H.—29a

Page 158.- " Milk-borne epidemics occur mainly in areas where raw milk is extensively drunk. It is significant that in the United States milk-borne disease has been practically banished from the large cities, where the great majority of the milk is pasteurized, and is now almost entirely confined to the rural districts and smaller towns, where most of the milk is consumed raw. " Since Toronto introduced compulsory pasteurization in 1915, not a single case of infectious disease carried by milk has been recognized. '• Numerous instances are on record where the same supply of milk has been drunk both raw and pasteurized and where disease has been confined to consumers of the raw-milk portion. A typical example is afforded by the recent outbreak of gastro-enteritis at Wilton, where the raw portion of the infected milk gave rise to at least 132 cases of acute food poisoning, while the pasteurized portion was consumed with impunity." Page 176.--" In a very small outbreak of typhoid fever in New York State in 1931, involving only four persons, the pasteurized milk was found to have been infected from a typhoid carrier employed in hand-capping the bottles." (This goes to prove the necessity of machine sterilizing and bottling.) Paqe 180. —" Though the sale of liquid milk in Great Britain has increased of late years, the average per caput consumption is still considerably less than that in several other countries. One reason for this is believed to be the distrust, felt both by the medical profession and by the more educated members of the laity, for our raw-milk supply, which is more heavily infected with pathogenic micro-organisms and more likely to give rise to disease than any other article of common use in our dietary. Not until milk is regarded hygienically in the same light as water, and freed by suitable measures from the risk of causing disease, will doctors feel justified in recommending its unrestricted use as a food and a beverage without incurring, as they do at present, the moral responsibility for endangering the health of those under their care." Page 181.-—" Careful estimates made in two different ways show that the probable number of deaths in England and Wales in 1937 from infection with the bovine type of tubercle bacillus was between 1,500 and 2,000. " With regard to epidemic milk-borne disease, excluding that caused by milk products, there are records available in Great Britain between the years 1912 and 1937 of at least 1 13 outbreaks of scarlet fever, septic sore throat, diphtheria, typhoid fever, paratyphoid fever, dysentery, and acute gastro-enteritis affecting about 14,000 persons. To these must be added an unknown number of outbreaks of. acute nausea and vomiting due to milk rendered toxic before ingestion by staphylococci or other organisms. Part also of the 190,000 deaths in England and Wales during the years 1912 to 1937 caused by summer diarrhoea of infants and young children must be attributed to raw milk. In view of these figures it is impossible to deny the gravity of milk-borne disease." Page 185. —" If some measure of compulsory pasteurization is introduced, it is important that the supply of milk and its heat treatment should be as satisfactory as possible. It is therefore suggested that — " (a) A pre-pasteurization standard of bacterial cleanliness should be laid down so as to ensure a satisfactory article for processing : " (h) The licensing of pasteurizing-plants should be transferred from local authorities to the County Councils : " (c) The personnel of pasteurizing-plants should be subject to the same type of medical and bacteriological control as that recommended by the Ministry of Health for the employees of water undertakings : " (fI) All pasteurizing-plants should be subject to regular and frequent inspection : " (e) Since most Sanitary Inspectors have neither the time nor the detailed knowledge and experience to perform this duty satisfactorily, specially trained whole-time Inspectors should be appointed, preferably on a regional basis, whose duty it would be to advise County Councils of the granting of licenses, to inspect plants in operation, and to take samples of the milk for examination both before and after processing : •' (/) Samples of the pasteurized milk should be examined as a routine by the phosphatase test, but this test should be checked at intervals by the method of guinea-pig inoculation." Professor Wilson concludes by saying— Page 186. —" To refuse to act on this knowledge, and to allow the continuation of a wholly unnecessary amount of suffering, invalidity, and death, may be justifiable on grave economic grounds, but can no longer be excused on the plea of ignorance except by those who, through natural or acquired defect, are too blind to see or too dense to understand." One cannot stress too strongly the observation by Professor Wilson that we should treat the milk-supply with the same care as we treat the water-supply. I agree with all the recommendations of the Commission with the exception of those enumerated in this report regarding the powers of Milk Councils and the putting into operation of those powers. The most important recommendations of the Commission are those in relation to a Producers' Supply Association providing all milk to a city, the purchase of milk on quality, adequate sampling and testing, and the supply of high-standard safe milk to the consumers at reasonable prices. I consider these recommendations cannot operate successfully unless there is a local authority purchasing and treating all milk to be pasteurized. This 16th day of August, 1943. (Signed) G, W. Dell, Member.

110