If a case of contagious disease in any farmhouse occurs, the local health officer should see that a proper quarantine is established and that the individuals in such a house are instructed in the danger of contamination and in the necessity of avoiding infection in the dairy. It is, however, the Board of Health in the city where the milk is consumed who have a particular responsibility. Such a board has no jurisdiction or authority over matters outside of their city, so that their executive cannot go out into the country, into the district of another health board, and order improvements made in the methods of production. All that a city board can do is to enact and publish restrictions under which milk must be sold in that city.
This is the method pursued in the city of New York, where tons of milk are consumed every day and where manifestly the jurisdiction of the city officials cannot extend over the thousands of farms located in the five states from which the milk supply is drawn. In New York City the local sanitary code provides that no milk shall be received, held, kept, offered for sale, or delivered in the city of New York without a permit from the Board of Health, and the Board makes this permit depend upon the sanitary conditions existing at the dairy or farm where the milk is produced or handled. In order to find out whether the conditions at the dairies and farms throughout these five states are in a sanitary condition, the city has a force of twenty-five inspectors who are continually engaged in traveling among the farms and in reporting on their condition. If a farm is found where the cows are diseased, or if the buildings in which the cows are stabled or in which the milk is cooled and strained are not clean or are lacking in proper ventilation or otherwise unhygienic, or if the water-supply is bad, the farmer is notified that conditions are such that the city of New York will refuse to receive his milk. He is not forced to clean up, and no orders are given him, but the attitude of the city authorities is made plain, and then it is left to him to decide whether it may not be wise for him to accept the suggestions made by the inspectors. Dr. Darlington, late Health Commissioner of the city of New York, reported in 1907, after two years of inspection, that out of 35,000 dairies inspected, only 47 were shut out on account of unclean conditions, although many more were warned with the result that remedial measures were at once taken. The same sort of procedure may be adopted by any city, and is, in fact, practiced by a number.
Another method of securing a better grade of milk which results in forcing farmers to clean up the barn and barnyard, at the same time allowing the local official to remain within the strict letter of the law, which gives him no direct authority over conditions on farms outside a city, is to limit the number of bacteria found in samples of milk supplied by the dealer. A common rule is that no milk shall be distributed which contains more than 50,000 bacteria per c.c., and when milk contains a number in excess of this, the milkman is warned, and if, at the next sampling, the number is still higher, the milkman is notified that his milk will no longer be received. Experience has shown that a reasonable regard for cleanliness in the stable and dairy room, with a prompt cooling of the milk, will limit the bacterial growth to this standard, and the requirement, meaning, as it does, only a decent regard for such cleanliness as a self-respecting dairyman would recognize as essential, works no hardship on any one. New York City prints its dairy rules on linen and has them tacked up in every cow barn concerned in the city milk supply, and while they have merely the force of suggestions only, practically they have the force of law in that a disobedience to these rules is likely to involve the refusal of the milk from that particular dairy.
LAWS GOVERNING QUARANTINE
It is much to be regretted that, in these days of scientific knowledge, when the exact and fundamental causes and processes of diseases are so clearly known to medical men and when laws based on this knowledge have been enacted for the purpose of reducing mortality and preventing the spread of disease, ignorant individuals should allow their prejudices to stand in the way of compliance with the spirit of these laws.
In New York State, Section 24 of the Public Health Law requires the local Board of Health to isolate all persons and things infected with or exposed to infectious diseases. They are required to prohibit and prevent all intercourse and communication with or use of infected premises, places, and things, and to require and, if necessary, to provide the means for the thorough purification and cleansing of the same before general intercourse with the same or use thereof shall be allowed. The Penal Code of the state further provides that a person who, having been lawfully ordered by a health officer to be detained in quarantine and not having been discharged, willfully violates any quarantine law or regulation is guilty of a misdemeanor, punishable by fine or imprisonment or both. In spite of this prohibition, it is very rare to find that a person in a quarantined house feels any personal obligation. He stays in or out, if obliged to by a policeman, or, if the sentiment among the neighbors is aroused in favor of quarantine, he waits until dark enough to escape observation.
In New York, two years ago, a case of diphtheria broke out in the family of a Christian Scientist. The health officer visited the house, offered to use antitoxin, which was refused, and instructed quarantine. The mother and one daughter died, and the healer was imprisoned for entering the house in defiance of the quarantine law. This case illustrates how the moral obligation may be distinctly repudiated because of religious prejudice. But even religious belief must be subservient to the laws governing the community in which a man chooses to live, and, so long as the residence continues, the laws governing quarantine, as all other laws, must be obeyed. In this case another count against parents may be found. Section 288 of the Penal Code provides "that a person who willfully omits without lawful excuse to perform a duty by law imposed upon him to furnish food, clothing, shelter, or medical attendance to a minor is guilty of a misdemeanor." It would seem, therefore, that the law is provided by which fanaticism may be overruled in the interests of the health of children, although it must be said that this phase of the law is generally disregarded. Again, in spite of the ample proof to the contrary, there are to be found persons who refuse to be vaccinated even in the midst of a smallpox epidemic. A law in New York State provides that no unvaccinated child shall attend public schools, the law being mandatory upon the school trustees. If this law were faithfully carried out, smallpox would entirely disappear from the state within a few years.
Other instances might be cited to show how the force of the law is invoked to minimize the effects of unhealthy living and to prevent that perfect individual liberty which a few irresponsible persons would assume to themselves. But it will always remain for the good sense of the individuals to direct their actions in such a way as to inflict no evil on the community. Unfortunately, laws are generally the result of some calamity. A law prohibiting child labor is passed only after the evil effects of such labor have been demonstrated by sad experience. Laws forbidding the sale of diseased meat or of spoiled fruit are passed only after repeated cases of illness have demonstrated the need of such laws. Laws involving quarantine are the result of epidemics which have showed plainly, at the cost of valuable lives, perhaps, the need of such quarantine.
It is the aim of hygiene, whether rural or urban, to raise the standards of living to such a degree that not only will any violation of health laws seem unreasonable and obnoxious, but also every instinct, of the individual will, even without specific laws, direct him so to live that no hygienic offense will be directed towards those with whom he comes in contact. Only in this way will the present violations of the requirements of hygienic living be avoided, and the normal man be enabled to live as he should in absolute harmony with his environment.