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VERMONT STATE BOARD OF HEALTH.

Volume VIII. No. 4.
Issued Quarterly at Brattleboro, Vermont.
The Bulletin is published quarterly by the State Board of
Health under the authority of Section 5 of Act No. 90, Legisla-
ture of 1900. It will be sent to all Boards of Health. A copy
will be sent to any person in the state upon request addressed
to the Secretary, Henry D. Holton, Brattleboro.

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NEWS ITEMS. The New York legislature has just defined the powers and duties of local boards of health and local health officers in the matter of the protection of the people of the state from tuberulosis. Among these provisions is the following: Tuberculosis is declared to be an infectious and communicable disease, dangerous to the public health. It is made the duty of every physician to report all persons known by him to have tuberculosis.

TUBERCULOSIS From BUTTER, The close connection between the pure food movement and the campaign against tuberculosis, which is engaging the attention of the world at the present time could not be better shown than by the results of the elaborate investigations made by the United States department of agriculture on the dairy industry, relative to its responsibility for the “White Plague.” The result of the latest of these investigations has been reduced to the form of a report to the secretary of agriculture dated January 22, 1908, by the chief of the bureau of animal industry, and introduces an able article of twenty pages by Dr. E. C. Schroeder, M. D. V., superintendent, and W. E. Cotton, expert assistant of the experiment station, entitled, “Tubercle Bacilli in Butter: their Occurrence, Vitality and Significance." (Issued April 4, 1908, as circular 127.)

Numerous experiments were made by inoculating guinea pigs with butter infected with tubercle bacilli, and by noting the effects; and these experiments combined with the investigations by other eminent foreign and American experts upon tuberculosis, which are referred to in the article

, together with the opinion of the authors, make up the pamphlet, which is most instructive and which closes with the following summary:

SUMMARY. (1) The conduct of tubercle bacilli in milk is to move both upward with the cream and downward with the sediment and thus, in both directions, away from the intermediate layer of skim milk. The downward movement is due to their high specific gravity and the upward movement to the tenacity

with which they adhere to the comparatively large cream globules. Hence when cream is separated from infected milk it will contain, volume for volume, more tubercle bacilli than the milk.

(2) The frequency with which tubercle bacilli occur in sediment from milk is a fair measure of the frequency with which they occur in cream. What this means for the infection of commercial cream may be judged from the following paragraph quoted verbatim from the last annual report of the secretary of agriculture:

“The examination of sediment taken from cream separators of public creameries throughout the country has demonstrated the presence of tubercle bacilli in about one fourth of the samples."

(3) When butter is prepared from infected cream, tubercle bacilli are transferred to it in such numbers that they will be present in greater concentration that in the milk from which the cream was derived; hence, measure for measure, infected butter is a greater tuberculous danger than infected milk.

(4) Tubercle bacilli embedded in ordinary salted butter remain alive and virulent a long time; after ninety-nine days they show only a doubtful reduction of pathogenic virulence.

(5) Butter seemingly contains nothing excepting salt that acts against the life and virulence of tubercle bacilli. The germicidal value of salt, especially in the proportion in which it is used in commercial butter, is very low. Besides, the distribution of salt in butter is not homogeneous, and hence tubercle bacilli may be so embedded in butter that they are not exposed to the salt it contains.

(6) Sunlight is the most potent, natural agent for the sterilization of tubercle bacilli; it kills them in less than one hour when they are exposed to the direct rays of the sun in translucent layers of infectious pus, and in less than five hours when they are exposed in thick, opaque masses of such pus. Weinzirl asserts that tubercle bacilli, as well as other nonsporulating pathogenic bacteria, are destroyed in from two to ten minutes by direct sunlight, and Koch, Jousett, Flügge, Heymann, Di Donna, Cadéac, and others earlier called attention to the rapidity with which tubercle bacilli are destroyed by desiccation and exposure to light. Hence, we may conclude that the conditions by which tubercle bacilli are surrounded in butter, the moist opaque character of which shields them against the germicidal action of light and drying, are ideal for their long preservation. As a matter of fact it is difficult to imagine a better environment for the conservation of the life and virulence of tubercle bacilli not actively associated with tuberculous lesions than butter affords.

(7) Unimpeachable evidence proves conclusively that tubercle bacilli of the bovine type, from bovine sources, must be classed as highly infectious for man; hence, tubercle bacilli in butter cannot be ignored, because they are usually derived from the bovine sources. .(8) Since tubercle bacilli of the bovine type are certainly more virulent than those of the human type for all species of animals with which comparative tests have been made, it seems reasonable to ask, Why should they be regarded as less virulent for man?

(9) Tubercle bacilli of the bovine type are more frequently associated with the tuberculous lesions of children than with those of adults. Does this mean that children are oftener affected with tuberculosis from bovine sources than adults, or does it mean that mutations, shown to occur among tubercle bacilli, have had more time to pass thr ugh a complete transition from the bovine to the human type in tuberculous adults than in tuberculous children? This question is of special interest in connection with Von Behring's view—that tuberculosis, at whatever age it occurs and wherever the lesions are located, arises from latent tubercle bacilli that entered the body through the intestinal canal during childhood.

The authority of Von Behring in the field of tuberculosis is so great that we could not afford to discard his view lightly even if it lacked the abundant support other investigators have given it. If it is true, we certainly have good reasons to believe that the mutations, which quite a number of investigators have recorded as occurring among tubercle bacilli, have had ample time in the lesions of adults to result in a complete adaptive transition from the bovine to the human type of bacillus. Tuberculosis is undoubtedly contracted from two great sources, namely, from tuberculous individuals and tuberculous cattle. When contracted by persons from a human source the bacilli should have the human type; when contracted from cattle we should find the bovine type common in the lesions of young children, less common in those of older children, and very rare in adults. The occurrence of the bovine type, or of transition forms, in the lesions of adults would signify an exception to the rule of infection through latent bacilli introduced into the body during childhood.

This conception of tuberculosis, like inost other modern views of the disease, brings with it no encouragement to regard tuberculous dairy products with complacency; on the contrary, it stamps the tuberculous cow as one of the greatest dangers to which public health is exposed.

(10) The inhalation theory to account for the occurrence of pulmonary tuberculosis has been shown to be no longer tenable, because no substance can be carried into the finer bronchioles by the respiratory process, and because tuberculous lesions in the lung have been shown to spread from the vascular system, the finer capillaries, and not from the air passages. Dried and pulverized tuberculous material has been shown to lack infectiousness, and the infectious spray discharged from the mouths of tuberculous persons during speaking and coughing has been shown to be of importance only in their immediate environments unless such persons are permitted to handle articles of food, to which the larger droplets of the spray may adhere. The introduction of bacilli into the body through the uninjured wall of the digestive tract, anywhere from the mouth downwards, has been shown to be the chief mode of infection with tuberculosis:

Consequently, fresh, virulent tubercle bacilli in articles of food must be regarded as the greatest of tuberculous dangers, and among these, tubercle bacilli in butter, because of their frequent occurrence and their long-continued life and virulence, must rank very high as a danger of the utmost significance for public health.

(11) It is imperatively necessary for the protection of public health that all dairy herds should be cleared of tuberculous animals. It makes no difference whether the milk obtained from a tuberculous herd, or a herd that contains one or more tuberculous animals, is sold as milk or cream or butter; in all forms it is equally objectionable and dangerous. It is not a question of the exposure of children alone, but also of adults; the former drink more milk, but the latter eat butter oftener and in larger quantities.

(12) Until we are certain that the milk delivered to us by dealers is obtained from healthy cows in every way protected from exposure to tuberculosis, we should not use it until it has been pasteurized or sterilized, and all cream that is not above suspicion should at least be pasteurized before it is used in the preparation of butter.

While we are not special advocates of the pasteurization or sterilization of dairy products, we recognize that the public is forced to resort to some such expedient for its protection, not only against tuberculosis, but also against numerous other infections. Thoroughly clean dairy products require no pasteurization. While unclean, pasteurized milk is fairly safe, unclean raw milk is to-day the most important cause tolerated by civilization for unnecessary disease, suffering, and death.

To Health Officers: It is apparent that, in too many instances, the first cases of various communicable diseases are not reported to the health officer, the result being that these diseases are spread broadcast. We would therefore call the attention of all local health officers to chapter 225, section 5454, of the Public Statutes. This section imposes a fine of not more than fifty nor less than ten dollars on any head of a family or a physician who fails to give such necessary notice. You will, in the future, in all cases when any of the communicable diseases which may exist in your town are not reported promptly to you, either by the head of the family or the attending physician, at once report the case to the state's attorney of your country, with such evidence as you may be able to secure with reference to such omission to report, with the request that he will prosecute the parties who have failed to make report as required by law. See Section 5464, Public Statutes.

Foods that Do Not Comply with the Law:—The State Board of Health has directed Dr. L. P. Sprague, one of the chemists of the Laboratory, to seize and destroy any food substances which do not meet the requirements of the pure food laws of the state.

SCHOOL OF INSTRUCTION FOR

HEALTH OFFICERS

BURLINGTON, VT.

June 29 to July 2, inclusive, 1908

PROVISIONAL PROGRAM*

MONDAY EVENING, JUNE 29, 8.00 O'CLOCK.

Address: Charles S. Caverly, M. D., President of the State Board of

Health, Rutland.
Address: Governor F. D. Proctor, Proctor.
Address: Hon. Walter J. Bigelow, Mayor of Burlington.
Address: Judge Edward C. Mower, Burlington.

TUESDAY MORNING, JUNE 30, 9.30 O'CLOCK.

"Infectious Diseases," by Charles C. Caverly, M. D., President of the Board. Discussion: W. B. Hyde, M. D., Bakersfield; J. H. Bean, M. D., Cam

bridge; F. C. Kenney, M. D., Greensboro. “Nuisances—How Cared For,” by S. E. Darling, M. D., Hardwick. Discussion: H. E. Somers, M. D., West Derby; M. P. Stanley, M. D.,

Hartford; I. S. Coburn, M. D., Milton.

TUESDAY AFTERNOON, JUNE 30, 2.00 O'CLOCK.

"The Local Health Officer and Local Boards of Health,” by H. L. Still

son, Esq., Bennington. Discussion : A. C. Bailey, M. D., Randolph; C. M. Campbell, M. D.,

Rochester; Fred C. Russell, M. D., Wells River. * Subject to slight modifications.

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