THE MILK SITUATION IN THE DISTRICT OF COLUMBIA. 99 



pasteurized, as also much of the tuberculin-tested product. During 

 the summer of 1909, when only about 30 per cent of the milk used in 

 Chicago was pasteurized, a decrease of 521 was noted during that 

 brief period in the deaths from diarrheal diseases reported among 

 children under 1 year of age. The average bacterial count of raw 

 milk in 1909 was 5,547,502 per cubic centimeter, while in pasteurized 

 samples taken from plants, a bacterial count of less than 200,000 

 was shown. The writer refers to the extreme importance of prevent- 

 ing the practice prevailing in some retail establishments of selling 

 left-over samples from the previous day's delivery, which practice 

 is responsible, in his opinion, for most of the high counts obtained 

 in pasteurization. 



Dr. Tonney contends that, while the effectiveness of pasteurization 

 in preventing milk-borne tuberculosis is fully conceded, the milk 

 situation in large cities involves so many other factors that tuber- 

 culosis of necessity may be regarded as only one among many sources 

 of danger, several of which, in his judgment, are even more impor- 

 tant from a public-health standpoint. In a large city, says he, there 

 must always be present the element of distance between the producer 

 and consumer, and this factor gives opportunity for the thousand and 

 one sources of contamination occurring as a result of multiplicity of 

 handling, time consumed in transit, improper handling durii g 

 transit, etc., all of which factors tend to multiply enormously the 

 common polluting agencies to which milk is subject. The final 

 product which reaches the consumer, he continues, may therefore be 

 dangerous from the standpoint of five or six groups of diseases, which 

 he enumerates in the order of their importance, as follows: First, 

 and by far the most deserving of attention, the group of infantile 

 diarrheal diseases, which are responsible for about one-third of the 

 death rate among children under 2 years of age in our large cities; 

 second, typhoid fever; third, tuberculosis; fourth, scarlet fever; 

 fifth, diphtheria ; sixth, a group of miscellaneous infections not par- 

 ticularly important in this country, such as cholera, foot-and-mouth 

 disease, milk sickness, and others. As tuberculosis, he observes, may 

 be eradicated by strict application of the tuberculin test, so may these 

 other infections be eradicated by the strict observance of sanitary 

 rules in the production and handling of milk, and since improvement 

 in this respect involves an educational campaign and the development 

 of an adequate inspection system, he insists that the public, which is 

 entitled to immediate protection, must turn to pasteurization, there 

 being no other single agency of purification of such wide applica- 

 bility. The feasibility of compulsory pasteurization has, he con- 

 cludes, been demonstrated by the experience of the city of Chicago 

 during the past 18 months. 



Dr. Park assigns the same relative importance as Dr. Tonney to 

 milk as an infectional factor in the following diseases, namely: (1) 

 Typhoid fever, (2) tuberculosis (in children), (3) scarlet fever, (4) 

 diphtheria. 



Of all foodstuffs milk is the most difficult to preserve pure and 

 handle with success. It requires not only intelligence, but a high 

 degree of technical training, as well as unceasing vigilance, to pro- 

 duce clean and safe milk. Many believe that this end may be ac- 

 complished by official supervision and an effective system of inspec- 

 tion, but we can scarcely conceive of any system of surveillance of 



