Another unclassified group occasionally present in milk is represented by moulds, particularly Oidium lactis, the mould which causes a white fur, possessing a sour odour. It is allied to the Mycoderma albicans (O. albicans), which also occurs in milk, and causes the whitish-grey patches on the mucous membrane of the mouths of infants (thrush). These and many more are occasionally present in milk.
3. The Disease-Producing Power of Milk
The general use of milk as an article of diet, especially by the younger and least resistant portion of mankind, very much increases the importance of the question as to how far it acts as a vehicle of disease. Recently considerable attention has been drawn to the matter, though it is now a number of years since milk was proved to be a channel for the conveyance of infectious diseases. During the last twenty years particular and conclusive evidence has been deduced to show that milch cows may themselves afford a large measure of infection. The recent extensive work in tuberculosis by the Royal Commission has done much to obtain new light on the conveyance of that disease by milk and meat. The enormous strides in the knowledge of diphtheria and other germ diseases have also placed us in a better position respecting their conveyance by milk. Generally speaking, for reasons already given, milk affords an ideal medium for bacteria, and its adaptibility therefore for conveying disease is undoubted. We may now suitably turn to speak shortly of the outstanding facts of the chief diseases carried by milk.
Tuberculosis. It is well known that this disease is not a rare one amongst cattle. The problem of infective milk is, however, simplified at the outset by recognising the now well-established fact that the milk of tuberculous cows is only certainly able to produce tuberculosis in the consumers when the tuberculous disease affects the udder. This is not necessarily a condition of advanced tuberculosis. The udder may become affected at a comparatively early stage. But to make the milk infective the udder must be tubercular, and milk from such an udder possesses a most extraordinary degree of virulence. When the udder itself is thus the seat of disease, not only the derived milk, but the skimmed milk, butter-milk, and even butter, all contain tuberculous material actively injurious if consumed. Furthermore, tubercular disease of the udder spreads in extent and degree with extreme rapidity. From these facts it will be obvious that it is of first-rate importance to be able to diagnose udder disease. This is not always possible in the early stage. The signs upon which most reliance may be placed are the enlargement of the lymph-glands lying above the posterior region of the udder; the serous, yellowish milk which later on discharges small coagula; the partial or total lack of milk from one quarter of the udder (following upon excessive secretion); the hard, diffuse nodular swelling and induration of a part or the whole wall of the udder; and the detection in the milk of tubercle bacilli. The whole organ may increase in weight as well as size, and on post-mortem examination show an increase of connective tissue, a number of large nodules of tubercle, and a scattering of small granular bodies, known as "miliary" tubercles. Tuberculin may be used as an additional test. The udder is affected in about two per cent. of tuberculous cows.
There are a variety of causes in addition to the vera causa, the presence of the bacillus of tubercle, which make the disease common amongst cattle. Constitution, temperament, age, work, food, and prolonged lactation are the individual features which act as predisposing conditions; they may act by favouring the propagation of the bacillus or by weakening the resistance of the tissues. To this category must further be added conditions of environment. Bad stabling, dark, ill-ventilated stalls, high temperature, prolonged and close contact with other cows, all tend in the same direction.
Though there can be no doubt as to the virulence of tuberculous milk, it may be remembered with satisfaction that only about two per cent. of tuberculous cows have unmistakably tubercular milk. Even of this tubercular milk, unless it is very rich in bacilli and is ingested in large quantities, the risks are practically small or even absent. Practically the danger from drinking raw milk exists only for persons who use it as their sole or principal food, that is to say, young children and certain invalids. With adults in normal health the danger is greatly minimised, as the healthy digestive tract is relatively insusceptible. Moreover, dairy milk is almost invariably mixed milk; that is to say, if there is a tubercular cow in a herd yielding tubercle bacilli in her milk, the addition of the milk of the rest of the herd so effectually dilutes the whole as to render it almost innocuous.
But if for practical purposes we look upon all milk derived from tubercular udders as highly infective, we may adopt a comparatively simple and efficient remedy. To avoid all danger it is sufficient to bring the milk to a boil for a few minutes before it is consumed; in fact, the temperature of 85° C. (160° F.) prolonged for five minutes kills all bacilli. The common idea that boiled milk is indigestible, and that the boiling causes it to lose much of its nutritive value, is largely groundless.
Milk may become tubercular through the carelessness or dirty habits of the milker. Such a common practice as moistening the hands with saliva previously to milking may, in cases of tubercular milkers, effectually contaminate the milk. Again, it may become polluted by dried tubercular excreta getting into it. Such conveyances must be of rare occurrence, yet their possibility should not be forgotten.
An infant suckled by a tuberculous mother would run similarly serious risks of becoming infected with the disease.
In Liverpool, Dr. E. W. Hope, the Medical Officer of Health, has organised an admirable system of examination by skilled bacteriologists to find to what degree the Liverpool milk supply is contaminated with tubercle. The final result of this pioneer work, which ought really to be undertaken by every great corporation responsible to the citizens for a pure water and pure milk supply, is to the effect that in Liverpool 5.2 per cent. of the samples of milk taken from the city shippons contains tubercle bacilli. As regards the milk sent in from the country, the return is that 13.4 per cent. is contaminated with the bacillus of tubercle.