first over made and published of sections of 
an udder responsible for two scarlet fever outbreaks eight 
months apart—with tho streptococci appearing “in person.”, 
Tho winter before last wo had an outbreak of 375 
casos of soptic soro throat in a village of 1900: ono-fifth of 
tho population affected. It is a coincidence that tho producer- 
dealer whoso raw nllk was responsible sold approximately ono- 
fifth of tho village supply. Tho only other circumstances I 
want to mention arc that seventeen of tho 375 patients wore said 
to have had typical scarlet fever and another seventeen to have 
Spooled”, while one patient had erysipelas. 
In an epidemic of 500 cases of septic sore throat in 
a good-sized village (about one in eight of the population 
affoctod), there wore six cases of erysipelas; 'two with 
erysipelas alone and four with erysipelas complicating'throat 
infections* No typical scarlet fever cases wore soon but 
several patients had atypical rash* Tho responsible cow had a 
teat injury; an unstorilizod teat dilator was usod and acute 
mastitis followed. ASSOCIATED ETIOLOGY OF SCARLET FEVER, SEPTIC 
SORE THROAT, AND ERYSIPELAS 
I am referring to tho clinical features, particu- 
larly, in those two epidemics because tho study of milkborno 
epidemics of scarlet fever and septic sore throat has helped 
to throw now light on tho subject of beta-homolytic strepto- 
coccus infection in general. Tho idea has prevailed for many 
years that scarlet fever, septic sore throat, and erysipelas 
wore separate and distinct diseases, incited by different 
typos or strains of organisms. However, in our epidemics 
it has boon repeatedly observed that when a cow!s udder is 
infected by one individual who may have either scarlot fever, 
sore throat alone, or a wound infection, tho ensuing epidemic 
produces cases with and without scarlatinal rash (apparently 
tho only distinction between scarlot fever and septic sore 
throat) as well as cases of erysipelas. When all of those 
conditions can bo incited, as quite evidently they are, by 
tho same organism, it seems equally obvious that they arc 
simply different manifestations of tho same infection. Ap- 
parently, if tho infection is inoculated into tho skin of a 
susceptible Individual, erysipelas results. If tho infection 
passes through tho usual oral channel, tho reaction seems to 
depend partly on tho toxin-producing power of tho organism and 
partly on tho susceptibility of tho patient. If tho original 
infection came from a case of so-called scarlet fever, it 
appears that the susceptible recipients develop scarlot fever 
if they have not had it or boon artificially immunized against 
it; otherwise they have what wo have boon calling septic 
sore throat. If tho original source wore a case of septic 
sore throat, it would appear that only those patients who 
ar'c especially susceptible would react to tho small amount 
of rash-producing toxin by developing a scarlatinifom rash 
as well as tho throat and other symptoms. Perhaps if I wore 
more of a scientist, I should bo more cautious about expounding 
those still theoretical explanations—but there they are for 
whatever they are worth. 
CLASSIFICATION OF INCITANT STREPTOCOCCI 
Finally, having ventured so far, I am going to 
venture a little further and say something about classification 
of streptococci, this time with tho reservation that I am not 
a bacteriologist and can give only my understanding of tho 
facts. The changes from old to now terms and classifications 
are confusing. If my attempt at explanation does not clarify, 
I trust it at least will not add to tho confusion because it 
is quite necessary to got some of those things straight if wo 
are to understand tho relationship between bovine and human 
streptococcic infections. 
’ Tho latest and most generally accepted classi- 
fication into Alpha, Beta, and Gamma streptococci is based 
on tho reactions produced by tho organisms when Incubated on 
blood-agar plates. The Alpha group, which includes what wo 
have called Streptococcus viridans, produce a brown discolora- 
tion and only slight or incomplete hemolysis (dissolving of 83 
rod blood colls) around tho colonies* Thoso of tho Beta group 
produce clear, colorless zonos of hemolysis, and so aro spokon 
of as Bota-homolytic streptococci• This is tho group that con- 
cerns us hero. Thoso of tho Gamma group produco no homolysis* 
Lancofiold, on tho basis of sorologicol tests, has 
subdivided tho Bota-homolytic streptococci into nino sub-groups, 
which sho has dosignatod as A, B, C, D, E, P, G, H and K. 
This is callod Lancofiold!s classification and appears to havo 
boon quite generally accepted* 
Group B probably corresponds roughly to tho old 
agalactao or Streptococcus mastitides grouping, bocauso it is 
thoso of this group which aro tho chief causo of bovino masti- 
tis. Howovor, it is Group A which concerns us in this discussion 
bocauso it consists almost wholly of Bota-honolytic streptococci 
of human origin and includes tho incitants of so-called scarlot 
fovor, soptic sore throat, and orysipolas, as woll as sorious 
wound infections* Thoy aro also highly infective for tho bovino 
uddor whon thoro aro breaks in tho protoctivo tissues through 
which thoy can ontor* This explains tho risk which dairymen 
take whon thoy allow persons with sore throats and wound in- 
fections to milk thoir cows. 
SUMMARY 
So there aro some very practical conclusions which 
can ho drawn from such a study as this of milkborno epidemics. 
Such opidomics occasion sorious inconvonionco and financial 
loss as woll as danger to lifo and health. Theoretically they 
aro preventable by strict compliance with health regulations and 
intelligent and conscientious application of satisfactory trade 
practices and hygienic principles which should bo a matter of 
common knowledge among ordinarily well-informed people. Viewing 
the natter practically, however, not all people in the milk 
business aro intelligent and honest, any more than aro all people 
in any other lino and not all intelligent and honest people aro 
well-informed concerning hygienic principles. Generally speaking, 
therefore, the "human element11 can not bo trusted. Our hope of 
protection from milkborno infection, to repeat what is becoming 
an axiom and again speaking generally, lies in pasteurization* A SCARLET FEVER OUTBREAK DUE TO RAW MILK 
By Roy P. Peemstor, M.D., Dr, P.H., and 
J. M. Kingston, V.M.D, 
(Reprinted from the New England Journal of Medicine 
Vol. 209, No* 6, pp. 275-278, Aug. 10, 19-33) 
As long as we have milk supplies unprotected by 
pasteurization, we shall continue to have outbreaks of disease 
carried by milk. Fortunately over 85 per cent of the milk of 
Massachusetts is pasteurized and outbreaks are limited to fewer 
and fewer cases since no largo supplies are now unprotected. 
During the last five years there have been 16 known outbreaks 
of milk-borne disease in Massachusetts, and in not a single 
instance has a milk supply of over 300 quarts boon involved. 
This report deals with another epidemic on a small raw milk 
route. 
ESTABLISHING THE PRESENCE OP AN EPIDEMIC 
It took very little investigation to establish the 
fact that there was a milk-bomo outbreak at the time our atten- 
tion was called to the situation. Between PGbruary 1 and April 
15, 1933, a period of ton woeks, there had boon only 13 reported 
cases of scarlet fever in East Bridgewater (population 3,591). 
At tho beginning of the investigation on April 24, 21 cases had 
already boon reported since April 15. Forty-one cases even- 
tually occurred in tho two weeks April 15 to April 30 (see 
Table I). Tho distribution of the cases among tho milk dealers 
clearly pointed to tho one milk supply (Dealer E) already under 
suspicion, as shown in Table II. Furthermore, the cases wore 
scattered all over tho town and there was no possibility that 
they could have been contact cases for some lived throe or four 
miles apart, and there had boon no social function or other 
mooting which all had attended, and tho milk supply was tho only 
factor in common. 
In West Bridgewater (population 3,206) tho earliest 
cases reported wore in tho families of tho two regular customers 
of two stores supplied by Dealer E and tho lator cases among 
families who bought only occasional quarts at tho same stores. 
Hero again tho casos could not bo accounted for by contact, as 
tho families woro scattorod. No casos of scarlet fovor wore 
reported in the period February 1 to April 15 (Seo Table I). 
Twenty-one casos occurred between April 15 and April 30, all 
of them except one boing in families who used milk from tho East 
Bridgewater dealer. 
Another fact which pointed to a milk-borne outbreak 
was that several members of a family became ill practically 
simultaneously, those who did not show clinical scarlet fovor 
having severe sore throats resembling tho clinical picture of 
septic sore throat. One incident further supported tho suspicion 
of tho milk supply. Throe children from Boston visited their 
grandparents in East Bridgewater and drank tho milk for two days. 
Tho next day after returning homo, two of them woro ill with TABLE I 
Scarlet Fever Cases Reported by East Bridge-water 
and West Bridgewater February 1-May 13 
Week Ending 
Number of 
East 
Bridgewater 
Cases Reported 
West 
Bri dgewater 
Feb * 
4 
1 
0 
•1 
11 
0 
0 
n 
18 
0 
0 
n 
25 
0 
0 
Mar. 
4 
1 
0 
n 
11 
0 
0 
H 
18 
2 
0 
it 
25 
1 
0 
Apr* 
1 
2 
0 
n 
8 
3 
0 
M 
15 
4 
0 
n 
22 
23 
9 
ft 
29 
14 
12 
May 
6 
2 
0 
It 
13 
3 
0 
Distribution of Cases Among Milk Dealers 
of East Bridgewater 
TABLE II 
CasoB of Scarlet Fever 
April 15 April 30 
Dealer 
Quarts deliv- 
ered daily 
Number 
Rate per 
100 quarts 
A 
300 
2 
0.6 
B 
200 
0 
0 
C 
150 
0 
0 
D 
100 
0 
0 
E 
75 
35 
47. 
F 
50 
0 
0 
G 
30 
0 
0 
H 
20 
1 
5, . 
Private 
supply 
2 
— 
scarlot fovor and wore sont to tho Boston City Hospital contag 
ious disoaso ward. 
Another interesting opidomiologlcal fact was 
that in oach of four families whoro casos of scarlot fovor 
occurrod an Infant was boing givon either pastourizod or 
boilod milk and consequently escaped tho initial infection* 
In two of tho families tho infant later developed a sec- 
ondary case of scarlot fovor from contact with earlier casos 
in tho homo. 
Tho chronological occurrence of tho cases Is 
shown in Tablo III. Tho fact that tho casos continued to bo 
reportod almost daily ovor a period of two weeks would soora 
to indicate that tho milk carriod tho causative.organism 
practically continuously for a considorablo length of timo. 
Such a condition points strongly to an infoctod uddor in tho 
dairy hord for it is difficult to boliovo that a carrier or 
a case could koop tho milk so consistently and so heavily contamlnatod. Thoro is a bunching of tho c.asos somowhat into 
throo groups around tho datos of April 18, 20 and 24, which 
TABLE III 
Chronological Occurrence of Infections Among 
Users of the Suspected Milk Supply 
Scarlet Fever Sore Throat Total 
Primary Secondary 
Cases Cases 
April 
15 
3 
i 
4 
n 
16 
4 
4 
II 
17 
5 
6 
11 
II 
18 
4 
11 
15 
II 
19 
1 
5 
6 
U 
20 
7 
3 
10 
II 
21 
4 
4 
II 
22 
4- 
2 
6 
M 
23 
2 
T 
1 
4 
II 
24 
8 
1 
7 
16 
<1 
25 
5 
1 
1 
7 
R 
26 
1 
1 
2 
n 
27 
1 
I 
2 
II 
28 
1 
T 
2 
n 
29 
l 
1 
n 
30 
— 
i 
— 
1 
Totals 
50 
“7 
38 
95 
suggests that tho milk may havo boon more hoavily contaminated 
two or throo days boforo each of thoso datos. This concen- 
tration at particular dates was not limited to casos of primary 
scarlet fovor, Tho cases of soro throat among other members of 
tho family displayed tho sane characteristic grouping (Tablo 111\ 
Some of the 7 casos classed as secondary may havo boon primary, 
duo to drinking tho milk at a lator timo, but when moro than 
throo days olapsod botwoon tho first and succeeding oaso in a 
family, tho lattor was classed as secondary* 
THE SOURCE OF THE INFECTING ORGANISMS 
It was impossible to determine tho exact source of 
tho epidemic. Tho milk dealer would not admit that there had 
boon any suspicious illness in his family during tho weeks pre- 
ceding tho outbreak and nothing could bo found on physical 
examination to load to such a suspicion. Throat cultures of 
tho family disclosed that five of tho ten wore carrying hemoly- 
tic streptococci but they may have picked them up from tho milk, 
which they used in considerable quantity themselves, as eight 
days had already elapsed since tho first case occurred. It 
happened that the two who handled tho milk did not have strep- 
tococci in their throats. 
As mentioned above, tho distribution of tho casos 
pointed to an infected udder. Tho herd was examined on tho 
first day of tho investigation and two cows wore found to have 
mastitis, one of rocont origin and one of long standing with 
atrophy. In each instance tho infection was limited to a single quarter, Milk obtained from the cow with the more acute in- 
fection did not show hemolytic streptococci but showed nu- 
merous other bacteria. No milk was obtainable from the 
atrophied quarter of the other cow, only a small quantity of 
inflammatory exudate being forced out through a milk tube. 
This material showed hemolytic streptococci. Milk from the 
other throe quarters of the two cows as well as from all the 
other cows in the herd did not show hemolytic streptococci. 
The dealer was using the milk from the three good quarters 
of the two cows but assured us that none from the affected 
quarters had boon used. The herd was reexamined five weeks 
after the outbreak. The cows wore found in good condition 
and no other udder infections had occurred in the meanwhile. 
Samples of milk wore obtained from all the cows and found to 
bo free from hemolytic streptococci. 
Slnco no suspicious illnoss had apparently 
occurred on the milk farm, sources from which the organisms 
might have boon imported wore looked for. It was found that 
there had boon an illnoss in tho homo of ono of the doalorTs 
customers that was quite likely scarlet fever. Tho onset 
was April 6. There was also a definite case on his milk 
route with an onset on April 11. Whether tho streptococci 
might have boon imported into tho dairy from ono of those cases 
will never bo known and is probably loss likely than that 
it camo from tho throat of ono of tho milkors. 
THE INCUBATION PERIOD 
Because some of the families bought most of 
their milk from other sources and only an occasional quart 
from the infected supply, the Incubation period can bo 
fairly accurately estimated in a few instances, whore the 
infection was definitely duo to a particular quart of milk. 
Table XV shows the date on which the milk was used and the 
dates of onset of the cases of scarlet fever or sore throat 
in six families. In two instances a small child was ill by 
the end of 24 hours. Forty-eight hours was the most fre- 
quent time elapsing between using the milk and the appear- 
ance of the first symptoms; in 11 of the 15 cases the period 
was this length or loss. In one instance the exact number of 
hours could bo determined. The milk was used late Sunday 
night (April 23) and before Tuesday noon all throe of the 
family wore ill and two wore in bod. The father had a severe 
sore throat with recrudescences over a period of ton days. 
The child had a definite case of scarlet fever; the mother 
suffered only a moderately severe sore throat. TABLE IV 
Estimation of Incubation Period 
Date on Datea of Onset Remarks 
which milk 
was used 
April 
17 
April 
18, 
19 
Infant ill first, 
sore throats. 
It 
It 
19 
20 
H 
H 
21, 
22 
21 
Both scarlet fever.' 
Scarlet fever. 
If 
22 
n 
24. 
25 
Both scarlet fever. 
ft 
23 
H 
25, 
25, 
25 
1 scarlet, 2 sore 
throat. 
ft 
23 
n 
24, 
25, 
26, 27 
Youngest child 
first, all scarlet 
fever. 
THE CLINICAL PICTURE 
The illness caused by drinking the milk varied all the 
way from easily diagnosed scarlet fever, with a characteristic 
rash, throat, tongue, fever and prostration, desquamation, and 
subsequent otitis or adenitis, through the various milder forms, 
in.which some of the usual features were missing, to the other 
extreme where there was only a sore throat of varying degree, and 
in one or two instances even the sore throat was so mild that it 
might have been overlooked had not the cervical glands become 
.enlarged and painful. 
In a few cases the sore throat was very severe. There 
was marked prostration, high fever, edema of the larynx suffi- 
cient to interfere markedly with breathing, and in two cases a 
pharyngeal abscess developed* 
One case, a man of-26, developed broncho-pneumonia 
and streptococcic septicemia and died within a day or two after 
admission to a contagious disease hospital. This was the only 
fatality. 
THE INCIDENCE OP CASES AMONG USERS OP MILK 
A visit was made into practically every household 
v/here the milk was delivered regularly and information obtained 
as to illnesses which had occurred since the beginning of the 
outbreak. In these households there wore 167 individuals. Of 
these 19 claimed not to have used the milk raw, leaving 148 who 
did use the raw milk. Fifty-seven cases of scarlet fever and 
thirty-eight cases of sore throat occurred among those individ- 
uals, which gives a total of 95 infections of some kind. In 
other words, 64 per cent of those v/ho were known to have used 
the milk became ill (see Table V). Every individual who had 
used the milk could not be reached because there were some who 
had bought only an occasional quart at the stores and the pro- 
prietors had kept no record of those who had purchased some of 
the infected supply. Further study of the tabic brings out some other 
interesting points. As would have been expected, the highest 
attack rate for scarlet fever was in the lower age groups and 
the rate became progressively lower with increase in ago. The 
concomitant sore throat in other members of the families did 
not show any such relationship to age, but there was a ten- 
dency for the highest rates to occur in the older age groups* 
The highest rate was among those over 25 and the lowest 
among those 5 to 9. 
It is also noteworthy that 95$ of the children 
under 5 years v/ho used the milk became ill and that the attack 
rate for total infections progressively decreased with ago* 
Attack Rate Among Users of Infected Milk, 
East and West Bridge-water 
table v 
Ages 
No. of per- 
sons in 
households 
No, "who 
used 
milk 
Number 
Scarlet 
Fever 
of Cases 
Sore 
Throat 
Total 
Infec- 
tions 
Attack Rates 
Scarlet Sore Total 
Fevel* Throat Infec- 
tions 
0-4 
24 
20 
15 
4 
19 
75.0 
20.0 
95,0 
5-9 
14 
14 
9 
2 
11 
64.2 
14.3 
78.6 
10-14 
19 
19 
10 
5 
15 
52.6 
26.3 
79.1 
15-19 
15 
15 
5 
5 
10 
33.3 
33.3 
66.7 
20-24 
16 
16 
6 
3 
9 
37.5 
18.7 
56.2 
25 and 
over 
79 
64 
12 
19 
31 
18.8 
29.7 
48.4 
Total 
167 
148 
57 
38 
95 
38.5 
25.6 
64,2 
There were 13 individuals among the 148 who used 
the milk who gave a definite history of having had scarlet 
fever. However, it was not felt that the history of previous 
scarlet fever was known or remembered accurately enough to 
make it justifiable to modify the tables with these 13 cases 
when undoubtedly a number of others in the 148 must likewise 
have had scarlet fever in the past. If Table V could have 
shown the attack rate among the actual suscoptibles, as 
determined by the Dick tost or other accurate measure of im- 
munity, the rates would have been oven higher. 
CONTROL MEASURE INSTITUTED 
The milk dealer was immediately ordered by the 
local, boards of health concerned not to deliver any more milk 
which (1) included milk from the cows under suspicion, and 
which (2) was not pasteurized. Because the epidemic had 
disrupted his retail trade, ho decided to give up his route 
and dispose of his milk to a dealer in a nearby city who 
sold only pasteurized milk. Likewise ho was convinced that 
it would bo economically expedient to butcher the two cows 
under suspicion. After slaughter, hemolytic streptococci 
were recovered from the udder of the one cow whoso milk 
had earlier contained the organisms. summart 
An outbreak of 57 casos of scarlot fovor and 38 eases 
of sore throat occurred on a milk route of only about 75 quarts 
delivered daily* 
Tho consistent and heavy infoction of the milk, as 
evidenced by tho chronological occurrence of tho casos, points 
strongly to uddor infoction in tho herd. Hemolytic streptococci 
v/oro found in tho uddor of one cow. 
Ninety-five per cont of tho children under 5 and 
sixty-four per cont of persons of all ages who usod tho milk 
had either scarlot fovor or soro throat. 
In 11 casos out of 15 in which it could bo estimated, 
tho incubation period was 48 hours or loss. 
Four infants who woro being given pasteurized or 
boilod milk did not bocomo ill whon tho Initial casos occurred 
in tho family. Two dovolopod contact casos of scarlot fovor 
lator. 
Tho occurrence of secondary casos duo to contact in 
tho families affoctod emphasizes that tho total effect of such 
an outbreak is not over with the first generation of casos. 
Again wo havo an outbroak of railk-bomo disoaso spread 
by raw milk through a small routo. With about 85 per cont of 
our milk pastourizod, it is tho small raw routos that are tho 
potential monaco. 93 
(Reprinted by permission from Tho Rural Now Yorkor 
of Docombor 13, 1930, pago 1355.) 
EXPERIENCE WITH AN EPIDEMIC 
As a dairyman I make this report for tho general 
good. I have a good herd, my plant and my bacterial counts 
have boon consistently low. One of my cows cut a teat on a 
barbed wire fence. I sewed it up. It healed promptly. After 
tho cut had healed tho milk was put in and shipped with tho 
rest. Nearly two weeks after tho accident two calves got out 
of their pen and nursed her dry, probably injuring tho tender 
tissue of tho now healing. Tho next day when wo put tho milker 
on there was a hole in tho teat and tho milk leaked out. Wo 
fed hor milk to tho calves for a few days and then turned her 
out to pasture. 
Just before tho toat was torn opon tho socond time, 
two of my men and I had soro throats. Tho doctor said one of 
tho men had tonsilltls. Tho othor man wont to another doctor and 
his caso was callod a bad pair of tonsils. Neither doctor, so 
far as I know, said anything about not milking. Thon it was 
roportod that a number of pooplo in town woro sick with soro 
throat and wore saying that milk was tho cause, but tho thought 
that my milk had anything to do with it.novor occurred to mo. 
Howovor, an oxtonsivo opidomic of soro throat followed with 
several doaths. On chocking up on tho caso, tho Board of 
Hoalth found that tho pooplo affoctod had usod milk from ono 
or tho othor of tho dealers who got my milk. This was their 
first duo. 
A veterinarian examined my cows, and took separate 
samples of milk. Some of tho cows had had slight garget trouble* 
Tho health authorities found nothing. However, my milk was con- 
sidered tho source of tho trouble and,shipment was stopped about 
eight or nine days after I had stopped milking tho cow with 
tho injured teat. Thon the State Health Dopartmont took samples 
from all tho cows in tho barn including two that wore just 
drying off. Those showed nothing. Tho hoalth officials still 
insisted that there must have boon a cow responsible for tho 
opidomic and that thoy ought to find her. They took cultures 
from each of our throats and I got my first introduction to tho 
germ callod Hemolytic stroptococcus. How to spoil tho name is 
one of tho things I learned, but tho "bug" was worso than tho 
nano. Tho throo of us wore found to have the gems in our 
throats. 
Aftor tho opidomic was over, a hoalth dopartmont 
doctor showed no a chart of tho opidomic• It indicated that 
nost of tho patients had taken sick within two or throo days 
of each other (what ho called tho wppak” of tho epidemic) and 
then tho casos began to fall of rapidly until there wore no 
more* lifter ho loft, I got to thinking about tho "peak”• Tho 
casos had already began to drop off before my milk was stopped# 
This lookod funny* They told mo that it took anywhere from a 
few days to two wooks for tho disoaso to develop aftor a person 
got tho germ. This thoy callod tho "incubation period51. It 
thon occurred to mo that just a few days before tho cases began to fall off, I had stoppod milking tho cow with tho injured 
teat. Previously I had not thought of her so I got her in, 
boiled a bottle, took a sample and delivered it to tho State 
laboratory. They said it looked "suspicious'1. Something was 
wrong with the sample, and they did not get the "bug". They 
sent me sterile bottles and at their request I got a sample 
of milk from each quarter. This I did and from the samples 
they found the "strep" which they, were looking for. They found 
it in one of the uninjured quarters and not in the Injured 
one where the trou.blo must have started. Tho doctor told 
me this sometimes happens. The trouble will clear up in 
tho originally affected quarter and work into another quarter. 
Then two State doctors including tho Deputy Commissioner of 
Health came and took more samples and cultures. Those chocked 
out correct with the samples I had taken and it was definitely 
established that this cow was tho medium that had contaminated 
my milk. It was a relief to find tho mystery cleared up. 
The doctors say that one of us must have had the 
germ first and infected the cow in milking* If it must 
have occurred a short time before the epidemic started. When 
I stopped milking her the epidemic stopped. It is clear now, 
but it certainly was a mystery at the time. 
My oxporlonco has its losson and it helps rovoal 
our responsibility as dairymen to ourselves individually and 
collectively as well as to the public. If a cow has an injured 
teat or udder, her milk should not bo used for human consump- 
tion until a laboratory tost has shown it to bo safe* I have 
dlways believed that milk from a cow with oven a mild case of 
mastitis should not bo used until a laboratory tost has boon 
made. If nothing more, it is likely to run bacteria count 
up. But this experience shows that a cow can have mastitis 
caused by dangerous bacteria and still show no signs of in- 
flammation. If there is any question about a cowfs condition, 
it is bettor to nplay safe” every time. The loss of milk 
from a single cow is nothing compared with the loss that 
results from a loss of market for several weeks and no matter 
how good one1 s reputation is, .even when the trouble is over, 
it takes consumers a long time to got over their suspicion 
of your milk. The experience also shows that no one with a 
sore throat should milk cows or handle the milk in any way. 
Finally, I have got a different idea than I had before of 
the service of the Health Department and the good in its regu- 
lations. Wo farmers know little about epidemics unless wo 
actually run up against them, which fortunately does not happen 
very often, but the health authorities know what is going on 
over a wide territory. It is their business to help dairy- 
men avoid experiences of this kind, and my contact with them 
convinces'mo that they are anxious to avoid those troubles. 
Since milk is a medium that carries those dangerous germs, 
wo should cooperate in every way with the health authorities 
in their efforts to keep milk in its proper place as nature’s 
greatest food. 
DAIRYMAN. EXCERPTS FROM THE TEXTBOOK, 11 PREVENTIVE MEDICINE 
AND HYGIENE,11 SIXTH EDITION, BY DR. MILTON J. 
ROSENfiU, PROFESSOR OP PREVENTIVE MEDICINE AND HY- 
GIENE AT HARVARD MEDICAL SCHOOL, AND FORMERLY 
DIRECTOR OF THE HYGIENIC LABORATORY, UNITED STATES 
PUBLIC HEALTH SERVICE; PUBLISHED BY D. APPLETON - 
CENTURY COMPANY, NEW YORK. 
Page 147; '’Milk-borne typhoid, is always due to raw milk. There 
is no instance on record of such trouble coming from properly 
pasteurized milk. 
Page 391; "The mode of transfer (of undulant fever) is usually 
through raw milk and sometimes through dairy products containing 
Brucella; or by direct contact with infected animals or their 
tissue s.M 
Page 393; "The Brucella genus is readily killed by heat.... 
I have shown that 60 degrees Centigrade for twenty minutes is 
sufficient to destroy the melitensis strain in milk and pro- 
vides a margin of safety. Murray, McNutt and Furwin found 
that the temperature of pasteurization (62 to 63 degrees 
Centigrade) killed Brucella in throe minutes." 
"Undulant fever is usually contracted by drinking raw 
milk or by contact with infected animals." 
Page 395; "Our knowledge of the cause and modes of transmission 
of undulant fever makes the prevention of this disease in man a 
comparatively simple problem. The reservoir of infection is 
in livestock. Prophylaxis that would bo fundamental and enduring 
consists in its elimination from our domestic herds. This is 
not easy.*'• Even though herds be clean, they are readily reinfected. 
"Milk, including goat!s milk, should be pasteurized. 
Page 781; "The diseases conveyed through milk are; 'tuberculosis, 
typhoid fever and paratyphoid fever, food infections, diphtheria, 
scarlet fever, septic sore throat, raalta fever, undulant fever, 
foot and mouth disease, and milk sickness; also some of the 
summer complaints of children, and the diarrheal and dysenteric 
diseases of adults, which are often referable to infected milk. 
Epidemic arthritic erythema and infantile paralysis have been 
added to this list." 
Pago 782; "when all the facts arc brought together they make 
a strong indictment against raw milk. Thus the official record 
of milk-borne infections in Massachusetts tells the story.- Since 
the general.adoption of pasteurization for the milk supplies of 
the large cities in Massachusetts, milk-borne outbreaks occur 
characteristically in the small unpastourized supplies." 
Page 783; "Live tubercle bacilli have not been disclosed in 
pasteurized milk." page 784; 11 It is clear that raw market milk furmlshed all 
large cities and probably mosVsmall towns often contains 
tubercle bacilli*” 
Page 784; u0f milk-borne epidemics, typhoid fever takes the 
lead*..*.All outbreaks occur on raw milk routes*” 
Page 786: “The Boston outbreak (of se,ptio sore throat), 
in 1911, was characterized by its extraordinary virulence 
and comparative immunity of children, and high mortality 
among the aged and infirm* In this outbreak there were 
over 2,000 cases with about 48 deaths* One of the features 
of special Interest was that the milk incriminated had always 
been a particularly clean, fresh and satisfactory supply. 
It was obtained from tuberculin-tested cows under veterinary 
supervision, and the milk Itself subjected to frequent chem- 
ical and bacteriological tests. The milk was bottled at the 
dairy, the bottles wore sterilized, and many extra precau- 
tions were taken to insure its cleanliness. For twenty- 
eight years not a breath of suspicion was attached to this 
milk until this catastrophe occurred. It emphasizes the 
lesson that raw milk is apt to be dangeFbus milk,^and our 
only protection against those particular dangers is through 
pasteurization*^ 
“Another instructive outbreak reported by Benson 
and Sears, occurred in Portland, Oregon, March 24 to 31, 1922* 
In this epidemic there were’ 487 cases and 22 deaths. “Almost 
all of the cases and all but one of the deaths occurred among 
people who had drunk raw milk from one dairy which had been 
rated as one of the bTTsF in the city*” This is the common 
story.” 
Pago 789: outbreaks of disease are always due to 
raw milk: often milk of good qualityj oven certified milk, 
tho'r.p is no record of a milk-lb or no outbreak, attributable to 
properly pasteurized milk*n 
Page 790; “pasteurization prevents sickness and saves lives* 
Pasteurization is not ideal, but only expedient. It is advo- 
cated because milk is apt to convoy the viruses of a number of 
diseases harmful to man. Pasteurization effectively prevents 
this hazard. It implies precaution, protection and prevention. 
It is the best insurance both for'the industry and the con- 
sumer, and the simplest, cheapest, least objectionable and 
most trustworthy method of rendering infoefced milk safe. 
Next to water purification, pasteurization is the most impor- 
tant single prevention measure in the field of sanitation. 
£ago 792; “No one should drink raw milk that cannot bo guar- 
anteed by the off icer as safe and~pfree from danger. 
Ivon certif ied milk' or" milk or equally high character is 
only reasonably safe without pasteurization...There is no 
aulnont1 ic~ roc or d of any milk-borne epidemic caused by properly 
pasteurized milk.” Page 793; (by the health department) gives us 
a cleaner and better, but not necessarily safe milk. In- 
spectors cannot be present all the time, and furthermore, even 
if they were Pasteurs, they could not see missed cases and 
carriers* Pasteurization destroys the dangers inspection 
cannot see. The combination cf inspection and pasteurization 
corresponds in all respects to the modern principles of 
furnishing a safe water supply to a large city. The watershed, 
through inspection, is kept as clean as practicable, but the 
water is filtered or chlorinated to protect the consumer. 
,fThDro can be no more objection to the heating of' 
milk for the use of adults or children above the age of one 
year than there is to the cooking of moat. Infants should 
receive btfoast milk.' There is no adequate substitute. When 
this is .not possible, they should have the best and freshest 
cow*s milk that can be obtained. Whether such milk is to be 
pasteurized, modified,boiled or otherwise treated rests with 
the pediatrician. Pasteurization has the well-nigh unani- 
mous endorsement of sanitarians and ocdiatrlcians,M TEE PASTEURIZATION OP MILK 
By C. J. Babcock, market-milk specialist. Division of Market- 
Milk Investigations, Bureau of Dairy Industry 
UNITED STATES DEPARTMENT OP AGRICULTURE 
Leaflet No. 177, January, 1939. 
Milk is a medium in which bacteria live and multiply, 
and there are a number of ways in which they may enter an un- 
guarded milk supply. 
The vast number of people engaged in the production 
and handling of a city’s milk supply makes it physically im- 
possible for health authorities to be sure that some of the 
milk at some time will not come in contact with a so-called 
’’carrier,” that is, a person who unknowingly harbors organisms 
of a communicable disease. It is also impossible to be sure that 
all dairy farms are free from a polluted water supply and other 
sources of contamination, or that the milk from a diseased cow 
will not inadvertently enter the milk supply. Because of such 
uncertainties, a city or community that permits the general use 
of raw milk cannot consider itself free from the danger of milk- 
bomo diseases. 
Science, however, has developed the process of 
pasteurization, which if properly performed, makes themilk 
supply safe ;for consumption and at the same time maintains the 
nutritive value of the milk. 
STATUS OP PASTEURIZATION 
The pasteurization of milk for direct consumption, as 
applied under commercial conditions, moans a process of heating 
every particle of milk to a temperature not lower than 142 de- 
grees P. for not loss than 30 minutes (holder process), or to a 
temperature not lower than 160 degrees P. and holding at that 
temperature or above for not loss than 15 seconds (short-time, 
high-tornporaturo process). After the milk is pasteurized, it 
is immediately cooled to 50 degrees P. or lower. 
The holder process of pasteurizing milk is the method 
most generally practiced today. Some cities prohibit the use 
of the short-time, high-tomporaturo process. 
Pasteurization is at prosont favorably rogardod by 
most .physicians, sanitarians, dairymen, and consumers. As a 
result there is a constantly increasing trend toward pasteur- 
ization throughout the United States, At prosont more than 80 
percent of the milk supply of cities having a population above 
75,000 is pasteurized. As the relative size of the city in- 
creases, the percentage of the milk that is pasteurized in- 
creases, and very little raw milk is sold in the largo cities. 
In the smaller tov/ns and rural districts, however, only a small 
proportion of the milk is pasteurized. The United States De- 
partment of Agriculture recommends efficient pasteurization as 
a safety measure and advocates the pasteurization of all general 
milk supplies7 FACTS CONCERNING PASTEURIZED MILK 
Considerable opposition has attended the develop- 
ment of the practice of pasteurizing milk, and some opposition 
still exists. Most of the objections, however, have boon based 
on theory, or on experiments and experience in which the milk 
has not boon pasteurized under properly controlled conditions. 
One-of the early objections to pasteurized milk 
was that heating destroyed the lactic acid-producing bacteria 
but not the putrefactive organisms. It v/as contended that 
these putrefactive organisms, relieved from the restraining 
action of the acid-forming bacteria, would develop and form 
toxins and putrefactive products. It is now known that pasteur- 
ized milk sours in a manner similar to that of high-grade raw 
milk and that there is no more reason to fear the growth of 
excessive numbers of putrefactive organisms in it than in any 
other high-grade milk. Pasteurization, however, does destroy 1 
many of the lactic acid-producing bacteria, most of which got 
into the milk with dirt, and this accounts for the fact that 
pasteurized milk usually keeps longer than raw milk. ' ' 
Another contention has been that bacteria grow 
faster in pasteurized milk than in raw milk. Experiments, 
however, have shown that the rate of bacterial increase is 
approximately the same in raw milk and i'n pasteurized milk 
having about the same bacterial content* 
It is often stated that pasteurization oven though 
it kills bacteria, doeis not destroy poisonous products of their 
growth. If poisonous products of bacterial growth are present 
in raw milk, however, and if pasteurization does not destroy 
them, the pasteurized milk would bo no- worse than-the raw milk* 
The important point, of course, is that efficient pasteurization 
will kill all disease organisms that find their way into the 
milk, and they are certainly loss dangerous when dead than when 
alive* 
. - Objection to pasteurization has been based also 
on the supposition that it would have an unfavorable influence 
on the milk producer. It has boon assorted that pasteurization 
would load to lax methods on the farm because farmers knowing 
that the milk is to bo pasteurized, would bo careless in its 
production. However, only milk of high quality should bo pas- 
teurized, and at the present time standards of sanitary quality 
are proscribed for raw milk that is to bo pasteurized.1 
If has also boon contended that pasteurization 
may bo carolossly dono and therefore that it is not infallible* 
A study of the milk-borne epidemics of disease shows that oven 
in the early days of pasteurization, pasteurized milk was safer 
than raw milk* Moreover, the present practice of official in- 
spection in all pasteurizing plants greatly reduces the likeli- 
hood that the process will bo carolossly performed. Tho question of whether pasteurization destroys 
beneficial enzymes is still open* In the light of tho present 
knowledge of the enzymes in milk and tho part they play in tho 
digestive process, it is quite impossible to settle tho question 
of their importance. It is evident, however, that tho present 
methods of pasteurization have little effect on most enzymes. 
It is frequently stated that vitamins arc destroyed by 
pasteurization and if this wore so it would be important, 
especially in Infant feeding. Of tho several vitamins present 
in milk only one, vitamin C, which prevents scurvy, is impaired. 
However, milk is ordinarily such a poor source of this vitamin 
that when used as tho only food as in tho case of babies it 
should bo supplemented with antiscorbutics such as orange juice 
or some other suitable fruit juice. 
Serious objections have boon raised to pasteurized 
milk on tho theory that tho heating produces chemical changes 
that render the milk loss digestible, particularly for infants. 
Feeding experiments with babies, in which some were fed raw milk 
and others pasteurized milk, have shown there was only a slight 
difference in the average not dally gain in weight during tho 
feeding period. Tho slight difference was in iimny cases in 
favor of tho pasteurized milk. 
Consumers sometimes object to pasteurized milk because 
of a cooked taste. If a cooked taste occurs, it is duo to over- 
heating or to heating too rapidly. Properly pasteurized milk 
is equal to raw milk in flavor. With present apparatus for pas- 
teurizing milk, temperatures can bo so controlled that tho 
flavor is not affected. 
It has also boon stated that pasteurization reduces 
tho cream lino. When this occurs, it is due to overheating. 
In experimental work, milk heated to 143 degrees P. for 30 
minutes showed practically no decrease in tho cream volume, and 
in some cases an increase resulted. Moreover, a slight reduction 
in tho cream lino would not moan that any cream had boon taken 
out of tho milk. 
Tho fact that pasteurization increases tho cost of 
milk is a frequent argument against pasteurizing milk. When 
milk is pasteurized in largo quantities the cost is but a frac- 
tion of a cent a quart. Naturally tho smaller tho quantity of 
milk handled, tho greater tho overhead, and therefore tho cost 
may rise to approximately a cent a quart. From the standpoint 
of safety, efficiently pasteurized milk as compared with tho 
samo milk in its raw state is easily worth a cent or two a 
quart more. Tho additional cost of pasteurized milk is cheap 
insurance against milk-borno diseases. 
It is froquontly stated that pasteurization is un- 
necessary in the country, whore milk goes directly and promptly 
from producer to consumer. The fact that a largo proportion 
of the epidemics of milk-borne disease occur outside of the 
largo cities and that a largo percentage of those epidemics 
have had their source on tho farms, shows that pasteurization 
is as accessary in tho country as in the city. HOME PASTEURIZATION 
Ytfhoro it is impossible or impracticable to obtain 
pasteurized milk, milk may bo conveniently pasteurized in tho 
bottles in which it is delivered. Remove the cover from one 
bottle, pour out a little of tho milk, punch a hole in tho 
cover, replace the cover,' and insert a thermometer. Then sot 
all tho bottles of milk on a rack in a pail filled with cold 
water nearly to tho top level of *tho milk and heat until tho 
thermometer in tho milk registers 145 degrees F. Remove tho 
pall from tho heat and leave tho bottles in tho hot water for 
50 minutos, reheating if that is necessary to keep tho milk 
at 145 degrees P. After tho 30-minuto period, replace tho hot 
water gradually with cold until tho milk has cooled, preferably 
using ice in the last water. After cooling, keep tho bottles 
in tho coolest place available. 
VALUE AND NECESSITY OF PASTEURIZATION 
Tho valuo of pasteurization is greatest when 
applied to tho general milk supply# Tho pasteurization of milk, 
when tho process if properly performed, affords protection 
against pathogenic organisms. There have boon reported in tho 
United States numerous outbreaks of typhoid and paratyphoid 
fever, diphtheria, septic sore throat, scarlet fever, dysen- 
tery, and gastroenteritis traceable to raw milk* Investigators 
have shorn that the thermal death point of .pathogenic bacteria 
ordinarily found in milk is relatively low and that whore 
epidemics have boon due to milk, efficient pasteurization was 
effective in controlling the spread of tho epidemic through tho 
agency of milk. Furthermorej it is known that certain diseases 
of the cow nay bo transmitted through the milk to human boingsT 
Among human diseases so transmitted are tuberculosis and undu- 
iant favor. It is therefore absolutely essential to have a 
method of rendering the general milk supplies safe. Pasteuriza- 
tion is that safeguard. SHOULD ALL PUBLIC MILK SUPPLIES BE PASTEURIZED? 
And if So, Why? 
Prof, R. M. Washburn 
Roprintod from Tho Milk Dealer, September, 1931 
By 
An epidemic has hit us again, but this time, for- 
tunately, it is only an epidemic of propaganda instead of being 
an epidemic of some preventable disease. The disease may bo 
expected later, if the anti-pastourizationists have their way 
about it* 
Anyway, this would seem to bo tho fooling of tho 
llCommittoo on Milk,11 U. S. Public Health Report, Juno 19, 1931, 
who wrote: 
t;,To counteract raw milk propaganda based upon unsci- 
entific evidence, this committee quotes several studios which 
find pasteurized milk tho nutritive equivalent of raw milk, 
and urges tho U. S. Public Health Service to settle the ques- 
tion once and for all.* 
Tho differences between ,ftho two schools” are not so 
much questions of facts as they are of opinion concerning tho 
value or weight of tho facts. The economic losses of tho thou- 
sands of men and women temporarily incapacitated by some disease,*- 
as well as tho valuo of a life whether it be man, woman, or 
child—these are tho things which offset and more than outweigh 
in tho minds of many any possible superiority that raw milk, 
as such, may have over milk which has boon heated. 
The contention of those who advocate tho pasteuriza- 
tion of milk is well told in a paragraph from "The Pasteurization 
of Milkw in Western Dietitian, Juno, 1926, page 30, which roads: 
"One prevailing popular idea should bo commented upon* 
That is, that pasteurization is a process by which inferior milk 
is made usable* This is a mistaken notion. Pasteurization will 
not make good milk out of bad. It will not improve poor quality 
milk* It will not make clean milk out of dirty milk, but it 
does make clean .milk safe milk. Proper pasteurization does not 
affect tho flavor, odor, appearance, or cream lino of milk, 
materially alter its chemical components, nor diminish its 
digestibility or nutritiousnoss 
It was in 1857 that it was first definitely proved 
that milk could bo tho moans of spreading contagious diseases 
among humans« At that time thoro wore fow public agencies 
concerning themselves with the public health—epidemics ran their 
courses without investigation; but by 1880 tho matter had become 
sufficiently serious as to attract public attention so that 
better records wore kept, though often by private individuals. 
From 1881 to 1926 there wore recognized and reported 791 milk 
borne -epidemics in tho United States* During tho last quarter century In this country 
cities and towns havo grown tremendously in populations, but 
ovon more significantly in thoir control of tho public health. 
This control has had to do with tho wator supply, tho milk 
supply, tho fly supply, sowago disposal, and tho goncral sani- 
tation of stroots and alloys, Qno of tho elements of intorost 
in this connoction is tho almost complete disappearance of 
what was known as tho 11 town cow.11 Instead, there has grown up 
around the several towns and smaller cities a large number of 
dairy farmers who make it their business to produce milk in the 
country and sell it in the towns. 
Many of these farmers are naturally clean in 
their habits and naturally intelligent, but they are not 
naturally educated with respect to bacteria, culture media, 
methods of disease spreading, nor in the recognition of disease 
epidemics* 
This is the reason that in 1912 the Medical Milk 
Commission felt it necessary to lay down 97 specific rules for 
the guidance of the dairyman. It is a little difficult to 
visualize a practical dairyman applying 97 .varieties of ”do’s!f 
and ndonftsl! with respect to milk production, and yet there 
are that number that apply to the production of certified or 
certifiable milk. But oven with those safeguards and pre- 
cautions, several epidemics have occurred with certified milk 
as the vehicle* 
An article entitled Certified Milk bo 
Pasteurized” in American Journal of Public H0alth and the' 
Nation’s Health, has this to say: 
ltWhilo wo advocate pasteurization, and have 
advocated it for many years, wo still believe that raw certified 
milk is as good or bettor than a poorly pasteurized product, 
or one which has received proper treatment, but careless 
aftor-handling• In this connection, it might bo stated that 
the term pasteurization should not bo qualified. If the treat- 
ment is not properly carriod out, it is not pasteurization, 
and the process should not bo blamed, as it often is, for the 
faults which lie in apparatus or in operation.1* 
Or, in other words, a first class raw milk is as 
good as a second class pasteurized milk* Today we believe the 
reverse. 
Many dlarymon, of course, arc not attempting to 
produce certified milk but simply a so-called sanitary or 
’’Grade A” milk* All appreciate that a clean milk is far bettor 
than one not clean, that a Grade l,A” is doubtless bettor than 
a ,fBw or "C" milk* Wo all believe in sanitary production, but 
hero is the pinch in the matter. All milk, oven the best of 
milk, yes, even certified milk, may become infected with a 
specific communicable disease and thereby transfer it to the 
human being* This is not speculation—-it has occurred. Tho situation can be likened to a farmer and his wheat. 
The wheat itself may be shrunken, immature, or moldy and thus 
unfit for seed. On the other hand the wheat itself may be 
excellent and yet be infected with mustard or wild oats which 
would cause specific trouble were that wheat sown without first 
being treated for the removal of the trouble makers* When milk 
is consumed it is, in fact, a sowing of whatever bacteria there 
are in the milk, in the culture tube of the body* Many typos 
of bacteria die, some live, some grow—there arc thousands of 
kinds of bacteria with many diverse natures. Our jobs as 
dairymen consist in giving the consumer a milk which is not only 
clean, sound and wholesome in and of itself, but which is also 
free from the ’’wild oats and mustard.” 
For a hundred years or longer it has been known that 
the milk of sick, emaciated, or fatigued cows is not as good as 
the milk from healthy and contented ones. The infant mortality 
was shockingly groat in some of our American cities during the 
ugood old days” of keeping herds of'cows in .the cities, in 
basements, or other foul places whore they wore fed almost wholly 
upon what was well termed ’’swill,” Both the cows and the food 
wore unfit for the making of a wholesome milk. Wo older men 
recall readily the fight that was made by these so-called ”swill- 
ers” to maintain their systems of production despite the effect 
of their product on their neighbors* children. Public attention 
was directed to this as early as 1836. Public sentiment pre- 
vailed, but it v/as not until about 1906-1910 that herds were 
dispersed, removed to the country whore they belong. They are 
now kept under better conditions than ever before. The raw 
milk produced today in this country is far superior to that 
produced 40 or even 25 years ago, and yet this is what the 
department of health of Canada (Pub. No. 36) has to say regarding 
’’Pasteurization of Milk for Small Communities.” 
,HRaw milk is safeguarded in the careful supervision of 
processes of handling and by medical supervision of employees. 
While this supervision dons much to reduce the possibility of 
infection, experience has shown that the risk of contagion is 
no moans, small. Epidemics spread by supposedly carefully 
regulated raw milk supplies are of frequent occurrence. The 
United States Public Health Service has Issued a statement show- 
ing that 31 epidemics wore reported as occurring in the United 
States in 1924, all of which wore caused by infection of raw 
milk supplies. In one' case, the" paratyphoid"opidomic of* Now 
Rochelle, U .'"S'. A., reported by Dr. Huntington Williams in the 
Journal of the American .Medical Association, the infection was 
spread by the raw milk of a certified dairy. Contagious diseases 
arc practically never spread by properly pasteurized milk.u 
Dr. S. J. Crumbino, general executive, American 
Child Health Association, stated in an address before the 
Association of Dairy, Pood and Drug Officials of the United 
States, mooting at Lincoln, Nebraska, the following; "Undulant fovor is a lingering illness that weakens 
and incapacitates its violins over a long period or time, even 
of years. It is not a disease to bo considered lightly. Since 
the source, of the contagion is milk/ wo pan proven! the dis- 
ease by rendering the milk supply clean and safe* There Is 
unanimity of proof that pasteurization at the standard tem- 
peratures is completely effective so far as the organism caus- 
ins undulant fovor is concerned. 
nWit;h each now advance in the knowledge of infec- 
tious diseases, wo aro impressed with what appears to be the 
increasing health hazard in relation to those diseases duo to 
the consumption of raw milk*1,1 
Thus wo soo that ills other than those of long 
acquaintance are coming in for their day* 
Tho following statement of tho Department of 
Health of tho Stato of Now Jersey, is to tho point: 
"It is manifestly unfair, of course, to lay upon 
this one malady (undulant fovor) tho whole responsibility for 
requiring pasteurization. Outbreaks of four other diseases— 
typhoid fovor, scarlet fovor, diphtheria and septic sore throat-- 
have boon traced to tho use of raw milk so many times and in so 
many parts of the country that, wore undulant fever unknown, 
tho argument for pasteurization would still bo substantially 
tho same. 
"in New Jersey alone, during the last 13 years, 
22 outbreaks with 658 cases of tho first throe of those diseases 
wore attributable to raw milk. None could bo assigned to 
pasteurized milk in those 13 years, although such milk con- 
stituted tho major part of tho supply of tho stato. 
?,,Efforts of milk producers to rid dairy herds of 
tuberculosis, contagious abortion and mastitis aro important 
contributions to the production of clean milk. Such efforts, 
however, offer no protection against milk-borne infection of 
the typo which caused the 658 cases of typhoid, scarlet fever 
and diphtheria* 
"The only practical way yet dovi'sod of combining 
safety and moderate cost is milk pasteurisation 
Horo aro 1,365 noro reasons for pasteurizing milk 
and ice cream mixes: In the single state of Massachusetts for 
the throe years, 1927-1928-1929, there wore 10 outbreaks of 
contagious disease, all traceable to milk as aicarrier of the 
illness, according to Amorioan Journal of Public Health, October 
1930, issue. In those 10 outbreaks 1,365 persons wore affected 
and 68 died. Of those deaths, 48 wore cases of septic sore 
throat. ‘iNinotoen twenty-nine Is tho first year (in Massa- 
chusetts) since tho first outbreak of typhoid fever was reported, 
in 1886, that has not witnessed an outbreak of milk-borne 
typhoid fever. There has boon no outbreak of-milk-borne 
diphtheria for four years.t! 
The general benefits of pasteurization were shown 
by Louis Pasteur about 1865 and adopted in Sweden and Germany 
within a few years. A generation later it was applied and made 
useful in the United States by that great philanthropist, Nathan 
Straus. But it required almost another generation to get the 
process into wide usage, and even today a large part of the milk 
consumed has not been treated to insure safety to the consumer. 
Several states soon passed laws requiring that skim milk and whey 
be pasteurized to prevent infecting the pigs and calves,' though' 
they still permit raw milk to bo sold for human consumption. 
The proponents of raw milk usage are still tolling 
consumers that raw milk is by far superior as a food for their 
young and in some cases even sbrongly suggesting that 
pasteurization of milk, in and of itself, renders the milk all 
but unfit for use. One supposedly scientific paper In parti- 
cular has boon widely circulated to increase the sale of raw' 
milk* Not only does this paper draw conclusions unwarranted by 
tho data presented but in addition totally ignores the communi- 
cability of specific and various human diseases and tho part that 
milk has played for more than three-quarters of a century bo 
our knowledge, in tho spread of such diseases* 
Fortunately, disease germs are easily killed by heat. 
Diphtheria germs are killed by tho heating of milk to about 131 
and septic sore throat, and communicable cold germs are killed 
at about 134, while typhoid fever germs require 137 and tuber- 
culosis germs about 139. With those things established tho 
pasteurization of milk has boon fixed by statutes and ordinances 
at 143 to 145 degrees. Then to make assurance doubly sure, tho 
milk is to bo hold at such temperature for half an hour. Tho 
relation of temperature to grom destruction is well illustrated 
in tho graph of eight thermometers shown in this article. 
Pasteurization has boon going on for many years, with 
millions of children thriving on such milk, but now wo arc told 
that the temperature of 145 materially Injures some valuable 
property of tho milk* Wo wish at this point to call the atten- 
tion of tho raw milk'enthusiasts to the Tact thnt the motnors' 
of Europo havo ho on scalding tho milk at 185 degrees Tor theTr 
babies or ovon boiling It, nt 212 degrees, lor centuries, and 
they1are still doing lt« The Sv/iss people, notocl i'or tnoir 
sturdiness, arc as infants fed on boiled miIkV Throughout"all 
southern Europe scalding or boiling of the milk'has boon a 
traditional housewifely knowledge for we know not how many 
centuries, and is still taught not only by mothers to daughters, 
but by physicians both there and hero* ~ Dr. Abraham Jacobi, formerly of Columbia Univer- 
sity, said; . 
wTho most Important thing in tho ease of Infants 
is-lust this: *uso no raw miiic,^u " 
Dr. Jacobi first advocated boiled milk in tho 
United States in 1869, and yet, after 50 years of wide practice, 
ho hold the same view, if anything more strongly than at first. 
- When tho work of tho renowned Robert Koch made 
the- identification of tuberculosis in cattle possible, and it 
was found that a high percentage of all European cows wore 
tubercular, then milk was ordered to bo pasteurized and pas- 
teurization was established at 185 degrees and has continued. 
Moreover, the preservation of evaporated, sterilized milk in 
tins requires-a-temperature of about 235 degrees maintained 
for-15 to 20 minutes, and yet on this milk thousands of children 
are being raised, Tho children of the white residents in. China, 
India*: Africa,-. Central America, Alaska, Philippine. Islands, .and 
many mining and lumber towns of this continent arc being . 
raised very, largely on sterilized, evaporated milk which has' 
boon „,hoatpd,;to a temperature', hot 145, “n'6^}:lB5i212, 
but to 235, and still' they'■thrive Inf‘ants and young children 
of our, cities are-also .thriving .on sterilized-milk. 1 
Here is what tho same U. S* Bureau of Public Health 
has to say regarding tho general safeguarding of tho milk 
supply in this country: 
“With growth in our milk industry, with its 
complicated methods of collection, shipping, and distribution, 
tho. difficulty of properly controlling tho quality of tho market 
article has greatly increased. Milk is subject to infection 
from the time before it loaves the cow to tho time of its con- 
suoption, and whon onco infoctod, it Ts an excellent culture 
modi-hm for tho growth of many kinds of bacteria. 
* 11 In 1912 tho American Association of Medical Milk 
’Commissioners laid down 97 different rules and regulations 
which represented in its opinion minimal requirements for tho 
protection of a raw milk sufficiently safeguarded to bo sold 
as milk,* 
■ ■ • llWhon wo consider milk derived from 21,000,000 
cows -sc at to rod ovor tho whole of tho United States on somo 
4,500,000 farms and handled by millions of pooplo tho impossibil- 
ity of securing an adequate supply of properly safeguarded raw 
milk at a price within roach of tho masses is evident. Tho 
solution of tho problem in minds of most sanitarians lies in 
surrounding milk production with all practicable safeguards and 
then adding additional and essential safeguard of adequate 
pasteurization in machines of proper and approved design 
properly operated and controlled, the pasteurized product 
should bo promptly cooled, put into sterilized containers, 
capped without tho use of human hands, and promptly delivered to tho consumer. Boiling in tho homo constitutes tho last word 
in furnishing tho family a supply safo from infection,” 
In ono of tho papers roforrod to from which tho raw 
milk advocatos havo gathorod ovidonco that pasteurization is 
injurious, tho conclusion is basod upon tho woll being of eight 
(8) whito little rats, whereas on tho other sido of tho question, 
wo havo thousands, yos, tons of thousands of strong human child- 
ren growing healthfully, thriftily, as children should on 
pastourizod milk. Moreover wo havo as ovidonco a most romarkablo 
tost mado at Washington, D. C., in which 208 human babios woro 
fod on raw milk and 111 on a part of tho same milk pastourizod. 
At tho ond of 18 months thoso rocoivlng the raw milk had gained 
an avorago of ,4253 ouncos per day por child and tho pastourizod 
milk group had gainod ,4274 ouncos por day. 
Dr, C. A. Harpor, socrotary, Wisconsin State Board of 
Health, has tho following to sayj 
"Dovotoos of raw milk, of whom thoro are known to bo 
largo numbers throughout Wisconsin, aro continually throatonod 
by two particularly dangorous onomlos, typhoid fovor and soptio 
soro throat, and thoir children aro ondangorod by soarlot fovor. 
"In scattered localities, chiofly tho larger cities 
of tho state, local milk ordinances losson tho danger of con- 
tracting thoso disoasos, by moans of rigid sanitation provisions, 
but in tho greater aroa of the state unpastourlzod milk fre- 
quently has given rlso to serious opidomics and innumerable 
instances of contagion. 
"Soptio soro throat has roachod opldomlc sovorlty in a 
numbor of communities during the past five years, and all of 
thoso opidomics havo boon traood to tho milk supply of tho 
victims. 
”To tho old question as to whether safeguarding milk 
should fall to the duty of tho community or tho milk industry, 
loading citios of tho stato havo assumed tho duty from a muni- 
cipal standpoint, and tho stato board has urgod that this public 
health moasuro be adopted by tho smaller communities until all 
milk produced in Wisconsin will bo so handled as to bo abso- 
lutely safo. 
"Tho majority of raw milk drinkors in this stato, tho 
board boliovos, drink it from nocossity rathor than from choice, 
duo to lack of pasteurizing facilities in tho rural roaches,” 
Horo wo quota from tho 1924 Annual Report of Dr* 
E. R. Kolloy, Commissioner of Hoalth, Massachusetts Stato 
Department of H0alth, and from among tho last things vAiich ho 
wrote j 
"Tho fact that milk ■under tho groat os t procautions and 
highest standards of general cleanliness can still transmit 
virulent tuborclo bacilli and tho organisms of typhoid, scarlet 
fovor, diphtheria, and soptlc soro throat, not to mention various minor typos of infection, has lod the health authorities of the 
state at largo persistently to advocate officiont pasteurization. 
As a rosult, epidemics from tho four diseases mentioned have 
become very rare and tho total number of cases traced to milk 
has fallen from an average of well over 1,000 annually for tho 
years 1907 to 1915 to an average of a little over 100 for tho 
past four years. During tho same four years tho percentage 
of the total pasteurized milk supply of the state has increased 
from 34 to over 75, with many of tho largo cities reporting 
over 90 per cent pasteurized. Many important legislative 
measures, both statewide and of local application, have boon 
made effective, culminating during the present year in action 
by several progressive cities which in effect provides that in 
tho future no milk can bo sold In those cities unless it is 
both of a high grade of cleanliness and efficiently pasteurized, 
or, if sold raw, that it must bo from herds officially certi- 
fied to bo entirely free from tuberculosis 
One of tho most conspicuous milk-bomo epidemics 
in recent times occurred in Canada last autumn and was reported 
in tho Canadian Public Hcalth Journal, May, 1931. It says; 
T,*A sovoro epidemic of soptlc sore throat occurred 
in Kirkland Lake, Ontario, in December, 1930. In a few wooks 
over 450 cases and four deaths wore thereby added to tho toll 
of disease spread through the use of raw milk.1* 
Tho science of preventative medicine and tho 
science of public health administration have grown up with tho 
past quarter of a century. 
Dr* Milton J* Rosonau, Professor of Preventative 
Medicine, of Harvard University, says; 
,fPasteurization savos lives and prevents sickness. 
It does not injure the quality of tho milk in any .way and does 
not diminish its nutritive value. Pasteurization is tho 
cheapest form of life insurance that tho customer can take out.w 
Tho U. S. Public Health Service says; 
nMilk is second in importance only to water as a 
vehicle of disease transmission.tr 
Others who aro in a position to know tho facts, 
yet aro in a noutral position in tho matter, may bo quoted: 
Dr. Thomas D. Wood, Columbia University; 
uAt tho prosont time, on tho basis of tho ovidonco 
within my knowlodgo, I boliovo that compulsory pasteurization 
for all milk is a dosirablo safeguard for tho public health/* 
Dr. W. A. Evans, national authority on foods and 
health, says; 
,!In tho spring of 1912 thoro was an opidomic of 
soptlc sera throat which again emphasized tho hazard of raw milk supply in a city. In this epidemic there wore 487 cases of 
epidemic septic sore throat. There wore 22 deaths. This is a 
rather heavy hill to pay for the privilege of drinking raw milk. 
Of the cases, 23 drank the milk in a hospital and 104 in a 
girls* home. The remainder were in private homes. Some 
pitals and some girls* homes are not free from the folly of 
drinking raw milk. Pasteurization as a routine would have pre- 
vented it.11 
Dp* 1/foi. H. Peters, Health Commissioner of Cincinnati, 
says; 
"All certified and inspected milk in Cincinnati, after 
December, 1929, must be pasteurized, by order of the board of 
health, in co-operation with the milk commission of the academy 
of medicine and the producers. Certified inspected milks 
were always rated high; but the opinion prevailed that both 
would be just that much bettor after pasteurization, whiph wo 
look upon as an additional safeguard.” 
S. J. Crumbino, M. D., executive officer, American 
Child Health Association, in a paper on "A National Co-operative 
Campaign for Clean and Safe Milk," given at the seventeenth 
annual convention of the International Association of Dairy 
and Milk Inspectors, said: 
MIt is noted that in the larger cities the consumption 
of pasteurized milk is greater than in'the smaller ones. As 
in the case of water, so wo have the anomalous situation that 
the safest water and the safest milk is that distributed by 
the larger cities. By the same token typhoid fovor has become* 
almost unknown in the larger cities; indeed, this disease 
is now sometimes known as the rural disease, depending chiefly 
upon its dissemination through unguardod water supplies and 
unpasteurlzod milk supplies 
Appreciating all those things the Illinois State 
Department of Public Health in co-operation with the medical 
college is undertaking a campaign of education of consumers of 
milk, especially in smaller places, and have the following to 
say: 
"The advantages of pasteurized milk need not bo dwelt 
upon in this journal. Our purpose is to report experiments 
upon the use of vacuum and insulated heat retaining bottles to 
pasteurize milk in small quantities for homo use. This is a 
part of a program of the Illinois State Department of Public 
Health to reduce infant mortality in communities too small 
to enjoy the benefits of commercial pasteurized milk.” 
And we notice in the report of "Subcommittee on 
Communicable Diseases Transmitted Through Milk” (preliminary 
report of White House Conf.), reported in U. S. Public Health 
Report, April 3, 1931, Vol. 46, p. 776: 
"The probable reason for the higher incidence of milk— 
homo epidemics in the small country towns and rural sections, 
and the cities of from 5,000 to 25,000, is that in such com-* mimitios wo find tho larger population groups boing sorvod 
almgst wholly by raw milk; that is, milk not produced under 
effective or, in the majority of instances, any source of 
continuing controlling* 
Our- national neighbors to tho south as well as ,. 
north a position well expressed byDr. Charles Hastings-,, 
Medical Officer of Health, Toronto, Canada, who saidi • 
tfIt is inconceivable how any thinking person will 
in the light of modern knowledge, jeopardize his own reputation 
by advancing arguments against the scientific pasteurization 
of milk* In my .1 udgmont, any municipallty failing to safoguard 
its milk supply by moans of scientific pasteurization is, in 
tho light of modern knowledge, guilty of criminal negligence*** 
Tho several common chomlcal components of milk 
aro not injured by boat, so far as experience or tost has yot 
shown and thoro aro decided physical benefits as well as health 
insurance* Thoro arc six or seven kinds of vitamins and all 
aro found in milk* Of those, t*ho one that prevents scurvy, 
called tfC," is tho only one that is injured by heating* It 
is reduced about one-half. , But thoro is a deficiency of this 
vitamin in milk anyway under practically all conditions of 
production, thus requiring that orange or tomato juice bo ad- 
ministered to Infants and that most any fruit or vegetable bo 
used by older children and adults. 
Simmered down to its last analysis, the question 
is whether wo, should encourage, a milk containing' tho last 
possible traces of vitamin nCfl value or whether wo should 
encourage tho consumption of milk, produced tho host that 
science and,economics will permit, made safe by pasteurization* "THE NUTRITIONAL ASPECTS OF MILK PASTEURIZATION" 
By Dr. E. V. McCollum, F.A.P.H.A., Johns Hopkins University 
Baltimore, Md. 
EXCERPTS' PROM; 
Intomationally known Export on Nutrition and Hoalth of tho 
Loaguo of Notions 
From tho American Journal of Public Health, Vol. 24, No. 9, 
Published by tho American Public Health Association, 50 West 
50th St. N. Y. C. 
"Tho ovidcncos of animal oxporinont do not show any 
nutritional dlfforoncos botwooh raw and pastourizod milks.” 
"Thoro is no convincing ovidonco that raw milk, ovon 
if it woro safo, is superior to pastourizod milk in Infant 
fooding. Pastourizod milk is probably bottor sinco it is moro 
oasily dlgostod. Tho growing practice by pediatricians of 
boiling milk or of fooding ovaporatod milk to infants, shows 
that it is cortainly satisfactory* Tho idoa of splitting hairs 
ovor slight assumed dlfforoncos is absurd*11 
t!Tho hoating of milk is so groat a safety factor in 
preventing disoaso that thoro should no longor bo any argument.” 
"Wo have an immense amount of clinical evidence 
gathered from many countries which shows that, pasteurized milk 
has fulfilled tho needs for feeding infants and children over 
many years, with no evidence of damage." 
"Tho opponents of pastourizod milk havo conspicuously 
failed to make a ease against it in favor of tho raw product. 
Tho marked lessoning of incidence of intestinal troubles and 
contagious diseases carried by raw milk accomplished by pas- 
teurization makes it hard to understand how opposition can 
longor be justified." 
"Tho Lanarkshire, Scotland, study of 10,000 children 
rocoiving throo-quartors of a pint each daily - 5,000 raw, 
grado A milk and 5,000 pastourizod milk - with 10,000 as con- 
trols, gave cloar ovidonco of tho bonoficial offoct of milk 
fooding on tho rate of growth. Thoro was no difforonco in tho 
raw and pastourizod milks.” 
"Schounort and Blschoff studied tho food valuo of 
raw and hoatod milk, and found no detectable chango in food 
valuo. Those experiments furnish cogent evidence that cooking 
(foods other than milk as well as nilk) as ordinarily practised, 
does not interfere with its usual influence on coll metabolism 
or prevent its utilization for such characteristic demands as 
growth and reproduction.” 
"Fortunately wo now havo available an oxcollont study 
of Leslie C. Frank and others of tho U. S. Public Hoalth Sorvico, 
which should finally silonco tho critics of pastourizod milk* 
Those investigators studied children fod raw and hoatod milk, 
supplomonting tho dlots ordinarily rocoivod by American Children in 39 citios and in 10 states* Tho children to the number of 
3,700 wore from 10 months to 6 years. Tho report states; 
*rho growth-promoting capacity of heated milk 
plus tho supplementary diet received by the average American 
child of 10 months to 6 years is not measurably loss than tho 
growth-promoting capacity of raw milk plus tho supplementary 
diet received by tho average American child of 10 months to 
6 ‘years* Children who are fed pasteurized milk thrive as well 
as children* who arc fed raw milk, and contract certain com- 
municable diseases loss frequently.’ 
”Tho average weight of tho children in tho two 
groups was 33*6 and 33.2 lbs. respectively for those fed heated 
and raw milk. There was no significant differences in tho 
heights of tho children of tho two groups, i.o., 37.5 and 37.4 
inches respectively.” 
”Tho report shows a significantly higher incidence 
of diphtheria, scarlet fever; and intestinal disturbances among 
users, of raw milk.” 
"Since tho'offoct* of pasteurization on tho food 
value of milk is too slight to bo apparent even in specially 
designed experiments, and is not apparent in observations on 
children living under ordinary American conditions, there is 
no valid argument which can be brought forward In support of 
the marketing of raw milk for the general population.*1 ' ” 
”Tt seems ,(strongo indeed,that, when wo accept so 
generally tho cooking of most df our foods, thoro should still 
remain in certain areas a'serious objection to tho milk heat 
treatment of milk involved in pasteurization. Tho menace of 
bovine tuberculosis to the health of children is so great that 
universal pasteurization would be imperative if only for tho 
prevention of the spread of this disease alone among children.” REPRINTED PROM THE JOURNAL OP THE AMERICAN MEDICAL 
ASSOCIATION, VOL. 115, NO. 20, NOVEMBER 16, 1940, 
BEING AN EDITORIAL IN WHICH THE AMERICAN MEDICAL 
ASSOCIATION AGAIN RECOMMENDS PASTEURIZED MILK. 
"JUG STATION" MILK 
In 1952 the Journal condemned the sale and use of 
bootleg milk, namely milk offered for sale outside municipal 
limits and therefore not subject to the regulations governing 
the sale of milk within the municipality. Several health 
officers at that time were confronted with the health hazard 
developed by the sale of milk at roadside stands to residents 
of nearby cities. Such milk was cheaper than milk sold in 
the city. Often it came from farms of such insanitary condition 
that their product could not be offered within the city limits. 
Studies by the United States Public Health Service 
and the former American Child Health Association have demon- 
strated again and again that milk-borne epidemics are due al- 
most exclusively to raw milk supplies. In many parts of this 
country, especia11y the smaller cities, raw milk still consti- 
tutes an appreciable percentage of the daily milk distribution. 
Raw milk unless certified is frequently produced under condi- 
tions not conducive to safety* The danger of contamination of 
raw milk has been recognized even to the extent that producers 
of certified milk and the American Association of Medical Milk 
Commissions, which supervises certified milk production, are 
agreed that pasteurization would be an additional safeguard 
even for certified milk. 
The sale of raw milk continues in spito of the fact 
that pasteurized milk is safer. Certainly there is no estab- 
lished evidence to indicate that raw milk is any more desirable* 
nutr i t ion ally than pas tourize d mi ITT The Council on Foods and 
Nutrition of the American Medical Association has published 
the following decision concerning the relative nutritional 
values of raw and of pasteurized milk. 
"Milk is an excellent medium for many dangerous 
bacteria as well as an excellent food for men. Disease germs 
may enter the milk directly from an ailing cow, bo introduced 
by insects, or bo transferred to the milk by the fingers or 
mouth-spray of persons having to do with tho collection or 
transportation of milk. 
"The pasteurization of milk is a public health measure 
The public should demand pasteurized milk for drinking and the 
use of pasteurized milk in milk products. The dairy trade 
shiould universally adopt pasteurization in the interest of 
public health. 
"There is no cogent evidence that pasteurized milk 
is significantly inferior nutritionally to raw milk." 
Even today bootleg milk stations, also called "jug 
stations" still operate outside the corporate limits and conse- quontly outside -the jurisdiction of some cities in which only 
pasteurized milk, other than certified, is legal. When every 
possible legal precaution has been taken to protect a community 
against potential dangers in raw milk, and milk consumers per* 
sist in c ire univenting the local regulations by buying milk 
from unsupervisod sources, the occurrence of milk-borne out- 
breaks of communicable disease''cannot be attributed to any 
failure on the "part of the health authorities". Unless county 
and, state authorities cooperate with ci¥y health officials in 
controlling this menace to health, outbreaks of milk-borne 
infection arc bound to occur. DAIRYMEN, DISTRIBUTORS, GROCERS, AND RESTAURANT 
OWNERS MAY BE HELD LIABLE FOR UNDULANT FEVER 
Excerpts from An Opinion of the Supreme Court of 
Washington Given August 30, 1940, As Presented In the Washington 
105 Pacific Reporter, 2nd Scries. 
The Opinion sustains a judgment of $7500.00 for a 
patient who acquired undulant fever from raw milk, and further 
states that similar law suits may be brought successfully 
against not only the immediate vendor, but also the retailer, 
wholesaler, producer, and all others who participate in the sale 
of deleterious articles, such as infected raw milk. 
Hence the dairyman producing raw milk, as well as the 
distributor, grocer, and/or restaurant owner who sells or 
servos such raw milk may be held liable should someone become 
ill from using such raw milk. 
(A large number of cases of undulant fever have been 
reported in Kansas'City, Kansas. Although most of the cases 
wore traced to Grade A raw milk sold to homos, and milk sold 
at milk stands just outside the city, some of the cases were 
traced to Grade A raw milk sold at stores and served in 
restaurants.) 
CASE OF NELSON V. WEST COAST DAIRY CO. ct al 
SUPREME COURT OP WASHINGTON 
AUGUST 30, 1940 
"Whore articles of food are sold for domestic use and 
immediate consumption, the law implies a warranty that articles 
are sound, wholesome, and fit to be consumed, and if consumer 
is made sick through consumption of food, he has a right of 
action against the vendors thereof, cither for breach of im- 
plied warranty or for negligence, and in such action it is un- 
necessary cither to allege or prove scienter, and consumers 
right of recovery is not limited to an action against his own 
immediate vendor, but roaches retailer, wholesaler, producer, 
and all others who may participate in sale and distribution of 
deleterious articles.11 
(Scienter means - Knowledge by the defendant that a 
certain article or act is harmful, wrong, or contrary to law.) 
"Negligence, like any pthcr fact, may be proved by 
circumstantial evidence, and such evidence sufficient to sustain 
a finding or verdict for plaintiff if it is shown that in all 
reasonable probability plaintiff’s injuries were proximate 
result of defendant’s negligence." 
"In action for injuries as result of negligence if 
there is proof of probable cause, whether injury resulted in 
consequence of established cause may be loft to reasonable 
inference "In consumer’s action against operators of dairy 
farm, a dairy to which operators sold milk, and individual v/ho 
conducted milk route selling milk purchased from dairy company 
for damages sustained from undulant fever contracted by con- 
sumer while drinking milk produced and marketed by defendants, 
evidence warranted finding that most probable cause of consumer’s 
illness was his consumption of infected raw milk furnished by 
dairy company.11 
"One who sells milk which fails to conform- to 
the standard prescribed by law is liable, even though the 
milk has not been tampered v/ith by the seller and is sold in 
the same condition as when it came from the herd. Prom the 
necessities of such situations, and in reason, the consumer’s 
right of recovery is not limited to an action against his own 
immediate vendor, but reaches the retailer, wholesaler, pro- 
ducer, and all others who participate in the sale and distri- 
bution of such deleterious articles of food." 
"Undulant fever is a disease which, as indicated 
by its name, manifests itself in recurring waves. Over a long 
period of time it may successively intensify and-subside• The 
medical profession has given it particular study since about 
1930, but as yet has discovered no cure for it. It has boon 
definitely established, however, that the germ of the disease 
is the same as that found in "brucella abortus," commonly known 
as "Bang’s disease", to which practically all animals, more 
particularly cattle, goats, and swine, arc subject. Cows that 
are infected with the disease arc likely to eliminate the 
organism in their milk because the germ localizes itself in 
the udder, and it has been found that fifty percent of all 
cows so infected actually do eliminate the organism in that 
manner. It has also been found that cows which, \ihon tested, 
show a blood titer of 1-200 almost invariably shod the germs 
in their excretions, including the milk, and that some cows 
having a titer as low as 1-50 will do likewise. The higher 
the titer, the greater and more virulent the organisms, and 
even milk with an extremely low bacterial count may bo heavily 
contaminated." 
"Bang’s disease is one of the most contagious di- 
seases to which cattle are subject. One cow can easily infect 
an entire herd. The incubation period in the animal varies 
from thirty days to four months." 
''According to well-rccognized medical authority 
upon the subject, undulant fever is contracted by human beings 
as the result of drinking raw milk or by contact with infected 
animals . If all milk yjoro efficiently pasteurized or boiled 
before being c'nsumcd, there would be no brucellosis (undulant 
fever j 'except' in those occupational groups whose work brings 
the* individual in contact with infected animals or infected 
carcasses. Among city dwellers and others who do not come 
in contact with animals, the chief sourse of undulant fever 
is raw milk. The incubation period of the' organism in human 
beings is said to range from two weeks to a month." "On January 31, 1936, a state tost was made of the 
K&M herd (one of the producers in this law suit), consisting of 
forty-nine cows at that time. The test was voluntary on the 
part of the owners of the herd. It showed, however, that eleven 
cows were infected with Bang’s disease, and that three others 
were "suspects." A subsequent test of the three suspects shows 
that one is a "reactor", v/hilo the other two wore clear. All 
reactors wore slaughtered as soon as their condition was dis- 
covered, In March, 1936, the whole herd, consisting of fifty- 
six heads at that tine, was again tested, showing no reactors, 
but throe suspected. The suspects wore separated from the 
rest of the herd, and later, upon another test, one was found 
to bo a reactor, while the ether two showed "negative." In 
November, 1936, a suspected animal alone, was tested, and v/as 
found to bo infected. No test of the entire herd v/as again 
made until November, 1937, several months after respondent 
(plaintiff) became ill, at v/hich time, out of a herd of fifty- 
seven cattle there were twenty reactors and four suspects." 
"A similar test cf the Hans, herd (the other pro- 
ducer supplying the dairy) was made in February, 1936. It 
disclosed two reactors, and they wore promptly slaughtered. 
In April, 1936, a test of twenty-five head disclosed no reac- 
tors and but one suspect. No further information concerning 
the suspect is furnished by the record. No further tests of 
the Hans, herd v/as made until September, 1938, at which time 
out of twenty-five head of cattle, there were three reactors 
and one suspect." 
(This illustrates that frequent testing of cattle 
docs not offer complete protection to either the dairyman or 
the consumer.) 
"Considering the evidence from every angle, we arc 
of the opinion that the trial court was fully warranted in 
finding that the most probable cause of respondent’s illness 
was his consumption of infected raw milk furnished by appellants, 
and that in arriving at that conclusion the court v/as not moved 
by, nor required to indulge in, conjecture or speculation. It 
is conceded that respondent had undulant fever; it is shov/n 
that among urban dwellers the principle cause of such fever is 
the investigation of raw milk that is infected with the germs 
of Bang’s disease; it was reasonably established that the cov/s 
from v/hich the respondent obtained the milk, through tho 
appclants, were afflicted with Bang’s disease during the period 
of such consumption It seems to us that respondent has, by 
circumstantial evidence, made as clear a case of liability as 
could be expected or required in a case such as this 
"The judgment is affirmed." 11 To the 
HEALTH COMMISSIONERS 
of the 
CITY OF LOS ANGELES 
A Report on the Local Milk Situation1' 
by 
GEORGE PARRISH, M. D. 
Health Officer - Los Angeles City Health Department 
(Reproduced with the Permission of Dr. Parrish) 
Approximately three score and ten years ago, Louis Pasteur, the 
world’s greatest biochemist and bacteriologist, began his resear- 
ches on the effect of heat in checking the fermentation in wine, 
which studies were later to extend to milk and lead to pasteuri- 
zation* Prom 185V to 1863 Pasteur worked with both wine and milk 
and found that bacteria could be killed by heat* In 1865 he 
announced to the Academy of Science at Paris, that maintaining 
wine for a fey/ minutes at a temperature of 140 degrees P. to 158 
degrees, kept it from spoiling. 
Dr* Jacobi.of New York, in 1875, seems to have been the first 
to recognize the public health aspects of pasteurization and ad- 
vised the use of heated milk for infant feeding* In.. 1886, the 
great German scientist, Soxhlet, continued experiments in pasteu- 
rization and devised the first small home made sterilizer. It was 
not until 1893 that a concerted and concentrated drive was begun 
on the use of raw milk. In that year, Nathan Strauss established 
in New York city a well equipped laboratory for furnishing pasteu- 
rized milk for infant feeding* In 1897 as Health Officer of New • . 
York City, he became distressed over the excessive death rate 
among the city's waifs living in institutions on Randall’s Island. 
Early in 1898 he erected a pasteurization plant on the island. 
Without any change in the regimen or diet, except that the same 
milk from their own herd of cows was pasteurized instead of toeing 
served raw, the death rate dropped from an average of 41.8 for the 
years 1895-1897 to an average of 21.7 for the next seven years. 
Nathan Strauss really v;as the pioneer in commercial pasteurization. 
Aclosc observer and a lover of children, ho was driven through 
desperation to do something to save the lives of the little ones. 
He said, "In 1892 great number of babies wore dying during their 
first and second year, often one half of thorn, and in some insti- 
tutions practically all of them. Sixty-four percent of one v/eek’s 
death roll was composed of babies under two years, who were almost 
wholly dependent on milk for nutrition.” Ho said, "I sensed the 
fact that most of those deaths wore due to impure milk*" 
••The success of his first station led to the establishment of 
others until for many years ho operated eighteen stations. His ' 
annual expenditures amounted to more than 8100,000 a year for many 
years. Having thus sown the seed of pasteurization as a protec- 
tion to child life in this country, ho wrote, "Thirteen years ago 
I believed that the pasteurization of milk was the only remedy. 
Today I know it. There can bo no question but "that the supply of 
milk everywhere should bo pasteurized, not only that intended for 
infants, since the use of raw milk for adults is almost equally 
f r&iight with danger•" Prom the days of Strauss down to the present moment, scienti- 
fic medical men, public health authorities, and the majority of 
all modern and up to date dairymen have striven to v. r.c/the;publ 
that the only safe milk is either pasteurized or certified. Raw 
milk is dangerous. Ur.f rtunately,in the ordinary course of events 
it takes twenty years or longer for knowledge of a medical dis- 
covery to spread through society and become a matter of common 
thought. During these years milk borne diseases have continued 
in the United States at the rate of fifty epidemics a year, al- 
ways claiming their toll of death and leaving many others 
maimed and crippled.The great struggle for better milk to date 
has not been without results, for in almost all cities of 50,000 
or over throughout the land, approximately 85 % of the milk, or 
more, is"now pasteurized and the percentage is constnatly in- 
creasing. 
In Los Angeles City about of the milk is pasteurized* 
But it is that one quarter that is still being sold as raw milk 
that causes uneasiness, unrest, and anxiety to your health 
authorities* In spite of all diligence and care, who can say 
what moment some raw-miIk-borne epidemic may start and who can 
predict what dire tragedy and results it may carry with it* 
Raw milk is and ever has been Public Health Enemy No* I* 
it Is too bad people jump at conclusions or are so easily- 
led* So many arc prejudiced v/ithout reason. What possible 
objections could anyone have against pasteurized milk? Do you 
Show what it really is, or is it just a name to you? Do"you 
realize"what'Pasteurized mllK moans to you or your child? 
PASTEURIZATION 
Milk should be heated to 142 degrees P* to 145 degrees P. 
and held for thirty minutes. This is called PASTEURIZATION. 
This process of'pasteurization will kill the viruses (poisons) 
of tuberculosis, typhoid fever, scarlet fever, diphtheria, tin-' 
dulant fever, dysentery, septic sore throat and other diseases* 
This temperature will kill practically all the non-spore bearing 
micro-organisms (bacteria) that cause disease in man* 
Heating milk to this temperaturc does not alter its taste, 
odor or digestibility. It docs not interferowith its food value 
and has the advantage of preventing much sickness and saving 
many lives. Pasteurization is the most trustworthy method of 
rendering milk safe. Only certified milk or milk of equally 
high character can be regarded as reasonably safe without pas- 
teurization. Pasteurized milk must bo handled at least as care- 
fully as Class A raw milk. rfbc( combination of pasteurization 
and inspection spoils safety. 1hero can foe no objection to 
pasteurization for the use of adults or children. Infants should receive breast milk. Babies raised'on cow’s 
milk, raw or cocked, should also be given orongc Juice. Pasteu- 
rization has been endorsed by the American Medical Association, 
the National Association for the study and prevention of Tuber- 
culosis, the American Public Health Association, the United 
States Public Health Service, the National Commission of Milk 
Standards, and by all ranking health officers. 
WHAT AUTHORITIES SAY of PASTEURIZATION 
The Annual Report of the International Association 
of Dairy and Milk Inspectors says: "Pasteurization of milk is now 
generally recognized, both legally and scientifically, as an 
essential feature of good dairy practice. Physicians, health 
officers, agricultural scientists, nutritional authorities. Jud- 
ges and leaders in the Daily Industry, are all agreed that modern 
pasteurization sets the final seal of safety on a clean milk' 
supply*" 
MARY STEWART Ph.D., Professor of Nutrition, Teacher’s Coll- 
ege, Columbia University, "Pasteurization is the safeguard 
against disease producing bacteria." 
WHITE HOUSE CONFERENCE, The White House Conferences called by 
President Hoover, September 29, 1932, "Pasteurization should be 
required wherever practicable. Pasteurization is not intended 
to take the place of the sanitary production of clean and whole- 
some milk, but rather to provide the final factor of safety from 
milk-borne diseases 
WILLIAM,.!!. PARKS, M. D., a world’s leading authority. New York 
Health Department* "Raw milk is not free of the danger of causing 
infection, when consumed by cither infants or older persons. 
Proper pasteurization of milk kills all possible varieties of the 
disease germs in it which wc know to be able to cause infection 
upon swallowing." 
DR* H* E* HAZELTINE, Senior Surgeon of the United States Public 
Health Service, has frequently ordered all milk pasteurized 
where the raw milk has caused an outbreak of communicable disease* 
CANADIAN PUBLIC HEALTH JOURNAL, in 1932, the Canadian Public Health 
Journal carried the following editorial: "The Canadian Public 
Health Association stands unequivocally for the pasteurization of 
all milk supplies as the one and only means at our disposal fbr 
the final safeguarding of the health of the public from the dan- 
gers associated with the consumption of raw milk. The necessity 
for general pasteurization is amply demonstrated every year in 
our-death rates from diarrhea and enteritis, in our milk-borne 
typhoid epidemics, our septic sore throat “Outbreaks, the increas- 
ing cases of undulant fever and our cripples from bovine tubercu- 
losis." W* J. TIEDMAN, M. D., New York State Health Department, says; 
"No natter how carefully raw milk Is produced, pasteurization 
will make it safer." 
AMERICAN JOURNAL OP NURSING, November 19, 1930, "Miss Alice Evans, 
who lias done much research work on undulant fever, cays: »No 
milk other than certified or pasteurized is safe, for the cattle 
disease is widespread in the United States. No raw milk is safe 
unless it comes from a herd that is absolutely abortion free and 
so certified by the official authorities.*" 
DRS. WILL 5c CHARLES MAYO, Rochester, Minnesota, "If the person 
milking the cows or handling the milk or the utensils is suf- 
fering from an infectious disease, such as septic sore throat, 
tuberculosis, diphtheria or scarlet fever, there is a strong 
possibility that they will infect the milk and spread the di- 
sease. Milk is the most valuable food, but it should be pas- 
teurized. The value of pasteurized milk cannot be overestimated. 
Pasteurization is the best of all know n treatments of the nation* 
milk supply and in the final analysis for all its dairy products." 
(Northwestern Journal). . . 
In a report issued by the Committee on Milk at the Conference 
of State and Provincial Health Authorities of North AmGrica> it 
said* Man is a far more important source of disease organisms 
in milk than is the cow and man is more difficult to control. 
It is for this reason that properly pasteurized milk is the 
safest milk." 
E. V. McCOLLUH 5c NINA SIMMONDS, Professor and Associate Professor, 
School of Public Health and Hygiene, Johns-Hopklns University, 
Baltimore, Maryland, in their book. Pood,•Nutrition and Health, 
wrote. Pasteurization came into use because of the frequent ex- 
periences of health officials that epidemics of typhoid fever, 
scarlet fever, septic sore throat, etc., wore traceable to the 
milk route. Pasteurization destroys the germs that cause these 
diseases. Those diseases have been spoken of as milk-borne 
diseases. In order to protect the public against such epidemics 
the practice of pasteurization was recommended by Pasteur." 
DR. LAFAYETTE B. MENDEL, Professor of Physiological Chemistry 
at Yale University (Thirty years on the teaching staff of Yale 
School of Medicine) says: Clean milk is not necessarily safe 
milk. Milk is only as safe as the man power standing behind 
it. Our greatest safety lies in the exclusion of the dangerous 
micro-organisms by effective pasteurization." 
SASKATCHEWAN DAIRY ASSN. In 1921, the Saskatchewan Dairy Assn., 
if5LUonvcnt;ion adopted the following resolutions 
Whereas the proper pasteurization of milk has been proven an 
Important, safeguard to the health of the consuming publicJ" BE IT THEREFORE RESOLVED that this Association go on record as 
favoring legislation in cities making it compulsory that all milk 
or cream sold wholesale or retail in such cities, bo scientifi- 
cally pasteurized.” 
DR. PAUL B. BROOKS. In 1931, Dr. Brooks, Deputy State Health 
Commissioner, New York State, wrote: ”It is doubtful if our raw 
milk, other than certified, is much safer today than it was ten 
years ago, except insofar as tuberculosis is concerned. Let us see 
if the facts'support this statement. In the past fourteen years 
in the state, outside of New City, we have had one hundred 
milk-borne outbreaks of'communicable disease, ninety-eight of 
them traced to raw milk. I am every day becoming more convinced 
that if raw milk is to continue to bo sold we should insist on the 
systematic application of all the actual safety measures now 
applied to certified milk. It may impose hardships on producers, 
but if we donTt do it, sooner or later the public is going to 
suddenly wake up, as it has a way of doing, to the situation wo 
have been trying so long to impress on it and say, ’Well, if you 
know raw milk wasn’t safe, why didn’t you do something about it.’ 
The municipal health authorities who in this day and age, permit 
the sale of ordinary raw milk, when pasteurized milk is available 
assume a heavy responsibility.” 
THE METROPOLITAN LIFE INSURANCE COMPANY: ’’Every rose has its 
thorns. Milk has its dangers. It is apt to become contaminated 
and convey the germs of disease. Pasteurization neither Improves 
nor harms the milk itself. Pasteurization itself has only one 
object and that is to destroy the harmful bacteria. Our only 
real safety lies in pasteurization.” 
The Metropolitan Life Insurance Company insures the lives of 
many hundreds of thousands of people. Its business is to try and 
make these people live many lyears. It recommends only those 
things which are beneficial to humanity and which will bring 
health and happiness. The Metropolitan Life Insurance Company 
recommends pasteurization. 
MEDICAL STAFF CALIFORNIA HOSPITAL. "Resolved by the California 
Hospital staff at regular session this May 19th, 1936, hereby 
endorse the stand of DR. GEORGE PARRISH in his- attempt to re- 
quire all raw milk in Losangcles City, excepting certified, to 
be Pasteurized; 
Signed 
E. J. Cook, Chief of Staff 
A. J. Scott, Secretary of Staff” 
Member ship, approximatoly 350• STATE AND CITY HEALTH OFICERS 
FRANK M. CARROL, M. D., Commissioner of Health, -Seattle Washington 
of Seattle’s milk is pasteurized and we hope in the near 
future to have 100% pasteurized. I am for pasteurization of 
all milk.” . r 
HERMAN N. BUNDESEN, M. D., Health Commissioner, Chicago, 111.: 
ffAll of Chicago’s milk is either Grade A pasteurized or certi- 
fied. Experience teaches that the best milk supply for a commu- 
nity is that which has been produced on clean farms from healthy 
cows and then properly pasteurized.” 
LOUIS R. THOMPSON, M. D., Acting Surgeon General, United States 
Public Health Service: "While it is true that pasteurization 
should not be regarded as a cure-all and that sanitary inspection 
at the source is necessary, nevertheless every thoughtful student 
of the problem must conclude that farm inspection is not infall- 
ible and that health examinations of herds and employees occa- 
sionally misfire. To make assurance doubly sure all milk should 
be properly pasteurized before it is consumed.” 
John G. ABELE, M. D., Heal.th Officer, Portland Oregon: ”the 
greatest worry a health officer can have is to see any part 
of the milk supply of his city sold raw.” 
JOSEPH G. GEIGER, M. D., Directof of Public Health, San Francis- 
co, California’; ”Pastcurizatlon of milk, as an added safety 
factor, has boon required of aHI milk in San Fran cisco except 
certified milk which constitutes less than of the total. The 
results of pasteurization in San Francisco has been so start- 
ling in the reduction of infant mortality and in the reduction 
of milk-borne diseases, that the San Francisco Department of 
Public Health is recommending to the California Legislature that 
appropriate legislation be passed to provide for compulsory 
pasteurization on aState wide basis, inwall communitiOs of more 
than 5,000 population.” 
JOHN_ R. RICE, M,"D., Commissioner of Health, New City: 
”Nsw York receives 2,500,000 quarts of milk a day. Of this 
98/o is! pasteurized and the remaining 2% is certified. I got a 
great deal of comfort in knowing that our milk supply is well 
safe guarded through pasteurization. We, in this city, are 
wholeheartedly in favor of the general pasteurization of the 
milk supply® • * 
J. W. BASS, M. D., Health Officer, Dallas Texas: ,fThc Health 
Department of the City °D Dallas has always advocated the 
pasteurization of all milk. In my opinion, even certified milk 
should bo pastcurizedo,f 
A. S. FELL, M. D., Director of Health, Trenton, N. J. ”A11 milk 
or cream sold in Trenton must bo pasteurized. This law became 
effective July lot, 1931.” B. B. JAFFA, M. D., Health Officer ,of Denver, Colorado: 
"Since 1931 all milk sold in the uity and County of Denver must 
ho pasteurized. Wo carried this fight to the Supreme Court. 
Since its passage, I believe I am safe in saying that not a sin- 
gle case of disease has been traceable to milk purchased in this 
city." 
P.K. HARDER, M* D., Acting Health Commissioner, Cincinnati, Ohio: 
11 All milk sold in Cincinnati, including certified, must be pas- 
teurized.' Wo feel that pasteurization is a very important factor 
of safety, even when the production of the milk is very carefully 
supervised#n 
HENRY F* VAUGHN, Dr. P*H., Detroit, Michigan: "I am a strong 
advocate of the policy that all milk should bo pasteurized. The 
only milk which remains unpasteurizod is certified milk and there 
is'little demand for certified milk in Detroit*area. A few weeks 
ago, both the Wayne county Medical Commission and the Detroit 
Board of Health passed a resolution requiring that certified 
milk be pasteurized. As soon as this new requirement becomes 
effective we will have 100$ pasteurization. At present wo have 
99.97 pasteurization." 
HUNTINGTON WILLIAMS, LI. D., Commissioner of Health, Baltimore, 
Maryland: "The absence of milk borne communicable disease out- 
breaks is the most conspicuous* characteristic of communities 
whore the milk supply is comictcly and properly pasteurized. 
Next to a pure drinking water supply, there is no greater pro- 
tection of the people's health than a comictely pasteurized 
milk supply." 
JOHN P* KOEHLER, M. D., Commissioner of Health, Milwaukee, Wis.: 
11994$ of Milwaukee's milk supply is pasteurized* The other one 
half percent is certified. I expect to amend the ordinance so 
that all milk will be pasteurized." 
WILLIAM B* KEELER, M.D., Health Commissioner, Boston, Mass#, 
ff of all milk sold in Boston is pasteurized* We feel that . 
oven our certified milk is not so safe but that pasteurization 
would make it distinctly safer. The larger the city, the more 
important arc those facts in relation to the milk supply 
RAY P. MOYER, M.D., Director of Public Health, Pittsburgh, Pa., 
of our milk supply is pasteurized. All raw' tiilk must have 
their herds tuberculin and blood tested." 1 ; 
JOSEPH P. BREDECK, M. D., Health Commissioner, St. Louis, Mo., 
"St. Louis has no raw milk sold within its boundaries, except 
certified. I do not believe any community is justified in per- 
mitting raw milk to bo sold*" • 
DR.' MILLARD KMOWLTON, Director, Bureau of Preventable Diseases,. 
Cv.ruicctiout . State Health Department, f,A community where" the 
milk is pasteurized will enjoy a sense of security against the 
dangers of milk borne'diseases DR. J. MOORE CAMPBELL, Director, Bureau of Communicable Disease, 
Pennsylvania State Health Department, "Raw milk of whatever 
grade may transmit diseases. Pasteurization makes milk safe. 
GEORGE PARRISH, M. D., Los Angeles City Health Officer, In his 
book written in 1927, ,fHealth, the Paramount Asset” says, 
"Pasteurized milk is the safest milk known* All milk should bo' 
pasteurized, except possibly certified milk. In the near future, 
even certified milk will be pasteurized#11 
PRANCES E. PRONCZAK, M.D., Health Commissioner, Buffalo, N* Y./ 
"We have had compulsory pasteurization of milk and cream in this 
city since 1918* Even our certified milk is no?/ being pasteurized* 
Pasteurization is the strongest safeguard wo can place around 
milk and cream, and the local dealers would not go back to the 
sale of raw milk and cream*5’ 
WILLIAM KUNSICKER, M.D. > Director of Public’' Health, Philadelphia, 
"Less than one percent of fluid milk sold in this city is in the 
raw state. The raw milk sold is done so under regulations 
equivalent to those fo certified milk#" 
P* E. HARRINGTON, M.D*, Health Commissioner, Minneapolis,Minn#, 
Minneapolis tried to haveall 'its milk pasteurized, but its pro- 
posed ordinance was defective and was declared unconstitutional," 
H. G. MORGAN*, M.D., Secretary, Department of Health, Indianapolis, 
"Indianapolis has had pasteurized milk since 1916* Since the ad- 
vent of compulsory pasteurization, wo have not had a milk borne 
epidemic, streptococci, typhoid fever or milk sickness." 
W. A. JONES, M. D., Commissioner of Health, Riverside, Calif;, 
"I am in favor of the use of pasteurized milk by all. It is the 
only assurance that wo have against milk-borne diseases. The 
use of pasteurized milk should decrease by 50% Infant mortali- 
ty under two years of age.” 
JOE SMITH, M.D., Health Officer, Kern County, California, "Wo 
have been working towards a goal of 100% pasteurization to all 
milk to bo sold in Kern County.” 
C. MATTHEWS ON, - M.D., Health Officer, Fresno, California,"'since 
1930 no milk other than certified or pasteurized has been sold 
in our city. I feel that all other cities should do the same," 
G. E. MCDONALD, M.D., Health Officer, Long Beach, California: 
"It Is my belief that the time will come in the not too distant 
future that all cities will make pasteurization a requirement. 
We have ample proof that raw milk is the cause of outbreaks of 
communicable diseases throughout'the country." WHAT LOS ANGELES DOCTORS THINK OP MILK 
HENRY F. GALIAGHER, M.D., " I am firmly convinced that whenever 
possible only pasteurized or certified milk should be available 
for the general public.,f 
SILAS A. LEWIS, M.D., "In these days when laboratories prove 
raw nilk a carrier of connunicable disease organisms. Why don't 
you put up a fight for the use of pasteurized and certified 
milk only? This is your duty and’certainly would receive the 
backing of all intelligent people." 
WILLIAM H. IEAKE, M.D*, "Every physician who has been in active 
practice'for any length of time has encountered illness traced to 
raw milk* I feel it is highly Important for Los Angeles to adopt 
an ordinance requiring all milk to bo certified or pasteurized*" 
JOHN C. RUDDOCK, M.D*, "As time goes on, the list of milk-borne 
diseases apparently seems to be increasing, and it is only by 
means of such measures — certified or pasteurized — that we may 
hope to control certain of our communicable diseases." 
BEN P* FEINQOLD, M.D., "Legislation which will bar out of this .cltj 
all milk, except certified or pasteurized, will decrease the 
incidence of such diseases as typhoid fever, undulant fever, and 
scarlet fever which arc so frequently milk-borne." 
E. EARL MOODY, M.D., "There is no place in the diet of'the human 
family for raw milk. Hie dangers of Malta fever and other infec- 
tions are too great unless the rav; milk has had the benefit of 
being produced under conditions laid down for certified milk. 
I would even go so far as to believe, with many other physicians, 
that even certified milk should have the benefit of pasteurization. 
GEORGE H. KRESS,looted Oculist and Editor of California and 
Western Medicine, "I have long been of the opinion that all milk 
other than certified should be pasteurized. As regards certified 
nilk, I believe its production and distribution should be so care- 
fully supervised that it would be as safe as it is possible to 
make it. 
WILLIAM M. HAPP, M.D., Pediatrician, "I have always insisted that 
my parents use either certified or pasteurized milk and I caution 
them against the use of any milk which is not pasteurized." 
WALLACE DODGE, M.D., Chief Surgeon, Georgia Street Receiving 
Hospital, "In this procedure, pasteurization. Is* made routine, 
I am sure it will cause a marked reduction in communicable 
diseases which arc now seen only too frequently." 
DONALD J. PRICK, M.D., "I have been fully convinced for a number 
of years that all milk sold for human consumption should be either 
pasteurized or certified. JOHN V. BARROW, M.D., "Until wo force the use of certified or 
pasteurized' on, all our major communities, v;c may expect to 
have more than civilization’s share of outbreaks of communica- 
ble discasoa." 
BARNETT LIPSON, M.D., !fThc Infant mortality rate from gastro- 
intestinal infections has dropped dramatically since pastou- 
rization has come into vogue* As a pediatrician I believe raw, 
uncertified milk is. dangerous and has no place in an infantfe 
diet.” ■ ; 
ROBERT W. HEALS, M.D., "Our experience has booh that a large 
number of cases can bo traced to infected milk, particularly 
undulant fever and typhoid, both seriously debilitating and 
highly communicable diseases* It has boon shown that pasteu- 
rization does not destroy the vitamins or other beneficent 
qualities of milk and I cannot urge you too.strongly to push 
this vital legislation." 
CHARLES R. PARRISH, M..D., "I am heartily in accord with certi- 
fied or pasteurized milk in all cities. These measures will 
definitely reduce some of our communicable diseases." 
A. J, SCOTT, M.D., "As a pediatrician Irdo not use any kind of 
nilk except certified or pasteurized, dangers to health 
from the use of raw, uncertified nilk are too nuncrous to non- 
tion and generally acknowledge • There should bo a national 
lav; forbidding the sale of any nilk except pasteurized or 
certified." 
JOHN W. SHUMAN, M.D., "Certification or pasteurization of milk 
is a stride in evolution forward." 
EDWIN F. PATTON, M.D*, "Barring milk which is not certified or 
pasteurized from the market is good sense. Not only v/ill it 
benefit humanity but it will be of economic benefit in the 
prevention of costly diseases." 
LLEWELLYN R. LEWIS, M.D., "Any measures,pasteurized or certi- 
fied, designed to protect the babies against milk-borne 
diseases, should be enacted*" 
ROBERT E. RAMSEY, M. D., "Knowing how impure milk can spread 
and carry diseases, wo must insist on pasteurization of all 
milk other than certified." 
WILLIAM E. BRANCH, M.D., "A law compelling the pasteurization 
of’all raw milk, except certified, would bo a step further on 
the road of conquering preventable diseases." 
ROBERT W, LANGLEY, M.D., "In my opinion, a law compelling the 
use of cither certified or pasteurized milk would be one of the 
greatest safeguards to public health that could be introduced 
in this city." VICTOR STORK, M.D., Pediatrician, ,fFor some years, I have urged 
the us? among my patients, of either pasteurized or certified 
milk and have frowned on all the special and trick varieties 
which are sold as commercial bait to stimulate sales• " 
ELIZABETH MASON HOHL, M.D., ffI am convinced of the need of taking 
precautionary measures regarding the use of unpasteurized milk 
and uncertified milk." 
PAUL ROEN, M.D#, Diagnosis and Internal Medicine, "The passage 
of a law by the legislature compelling the use of cither certi- 
fied or pasteurized milk would have much to do with the preven- 
tion of communicable diseases#" 
HARLAN SHOEMAKER, M.D., President of the County Medical Society, 
"There should be but two typos of mllk--pastcurizcd and certified# 
There is a necessity of controlling the milk supply of a city, 
particularly v/hcn the supply comes from so many parts of the 
state and is produced under a variety of conditions." 
CHARLES T. STURGEON, M.D., "I foci a law compelling pasteuriza- 
tion would bo a stop forward for Los Angeles as it is only in 
this way that such diseases as typhoid fever, \mdulant fever and 
other communicable diseases, can be controlled." 
LUCILE G. HARTWIG, M.D., "An ordinance prohibiting the sale of 
raw milk, other than certified is highly desirable." 
EDWIN 0. PALMER, M.D., ”1 am heartily in favor of protecting our 
city from the sale of milk other than pasteurized or certified." 
ELMER BELT, M.D., Urologist, "It has been my custom to recommend 
Grade A, pasteurized and certified milk to my patients, especial- 
ly to those.who have young children. Routinely, I advise my 
patients not to use any raw milk that is not certified, without 
first boiling it." 
GLENN MYERS, M.D., Compton Sanitarium, "Having had .two cases of 
undulant fever in my family, one of protracted length, notwith 
standing the fact that the milk was always obtained from one of 
our best dairies, I am for pasteurization." 
CHARLES P. SEBASTIAN, M.D#, "There is no doubt in my mind but 
what the fundamental protection of our children rests securely 
upon a milk supply that is free from communicable diseases. 
Every community should adopt strict regulations in .pasteurization# 
EARL M. TAlRR, M.D., "any regulation which proposes to remove from 
the reach of innocent and unsuspecting children such an unneces- 
sary health hazard as raw milk will at once.copnand the support 
of everyone who is courageous enough to face facts# The safest 
milk obtainable today is pasteurized and certified." 
PHILLIP STEPHENS, M.D., Past President, County Medical Society, 
"As a citizen I am interested in pure, safe, and nutritious fond# 
As a doctor, I know there are only tv/o safe milks, the one is certified and the other pasteurized.” 
ETTA GRAY, M.D., ”t an heartily in favor of an ordinance in our 
city which would prohibit any raw milk from being distributed. I 
personally believe that certified milk too would bo bettor if it 
wore pasteurized.” 
JOHN G. POMEROY, M.D., Los Angeles County Health ”In the 
growing number of undulant’fever cases, in our territory, most of 
them traceable’to raw milk, wo have a patent argument in favor of 
pasteurization.” (Sec Dr. Pk.croy’s Annual Report, 1934-55, Page 138) 
E. VINCENT ASKEY, M.D., Secretary-Treasurer, Los Angelos County 
Medical Society; "Personally I feel that any raw milk which is not 
certified is a dangerous thing from the public health standpoint. 
I am in favor of all milk, except certified, being pasteurized." 
MAtlRICE KAHN, M.D., "I am most emphatically in favor of an ordi- 
nance which will compel pasteurization of milk.” 
LYLE G. McNEILE, M.D., ”1 have never failed to warn the mothers 
to accept no milk except certified or pasteurized for their own 
use or for the uso of the children. The dangers of raw milk arc 
so well recognized that I cannot conceive of any opposition to such 
an ordinance except uninformed persons." 
W* H* Kiger, M.D., "A law compelling all milk .to be pasteurized or 
certified would reduce the occurrence of many communicable diseases. 
OSCAR REISS, M.D., Associate Professor Pediatrics, University of 
Southern California Medical School, "Certified milk is the only 
raw milk that is safe for human'consumption. There should'bo only 
two tjrpos of milk on the market, certified and pasteurized." 
PERCY T. MAGAN, M. D., President, College of Medical Evangelists; 
"All milk, other than certified, should be pastourizedi I favor 
such an ordinance•" 
DONALD CASS, -M.D. (Drs.Dickey &,Cass); "It is a mark .of progress 
of modern civilization to see the trend toward certified and 
pasteurized milk. The community should have this protection*" 
CARL R. HOWSON, M. D., "There arc a number of angles to the 
situation which I would like to discuss with you." (Dr. Howson 
expressed no opinion.) 
P. BERMAN, M.D., Medical Director, Los Angeles General Hospital; 
"Pasteurization or certified milk would remove ono important 
potential factor in the spread of communicable discuses." 
ALBERT G. BOWER, M.D., "Milk is an ideal food for human beings; 
it is also an ideal food for bacteria. I am in heartiest accord 
with any program to pasteurize or certify the cltyfs milk supply." DRS. HENRY DIETRICH, HUGH K. BERKLEY, FRED GLASSCOCK, AND 1I0RMAH 
K. NIXON, Pediatricians, "Wo are heartily in .favor of the exclu- 
sion of all milk, other than certifisu. or pasteurized, for public 
consumption* Until this is mads a law, a local city ordinance to 
permit the sale in Los Angelos of certified or pasteurized milk 
only, would receive the unqualified approval of most pediatri- 
cians and all interested in this important public health measure.” 
SVEN LOKHANTZ, M.D., Director of the School Health Department of 
Los Angeles, ”1 feel that any advantage which might accrue from 
the use of raw milk is more than outweighed by the danger of 
spreading communicable diseases through this medium*” 
ROSS-LOOS MEDICAL GROU P, ”Wd have in our filed hundreds of cases 
of illness, and severe illnesses at that, that can be directly 
traceable to raw milk. Pasteurization is a matter of vital im- 
portance to the health of our entire community, especially our 
babies.” 
CLIFFORD A. WRIGHT, M. D., Endocrinologist, ”Inasmuch as so many 
diseases may be transmitted through improper handling of milk, 
it is my opinion that an ordinance should be passed ¥/hlch will 
bar all milk from Los Angelos except that which is certified or 
pasteurized.” 
EDWARD M. PALLETTE, M. D., ”1 think that in all cities of 5,000 
or over, and especially in a city as largo as ours, all milk 
should be cither certified or pasteurized.” 
LOUIS I. SOKOL, M. D., ”A11 milk should be cither certified or 
pasteurized. You may expect my cooperation and support toward 
getting an ordinance to this effect.” 
DR. JOHN McLEAN; ”Many years of experience as a physician and 
surgeon have convinced me that there are only two kinds of milk 
that are safe, pasteurized and certified.” 
OSTEOPATHS 
DR. W. CURTIS BRIGHAM, ” A great number of milk borne infections 
appear each year. It is my opinion that if only'certified or 
pasteurized milk wore used many cases of acutd and-chronic ill- 
ness would not occur.” 
DR. ERNEST G. BASHOR, Board of Osteopathic Examiners, State of 
California, ” Since the evidence is preponderant in showing that 
raw milk causes many diseases that might bo prevented, it is only 
fair and just that wc should urge the passage of such necessary 
measures to limit the supply of milk to cortiflod or par.tourizorU DR* CARLE H. PHINNEY, College of Osteopathic Physicians and Sur- 
geons: Announcement has been made that Doctor Joseph Geiger, 
San Francisco Health Officer contemplates an introduction of a 
Bill'at the next legislature to compel cities having a population 
of 5,000 or over to use cither certified or pasteurized. Such 
a law would be of estimable value in protecting the residents of 
any city or particularly children from such diseases as arc milk 
borne.” 
SOME HISTORY OF EPIDEMICS 
During the past twenty years there has been an coverage, in 
America, of one case a week of a milk-borne epidemic of disease. 
Before that they wore more frequent. These outbreaks, with their 
resultant deaths, demonstrated the death roll part played by raw 
milk and compelled the unanimous opinion among health authori- 
ties that all milk should be pasteurized. 
A FEW EPIDEMICS CHOSEN AT RANDOM 
Between 1906 and 1926, there were recorded in the United 
States 479 epidemics of typhoid feveri Typhoid bacilli may 
swarm in milk without altering its taste, odor or appearance. 
The first milk outbreak of septic sore throat occurred near 
Boston in May 1911. macro were 2,000 cases and approximately 
50 deaths. The milk incriminated had always boon a particularly 
clean, fresh and satisfactory supply. For years not a breath of 
suspicion was attached to it until this catastrophe occurred. It 
emphasized the fact that raw milk is always dangerous. Pasteu- 
rization will prevent such a recurrence. 
Another instructive outbreak of septic sore throat, reported 
by Bonson and Scars, occurred in Portland, Oregon, in March, 1922. 
There wore 487 cases and 22 deaths. They wore all traced to raw 
milk which came from a first classt dairy. Ais is a common story. 
Pasteurization will prevent such a: recurrence• 
The United States Public Health Service reports 50 epidemics 
of milk borne disease in 1929, as follows: 
No. 
of Epidemics 
Wo. of Cases 
Deaths 
Para-Tyhpoid Fever.. 
1 
38 
1 
Typhoid Povor •••••• 
28 
528 
36 
Scarlet Fever 
11 
1052 
1 
Septic Soro Throat.. 
8 
939 
13 
Dysentery. 
1 
8 
Pood Poisoning • •••• 
1 
24 
50 
2589 
51~ There is a similarity between all the years for milk-borne epi- 
demics, Per instance, sec 1930. Forty-eight epidemics were 
reported. 
•No. 
of Epidemics ] 
No* of Casco 
No. of Deaths 
Typhoid Fever ...... 
30 
575 
41 
Scarlet Fevor 
2 
42 
Septic Sore Throat. 
9 
1116 
7 
Gastro-Entcritis ••• 
3 
46 
Dysentery 
1 
64 
2 
* 1' 
22 
6 
Food Poisoning •.••• 
J2 
103 
— 
48 
1968 
56 
1931 
Typhoid Fevor ...••• 
21 
217 
22 
9 
16 
Para-Typhoid 
Scarlet Fever * 
1 
1 
8 
Septic Sore Throat.-. 
6 
993 
Streptococcus ' 
Sere Threat ........ 
2 
27 ' 
Diphtheria- ......... 
1 
22 
Dysentery 
1 
65 
Gas tro-Entcritis ••. 
1 
13 
24 
34 
1368 
1932 
Typhoid Fever ...... 
23 
251 
22 
Septic Sore Throat .• 
3 
148 
3 
Scarlet Fevor •••••• 
6 
207 
3 
Gastro-Entoritis- ... 
1 
32 
33 
638 
28 
1933 
Typhoid Fover •••••* 
25 
299 
26 
Para-Typhoid ....... 
1 
17 
t 
Diphtheria 
2 
19 
3 
Septic Sore Throat.* 
7 
515 
5 
Scarlet Fever ••«••• 
3 
238 
4 
Milk Sickness •*.*•• 
2 
10 
1 
Udder Cocci •••..*.. 
2 
250 
39 
42 
* 1348 
1934 
Typhoid Fever •••••• 
26 
299 
27 
Para-Typhoid Fever*. 
1 
400 
S carlot Fever 
2 
39* 
, 1 
Septic Sore Throat*. 
8 
557 
13 
M n ff and 
Mixed Scarlet Fever. 
1 
92 
1 
Gastro-Entcritis ... 
3 
125 
Diphtheria 
1 
9 
i. 
Staphylococci Pood 
Poisoning •••••.••** 
J5 
220 
45 
1741 
42 In addition to the deaths that are caused by drinking raw milk 
stop and think of the terrific economic or financial loss caused 
each year as approximately 2,000 people are annually made desper- 
ately ill from the use of raw milk# Those 2,000 people recover 
but think of the mental and physical suffering they pass through 
suffering that could have boon avoided* The 'loss of salaries 
plus the actual outlay for hospitals, doctors, nurses and medi- 
cines runs well over a million dollars. ** * • * ...... 
INPANTILE PARALYSIS 
In at least three instances it seems to be demonstrated that 
raw milk was the avenue through which the virus of infantile., 
paralysis was spread. One of those was reported by Dr, John C# 
Dingonan at Spring Valley, New York (New State Journal of 
Medicine, 1916); second, by Doctors A, C, Knapp,- E. S, Godfrey, 
and W# L. Aycock at Courtland,Now York, (Journal A.M#A# 1926); 
and the third by W. L, Aycock (American Journal of Hygiene)* 
Since then, much confirmatory evidence has boon-gathered, 
Simon"FIexncr and Paul Lewis of the Rockefeller Institute tested 
the virus of infantile paralysis and found that pasteurization 
renders it Incapable of causing paralysis. Pasteurization will 
prevent such a recurrence* 
In March, 1932, the Michigan Department of Agriculture .issued 
the following statement, ,fA milk-borne typhoid* our Tor oak resulting 
in twelve cases and one death occrrod recently at Yale, Michigan* 
This outbreak is another argument against rav/ Milk*” 
During approximately one month in 1927 — fifty cases of ty- 
phoid fever occurred in the towns of Lincoln, Concord and Weston, 
Mass, and all of these but one wore definitely * traced to raw 
milk* An undiscovered typhoid carrier working'in*the dairy, 
which supplied the milk, caused the outbreak*' ' 
will prevent such a recurrence* 
* 
In 1934, forty epidemics, 1342 cases, and‘fourty-four deaths 
occrrod in eighteen states. Twenty-one of the-epidemics wore 
of typhoid fever; nine of septic sore throat; while 4 gastro- 
enteritis; 3 scarlet fever; 2 undulant fever; and 1 diphtheria 
made up the balance.’ All except one were traced, to raw milk# 
The one was doubtful* Pasteurization will Trrevent such a re- 
currence* '4 f • • 4 * 
Public Health News, published by the State of Nov; Jersey, 
November, 1930, writes, ”Sixty-four cases of dysentery which 
occurred in Hamilton Township wore traced to- raw milk, -two 
deaths occurred#’1 ’ * . 
Health News, New York State Health Departmenti JlSevonty- 
two cases of scarlet fever and sore throat occurred in the 
village of Red Creek, Wayne County, New York, during February 
1936* One death occurred, all cases traced to raw milk Dairy,” At Molino, Illinois, early in 1936, there occurred a very 
extensive scarlet fever epidemic. Up to March, 147 cases had 
been reported. The conclusions drawn by the investigators are that 
the epidemic was clearly milk-borne and that tho source of the 
outbreak was a raw milk dairy. This extensive epidemic demon- 
strates tho potential danger that lurks behind unpasteurized milk 
supplies. 
Trpnton, Nov/ Jersey, May 24, 1936: ” Infected raw milk traced 
to a Bergeh County raw dairy, has caused six deaths in the past 
week and sent more than 200 persons to physicians for treatment 
of septic sore throat, the State Healh Department said today.” 
(Thenton Newspaper)”So far six have died.” 
In 1934 in Now York State, outside of New York City, there 
were three milk borne opidbmics of sore throat and one of scarlet 
fever| all due to raw milk, besides 250 cases of undulant fevor, 
most of which wore traced'to raw milk. (New York State Health 
Department News, March 11, 1935). . , 
American Journal Public Health, July 1935: ”At Petersburg, 
Michigan, population 700, during September, 1934, there occurred 
an outbreak of streptococci sore throat. One hundred and eighty 
six wore ill and six died. The outbreak'due to raw milk was 
caused by the organisms of scarlet fever.” 
Many hundreds of epidemics traceable to raw milk might be 
mentioned. Some of tho most noted are: 
IN CALIFORNIA IN 1C55 
The following outbreaks of disease due to the use: of raw milk 
occurred in California in 1935; 
In 'August—In Vallejo there occurred fivo cases of typhoid fevoi 
with one death. 
In Turlock,’ three cases of typhoid fever. 
At Selma, 6 cases food-poisoning due to raw milk. 
At Escondido, 20 cases food-poisoning due to raw milk. 
In the State of California, 150 cases of undulant fever were 
reported for the year 1935. 
The most notorious typhoid epidemic in history was that at 
Montreal only a 'few years ago with 5,000 cases and over 500 deaths 
resulting from failure to pasteurize. Other epidemics were the 
Chatham typhoid outbreak of 1927 with 109 cases; Kirkland Lake 
septic sore throat epidemic in 1930 with 457 cases; the St. Cathe- 
rine epidemic of para-typhoid in 1931 with 487 cases, arid tho 
St. Maurice Valley, Quebec, outbreak with 527 cases. They arc 
Canadian-epidemics, but the United‘States outbreaks arc equally 
as numerous and just as disastrous. Many cases of undulant fever are being, traced to raw milk. 
For instance, the report of the United States Public Health 
Service issued for 1935 says: nIn addition to the milk-borne di- 
seases that wore reported, the following cases of undulant foyer 
were reported as having probably been transmitted by milk supplies; 
NUMBER OP UNDULANT FEVER CASES IN 1935: 
"Mow York .... 
. . . ,222 
Pennsvivaria ... 
,,, 81 
Florida .... 
California .. 
Wisconsin 
Connecticut, 
..59 
Il11nois .... 
. AA 
Kans ls ......... 
. .. 98 
Alabama••... 
. ,54 
Minnosola ... 
. . . • ln 3 
Mich'iqar ....... 
... 73 
TiOiri s 1 r>nn 
Iowa 
Ohio v . , , , 
Besides the above cases--oT"cry state had 'its number of undulant 
fever cases in 1935. 
California & Western Medicine, October, 1934: Karl P. Moyer, 
Ph.D., writes: "In order to appreciate the importance of the undu- 
lant fever problem, certain statistical data-referring to the State 
of California nay be of interest. Paring the period January, 1927 
to January, 1934, 591 cases of undulant fever have been reported. 
Although distributed through out the state, the ton southern 
counties form a solid block reporting 406 cases, or 68% of the 
total number observed within the boundaries of the State. Lqs 
Angelos City is represented with 31% of the total. The histories 
of these cases are by no means complete, but it is noteworthy that 
in 50% of the established infections no other possible source 
other than raw milk is mentioned.” If 591 cases ?;ere reported, 
it is probable that throe times that nymber escaped detection and 
went unreported. Pasteurization would have prevented all of thoso 
cases • 
NUMBER OP UNDULANT FEVER CASES REPORTED EACH YEAR 
No. of Cases 
No. of Cases 
1927 
217 
1951 ., 
1545 
1928 .... 
649 
1932 •. 
1 Af)7 
1929 ... . 
1301 
1933 ., 
* 
1716 
1930 .... 
1934 
Undulant fever tends to bo a long continued disabling disease 
which causes much economic loss of* time and suffering and does 
not often lead immediately to death. There are undoubtly many 
instances where it paves the way to a fatal ending from some 
other infection, which pounces upon the individual who has boon 
worn down by long continued fover. On the other hand, deaths 
from undulant fever arc by no means unknown and have’' boon reported 
from a considerable number of states. Undulant fever is being 
spread by infected raw milk. — 
It has often been pointed out that there is a close analogy 
between a water supply contaminated y with typhoid bacilli and 
a raw milk supply similarly polluted. The Illinois Health Messenger in 1931, said; 11 Milk is‘now a more 
important carrier of disease than wateri In Illinois, no less 
than seventeen milk-borne epidemics resulted in 288 cases of 
typhoid fever, while during the same period of time six water 
borne epidemics resulted in 437 cases of typhoid* More cases 
wore involved in the water borne outbreaks because the polluted 
water was consumed by more persons than was the contaminated 
milk •11 
Every community, largo and small, recognizes it duty and obli- 
gation toward supplying pure water. It Is equally guilty if it 
sanetlons‘the sale of unpastcurizod milk. There is a-wide differ- 
ence in the difficulties encountered in cities in preventing the 
spread of typhoid fever by water and milk, respectively. Water 
supplies are centralized and for the most part are under public 
control. On the other hand, raw milk supplies roach the city 
from numerous, widely scattered sources, difficult to control* 
Pasteurization of milk to correspond with filtration and chlori- 
nation of water supplies must come before milk borne diseases 
are conquered* 
NUTRITIONAL ASPECTS OP MILK PASTEURIZATION 
Almost all authorities are agreed that there is little, if. 
any, difference between the nutritional value of raw and pasteu- 
rized milk* 
MILTON ROSENAU, Professor of Preventive Medicine and Hygiene, - 
Harvard Medical School, in his wonderful bock, "Preventive 
Medicine & Hygiene," writes: "Milk heated to 145 degrees P. for 
thirty minutes (pasteurization) does not undergo, any appreciable 
physical.or chemical change. Milk contains but a moderate, 
variable amount of anti-scorbutic (scurvy) .property—Vitamin C. 
The amount of Vitamin 0, depends upon the quantity contained in 
the feed of the cow. This vitamin is influenced by age and by 
heat* Vitamin D is not affected by heat. Rickets, therefore, 
cannot be laid to pasteurization." 
Pastcurizod’milk has everything raw milk has and it is 
immeasurably safer* 
E* V. McCOLLUM, J0HNS-H0PKINS, says: "'%c evidences of experiment 
do not shO¥/ any differences between raw and pasteurized milks* 
There is no convincing evidence that raw milk, even if it were 
safe, is superior to pasteurized milk in Infant feeding* In 
infant feeding, a little orange or tomato juice should also be 
fed for the reason that Vitamin C in milk is variable in amount * 
As there is not an over abundance of Vitamin C in raw milk, 
juices should be used anyhow," 
THE METROPOLITAN LIFE INSURANCE CO., says: "Pasteurized milk 
is just as digestible and just as nutritious as raw milk." 
.(Health Library of the Metropolitan Insurance Company), CORKY MANN, Noted London authority, says; ”Hilk pasteurized at 
temperature of 142 degrees to 154 degrees for thirty minutes is 
not damaged as food for infants; and no incidence of scurvy was 
observed over a period of three years in children under two 
years of age given pasteurized milk without orange juice*” 
In 1932, the United States Public Health Service made a tho- 
rough and reliable study of the effects of pasteurized milk on 
the growth of children. Two groups aged from ten months to six 
years, were investigated, 1807 having received raw milk and 188G 
pasteurized milk, with similar supplementary diets in both groups. 
There was no dlffernnce between the average woights-hoights of 
the two groups. The authors stated that the results demons- 
trated that the growth promoting capacity of pasteurized milk 
was not less than that of raw milk. (U.S.PiH.S. Report 47). 
ARGUMENTS of the PROPONENTS of RAW MILK 
1. Raw milk dealers lay considerable stress upon the 
destruction of Vitamin C when pasteurized. It is evident that 
any' argument based on the destruction of Vitamin C, by pasteu- 
rization is fallacious and .cannot be maintained. (See fore- 
going statements by world's leading authorities.) 
2. Equally weak is their argument that pasteurization does 
not destroy all the disease germs present.’ (All laboratory 
tests prove the efficacy of,pasteurization.) 
3. Some raw milk advocates admit pasteurization does 
destroy disease germs, but they claim there arc considerable 
toxins left in the milk after the destruction of the germs by 
the heat. Scientists point out that the subject of toxins is 
a theoretical one. The only ones manifesting any interest in 
this connection arc the advocates of raw milk, who never sub- 
stantiate their claims. 
4* Equally untenable is the claim that pasteurization makes 
the mineral content of milk unassimilable. Scientists, dieti- 
cians, nutritionists and laboratories, have shown respectively 
that there is no difference between the nutrition of the raw 
and unpasteurized.milk* The raw milk advocates have proven 
nothing* 
•5. The raw milk people say that pasteurization of milk.destroys 
the lactic acid organisms in milk and hence it will not sour. 
The fallacy of this claim is easily demonstrated. Just, take 
a bottle of pasteurized milk, at ordinary room temperature and 
observe what happens, usually during the second day. As the 
milk stands, the acid formers grow and cause the milk to sour 
instead of decompose. 
6. final argument is that pasteurization is used as a 
substitute for cleanliness; that dirty milk is pasteurized. In view of the fact that state laws and city ordinances require 
that a certain high standard of milk and dairy equipment and 
cleanliness of cattle and personnel be maintained before the 
milk is acceptable and permitted to be pasteurized, refutes such 
statements. Pasteurization does not claim to replace sanitation 
and common decency*. It docs not atone for filth and is not 
used as a redemption process* Let mo ropcat--pastcurized milk 
has every virtue that raw milk has, plus the safety that goes 
w1th pasteurization. 
Thus the arguments and statements of the raw milk proponents 
crumble when the light of scientific investigation is turned on 
them. Unsupported statements made to an uninformed and unscien- 
tific group of laymen may sound logical and reasonable, but like 
all untruths or half truths, must give way before the truth. 
7. The raw milk advocates claim that compulsory pasteuriza- 
tion is an attempt of the distributors and the well-to-do dairy 
men to-put the snail dairyman out of business.. Such an argument 
is silly. The majority of the small dealers simply have not 
kept stop v/ith sanitation and hygiene. They not only have neg- 
lected their own education covering the subject of common clean- 
liness, but their equipment, in many instances, does not meet 
public health standards. Pasteurization will not put a single 
dairyman out of business, it will only prevent him from bottling 
it on his promises, because years of experience through put the 
United States shows it cannot be done there with safety. But 
should pasteurization put a few of the less forjtunate out of 
business, the question arises " lo it not better to do this than 
permit them to soil raw milk to innocent mothers and' children 
and scatter tuberculosis, undulant fever, scarlet fever, and 
many other diseases, as they do so?” It is a question of the 
dollar against your life, which shall Yt be? 
No one desires to injure a single dairyman. It will bo the 
duty and the pleasure of the Health Department to do everything 
it can to counsel with and assist all dairymen—particularly 
the smaller ones. 
"ALL ABOUT MILK" 
"Printed and Distributed by the Metropolitan Life Insurance 
Company for the use of its hundreds‘of thousands of policy- 
holders." 
"Milk is our best all-around food. It is the most perfect 
food wo have. It is also one of the cheapest foods. Milk 
tastes good; it is easily digested, and is very nourishing. 
It makes bone, brawn and blood. In fact, the vigor and success 
of a nation depends largely upon the milk it uses. Like all 
good things, milk has a few drawbacks, but those are far out- 
weighed by its advantages. Milk makes the ration complete, pro- 
motes growth and keeps the body strong. Thorc is no substitute for it. Save on other things, if you must, 
but not on milk. Milk is good fuel, because it contains fat and 
sugar# The body needs fuel to keep it warn and to make it novo 
and work and play# Milk is more than a fuel—it repairs waste, 
helps growth, build bene and flesh. Milk is rich in vitamins. 
It contains all .the different kinds of: ;vitamiris which are essen- 
tial to life. Milk contains a great deal of lime. Children 
need’plenty of .lime, especially for their bones and tooth. 
Childrc-n and adults need lino, because the hones arc always 
wearing away and this wear and tear must, be replaced. Milk 
also contains plenty of phosphates. Milk is an absolute 
necessity for the growing child. Each child should have a 
quart of milk a day. Lock at the children who do not get milk- 
pale and sickly; but milk is not only the food of choice for 
children, it unquestionably is the ideal food for the adults, 
especially for sick people and persons 45 years er over. After 
a person reaches middle life his digestive organs slow down, 
the same as the other organs of the body and assimilation is 
less .active, therefore, their burden must bo lightened, 
is the time to( go back to the foods of childhood. Milk is un- 
doubtedly the best and safest food for these persons who are 
45 years of age or older. 
"It was found in the Army hospitals that the wounded roccvered 
more quickly when given milk. Milk helps to keep the ,grown-ups 
strong, vigorous and young. Milk contains ’life* because it 
contains vitamins. Vitamins promote growth and favor utiliza- 
tion of food. It is not possible to live withoutfvitamins, 
oven* though large, quantities of food arc eaten. r%ere arc seve- 
ral kinds of vitamins. One of then is found in milk fat. 
Another is found in the watery part of the milk. Milk has 
everything needed in the diet. It is a complete nixed diet 
itself. It has and fat which give energy to move the 
body; -it 'has-minerq-l-'-salts v/hich build up the bones and keep 
the body in good’shape-;- and-albumen (protein) which, like meat 
and eggs, is important in making brawn and sinew. 
"Think of the value of having one food which .supplies all the 
necessary elements of a good mixed diet, and which at the same 
time can bo used without special preparation. In the home, milk 
should bo kept cold, clean and covered. Never lot the milk 
bottle stand around. Have a special place in the coldest part 
of the refrigerator for the milk bottles. Milk bottles should 
never be taken into the sick room. Milk never be 
used for any other purpose than to hold milk. 1hey should he 
rinsod in cold water and then washed and scalded before they 
are returned to the milkrjan. Inspection and pasteurization 
solve the milk problem. Milk is the best food. . Use' more milk. 
Make milk the fester mother of your children."' W. A. JONES, M.D., Co issioncr of Health, Riverside, 
California: I an in tlic favor of the use of pasteurized milk 
for all. It is the only assurance that we have against nilk 
borne diseases. The use of pasteurized milk should decrease 
by 50% Infant mortality under two years of age." 
HAROLD DEWEY BARNARD, M.D., "After 24 years in the practice 
of Medicine, I bebieve the nilk supply should be limited to 
certified and pasteurized milk. This would prove to be a 
highly efficient protective measure in the limitation of 
communicable diseases." PASTEURIZATION OP MILK 
NEW YORK STATE DEPARTMENT OP HEALTH 
EDWARD S. GODFREY, JR., M.D., COMMISSIONER 
BULLETIN M.S.53-1940 EDITION 
ORIGINALLY WRITTEN BY THOMAS 1 PARRAN, JR.,M.D. 
NOW SURGEON GENERAL,UNITED STATES PUBLIC HEALTH 
PROM THE 
SERVICE 
WHAT ABOUT PASTEURIZATION? 
The Department has been asked the question, "What 
about pasteurization?” so many times that it has been decided 
to discuss the question fully in a circular which can be sent 
to inquirers. Pasteuriation in New York State means heating 
milk in properly constructed apparatus to a temperature of 
not less than 145°P. and holding it at that temperature for 
not less than 30 minutes, or heating it to a higher temperature 
for a shorter period when apparatus and method are approved 
by the State Public Health Council. Both the "holding” and 
the "short-time" methods arc in operation in the State. 
There is a constantly increasing trend toward ' 
pasteurization not only in this state hut elsewhere. About 
98 per cent or more of the milk supply of the municipalities 
with a population of 10,000.or over in the State is pasteur- 
ized, The proportion in different cities, of course varies, 
but in most of the large cities very little raw milk is sold. 
In the rural districts a muchtsmaller; proportion is pasteur- 
ized, Data indicates that over'98 per cent of the milk sold 
in Now York City is pasteurized, the remainder being certified. 
In the remainder of the Stato, reports from health officers, 
dealers and an estimate of ‘sales ,in.rural areas indicate that 
approximately 75 per cent of the milk sold is pasteurized. 
The Department believes thoroughly in efficient pasteurization 
as a safety measure and has long advocated the enactment of 
municipal regulations, wherever feasible, requiring the past- 
eurization of milk. 
It is said that Abraham Lincoln, in presenting a 
case to a jury, followed the plan of presenting his opponents 
probable arguments and disposing of them before presenting 
his own case. Following the method of the "Great Emancipatory 
before setting forth the reasons for pasteurization wo will pro,*- 
sont and answer the 
ARGUMENTS AGAINST 
PASTEURIZATION 
There are, of course, arguments against pasteurization, 
as there are against practically all propositions which in- 
volve the interest of largo numbers of people and special 
groups of individuals. Wo have endeavored to collect and 
answer all that have come to our attention, oven though some 
are relatively unimportant. taste 
ARGUMENT NO. Is Pasteurized milk has a 11 cooked 
ANSWER: The "cooked taste” when it occurs, is due 
to overheating, pasteurization by the older methods frequently 
caused a cooked taste, but with modern apparatus the process 
can be so controlled that flavor need not bo affected. If the 
milk is held at just the right temperature for the right timo 
in proper equipment, even exports can not distinguish pasteur- 
ized from raw milk by the taste. At a dinner attended by about 
one hundred dairy and milk inspectors and .other milk experts 
in Harrisburg, pa., milk was served. Those present wore asked 
to "vote” as to whether it was pasteurized or raw. The vote 
was about evenly divided. The milk had- booh-pasteurized at 
145°- two degrees higher than the Nov/ York State requirement. 
While the "cooked taste” is objectionable to some people, it 
is bettor to have -the milk overheated than underheated. 
ARGUMENT NO. 2: Pasteurization reduces the "cream 
lino” or "cream volume." 
ANSWER; Investigators Jsave found that the volume of 
cream rising to the surface on a bottle of milk, or so-called 
"cream line” is not materially affected by heating to temper- 
atures below 145° for 30 minutes. The prescribed time and 
temperature relationships in '‘New York State are not less than 
30 minutes at 143° P. or more, and not less than 15 seconds at 
160° p. or more. If the temperatures rise above those prescribed, 
as they may occasionally do, there may be a slight reduction in 
the. "cream-line." Obviously this does not mean that any cream 
has been taken out of the milk but rather that some of the' 
cream does not rise to the top. 
ARGUMENT NO* 3: In raw milk the vitamins are intact. 
•ANSWER: The "inference here is that vitamins aro 
destroyed by pasteurization and if this were so it would be 
important in Infant The facts seem to bo that of 
the several vitamins present in milk only one, Vitamin C v/hich 
prevents scurvy, may be diminished in quantity. However, this 
vitamin is present in raw milk in such small and uncertain 
quantities that milk cannot be depended on to supply the infant 
with the necessary quantity. Vitamin C is present in larger 
and more certain quantities in orange juice and other fruit or 
vegetable juices which aro now generally used in connection with 
infant feeding. 
ARGUMENT NO, 4: Pasteurization takes tho "life11 out 
of milk. 147 
ANSWER; So far as this argument relates to vitamins 
it has already been answered. Referring to the so-called 
enzymes, which as Rosenau says in his book, "The Milk Question", 
"are the nearest approach to life with which-we are familiar 
in milk," Phelps (Public Health Engineering) presents a chart 
prepared by Dr. Charles E* North which seems to indicate that 
a temperature of over 144° for 30 minutes is required before 
the enzymes are destroyed. Recent evidence shows than an 
enzyme known as phosphatase is destroyed by pasteurization. 
However, we know of no evidence that the presence of this 
enzyme adds anything’ to the food value of milk. At any rate 
pasteurization, as Prof. Rosenau says, "does not devitalize 
milk any more than cooking devitalizes moat., vegetables or 
cereals 
ARGUMENT NO. 5; Children and invalids "do better on 
raw milk than on pasteurized# 
ANSWER: Scott and Erf in 1931 reported the results 
of a study made at Ohio State University, in which white rats 
wore fed on milk from a herd of cows receiving a special ration 
to which certain minerals had been added. The rats fed upon 
this milk after pasteurization showed a less satisfactory 
growth and considerable anemia, as compared with a similar 
group fed upon the same milk unpasteurized., Dr. Scott, a 
pediatrician, presenting a paper on this experiment before a 
group of milk control officials expressed the opinion that the 
results did not affect the desirability of pasteurizing the 
"ordinary market milk" for general use# 
Krause and others, working at the Ohio State Agricul- 
tural Experiment Station, later made a somewhat similar study 
using white rats but feeding them on milk from a herd receiv- 
ing an ordinary standard dairy ration. They reported that there 
y/as no material difference as to development and physical 
condition, between those fed on raw and pasteurized milk. 
Thdjf found that rats fed. exclusively on raw milk over a con- 
siderable period invariably developed anemia, but that this 
did not occur.when small amounts of iron and copper were added 
to the milk. , . • - 
Prank, of the United States Public Health Service, in 
Public Health Reports for September 23, 1932, reports the 
results of a survey which: furnidied convincing evidence that 
"The growth-.promdting capacity of heated milk plus 
the supplementary diet received by the average American child 
of 1G months to 6 years is not measurably loss than the growth- 
promoting capacity of raw milk plus the supplementary diet re- 
ceived by the average American child of 10 months to 6 years." 
Surveys were made by state health departments of 10 states, 
covering approximately 3700 children between the ages of 10 
months and 6 years, about half of whom had received no milk 
except heated milk, the other half having received raw milk 
for "more than the latter half of their‘lives." No significant difforonce-was found bet.wo.on tho average weights and heights 
of the children in .the two groups* "The parents of the chil- 
dren receiving predominantly raw milk reported a higher inci- 
dence of diphtheria, scarlet fever, intestinal disturbances, 
and rickets than did the parents 'of the children receiving 
heated milk only '• T :-i 
The evidence on this point speaks for itself* 
■ARGUMENT’NO. 6: The mineral content of milk may 
bo reduced by pasteurization. 
ANSWER; Mattick and Hallott in the Journal of Agri- 
cultural Science, 1929 under tho head of "Effect of Heat on Milk" 
reported results of experiments bearing on this point. "It is 
obvious," they said, "that tho total amounts of calcium, phos- 
phorus and nitrogen in milk cannot bo altered by the application 
of heat, although the differences observed in heated milk render 
it probable that some change in the.solubility of one or more 
of their salts may bo affected.” Carefully controlled experi- 
ments were made" to just what those changes, if any 
wore . 
Heating for 20 minutes at various temperatures, 
they found no "significant differences" in the amounts of 
diffusible nitrogen at any of the temperatures and none in 
diffusible phosphorus at temperatures below 175°P., but 
"the amount of total.calcium which becomes indiffusiblo is... 
about 2 per cent." This is of interest from a scientific 
standpoint, but so far as tho nutritive value of milk is 
concerned this relatively slight change probably is unimpor- 
tant, especially as milk is only one of several common sources 
of calcium salts. 
ARGUMENT NO, 7; Cooked milk is likely to be con- 
stipating. 
ANSWER: First of all, pasteurized milk is not 
"cooked milk." The prescribed temperatures are far below 
the boiling point. Pasteurized milk is no more* likely to 
be- constipating than is raw milk. In fact a prominent pedia 
trician (specialist in children's diseases) who prescribes 
boiled milk frequently for babies states that constipation 
occurs no more frequently among babies fed on boiled milk 
than among those fed at the breast. 
ARGUMENT NO. 8: There are certain physicians who 
recommend raw milk for babies in preference to pasteurized. 
ANSWER; Having answered the four preceding arguments 
there is little more that needs to be said in answer to this 
argument. Universal agreement on a matter of this'kind WCuld 
be too much to expect. Some time ago a questionnaire was sent 
to a number of the most prominent pediatricians in the country 
asking whether they preferred pasteurized or raw milk for infant 
feeding. Only a very small minority favored raw milk. Although 
we have made no canvass of general practitioners on this question 
we believe that a large majority would vote for pasteurized milk. ARGUMENT WO. 9; Pasteurization is an excuse for the 
sale of dirty,milk. 
ANSWER': There was a time, years ago, when this probably 
was true in many instances. For the past twenty-four years, 
however, the State Sanitary Code has prescribed definite stan- 
dards of sanitary- quality for raw milk which is to be pasteu- 
rized. If the health officers are doing their duty in enforc- 
ing the code requirements, "dirty milk11 can not be pasteur- 
ized. In fact, standards of cleanliness among dairymen and 
milk dealers are much higher today than they were in the early 
days. Furthermore, while dirty milk, whether raw or pasteu- 
rized, should not be tolerated, even such milk—if effectively 
pasteurized—probably would be safer so far as the dissemina- 
tion of communicable diseases is concerned than the '’general 
run” of rav/ milk. A survey made in' Now York State in 1930 
revealed the fact that milk being delivered to pasteurizing 
plants compared favorably, as to average bacterial content, 
with that sold ar raw milk’. 
ARGUMENT NO. 10;’ Pasteurization may be carelessly done. 
It is therefore not infallible. 
ANSWER: It is obviously true that either raw or pasteur 
ized milk may be carelessly handled. Pasteurizing plants 
in New York State, however, have for many years been inspected 
both by state and local health departments, and the efficiency 
both of apparatus and methods is constantly increasing. Not- 
withstanding the relative inefficiency that prevailed in the 
past, our record of railkborne communicable disease (to bo 
referred to in detail later) indicates that oven then pasteu- 
rized milk was much safer than raw milk. 
ARGUMENT NO. 11; Pasteurization destroys the souring 
bacteria so that milk Instead'of souring normally will putrefy 
if kept long enough. 
ANSWER: Fortunately pasteurization does destroy many 
but not all of the "souring” bacteria, most of which gets 
into the milk with dirt, and this accounts for the fact that 
pasteurized milk usually keep longer than raw milk. Pew 
people are likely to worry because their milk keeps sweet too 
long. Not all those bacteria are destroyed and the milk does 
sour "normally”, if usually somewhat less quickly than raw 
milk. 
ARGUMENT NO. 12: The"toxins formed by disease bacteria 
may not be destroyed by pasteurization, or posisibly dangerous 
substances might -be formed by destruction of other bacteria. ANSWERS There is a question whether the toxins formed 
by virulent hemolytic streptococci would be destroyed or rend- 
ered innocuous by. pasteurization• Dr, Ruth Gilbert of the 
Division of Laboratories and Research says, however; 
"I have never seen a report of an epidemic of septic 
sore throat traced to the use of properly pasteurized 
milk. One vould not expect serious Illness to result 
from the pre-forraed toxins that might bo in the milk 
if living bacteria were not present. Thus, as far as 
experience and the literature would indicate, hemolytic 
streptococci in milk are a menace only in case the 
organisms are alive, the-symptoms resulting from 
ingestion being due to infections rather than toxemias. 
The important point, of course, is that if those or other 
disease organisms find their way into milk they will be killed 
by efficient pasteurization and they, are certainly loss dan- 
gerous when doad than when alive. - 
As for the possibility of "dangerous substances" being 
formed by destruction of bacter-ia other than those which 
incite disease, there is no evidence that this occurs. If 
they are dangerous at any time they, like the pathogenic 
(disease inciting1) bacteria, are less dangerous when they 
are doad. 
ARGUMENT NO. 13: Pasteurization is unnecessary in "the 
country" where milk goes directly and promptly from producer 
to consumer. 
ANSWER; This argument is based upon a popular impression 
which experience has proved to bo entirely fallacious. It is, 
of course, desirable that milk be fresh,but.the slight delay 
incident to shipping it a reasonable distance and pasteurizing 
it is a matter of little moment, providng, that it is good milk 
to start with, is kept cold and otherwise properly handled. 
A more important consideration is that of the transmission of 
infection. records- of milkborno communicable disease (to 
bo discussed in more detail later) indicate that in this State 
in the past twenty-three years ? ■ 
(1) a largo majority of milkborne outbreaks occurred 
primarily outside of cities, and 
(2) in over 91 per cent of the outbreaks the sources of 
infection were on the farms. 
Naturally the farms' are in "the country." It is therefore 
clear that the proximity to the-farms affords no protection; 
in fact, if, for example, a typhoid carrier or a diseased cow 
on the farm infects the milk, the more promptly and directly 
the consumer gets the milk the greater is the likelihood of 
the germs still being active and virulent and of the consumer 
becoming infected. ARGUMENT HO. 14: pasteurization will increase the price 
of milk. 
ANSWER: It has been'determined that where milk is pasteur- 
ized in large quantities, the additional cost bo the dealer, 
figuring in the cost of apparatus, depreciation, "up-keep” and 
la bop., is a fraction of a cent per quart. Naturally the smaller 
the quantity of milk handled the greater is the "overhead” and 
for the small dealer the cost probably will approximate a cent 
a quart. Prom the standpoint of safety efficiently pasteurized 
milk as' compared with the same milk in its raw state is easily 
worth a cent or two more a quart. 
In these days people buy insurance against'all sorts of 
contingencies: death, accident, sickness, fire, burglary and 
!,what not .*1 The consumer who pays the additional cent or tvp 
a Quart for efficiently pasteurized 'mij.k is buying cheap and 
affective' insurance against milkbornQ' infection. 
To people in moderate or poor circumstances,particularly 
when they have large families to "raise and educate”, oven 
the addition of a few cents a week is an important considera- 
tion. However, if their families happen to bo amen g the vic- 
tims of milkborne infection the cost to them in a period of a 
few weeks probably will vastly exceed the additional cost 
incident to obtaining pasteurized milk over an equal number of 
years. Even conceding that their chances of becoming infected 
arc relatively small, this is still an important consideration. 
The three following arguments apply particularly to muni- 
cipalities considering the enactment of ordinances or regula- 
tions requiring the pasteurization of milk. 
ARGUMENT NO. 15; There are always some people who "demand 
raw milk.” 
ANSWER: It is a trait of human nature to "want what wo 
want when wo want it.” Some motorists for a time demand the 
d/ght to cross railroads ahead of approaching trains and to 
pass cars on the curves; parents have been known to demand 
the right to send their children suffering from whooping cough 
to school. While those "demands” admittedly are not in quite 
the same category as that for raw milk, they serve to illus- 
trate the point that there arc situations v/hich "demands” 
that some individual or body of individuals be given authority 
to take such action as may bo necessary to protect the interests 
and'safety of the community which, after all, ’is but a group of 
individuals. Many people who demand raw milk do so because 
t&cy have not taken the troubl e to inform themselves on the 
relative virtues of raw and pasteurized milk or because they 
have boon misinformed. The person who contracts a disease 
such as typhoid fever or scarlet fever from milk or otherwise, 
becomes a potential source of danger to others. A milkborne 
epidemic in any community hurts business and gives the community a ’’black eye.” In order that the safety and interests of the 
community as a whole may be protected, local authorities are 
wisely given power to enact such ordinances or regulations as 
may be necessary for the protection of public health* In exert- 
ing such authority they rarely act unreasonably or arbitrarily• 
In many places, as in New York City, the demand for raw milk 
has been met by permit ting the sale of Certified milk, a raw 
milk soiling for a comparatively high price because of the 
extreme prbcautions taken in its production*... , 
The'fact that 'in- the rural area ■of1-the-State whore a 
relatively largo per cent of the milk sold-is-raw probably ac- 
counts for ;the fact that tho majority of our milkborne commun- 
icable, disease outbreaks have occurred in this area* 
ARGUMENT NO* 16; If pasteurization is required many 
small dealers in raw milk will either have to go to the expense 
of buying pasteurizing apparatus or go out of business# 
ANSWER; This is an argument which is at times given 
serious consideration* We heartily sympathize with tho predi- 
cament of the person in any lino of business who finds it neces- 
sary to put more money into his business in order to keep up 
with tho march of progress or to moot competition and finds it 
difficult to raise tho money* On tho other hand, this is one 
of tho exigencies which a persen in any business must bo pre- 
pared to moot* As Harry Walker Hepburn says in his ’’Psychology 
in Modern Business,” the business man, ’’like the. savage .* .must 
occasionally * put his oar to the ground* to get the tendencies 
of tho times and then prepare to meet them* His guiding atti- 
tude must be that of expecting changes and preparing to meet 
them’! Furthermore, the financial interests of any individual 
or group cannot properly bo weighed against the protection of 
tho community as a v/holc • 
There is, moreover, another side often Overlooked* 
Many milk dealers who have started pasteurizing ”wlth fear 
and trembling” have eventually had their business materially 
increased as a result. One interesting example will suffice. 
A few years ago a small city suffered from a serious typhoid 
fever epidemic v/hich proved to bo waterborne. Before the 
source of infection had boon announced milk wa*s under more or 
less suspicion. A milk dealer afterward, told this story; 
”1 was selling raw milk and doing a good business* 
I was against pasteurization and didn’t care who know it* 
Then tho epidemic came along. One morning I went out on my 
route and found I had lost seventeen good customers* That 
settled it; when I got homo I got an agont for pasteurizing 
apparatus on tho phono. Tho next morning ho arrived and in a 
week I was pasteurizing.” Then followed tho most interesting 
part- of his story. ”lt took another week to got ray now bottle 
caps, so for a week I was soiling pasteurized milk under a ”raw” 
label. Tho first day I wont out with my bottles labeled ’’Pastou 
riaod” four or five custoe»r« looked at th$ label md »Oh, I don!t want pasteurized milkl I don(t like the taste 
of itl fWell,* I said, !You!ve been getting it for a week 
and didn!t know the difference.1 The upshot of the matter was 
that my business increased, I was relievedcf a lot of worry and, 
believe me, I wouldnft go back to raw milk. 
In some cities in which pasteurization ordinances have been 
enacted an increase in per capita consumption of milk, apparently 
due to Increased confidence on the part of consumers, has been 
noted. For those "producer-dealers'1 whose business is not large 
enough to warrant undertaking pasteurization there are other 
markets, somewhat less satisfactory from their standpoint, but 
usually adequate* They can deliver their milk to pasteurizing 
or manufacturing plants. 
ARGUMENT NO. 17: In rural communities the quantities of 
milk sold are so small that pasteurization is impracticable. 
ANSWER: So far as the sparsely settled sural community is 
concerned this argument comes near to being valid than any of the 
other sixteen. The "overhead" cost of pasteurizing less than 
two or three hundred quarts is relatively high. The answer, 
however, is fairly obvious. In these days, of motor transpor- 
tation most communities are near enough to larger centers of 
population so that they can easily be reached by dealers who 
can afford to pasteurize. They will como in if the "business 
is there." Most people like to "patronize homo industries" but 
they should not forgot that in recent years good roads, the 
automobile and the telephone have pushed back boundary lines 
so that "home" nov/ covers a much larger area than it once did. 
There is still another point; the dealer who can not afford 
to pasteurize, frequently can not (or thinks he can not) afford 
to take other necessary precautions in the handling of his 
milk. He should not expect to "set the pace" for the community. 
Now having answered these several major and minor arguments, 
we turn to the 
REASONS FOR PASTEURIZATION 
In the twenty-three year period betv/eon January 1, 1917 
and January 1, 1940, 157 milkborno outbreaks of communicable 
disease occurred in the State, exclusive of New York City, 
only three of which were traced to pasteurized milk. The total 
number of cases was at Idast 9135# The diseases occurring in 
these outbreaks were typhoid and paratyphoid fever, septic sore 
throat, scarlet fever, diphtheria, dysentery, poliomyelitis 
and gastroenteritis. 
Of these 157 outbreaks, 75 wore typhoid fever (paratyphoid 
being included here under this head). Fifty-five of the 75 
wore traced to carriers and 10 to cases on the farms. Many 
outbreaks of disease other than typhoid fever, which is not 
generally transmitted through the udder of the cow, have boon 
traced to cows with mastitis. The common form of bovine mastitis 
is not responsible for outbreaks of scarlet fever and soptio sore throat , but may be involved in outbreaks of gastro- 
enteritis, This same condition may have boon responsible 
for others where the infected cows wore not located. Of 
the entire 157 outbreaks, about 91 per cent originated on 
the farms. 
Of the 157 outbreaks, 154 were traced to raw milk. 
Of the throo recorded as duo to pasteurized milk, one appar- 
ently was traced with roasonablo certainty to contamination 
following-pasteurization by an employee in the bottling plant 
who had an unrecognized case of the disease. In another, which 
occurred early In the twenty-throe year period, missed oases 
of disease cn a farm apparently were responsible. In this 
instance the efficiency of the pasteurizing plant had pre- 
viously boon in question and there is some doubt as to whether 
the milk was actually pasteurized.- In the other case, the 
milk was labeled Pasteurized although the evidence indicated 
that it had not been pasteurized. 
The foregoing record does not include tuberculosis or 
undulant fever. It has been estimated that about cne-third 
of the tuberculosis among children is due to use of milk from 
tubercular cows. Bovine tuberculosis has been reduced to loss 
than-one-half of one per cent through tuberculin testing of 
cattle. 
PASTEURIZATION DESTROYS DISEASE BACTERIA, Tills is the 
most Important reason why milk should be pasteurizedi It is 
scarcely necessary to point out that by no moans all cases of 
communicable disease are chargeable to milk. But the occurrence 
of over 9000 cases of milkborne infection, not Including tuber- 
culosis and undulant fever, in twenty-throe years is no small 
matter. Undulant fever-is a seriously incapacitating disease 
frequently duo to the use of raw'nuIk or cream from herds in- 
fected with ncontagious abortion.11 Increasing numbers of cases 
of undulant “fever are "being discovered in Nov; York State, most 
of which are believed to have been contracted through the use 
of raw milk or cream from infected cattle. 
There is another important consideration; 
PASTEURIZATION HAS CONTRIBUTED TO REDUCTION IN OUR INFANT 
DEATH RATES. Within the memory of many of us, hundreds of babies 
died every year, particularly in the large cities from ”summer 
diarrhea,” This condition was chiefly duo to use of milk con- 
taining large numbers of ndirt bacteria,” the sort of bacteria 
that get into the milk with dirt from the cow»s skin, unclean 
utensils and dust. Notwithstanding the general marked improve- 
ment in cleanliness of our milk supply in recent years, consider- 
able numbers of such bacteria will still bo found in sd mo of our 
market milk in its raw state. Several factors have contributed 
to the steady decline-in recent years in deaths from diarrheal 
diseases among babies, but the most important factors have boon 
this general improvement in the cleanliness of the milk supply and pasteurization, particularly the latter. Pasteurization 
not only makes milk safer for babies but accounts far. the •. . 
fact that pasteurized milk ’’keeps11 longer than raw milk 
of;;’similar quality. 
The important part of the story might be summed up in the 
simple statement that 
EFFICIENTLY PASTEURIZED 
MIIIC IS SAFE 
and 
THE SAFEST MILK IS THE BEST 156 
MILKBORNE OUTBREAKS OF DISEASE 
NEWYORK STATE. EXCLUSIVE OF NEW YORK CITY 
YEAR 
DISEASE 
OUTBREAKS 
CASES 
KIND OF MILK 
RESPONSIBLE 
193.7 
Typhoid fever 
3 • 
53 
Raw 
1918 
Typhoid fever 
6 
114 
Raw 
1919 
Typhoid Fever 
5 
52 
Raw 
1920 
Typhoid Fever 
3 
50 
Raw 
Diphtheria 
1 
70 
Raw 
1921 
Typhoid Fever 
10 
211 
Raw 
Scarlet Fever 
1 
24 
Raw 
Dysentery 
1 
14 
Raw 
1922 
Typhoid Fever 
5 
69 
Raw 
Diphtheria 
1 
13 
Raw 
Scarlet Fever 
2 
149 
Raw 
1923 
Typhoid Fever 
7 
83. 
Raw 
Typhoid Fever 
1 
23 
* Pas teurized 
Sapltio'So*e • Throat 
1 
14 
Raw 
Scarlet Fever 
1 
59 
•Pasteurized 
1924 
Typhoid Fever 
6 
103 
Raw 
Scarlet Fever 
1 
20 
Rtaw 
Gastroenteritis 
1 
82 
Raw 
1925 
Typhoid Fever 
8 
174 
Raw 
Diphtheria 
1 
16 
Raw 
Scarlet Fever 
2 
1 70 
Raw 
Septic Sore Throat 
1 
11100 
Raw 
Poliomyelitis 
1 
11 
Raw 
1926 
Typhoid Fever 
7 
128 
Raw 
Diphtheria 
2 
24 
Raw 
Scarlet Fever 
2 
65 
Raw 
Gastroenteritis 
2 
157 
Raw 
1927 
Typhoid Fever 
2 
30 
Raw 
1928 
Typhoid Fever 
1 
7 
Raw 
Scarlet Fever 
1 
31 
Raw 
Septic Sore Throat 
1 
30 
Raw 
Gastroenteritis 
1 
84 
Raw 
1929 
Typhoid Fever 
1 
2 9 
Raw 
Septic Sore Throat 
3 
Raw 
1930 
Septic Sore Throat 
3 
3819 
Raw 
Gastroenteritis 
2 
34 
Raw 
1931 
Typhoid Fever 
1 
22 
Raw 
Septic Sore Throat 
3 
593 
Raw 
G astroenteriti s 
1 
13 
Raw 
1932 
Typhoid Fever 
2 
18 
Raw 
Scarlet Fever 
1 
29 
Raw 
1933 
Typhoid Fever 
2 
9 
Raw 
Septic Sore Throat 
2 
197 
Raw 
1934 
Scarlet Fever 
1 
92 
Raw 
Septic Sore Throat 
2 
146 
Raw 
Gastroenteritis 
1 
53 
Raw 
*See page 153 
1 Estimated 1100 of which 366 were reported 
2 One outbreak of 141 estimated with 115 reported and another of 75 with 
51 reported 
3 One outbreak of 720 estimated, 88 reported CONTINUED 
NEW YORK STATE, EXCLUSIVE OF NEW 1SORK CITY 
MILK BORNE OUTBREAKS OF DISEASE 
YEAR 
DISEASE 
OUTBREAKS 
CASES 
KIND OF MILK 
RESPONSIBLE 
1935 
Typho5i Fever 
1 
7 
* Pasteurized 
Scarlet Fever 
1 
, 5 
Raw 
Scptxc Sere Throat 
5 
X771 
Raw 
Gas ti- center itis 
4 
131 
Raw 
Dyse utery 
1 
131 
Raw 
1936 
Typhoid Fever 
1 
13 
Raw 
Scarlet Fever 
6 
841 
Raw 
Septic Sore Throat 
2 
61 
Raw 
Gastroenteriti s 
1 
36 
Raw 
1937 
Typhoid Fever 
Z 
15 
Raw 
Scarlet Fever 
3 
43 
Raw 
Gastroenteritis 
1 
75 
Raw 
1938 
Typhoid Fever 
1 
13 
Raw 
Scarlet Fever 
1 
14 
Raw 
Septic Sore Threat 
4 
491 
Raw 
Gastroenteritis 
2 
175 
Raw 
Dysentery 
2 
166 
Raw 
1939 
Scarlet Fever 
1 
18 
Raw 
Septic Sore Throat 
2 
638 
Raw 
Gastroenteritis 
' 3 
97 
Raw 
• See page 153 
1 One outbreak of 500 estimated, 344 reported and another of 120 estimated, 
29 reported. 
SUMMARY OF MILKBORNE OUTBREAKS 
OF DISEASE 
NEW YORK STATE, EXCLUSIVE OF NEW YORK CITY 
1917 - 1939 
DISEASES 
OUTBREAKS 
CASES 
Typhoid Fever 
75 
1203 
Diphtheria 
5 
123 
Scarlet Fever 
24 
1460 
Septic Sore Throat 
29 
5090 
Dysentery 
4 
311 
Poliomyelitis 
1 
11 
Gastroenteritis 
19 
937 
Total 
157 
9135 
98*0 per ©ent of outbreaks and 99*0 per cent of cases were traced 
to raw milk as the source of infection* 
BULLETIN M*S, 53—1940 Edition 
Issued by the Bureau of Milk Sanitation 159 
KANSAS STATE BOAED OF HEALTH 
F. P. Helm, M. D«, Secretary 
PREPARED FOR RADIO STATION KFBI 
Release Tuesday, January 14, 19^1 
Broadcast No, 9^-8 
UNDULANT FEVER 
The number of cases of undulant fever in Kansas is increasing, with the 
provisional total of 165 during greatly exceeding the total for any year 
since 1927, when first reports of this disease were received by the Kansas 
State Board of Health, This Increase does not necessarily indicate an actual 
rise in the incidence of the disease -- it is undoubtedly the result of more 
accurate diagnoses and Improved reporting. Undulant fever is transmitted 
directly by contact with livestock or carcasses of animals Infected with con- 
tagious abortion, or indirectly by milk from cows infected with this disease. 
Undulant fever can be prevented by two methods -- true prevention is based upon 
the detection and elimination of infected animals. The prevention of undulant 
fever induced by the use of infected milk can bo accomplished by pasteurization 
of raw milk. 
The first cases of undulant fever were recognized and reported in Kansas in 
March, 1927; by Major C, C. Hillman, of the U. S. Army Medical Corps. Major 
Hillman, who was stationed at Fort Riley, reported the cases in March, 1927; 
although onset was determined as having been in September, October, and December 
of 1926. Since, and including the three cases reported in 1927; Kansas has had 
1,106 cases with deaths charged to undulant fever; this does not include any 
deaths which may have occurred in as mortality tabulations are not yet 
completed. This disease, obviously, constitutes an Important public health 
problem -- fortunately one for which we know the answer, which is, application 
of the known means of prevention. 
Until a few years ago, this disease was generally called Malta fever, becaus 
it was first differentiated from other fevers typical of the Mediterranean coast 
area, by Marston, a medical officer of the U. S. Army stationed at Malta. 
Although British medical officers, who had served in Malta after l800, repeatedly 
described the occurrence and increasing prevalence of the disease, especially 
between and i860, it was differentiated from other fevers and fully des- 
cribed by Marsten in his "Report on Fever" for l86l, and was called, in this 
report, Mediterranean remittent, or gastric remittent fever. 
Studies progressed and Bruce discovered the organism in 1886; isolated it in 
1887, and gave it the name "Micrococcus melltensls" in 1893* The name "Brucella 
melitersis" was proposed in 1920, in honor of the discoverer. 
The first caco vao recognized and re-ported In America in 190*4-, and during 
1905-'2*4- Inclusive, 128 cases were reported in the United States. Compare this 
record of 128 cases in the nation in a twenty-year period to the 165 reported in 
the state of Kansas alone, in the one year 19*4-0. We repeat the earlier observa- 
tion, that the increase in the number of reported cases of this disease is un- 
doubtedly due to improved diagnosis and reporting. Physicians have learned to 
identify the disease by its clinical symptoms, with diagnosis confirmed by 
laboratory tests. 
The name "undulant fever" describes the wavelike fluctuations of fever 
characteristic of the disease. No. 9^8 
Undulant fever is characterized by three predominating symptoms, namely; 
(l) general feeling of weakness, especially in the afternoon, accompanied by 
headache, or general aching; (2) fever, which is usually preceded by a feeling 
of chilliness, or a definite rigor followed by a hob stage, and (3) profuse 
sweating. 
Onset of the disease may be gradual, and in cases where the attack appears 
to be sudden, Inquiry often reveals a previous stage of fatigue and Indigestion. 
A typical case of undulant fever shows chilliness and a step-like rise of fever 
on each successive night, profuse night sweats, and lover morning temperatures. 
This condition continues, generally for six to eight weeks or more, after which 
the fever gradually declines and reaches normal or subnormal. In some cases the 
fever may rise again, after several days of normal temperature. Between attacks 
of fever, the patient, except for weakness, feels normal. With recurrences of 
fever attacks, lasting for months, the patient becomes anemic and functional 
heart murmurs may develop. There is also loss of weight, extreme prostration, 
nervousness, and mental depression. Patients are rarely dangerously ill, and 
for that reason complete physical and laboratory examination is often neglected. 
The diseases most frequently confused with undulant fever are; typhoid 
fever, tuberculosis, malaria, influenza, heart disease, rheumatism, septicemia, 
and appendicitis. 
Human beings contract undulant fever chiefly by drinking raw milk from in- 
fected cows, although farmers, dairymen, veterinarians, packing house employes, 
and others whose work brings them in contact with cattle, hogs and goats or 
the carcasses of these animals, also are liable to contract the disease if they 
handle animals infected with Bang's disease or contagious abortion. 
Since the disease is chiefly spread by infected raw milk, Wilson G-. Smillie, 
(pronounced Smiley) one of the outstanding public health authorities of the 
United States, says -- we quote, "proper pasteurization of milk is the most 
effective measure in prevention of undulant fever that is available at present." 
Doctor Smillie continues, "State departments of animal industry have taken 
active measures in many states, to rid infected herds of Brucella infection. In 
some districts the Infection rate in cattle is very high and elimination of the 
infection is a slow process, A few dairies that produce certified milk have 
succeeded in completely eliminating abortus Infection from their herds; but the 
basic preventive measure is milk pasteurization." (end of quote). Testing 
herds of cattle, with elimination of animals infected with contagious abortion, 
is an important control measure. Herds are easily infected, and when a farmer 
or stockman rids his herd of infected animals, he must be on guard against 
reinfection. Slaughter-house employes and others handling cows, goats or hogs, 
should wear rubber gloves as a protection against undulant fever. 
Undulant fever is an Important disease economically -- because it results 
in much time lost from work, due to its characteristically Ibngthy course.