The City and Its Milk Supply

IF the death angel, Azrael of the flaming sword, stood before the gates of the city crying, “Open ye! For every street within your portals must yield to me one babe in ten,” what wailing and what lamentation would run quicker than thought through palace and through hovel ! But decimation does not suffice the death angel to-day. Two babes of every ten die in our great cities, and the world, filled with the rush of our modern age, scarce gives a thought to this fearful winnowing.

Nor is such a statement in any way an exaggeration. There can be little doubt that of one thousand children born, the fifth year will find more than one fourth of the whole number blotted out. And the majority of these have come from the narrow ways of the city. Boston and Washington lose over two hundred and fifty, New York over two hundred and seventy-five children, from every thousand. Many an empire-making struggle has passed with far less loss. Read on the tattered banners of historic British regiments the golden scroll of battles, from Malplaquet to Pretoria. How few of them show any such list of slain as do these records of the tiny victims of disease in peace.

Study the rows of figures further, and certain definite facts stand forth in the light. June, July, and August are the months of greatest infant mortality. Diseases of the digestive system cause forty per cent and more of the deaths. Not only that, but many deaths from other causes are rated as complicated by diseases of this class. No small number of these might well be added to the direct column wherein occur the greatest percentage of the deaths. That points to one thing as a source of danger, the food supply. Cow’s milk is the exclusive food of a great part of our children up to the time they are one year old. It is the chief food of practically all children from the age of one to the age of five. The inference is obvious.

It is remarkable that, with all the excitement concerning pure food laws which has stirred our wide expanse of territory during the last year, so little attention should have been given to the food of the child. We hear of laws to proride inspection for meat, laws to control the sale of drugs, laws to regulate the movement and inspection of vegetable products, but not one of all these important movements has to do with a substance so likely to cause widespread death, or to act as a carrier of disease, as the one we are discussing here. Most of the foods are cooked. Milk is served raw. Most of the foods are limited in the scope of their distribution. Milk enters evenhousehold. Most of the foods give comparatively little lodgment or nutrition to evil bacteria. Milk offers both. Can there be any greater municipal necesity than proper milk laws properly enforced ?

Strange to say, the little street of the Azores, or the mountain village of northern Italy, feeds its children better than we can feed our own. Smelling to heaven though these little towns may be, with gutters running with sewage, with walls and barns falling in dirty picturesque decay, their common milk supply is superior to that furnished even to the better class of our American cities. Twice a day, morning and evening, the herdsman leads his goats through narrow street and up rocky alley. Patiently the herd stands for its milking beside the clustering children, and the warm milk, fresh from the animal, goes directly to the child. The rising generation there gets pure milk. Pure milk is whole milk from a clean, healthy animal. Such milk is practically sterile, and if it be transferred to the consumer in that state, it is safe. But the danger from milk increases with every hour after it leaves the creature which produces it, unless precautions are taken to turn it over to the consumer in the same state in which it comes from the healthy animal. Therefore, since we can solve the problem in no such fashion as can the herdsman of the foreign streets, we must first understand the peculiar dangers which surround our city milk supply and then find the means of overcoming them.

Our common necessities of life, such as air, water, and milk, are taken so much for granted, that many of their ordinary properties escape our observation. The widespread course of milk, coming as it does to every family table, makes it a means for spreading disease, once pathogenic conditions have been introduced, second to no other medium, barring water. In one respect it is more dangerous than water, since a plague of typhoid or Asiatic cholera startles the community from its customary phlegm and causes immediate regulation of the single source of supply. But the death of children from stomach trouble or analogous disease makes no deep impression upon the people as a whole, and a hundred separate milkmen in a city are infinitely harder to regulate than is a common service of water. Other factors for comparison may be found in the inherent properties of the two liquids. The transparency of water causes its instant rejection when it bears visible sediment. The whiteness and opaqueness of milk serve as covering and shelter for insoluble substances. Dirt and filth, the carriers of disease, are easily hidden therein. A report from Germany, the home of systematic inspection, well shows the possibilities inherent here. Berlin, with its great system of vital statistics, reports that its inhabitants consume daily three hundred pounds of barnyard refuse in their milk supply. If that is true of Berlin, a city of extraordinary cleanliness, what must happen in our cities here ?

Still more important than the mere carriage of dirt or filth, stands the power of milk to give lodgment and nutrition to the bacterial hosts. These bodies are about us everywhere, lurking in the dust on the window-sill, floating in the sunshine, lying on the ground; they exist in such countless hordes that words like billion or quintillion utterly fail of significance when the number in an area of any size is to be considered. These invisible myriads of the air, moreover, increase with tremendous rapidity once they encounter favorable conditions for growth, such as moisture, warmth, and food. All these are furnished by milk. Raise barnyard dust near an open milkpail, and the whirling masses which have been lying in the refuse of the barnyard floor pour down upon the liquid as the destroying Huns of Attila poured down upon Europe.

But it must not be thought that all of the bacteria are evil. Suppose we try to separate the sheep from the goats. Roughly speaking, we may say that three great classes of bacteria may be present in milk, the acid-producing bacteria, the putrefactive bacteria, and the disease germs proper. The souring of milk is an everyday phenomenon, and every housewife knows that high temperature sours milk and low temperature keeps it sweet. Translated into scientific terms, the souring of milk means that lactic acid bacteria, the bacteria of the first class, have been busily working on the various constituents, and have changed a part of them over into lactic acid, which in turn has acidified the milk. This type of bacillus is commonly harmless, indeed it may have an absolutely beneficial effect, but the souring of the milk has been well called a placing of red lanterns to warn of danger, since the growth of these acidifying germs shows the growth of the other types, both of which are carriers of disease.

The putrefactive bacteria do not as a class belong in milk, but to be present must be introduced there from filth or outside refuse. This is the class of bacteria most dangerous to the child, since certain members of the group are the immediate cause of many of the serious digestive troubles of children. Dangerous, indeed, such troubles often are to adults, but far more dangerous when they assail the delicate system of the child. Once entered into the intestines, they produce putrefaction there, with grave accompanying disturbances. Cholera infantum, for example, long recognized as an acute milk poisoning, comes from these dangerous enzyme visitors, and its symptoms resemble those of poisoning by white arsenic, a violent gastro-intestinal irritant.

The third class, the pathogenic or disease germs proper, come in a way which is entirely preventable. They are the germs of contagious disease, the bacilli which cause typhoid, diptheria, and cholera, and they get into milk through milkers or handlers who are suffering from mild forms of disease, from persons who have been in contact with sufferers from such troubles, or else from deliberate or careless adulteration with a disease-infected water supply.

Besides this direct effect, we find one serious indirect result. All classes of bacteria by their growth extract considerable nutrient value, so that an infected or dirty milk, twenty-four hours old, gives less actual food to the child than does clean or fresh milk. And these infinitesimal bodies increase like wildfire. If two samples be taken, one from the milk of the night before, and the other from that of the morning of an examination, over one hundred thousand more bacteria per cubic centimeter will commonly be found to have sprung up over night in the uncooled evening’s milk, than are found in the fresh supply.

Responsible as man may be for carelessness which allows the growth of dangerous bacteria, he is even more directly responsible when he deliberately adds water for purposes of gain, or skims off cream from milk which is to be sold as whole milk. In either case the percentage of fat is cut down, and a constituent is removed which is needed, not only for purposes of nutrition, but also for the heat which keeps our body engine running. Thence comes a direct weakening of the resistant power and of the capacity of assimilation. The milk business, with its billions of gallons of milk, hundreds of millions of pounds of butter, and millions of pounds of cheese, is one of the great industries of the United States. With any such volume of business comes the tendency toward unrighteous gain. How great this evil is has been shown in St. Louis, wdiere it is estimated that over sixteen hundred gallons of cream is removed each day, — a loss of $900,000 a year to consumers, and one which bears most heavily upon the scanty purses of the poor. In New York the frauds committed by the milkmen are said to amount to about $10,000 per day, — a gain to a few individuals, which bears in its train two dangers, the transmission of disease and the lessening of bodily resistance because of diminished food value. Fortunately, business policy keeps one branch of the great industry, condensed milk, fairly free from adulteration and from disease. The great problem there is to get rid of water, as any increase of it would work injury. Not only that, but impurities in condensed milk may set up putrefaction, with resultant gases which may burst the can and necessitate the return of the stock.

There are, then, two factors to be considered in the control of milk. First, bacterial cleanliness, and second, the necessity for whole unadulterated milk. The first is the one which we most need to consider here. To fully recognize the necessity for proper bacterial conditions, we must trace the milk back to its source, consider the dairy farm, and what such a farm should be.

No matter how thoroughly imbued city men may be with city life and city ways, nothing touches most of them more closely than does the thought of country life. Typical of all wholesome outdoor joys is the mind picture of the old-fashioned barn. The wide doors swinging open to vistas of clover-scented meadow, the lofts laden with generous overhanging masses of hay, above which wheel the darting swallows, the cows and horses in their darkened stalls, and the broad bands of sunshine piercing the dusty windows, to broaden out into a full golden river before the open door, all give a figment of the imagination which completely fills the rural foreground of the average urban dweller. While that remains the conception of a dairy farm, the actual conditions are likely to be hidden completely from view. It is true that the old unswept barn where dust and refuse filled the air had evident difficulties, but it is also true that it had certain redeeming features. Our forefathers had a liking for “sightly spots” as they expressed it, and no one traversing the east to-day can fail to note how often a great red or white barn crowns some noble eminence. Those heights meant good drainage, good air, and free ventilation. The milk produced there, once it left the barn, was the especial province of the good housewife, and the spotless purity of her cool milkroom with its border of shining milkpans was her pride and joy. Not only that, but the short time which intervened before the warm milk reached its users left comparatively little chance for injury. Then, indeed, the foaming draught from the healthy pasture-fed cows might well bear health and strength.

No such conditions exist to-day in the majority of dairy farms. The milk supply of the city, if it comes from afar, must pass through hours of waiting by crossroad, by station, and in train, ere it reaches the urban terminal; and when it reaches the door it is likely to be anywhere from sixteen to forty hours old. Only when the greatest care has been taken in starting the milk clean, and keeping it throughout at a low temperature, can it arrive without accompanying millions of bacteria. If the milk comes from near at hand, the increasing value of real estate about a city only too often places the dairy farm in some damp, undrained spot. In either case the doctrines of fresh air, cleanliness, and sunshine spread slowly through the consciousness of the hired milker, an employee not uncommonly taken from some batch of immigrants just entering upon their first occupation in a new land. So seldom is any cleansing attempted in some of these bams that every movement of the milkers plants the seeds of numerous colonies of bacteria. An almost historic experiment of Freeman’s shows this clearly. Three culture plates, shallow dishes containing sterile solutions ready to give lodging and food to errant bacteria, were set for three minutes in separate places, one in the free open air, one just outside a barn, and the third placed inside, in front of a cow and beside a milkpail when milking was going on. The solutions were afterward developed, that is, were put under conditions favorable to bacterial growth, and the first plate showed six, the second one hundred and eleven, and the third, eighteen hundred colonies of bacteria. No result could more strikingly illustrate the possibilities of the dirty barn. Not only the floor but the cow herself is an immediate provider of such bodies, for the sides and udders of the animal lying in the filth of the stall carry many putrefactive germs. Then, too, those common carriers of disease, the swarming flies, may easily carry infection from a considerable distance.

The food of the herd must be good and ample if the milk produced is to be up to the standard. Where tower the walls of brewery or distillery the daily wayfarer may note streams of farm wagons which enter the big gates empty and come out full of dark spent grains. The farmer who buys those cheap grains is injuring the composition of his milk, and his wagon is bearing an improper food to the farm. That is only one of the dangers which come to the herd when greed of gain or ignorance holds sway instead of a wise progression. The milk of cows suffering from tuberculosis and other complaints is another example. Concerning this, one thing we may say. Whether bovine tuberculosis be fairly transmissible to man or not, the secondary products of toxine reactions in tuberculous cows, or the impure milk which comes from any diseased cow, may fill the milk with most injurious ingredients. But all these things are less likely to occur than is the ever-present trouble of unclean milkers, of unwashed dishes, and unswept floors. In cleanliness, in spotlessness, lies the great solution. One more point should be mentioned. Look out for sounds in the early morning hours which mean that milk is being bottled on the street in the wagon, instead of at the farm in the milk-house. The milk-house may well be in a far from perfect condition, but milk bottled there is far less liable to serious contamination than when it is taken from the farm in cans and bottled at the consumer’s door. On the street the possibility of contamination from dust, flies, and dirty bottles rises to a practical certainty.

The number of proper dairy farms is growing year by year. Those breezeswept sunny heights which called instinctively to the farmer of an older day, call because of their good drainage and ventilation to the modern farmer. His long, low barn, clean-swept, with floors where every form of filth may be easily and swiftly removed, his open stalls and stanchions, his separate hay barn, all show thought, care, and cleanliness. On such a farm the milk-house is properly separate from the bam and deserves a word for itself. There come the cleanhanded, white-clad milkers, with their covered pails whose contents have been drawn from clean cows. No milker enters the milk-house, but each pours his milk from an outside passage directly into the aerator or cooler. This piece of apparatus takes the warm milk fresh from the cow, and cools it immediately to 36° or 40° F., passing it from a tank over a large expanse of cylindrical pipe, whose interior is cooled by coils through which flows running water. From the cooler, the milk is run direct into sterile bottles. These are capped and placed on ice, where they remain, both on the farm and in the wagon, until the consumer is reached. Such a farm has, as a matter of course, a pure and sufficient water supply and clean and jointless milk utensils.

With all the difficulties which bar the way it must seem an Augean task to cleanse the city milk, to force the farmer to have proper conditions in his barn. Yet after all it is not so hard when one knows that there are definite ways to go about a cure, that dairy farms exist where pure milk is being produced, and that in some cities the milk supply is excellent. Since it has been proved that a satisfactory milk supply can be secured, the natural sequence is the arousing of the community to such a point that it will require every farmer who supplies it to have a proper farm, every dealer to keep and deliver his milk whole and clean.

The necessity for those standards which oblige the milk to have a certain content of fat and solids, that is, to contain the amount of nutriment which should exist in milk from a healthy cow, is fairly recognized. The difficulty in this respect has come less from a lack of city ordinances than from the appointment of incompetent or untrustworthy officials ; or else from insufficient appropriations, which too often keep good milk officials from covering any reasonable portion of the supply, to say nothing of taking care of the whole. The automatic law, which will work without ample appropriations, though long sought, is yet to be found.

The newer standard which requires that milk shall be free from injurious bacteria and germs, or that a fixed quantity of milk shall not contain more than a certain limited number of bacteria, is the one which chiefly needs our attention. For this standard a tiny mass of liquid, the cubic centimeter, about the thirtieth part of a liquid ounce, is taken. A small portion only can be used effectively, since even here the number of bacteria present may range from a meagre hundred to a host of ten million. But counting the bacterial inhabitants in a cubic centimeter is quite as effective a way of telling the condition of the milk as counting the bacteria in a quart would be. It is known that the greater the number of bacteria present the greater the chance for evil growths. We may, therefore, obtain a standard from the total number present, and decide that for practical purposes the purest milk is that milk which contains the smallest number of bacterial forms.

So the bacteriologist, bending over his microscope and culture tube in the quiet laboratory, stands between death and the children. No unworthy follower of St. George, the dragon-fighter of old, is this follower of science, fighting the modern dragons of disease and death. To him may safely be left the task of guarding the city, provided we have a law which will require a certain limit to the number of bacteria present, and inspectors to enforce the law. In his laboratory the samples received from the wagons and the farm are each carefully labeled, properly diluted, and poured on plates which hold sterile solutions calculated to give the best results in the way of bacterial growth when placed in warm, moist air. After a few hours under these conditions the plates begin to show dark spots which steadily grow larger and larger. These are the colonies from the individual micro-organisms, whose progeny have increased at the rate of hundreds, almost of thousands, an hour. Each colony means a single living organism at the start, and from the total of colonies the number of individuals present may be determined. Their kind also may be ascertained, be it harmless lactic acid form, dangerous putrefactive enzyme, or disease germ direct. Such bacteriological care insures the surest, safest, and healthiest supply that a community can possibly obtain.

The safeguarding of the city’s milk by sterilization and pasteurization has been so often considered that some reference to their action is essential. While heat up to 100° F. tends to increase bacteria rapidly, yet high temperature kills them, and the problem of the effect of temperature upon milk is no simple one. Whenever the housewife scalds her milk to keep it from souring she employs sterilization. Her real object in the process is to kill the lactic acid bacteria and prevent them from doing their work. In fact, practically all the living organisms of milk are destroyed by keeping it at 212° F, the boiling temperature, for ten minutes. But with this destruction come a series of changes which affect seriously the composition of the liquid. The gases, aromatics, and several of the watery constituents are lost, while some of the other constituents are modified. In consequence the digestibility of the milk is affected, and serious intestinal illness has been attributed to a constant use of such milk by infants. The process is a somewhat difficult one to perform properly; moreover, the appearance and taste, as well as the composition, of the sterilized milk, are injured. In consequence but little of it is used in American cities, though it is commonly found in continental Europe.

Pasteurization is the simple process of subjecting milk for twenty minutes to a temperature of not under 155°, not over 159°. This method, while it does not kill all bacteria, destroys the more dangerous of them, kills both putrefactive and disease germs, and commonly reduces the number per cubic centimeter from thousands and tens of thousands of bacteria to less than a hundred. Here is a possible safeguard for the individual family unable to obtain sanitary milk. The composition and appearance of the milk are not injured by pasteurization, and decided results are obtained. The destruction of the souring bacteria is in itself no minor matter, since milk which either has turned, or is on the point of turning, may be given accidentally to infants, with serious digestive troubles as a result. But far more important than this is the fact that the destruction of the germs of tuberculosis, typhoid, and diphtheria is practically certain. Pasteurization is inexpensive, simple, and easy to perform, does not require complex apparatus, but does demand care. Yet any process which heats milk above blood heat can never be wholly satisfactory, and pasteurization is by no means perfect. Nevertheless, it surely seems wiser for the individual consumer to have recourse to it than to chance the use of milk from a questionable supply.

Higher and higher loom the huge caravanseries where flock the city dwellers. Greater and greater wax the numbers of hospitals and institutions. With the increase of centres where hundreds and thousands may be fed from a single source of supply, has come a different problem from that which meets the individual consumer. At least one record exists which tells how milk received pure may be kept pure, even when distributed in many different directions.

Down beyond the North End of Boston, where the harbor air first begins to hold its own against the city smells, lies the Floating Hospital, a noble philanthropy nobly carried on. A year or two ago, when a new hospital ship was equipped for its use, it was determined that pasteurization should not be employed, and that no milk should be heated above 212° F., the boiling point. That meant that bacterial growths must be practically excluded from the supply, for the cases which enter the hospital are largely those of children suffering from digestive disease. No satisfactory apparatus by which institutions could keep milk down to a minimum of bacteria had been evolved, and the search to find a way to accomplish this fell upon the director of the food laboratory of the hospital, Mr. Frederic W. Howe. He took up the task and designed a laboratory which sends out milk day by day with a smaller bacterial content than has yet been recorded from any institution. The Boston Board of Health requires a standard of not more than five hundred thousand bacteria per cubic centimeter. The food laboratory of the Floating Hospital sends out milk to all its wards with a bacterial content of from one to two hundred. How is this possible of accomplishment ? It is done by means of a series of devices that insure absolute cleanliness in every process. That means a chance for the children, a decrease in infant mortality, which is one of the noteworthy accomplishments of the day.

The cramped space of a ship leaves little room for useless experimentation, so the sunny laboratory is a multum in parvo of four small rooms, cut off from the rest of the hospital and having communication by door only with the deck, by windows only with the corridors. The first room is the cleansing-room, where the nursing bottles back from the wards are washed by motor-driven brushes in tanks filled with hot cleansing solutions. From there the bottles are taken to the great sterilizer, — a rack-lined, copperfloored room where hundreds of bottles may be placed. The doors of the sterilizer are hermetically closed, and five steam, perhaps the greatest cleansing agent known, is turned on to fill every cranny of the room and of its contents. Then comes the modifier room, where the whole milk is modified to meet the needs of each individual patient. This room beyond the sterilizer is the essential part of the whole process. Any institutional apparatus must be of a sort to require a minimum of time and care with a maximum of efficiency. That is what is accomplished here. The modifier, a great square tank filled with cooling brine, holds a series of cylindrical tanks which supply the various liquids required for the milk mixtures used in the laboratory. The turning of a tap gives the milk. By a single connection of the hose each can is connected with a live steam pipe which cleanses and sterilizes it perfectly. Every can, once filled, is sealed save for its single delivery tube, and the bacteria instead of being killed are excluded. Last of all in the series, but first in actual use, comes the huge refrigerator where the clean milk from a model dairy farm is delivered at one side and taken into the modifier room on the other. Day after day and meal after meal pure milk mixtures are furnished to the children, and the percentage of cases gained and the number of children who pull through despite the handicap of the slum, is the best certificate of success. No institution or hospital but can profit by such experimental success as this.

One more record of modern research before we close; and this is another chapter of that great theory which shows the possibility of destroying germs of evil within the body by means of their enemies, the germs of good. It has long been known that certain health-giving properties belong to buttermilk, but the scientific value of this fact has only recently been recognized. It was found that in certain cases buttermilk was extremely successful in curing digestive difficulties. That gave a clue to start the development of the theory. If buttermilk stripped of much of its value in the butter-making, and dirty from the process, would do this, could not clean milk be so treated as to make it of greater value ? Experiment after experiment along this line has been tried. In the latest and most successful a pure culture of lactic acid bacteria is added to clean milk to acidify it. Sufficient of these bacteria are introduced to produce a maximum of seven-tenths of one per cent of lactic acid, a quantity which curdles the milk but gives in the soluble part a goodly growth of bacteria. These tiny warriors are the deadly enemies of putrefaction; once within the body they struggle with the bacteria of evil which have taken lodgment there, fighting on until they utterly destroy them. This is the same action in type as when antitoxine in diphtheria destroys the poisons which that germ disease has brought into the system. It is another step toward the prevention of disease by neutralization. No slight possibility for the future is such safeguarding of food by use of good bacteria to fight the bad. Among the many attempts tending towards the stamping out of disease this latest discovery may well stand as a precursor of great and noble deeds.

Probably the best results obtained today have come from the union of private enterprise with the physicians of the city and with the lay allies of reform. The encouragement of such united action may well become a public duty. Wherever wagons upon the street bear the sign “Certified Milk,” two things are likely to be true, — that the farm from which the wagon comes furnishes good milk, and that the dealer selling the milk has little difficulty in procuring customers. The sign is a most valuable advertising asset. Certified milk means, first, that a certificate has been issued to a dairy farm by a committee of physicians, and implies that the farm has been inspected and is in every way what it should be. It means, second, that the milk is delivered to the customer in some thoroughly satisfactory way. It is entirely possible that some features of any system like that of certification may not be practical for certain individual cities; but one feature, personal investigation of the conditions of the farm, should be a part of every milk inspection. In Vancouver, B. C., for example, the city milk-seller cannot obtain a license unless the farmer from whom he obtains his milk agrees to inspection. If the result of such supervision is not satisfactory, the trouble is removed by taking away the license.

But all attempts to create proper conditions have one difficulty, — they cost good money; and when we consider the low rate at which milk is now sold we are forced to question whether it is possible for the dairy farmer to live and supply clean milk at anywhere near the present rate. Yet after all paraphrasing, we come back to the old question, “What should not a man give for the life of his child ?” The alarming increase in the cost of latter-day living falls sorely on a great part of our population, but should we complain of the extra cost of the food of our children when we pay ungrudgingly for many luxuries ? The American pays from eight to fifteen cents extra a pound to get the choice cut of meat, and he considers an extra cigar or two a day a mere trifle. Can he logically refuse to spend the comparatively small extra amount which may mean life and strength to his child ? But paying a larger milk bill is not enough. Each consumer must see to it that every cent of the increased price stands for an increased excellence of product.

And now, to sum it all up: First, the modern study of milk tends to one end, the exclusion of bacteria by cleanliness, not their destruction by heat. In general however, it considers pasteurization a fairly satisfactory substitute where pure milk cannot be obtained. Second, mortality statistics tend to prove that exclusion is necessary for the child and for the nation. It may be that at the present moment we are a little weary of reform. The pendulum of warning may have gone too far in some directions, but in one it has not gone far enough. The lives of the city children hang in the balance to-day. If there is any means by which we can bring back ruddy cheeks and healthy bodies to children unjustly deprived of them, if there is any way in which we can lower our present fearful death rate, who of the community can refuse to lend interest, or give aid? The trumpet call which summons should rouse each deadened ear, quicken each dulled soul. It is the call to a new all-embracing, all-powerful children’s crusade.