pasteurisation

We touched upon the problems of infected milk supplies in a previous posting on abdominal TB and we’ll focus on the issue in more detail here. Mycobacterium bovis is the pathogen responsible for the development of TB in cattle, which is commonly referred to as bovine TB. The consumption of milk from cows infected with bovine TB and in turn the ingestion of mycobacterium bovis can lead to an individual developing TB. This was for many years a very common cause of TB in humans and remains so in countries that do not routinely pasteurise milk. Pasteurisation involves the heating of the milk in such a way as to kill off any bacteria that might be present, and through its use the spread of bovine TB to humans has nearly been eradicated in the UK.

The 1875 Public Health Act made it compulsory for local authorities to appoint a Medical Officer of Health (MoH) who produced an annual report detailing any health and sanitary issues in the district as well as giving a wealth of statistical information related to birth and death rates, population, infectious diseases and causes of death. The MoH for Northumberland makes regular reports on the situation in the county regarding tuberculosis including comments on the causes of abdominal tuberculosis and efforts made to prevent its spread. In the 1906 report he states:

“That about 30 per cent of the milch cows in England are tuberculous, and that consequently infants and persons suffering dangerous illness are in many cases being fed milk containing the organisms of tuberculosis” [NRO 3897/3, 1906 p.21]

The problem of infected animal products is clearly recognised by medical and sanitary officials early on in the 20^th century but little is done to tackle the situation head on and so abdominal tuberculosis continues to be a significant problem. Three years later in 1909 the MoH expresses his frustration at the situation and lack of power to change it:

“The elimination of tuberculosis from dairy herds is a matter of great difficulty since, at present, no assistance is given, by the state, to the farmer who, for the benefit of the general public as well as for his own advantage, may wish to obtain a herd free from this disease.” [NRO 3897/3, 1909 p.33]

It is not until the 1940s that significant steps were taken to introduce tuberculin tested milk and encourage pasteurization.

“The eradication of tuberculosis from our milk supplies is a matter of greatest importance to us all, and it is encouraging to note the marked increase in the production of milk from tuberculin tested cows. 45% of all the milk produced in the County was from such herds, and it is known that in 1948 the proportion had risen to more than 50%.” [NRO 4081/1, 1947 p.8]

HOSP/STAN/11/1/51 Boys at work on the farm — HOSP/STAN/11/1/51
Boys at work on the farm

Milk supplies were something given great consideration by those responsible for the establishment of Stannington Sanatorium from the outset. In 1905, two years before the official opening of the sanatorium, a farm colony was established on the site to take in young boys and provide them with training. It was from here that the sanatorium was able to receive a safe supply of milk from tuberculin tested cows. Tuberculin testing is another method used in preventing the spread of bovine TB whereby the cows were tested to see whether they carried mycobacterium bovis rather than treating the milk itself. This method was used quite commonly early on before the onset of widespread pasteurisation and would have been essential to the recovery of many of the patients and in preventing any of them acquiring any further infection. As time goes on, and tuberculin testing and pasteurisation is implemented more widely across the county, it is notable when looking at the patient files that instances of abdominal TB decrease particularly as we enter the 1950s.

Sources:

ALLISON, T. M. (1908) Children’s Sanatorium, Stannington, Northumberland, British Journal of Tuberculosis, 2 (3), p.204

SCHOFIELD, P. F. (1985) Abdominal Tuberculosis, Gut, 26 (12), pp.1275-1278

NORTHUMBERLAND ARCHIVES: NRO 03897, Northumberland County Council: County Medical Officer of Health Reports, 1893-1935

NORTHUMBERLAND ARCHIVES: NRO 04081, Northumberland Health Authority: Records, 1942-1970

Abdominal tuberculosis was a common diagnosis amongst the patients of Stannington Sanatorium and the patient case notes and radiographs give some indication as to the progression and manifestation of this form of TB. As was seen in the post from 19 November detailing the different types of TB, abdominal tuberculosis was a common extra-pulmonary form of the disease in which patients had often contracted the bovine strain of tuberculosis (mycobacterium-bovis) through the ingestion of unpasteurised or contaminated milk. We will explore the problems that arose from contaminated milk in a later post.

Abdominal TB most commonly affects the intestinal tract, mesenteric lymph nodes, and peritoneum and presents with symptoms such as abdominal pain, diarrhoea, rectal bleeding, and weight loss. The diagnosis of suspected extra-pulmonary forms of TB can often be assisted by chest x-rays where either active or healed tuberculous lesions can be seen. However in the case of abdominal TB where the primary point of infection is often not through the lungs but through the digestive system there may not be any evidence of any associated pulmonary infection. (Lambrianides et al, p.888) We don’t see as many radiographs within the Stannington records relating to abdominal tuberculosis in comparison to other manifestations of the disease such as pulmonary or bones and joints but there are nevertheless some good examples throughout the collection.

Case Study 1

Figure 1 - HOSP/STAN/7/1/2/21 (2) — Figure 1 – HOSP/STAN/7/1/2/21 (2)

Figure 2 - HOSP/STAN/7/1/2/21 (3) — Figure 2 – HOSP/STAN/7/1/2/21 (3)

The above radiographs are some of the earliest examples of abdominal TB from amongst the Stannington collection. They both relate to patient 80/21, a 9-year old female admitted in 1939 who presented with “vague abdominal signs and pain and traces of albumin in urine,” and a report on an x-ray taken prior to admission states that “calcified glands visible in abdomen above sacrum.” The reports given on the above two x-rays in the patient’s medical notes are very brief, with the first, figure one, being taken on 20 April 1939 and the report simply stating “gland to right of spine.” The second, figure two, was taken on 12 October 1939 and the report stated “calcification better seen in abdominal glands.”

Case Study 2

NRO-3000-HOSP-STAN-07-01-02-1463-06 — Figure 3 – HOSP/STAN/7/1/2/1463 (6)

Figure 3 relates to a patient who was originally admitted in June 1940 as patient 86/46 and discharged in May 1941 only to be re-admitted some years later in September 1947 as patient 118/1947. On his first admission he was 5 years old and it was reported that during the past year he had had several attacks of vomiting and abdominal pain but an initial examination found no resistance in the abdomen and no mass was felt. No glands were seen in the x-rays of his abdomen taken at this time. The above radiograph was taken in October of 1947 following his second admission and the radiographic images from this slightly later period tend to be much clearer and better defined than those from the early 1940s, such as in figures 1 & 2. When he was admitted the second time he presented with “listlessness, poor appetite, vague abdominal pain & night sweats” but during his stay no evidence of any active disease was actually found, with the above x-ray showing calcified abdominal glands, presumably as a result of his previous, now quiescent, case of abdominal TB from 7 years earlier. He was discharged less than three months later once his symptoms had settled down.

There is little evidence of surgical treatments being employed in Stannington to treat abdominal tuberculosis, particularly in the earlier files. This is corroborated by early literature on abdominal TB in children where rest and sunshine are cited as the main methods of treatment alongside the prevention of the putrefaction of bowel contents by reducing the intake of meat and eggs and the administration of charcoal and the occasional dose of mercurial aperient. (Sundell, 1926) Later studies however recommend the use of surgical treatments to deal with intestinal lesions in order to prevent healing by fibrosis which could lead to obstructions causing later problems. (Kapoor & Sharma, 1988) This healing process is evident in the radiographs of patient 118/1947 showing the calcified glands, with the possibility of problems occurring later on in life being something to consider with many of the Stannington patients.

Sources

KAPOOR, V.K. & SHARMA, L.K. (1988) Abdominal Tuberculosis, British Journal of Surgery, 75 (1), pp.2-3

LAMBRIANIDES, A.L., ACKROYD, N. & SHOREY, B.A. (1980) Abdominal Tuberculosis, British Journal of Surgery, 67 (12), pp.887-889

SUNDELL, C.E. (1926) Abdominal Tuberculosis in Children, Postgraduate Medical Journal, 2 (14), pp.24-26

Safe Milk Supplies

Case Study – Abdominal Tuberculosis