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we align ourselves? Are we our brother's keeper? If so, which brother do we propose to help? Do we propose to keep in with the vested interests, large and small, who make fortunes through ruining the lives of others? Do we propose to keep in with them through our ignorance, through our silence, through our inertia? Or do we propose to come to the aid of those unfortunate ones, those unhappy customers who buy drugs from those who have them to sell?

Let us realize exactly what we are facing. We are facing a huge commercial industry, which has for its object the making of drug consumers all over the world. This commercial adventure has gone on for many years, until now it has become highly organized and systematized, and reaches out into every known land. It is immensely powerful and capable of exerting enormous political pressure upon nations and inidviduals. It has grown to its present dimensions through lack of opposition due to ignorance of its existence. can only be fought by an enlightened, fully informed public opinion, which will no longer tolerate this condition, the prosperity of a class which fattens on the misery and degradation of thousands. Until this public opinion is awakened in all countries, there is no way of fighting the international drug traffic. The fight will be a long and hard one. A preventable disease cannot be prevented by apathy and indifference.

We can fight cholera and typhus because we are no longer ignorant as to how those diseases are spread and carried. We know what measures to take to prevent them. So with smallpox. So with tuberculosis. But imagine the difficulties of preventing all those communicable diseases if at the back, somewhere underground, there were hordes of vested interests, great and small, that make money over each new patient that came along? What chance would we have had in combating such diseases, if every new patient meant money in the pocket of some unscrupulous individual? If plague and pestilence had had any financial value, if there had been an army of middlemen secretly infecting all ranks of society, and making a pretty penny each time they succeeded in spreading the infection, well, our fight against preventable diseases would have been infinitely more complicated and difficult. But we must realize that this is exactly the situation that confronts us in fighting the drug evil. There are powerful interests that wish it to increase and to continue. Each new recruit to the ranks of drug takers means a bigger market for the sale of drugs. Have you ever noticed that there is a seemingly endless supply of habit-forming drugs? Apparently, an inexhaustible supply. The overflow trickles into those countries which try to protect themselves from it by laws, but the laws are scoffed at and evaded. The reason for this steady, constant supply is steady, constant production. These drugs are not raised for medical purposes. They are raised in excessive amounts, far beyond all reasonable medical requirements. This excessive over-production is simply and solely for drugging. Production for medical purposes does not pay, but excessive production, for drugging purposes, pays handsomely.

The first thing to do is to inform ourselves of the actual conditions. Let each one of us, in our own countries, try to learn what is going on. If we happen to live in the producing countries, that is, in countries where the crude drug, such as opium, is cultivated, let us investigate and see whether the production is large or small, destined for medical use or for supplying the needs of drug takers. In countries where opium is sold through licensed shops, as freely as cigarettes, let us stand in the queue of buyers before these shops, and study the people in line. As public health workers, the condition of these drug habitués will be interesting. If we live in countries where opium smoking is legalized, let us go into these smoking dens and consider whether or not the spectacle is reassuring. If we live in European countries, let us go into the police courts now and then, and note the victims as they come up for punishment or imprisonment, and let us wonder whether all is well. In short, let us inform ourselves as to the reality of this drug problem, and what it means to the well-being of those thousands of victims who have become enmeshed in a well nigh unbreakable habit. When we have become familiar with this traffic, the existence of which is so new to many of us, let us then consider whether or no we wish it to continue.

by

Colonel George G. NASMITH, C.M.G., D.Sc., D.P.H., and Dr. Ruggles GEORGE, B.A.,M.B., Canadian Red Cross Society.

of them had been accustomed to do when the milk was dipped from cans. Tampering with milk in bottles was easily detected.

ORGANIZATION OF CONTROL

The City of Toronto in Canada has a population of adding water to or skimming the milk as some of over half a million. Its Health Department, spends each year nearly three-quarters of a million dollars, a large sum, but the citizens vote the money with no reluctance. Estimates of other municipal departments may be cut and scraped to the bone but the health budget is always passed gladly. Why? Because the citizens know that the Health Department saves health and lives and money. For example, milk control alone saves each year a sum equal to the whole budget of the Health Department.

The first essential in the control of the municipal milk supply was to localize accurately the responsibility for the production, carriage and handling of milk. There were four classes involved the farmers or producers; the railway companies and men who carried milk by other transport to the city; the dairymen who handled and delivered it to stores, restaurants, hospitals and customers; and the sub-retailers such as grocers and restaurateurs, who sold it direct to the con

sumer.

Two essential things were done to control this situation and the complications arising out of it. In the first place, the farmer or producer was required to seal his cans with a lead seal bearing his initials. If the adulteration of milk was practised by the milkman who handled the milk—and frequently a man was found leaving his district with 12 cans of milk and arriving in the city with 14 or 15 cans--he was soon discovered and eliminated from the market.

When the milk arrived in the city it was analyzed before it went to the dairy, and after it was bottled samples were taken from the wagons delivering it. Thus a check was kept on the dairyman also. Since the Soo shops which sold milk could only sell it in bottles the temptation was largely removed

Control is organized under the Director of Laboratories of the Department of Public Health, who has a staff of laboratory workers and inspectors, but it begins on the farm and is continuous until the milk is delivered to the consumer. cedure is best described by following a sample of milk from pail to palate.

The pro

When a farmer wishes to ship milk to the city his farm is visited by a farm inspector, a qualified veterinarian with special experience in the production of pure milk. The Inspector makes a written report of conditions and if these are satisfactory, the name of the farmer is added to the Producers' List.

A producer is instructed to fulfil certain conditions,some of which are obligatory and others desirable. The obligatory requirements are expressed in the two words which are the motto of every good milk producer-"Clean and cool". The cows must be clean, especially the flanks, udder and tail. This necessitates clipping the flanks and tail and wiping the udder and teats before milking. Cows can be kept clean only in a clean stable. Therefore, the stable must be well constructed with tight ceilings to prevent dust falling into the milk pail, and a tight floor so constructed and drained that the cows will not lie in their own excreta. The milking must be done dry-handed with clean hands, preferably into a small-mouthed pail, which must be sterilized. The milk must be stored in a separate and well constructed milk house and kept in a covered, cool, clean can until

shipped. This requires the use of a tank with cold or running water and, in some cases, cooled with ice in the summer.

The farm inspector visits each producer at irregular intervals, at least once a year for good producers and oftener if the milk is not satisfactory. These visits include a detailed inspection of the cows, stables, milk house and methods of milking. The inspector endeavours to encourage and assist the producer with advice, bearing in mind the difficulties and limitations peculiar to each producer and trying steadily to raise the standard of production. The success of this education of the producer naturally depends largely on the tact and ability of the inspector. He gives the willing and intelligent farmer a gentle hint here, a word of advice there, compliments him on the appearance of the new calf and inquires after the baby's teeth. The farmer feels that the inspector is a friend who is helping him to produce more milk and better milk. The careless farmer often responds to such diplomatic treatment but, in some cases, more severe methods are required. The inspector can, and does, if necessary, talk to him like a father. If improvement does not

follow, the Department of Health writes him an official warning, which, if not effective, is followed by exclusion from the market for at least a week or until necessary improvements have been made. In a few cases this exclusion is permanent. The "big stick" is kept well in the background concealed behind a screen of co-operation and assistance, but the "big stick" is there and the farmer knows it.

The legal authority for milk control is adequate but kept purposely in the background. An equally compelling force is the economic one; the Toronto market pays the producer about 15 cents per 100 lbs. more than the price at the cheese factory. This price is sufficiently attractive to make the producer willing to meet the regulations. Exclusion is a more effective preventive of unsatisfactory milk than court prosecution.

The milk is shipped in sealed cans either by rail or road. The motor truck is becoming increasingly popular for comparatively short hauls over good roads. Individual shipments by rail are made in luggage vans, a method that often fails to keep the milk cool. Collective shipments by rail are made through ten shipping stations, at which the

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ON ARRIVAL AT THE DAIRY A RECORD IS MADE OF THE WEIGHT AND NAME OF SHIPPER OF EACH CAN.

Courtesy City Dairy Co. Toronto.

milk is collected locally, kept cool and shipped to the city in a chilled railway car. The decreased charges on the transportation of a carload enable the dairies to operate these shipping stations without loss.

Control in the city is exercised by four dairy inspectors who supervise the work of the fifty-four dairies in the city. The milk is received from the shipper in sealed cans, weighed and kept cold until pasteurized. Pasteurization takes place in vats at a temperature of from 142 to 145 degrees F. and held from 20 to 30 minutes. Time and temperature are checked by the fact that they are charted on recording thermometers owned by the Department of Health and operated by the Inspector. Immediately after this process the milk is cooled, either in the vat or by passage over a series of cold pipes. It is then bottled, capped and placed in a refrigerator awaiting delivery. In some dairies capping is done automatically by machinery. This avoids contact by hand and is an improvement which will soon be general. After use, all machinery is cleaned with water and soda, followed by either steam or a chlorine solution. Cleanliness of machinery is most important.

The empty bottles are washed in hot soda, rinsed in hot water and sterilized by live steam. The empty cans are given the same treatment, dried with hot air in many dairies, and sealed before return to the producers.

Sediment tests are made by the dairy inspectors and in some cases, by the dairymen. The disks of each producer are pasted on sheets of paper and

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This improvement in one decade is startling. In 1911 very few dairies pasteurized milk scientifically. By 1915, through official pressure and the campaign of education conducted by the Health Department, over 90 per cent of the milk in Toronto was scientifically pasteurized and pasteurization was made compulsory. In 1910 the citizens of Toronto had paid $350,000 for water purchased as milk.

Means to encourage good dairymen were found in the monthly publication of an honour roll of dairymen who scored at least 80 %. Only those with pasteurization plants could possibly win a high score. The result of publicity was that the dairymen on the honour roll began to increse their sales and the dairymen below 80 % began to lose. Since the small dairyman selling only from six to eight cans of milk a day could not afford a proper pasteurization plant and other equipment, the net result was that he sold out or formed a combination with one or more other small dairymen; they then pooled their holdings, bought the necessary equipment and were soon on the honour roll and increasing their sales.

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COST OF CONTROL

Milk control costs but it is money well spent and the cost per quart is trifling when compared to the increased purity of the finished product.

THE MILK

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During the same period bovine tuberculosis has become very rare amongst city children, although cases are often brought in from the country districts where the milk supply is not supervised. Since pasteurization became general there have been no epidemics of milk-borne disease.

CONFERENCES

The World's Dairy Congress will be held in Washington, U. S. A., from October 2 to 10, 1923. The President of the United States has invited all nations to send official representatives. Associations, research institutions, business firms and individuals interested in the production, manufacture, distribution or use of dairy products are invited to attend. In order to give the delegates and visitors the most comprehensive survey of what the United States is doing in the production and distribution of milk, the sessions will be held at three cities, as follows: Washington, D.C., October 2 and 3, Philadelphia, Pa., October 4, and Syracuse, N. Y., October 5 to 10. Details of the Congress rules and programme will be forwarded, on request, by the World's Dairy Congress Association, Inc., 426, Star Buildings, Washington, D.C., U.S.A.

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The United States National Education Association has announced a World Conference on Education to be held in Oakland, San Francisco, from June 28th to July 6th. An important feature of this conference is the International Health Education Conference, which will discuss aims, ideals and methods of health education in relation to all

school age children. Miss Theodore George, Associate Chief of the Junior Red Cross Division, will officially represent the League of Red Cross Societies at this conference. Dr. H. N. MacCracken, of Vassar College, U.S.A., will give an address on the aims and ideals of the Junior Red Cross.

A Conference on Infant Welfare will be held at Carnegie House, 117, Piccadilly, London, W. 1, on July 2nd, 3rd and 4th, 1923, under the auspices of the National Association for the Prevention of Infant Mortality and National Baby Week Council of Great Britain. For all particulars and for tickets application should be made to Miss J. Halford, Hon. Secretary, National Association for the Prevention of Infant Mortality, Carnegie House, 117, Piccadilly, London, W. 1.

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