June 2, 1911] 



SCIENCE 



837 



ease is not whether a particular measure is 

 entirely devoid of value, but whether it is 

 the most effective way of utilizing avail- 

 able resources. As matters now stand 

 there are a number of unquestionably 

 valuable measures that can not be prose- 

 cuted with sufficient vigor because of the 

 enforced diversion of funds into other 

 and less profitable channels. 



Efficacious measures may sometimes be 

 distinguished from the fruitless or rela- 

 tively unprofitable by their direct and un- 

 mistakable outcome in the saving of life 

 and the prevention of disease. A few illus- 

 trations may be noted. 



The importance of control and super- 

 vision of the sources of public water supply 

 has long been recognized, but the impor- 

 tance of controlling the quality of the pub- 

 lic milk supply, although frequently urged 

 by sanitarians, is not always appreciated. 

 At the present time in the great majority 

 of American cities it is safe to say that for 

 every case of infectious disease due to 

 drinking water ten eases are caused by in- 

 fected milk. It is difficult to secure ade- 

 quate funds for the sanitary control of the 

 milk supply. By sanitary control of milk 

 is meant not the upholding of a rigorous 

 standard of butter fat and total solids, but 

 the maintenance of proper standards of 

 cleanliness and health for dairy cows and 

 especially the safeguarding the milk from 

 infection during collection and transpor- 

 tation. Under some conditions the protec- 

 tion of the consumer against milk-borne 

 infection may be best brought about by 

 compulsory pasteurization of that portion 

 of the milk supply which can not otherwise 

 be raised to proper standard. "Whatever 

 method of control be adopted, it is certain 

 that any genuine improvement in the char- 

 acter of a milk supply will be followed in 

 the long run by a lessening in the amount 

 of typhoid fever, diphtheria, scarlet fever 



and to some extent tuberculosis. The early 

 detection of a single ease of typhoid fever 

 or scarlet fever on a dairy farm may be the 

 means not only of preventing an extensive 

 epidemic, but of avoiding the formation of 

 scores of new foci which can in turn serve 

 to light up subsequent cases for many 

 years. Proper pasteurization of milk has 

 been followed in many cities, as in Glasgow, 

 Liverpool and London, by an immediate 

 and material reduction in the amount of 

 typhoid fever. In other words, the connec- 

 tion between an expenditure of public 

 money and a direct return in prevention 

 of disease can be more clearly demonstrated 

 in the case of milk-supply control than in 

 some other of the usual municipal health 

 department activities. 



The question whether the quality of a 

 city milk supply can be more favorably in- 

 fluenced by inspection and supervision at 

 the source, or by generally enforced and 

 controlled pasteurization is one upon which 

 there is still some difference of opinion 

 among experts. There is little doubt, how- 

 ever, that simply as a matter of economy 

 of administration much is to be said at 

 present in favor of centralized pasteuriza- 

 tion of a large portion of the supply. 

 Viewed as a method for preventing a large 

 number of cases of infectious disease at 

 relatively small expenditure the pasteuri- 

 zation of milk certainly ranks high among 

 effective health measures. 



One of the important bacteriological ad- 

 vances of the last few years has been the 

 discovery that a considerable number of 

 healthy persons, convalescents or others, 

 harbor disease germs and that these per- 

 sons are important agents in spreading dis- 

 ease. The detection and proper treatment 

 of disease-germ carriers, particularly in 

 the more serious diseases and before or in 

 the early stages of an epidemic, is now rec- 

 ognized as an important although difficult 



