52 BACTERIOLOGY 



of slaughtered animals play a much less important part than 

 the product of the living animal milk. An enormous amount 

 of tuberculosis, especially among young children, is directly 

 traceable to this cause ; and " clean milk " or even compara- 

 tively clean milk is still practically an unknown commodity 

 among us. In fact, until the public has become sufficiently 

 educated to recognise its own peril from the contaminated and 

 often filthy milk at present so commonly purveyed for its 

 consumption, and until it demands from its legislators proper 

 and sufficient safeguards thorough cleanliness and sanitation 

 in byre and cowshed, in dairy and milk -depot as long as tuber- 

 culosis is not ruthlessly stamped out from among our cattle, so 

 long will the public be liable to preventable disease and death. 

 Something is being done in this direction in some parts of the 

 country, but far more drastic powers are required by our public 

 health authorities, and far more thorough methods of inspec- 

 tion of farms and dairies is necessary. Far more thorough 

 bacteriological examination of the milk itself, especially by 

 means of animal inoculation, is essential, and it is no exaggera- 

 tion to say that, in many of our towns where such examination 

 is more or less thoroughly carried out, some eight or ten per 

 cent, or more of the samples examined may be proved to be 

 tuberculous. 1 Mere inspection of the cows themselves is not 

 sufficient, as an animal may appear healthy and yet be tuber- 

 culous and spreading the disease far and wide in its milk. The 

 tuberculin test must also be systematically carried out by 

 experts as there are many fallacies and pitfalls in its use by 

 the inexperienced. 



What is known as " surgical tuberculosis," i.e. tuberculosis 

 of bones and joints and glands, is mostly due to tubercle bacilli 

 derived from milk. The infant and child mortality in this 

 country from such infection is appalling; the death-rate in 

 Edinburgh and Glasgow being, in Europe, second only to that 

 in Budapest. In the surgical wards of the Royal Hospital for 

 Sick Children, Edinburgh, operations for tuberculosis constitute 

 some 50 per cent, of all operations done ; whilst in the post- 

 mortem room, in above 30 per cent, of a consecutive series of 

 over 600 autopsies performed by the writer in the past four 

 years, death was directly due to the tubercle bacillus ; and 

 important experimental work done by the surgeons of that 

 institution has proved that from 60 to 90 per cent, of all the 



1 Dr. James Miller, in the Edinburgh Medical Journal for Feb. 1914, 

 in a paper on " The Prevalence of Living Tubercle Bacilli in Edinburgh 

 Milk," gives the results of an investigation in which he proved that 

 13 per cent, of samples bought from Edinburgh dairies contained living 

 tubercle bacilli capable of producing the disease. 



