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not be limited to the questions to which Dr. Ballard specially directed attention, but that the inquiry
should include also the investigation of the previous history of the animal from which the food is
obtained. Again during the last few years two Royal Commissions have reported upon tuberculosis,
and considerable advance has been made with regard to knowledge of that disease. The proof of the
identity of bovine and human tuberculosis has specially emphasized the need for taking due precautions
against infection of the human subject by tuberculous milk and meat.
There are two forms of food which have comparatively recently been shown to be capable of
conveying disease to persons consuming them.
In the case of oysters in relation to enteric fever, the connection has been established by the
first of the methods referred to above, by the kind of evidence which showed that enteric fever and
cholera had been communicated by water, and that milk was responsible for certain outbreaks of
illness. The other case is that of ice-cream, and here, while evidence such as that just referred to is
not altogether wanting, what has been mainly insisted upon is the existence of risk owing to the
conditions under which the commodity is prepared and sold; and it has been urged that the serious
nature of this risk is borne witness to by the results of the bacteriological analyses of ice-cream which
have been instituted. It is desirable, therefore, that the attempt should be made to form an estimate
of the value to be attached to the evidence collected with regard to ice-cream under one or other of
these heads of inquiry. Before doing this, however, it may be well to briefly summarise the
precautionary action which has been taken with a view to protecting the consumer from infection by
certain articles of food, in order that it may be seen, when actual conditions existing upon premises
where food is prepared in London come under review, to what extent the measures directed to be taken
with regard to particular articles of diet are carried out, and also to what extent it may be desirable
to extend the application of these precautions to other kinds of food.
The means taken for the protection and improvement of water supplies will not, of course, be
particularly referred to, the case of water being quite a special one. It is interesting, however, to
note what action has been taken with regard to milk and bread, the two foods which have received
special consideration. The need for this consideration as regards milk had been fully demonstrated
more than ten years ago, and the Dairies and Cowsheds Orders of 1885 and 1886, and the regulations
made under those orders, gave large powers to local authorities, some of whom made extensive use of
those powers. In London the Council, as the local authority, finds that in some respects modification
of the existing orders and regulations are necessary, but on the whole there can be no question that
great improvement in the condition of London cowsheds, dairies and milkshops has been brought about
by the enforcement of existing requirements. The sanitary condition of bakehouses has been subject
to some control ever since the passing of the Bakehouse Regulation Act of 1863. Attention has no
doubt been fixed upon the bakehouse as a place in which conditions harmful to the workers as well as
to the bread are apt to occur. So far as the latter consideration is concerned it is noteworthy that
evidence of spread of infectious disease by bread has not hitherto been forthcoming. The Act of 1883,
however, led to increased control being exercised over bakehouses, and during recent years a great deal
of attention has been devoted to them by London sanitary authorities. Great advantage has resulted;
bread is now prepared under conditions which are much less open to serious objection than was formerly
the case, and risk of contamination by drain and water-closet and sleeping-room emanations is in almost
all instances carefully guarded against.
The by-laws made by the Council, under section 39 (1) of the Public Health (London) Act,
contain a provision that no person shall construct a water-closet that is approached directly from any
room used for the manufacture, preparation or storage of food for man, and in this respect put such
places upon an equal footing with the bakehouse.
While the need for guarding against risk of contamination of milk, and possible risk in the
case of bread, has received recognition, little regard has hitherto been paid to the risk of conveyance
of disease by other kinds of food. In many towns on the Continent it has, of course, been otherwise
so far as meat is concerned. In London the power is given to sanitary authorities to inspect food, but
save in a limited number of districts very little or no use is made of this power, owing probably, so far
as meat is concerned, to the great difficulties which stand in the way of its inspection in the absence
of public slaughterhouses. Yet cases of food poisoning, usually from meat, from time to time
occur, and it is eminently necessary that increased efforts should be made with a view to preventing
contamination.
In the present report it will be convenient first to discuss in detail the evidence against icecream,
and as ice-cream prepared by Italian street vendors has been particularly called in question,
to describe the conditions under which such ice-cream is manufactured ; then to deal with the circumstances
under which certain other articles of food, to which attention has been specially directed, are
made and sold; finally the question how to remedy existing defects will be referred to.
An account of some of the recorded outbreaks of illness attributed to ice-cream.
Attention has been frequently called during recent years to the possibility of illness being
caused by the consumption of ice-cream. In Dr. Buchanan's report on an outbreak of scarlatina in
South Kensington, in 1875*, reasons were adduced for believing that a consignment of cream, supplied
to a house on the afternoon of a particular day, served in the form of creams or ice pudding at dessert,
and with coffee at a dinner-party on that day, and partaken of subsequently at other meals in the
house, caused throat illness in a number of those who had been guests at the party, the malady
attacking also others who consumed the cream. In this outbreak, however, cream seems to have been
at fault, ice pudding being involved as a result of the inclusion among its constituents of infected cream.
An outbreak which was attributed to the colouring matter contained in ice-cream, attracted
attention in America in 1884, 130 persons living in Brooklyn, New York, being attacked with
symptoms of irritant poisoning,† Again, in 1886, Dr. V. C. Vaughan, professor of physiological
* Report of the medical officer of the Privy Council and Local Government Board.
†Lancet, vol. ii., 1884, p. 441.