Catherine Tang
Philadelphia, Pennsylvania, United States

Global milk consumption has steadily increased over the past few decades, reaching an estimated 908 billion liters in 2021.¹ Rich in protein, fats, carbohydrates, vitamins, and minerals, milk is considered an “ideal food” for its abundant nutrients required by both children and adults. However, milk is also one of the primary victims of food adulteration, where the quality of food is degraded by either the substitution of low-quality materials or by the omission of valuable ingredients from essential foods. Adulteration can be deliberate to cut back on production costs, or accidental, arising from ignorance, negligence, and a lack of strong regulatory systems and policies.² In the American Public Health Association’s Public Health Papers and Reports, from the early 1870s to the early 1910s, the approach to milk adulteration evolved from reactionary to preventive. This evolution was influenced by the Bacteriological Revolution and early environmental sanitation movements, the professionalization of public health, the shifting of responsibilities from state to local governments, and the emergence of new public health actors.

The late nineteenth century saw a rising social consciousness among the middle and upper classes to improve the health and welfare of the poor, as well as an acknowledgment of the impact of the environment on people’s lives. In response to this sanitary revolution, the American Public Health Association (APHA) was formed in 1870. One important focus was food adulteration. After public apprehension crested, with an increasing belief that food adulteration was pervasive and dangerous to health, public health leaders, medical societies, and trade associations joined forces in 1870 to pass pure food and drug legislation.³ It was during this time that Professor Albert R. Leeds from Hoboken, New Jersey, published “The Adulteration of Foods” in 1883, which highlighted how high rates of milk adulteration disproportionately affected children. Leeds suggested setting a uniform legal standard for “adulterated milk,” implementing stricter fines for violations of anti-adulteration laws, and bringing legal suits against transgressors. However, he also criticized the “crudeness and imperfections of many of the present methods” that tested for the nature and amount of adulteration. In response, he proposed appointing specialized analysts of “high professional attainments and undoubted honesty”⁴ to carry out inspections, illustrating this period’s transition to a merit-based system for appointing public health officials. Leeds also emphasized the involvement of state boards of health, demonstrating the advocacy of the APHA for state agencies to assume the responsibility for public health enforcement.⁵

As the nineteenth century advanced, the APHA’s focus on epidemiological disease expanded to include sanitary inspections, plumbing and drainage, food inspection, and offensive trade regulation. The rapid increase in urban populations also gave rise to political economists who emphasized that the health of the population played a major role in determining a country’s strength—an idea explored in “The Milk-Supply for Our Large Cities: The Extent of Adulteration and Its Consequences: Methods of Prevention” by Dr. J. Cheston Morris from Philadelphia in 1884. Morris highlighted “the importance of [the] milk supply from an economic and commercial point of view” and targeted the “thin, watery, ghostlike” swill milk that caused disproportionate rates of infant mortality from diarrheal diseases. His observations paralleled considerations from other public health entities during this period, which focused on the production of swill milk from poorly kept cows jammed together in filthy conditions. While Morris acknowledged the difficulties of enforcement, he also emphasized the local and state government’s duty to oversee continued milk inspection by vigilant sanitary officers. In addition, he proposed importing a new method of packaging from France where milk was stored in glass jars or bottles “free from contamination with foul air^“6 — a nod to the miasmatic theory underlying the sanitary movement for much of the nineteenth century.

In the early twentieth century, public health innovation accelerated in tandem with discoveries of the Bacteriological Revolution. New germ theories coupled with urban development, technological transformations, and more responsive health departments boasting new fiscal authority⁷ led to rapid public health developments. Milk adulteration was no exception. It was during this period of change that Dr. William H. Park from New York City published his “Report of Committee on Control of Milk Supplies in Large Cities” in 1905. Park’s recognition of the most serious contamination of milk being “contagious of scarlet fever, typhoid fever, diphtheria, [or] tuberculosis…[and] infection with the bacteria derived from diseased cattle” illustrates this period’s emphasis on finding the specific vector of disease as the preeminent public health response. His proposed methods and solutions, however, also balanced adherence to traditional environmental sanitation measures with the adoption of novel methods addressing specific bacteriological diseases. Park recognized the importance of inspecting all parts of the milk production and shipping process including sanitary conditions at the farm, during transportation, and at delivery stations; regulation of temperature; well-lit and ventilated stables; and hand-washing by milkers and delivery persons. At the same time, after acknowledging the difficulties of procuring funds to conduct routine inspections, he also suggested establishing a separate commission giving sanitary officers “laboratory room[s] for chemical and bacteriological tests” on milk samples and identifying new public health actors, such as physicians and private commissioners, who would work in conjunction with municipal health departments.⁸

The reports by Leeds, Morris, and Park point to essential changes in methods employed by American public health authorities to address milk adulteration from 1873 to 1912. First, the Bacteriological Revolution sparked debates over whether public health measures should center around promoting environmental sanitation or targeting specific diseases. As seen through Morris’ and Park’s reports, increased attention was paid to whether or not milk contained germs for tuberculosis, typhoid fever, scarlet fever, diphtheria, and more. Accordingly, methods of prevention adapted to keep pace with the rise of laboratory testing of milk samples and more nuanced understandings of chemical and biological processes. Diagnostic bacteriological laboratories yielding more accurate results became a staple part of health departments, and public health officials increasingly subscribed to the idea that “disease vectors must be confronted through research and testing rather than through the old preventative methods.” However, anti-contagionists’ continued advocacy for the efficacy of improved environmental conditions, such as ventilation and sanitation led to a compromise, wherein “environmental sanitation assumed a complementary role with bacteriology in the maintenance of a community’s health, but not the primary weapon in combating disease.”⁹ In other words, while the old public health was more concerned with the environment, the new public health, rather than seeking to prevent all types of disease, increasingly focused on implementing new preventative measures for milk adulteration that concentrated on identifying and addressing specific germs found in milk samples.

The years between 1873 and 1912 also saw the professionalization and standardization of public health. By the early twentieth century, most health officers had received some sort of formal training, and public health evolved into a distinct medical specialty. Particularly after the creation of the APHA, public health increasingly became institutionalized in urban centers, with health departments playing a key role in educating the public on milk adulteration and eliminating the worst threats to community health. Milk distribution centers and visiting nurses became primary vectors in educating new mothers in infant care, thus cementing milk adulteration’s connection to child health—a trend that has endured to this day. Furthermore, the rise of public health professionals resulted in changes to how inspections were carried out to increase adherence to regulatory statutes. For instance, Park suggests that officials should conduct “far fewer inspections…at unexpected times [to] create a wholesome fear among the slack…if severe penalties are inflicted.”¹⁰ This is an example of the transition from reactionary to preventive measures, as inspectors sought to deter transgressions rather than mobilizing only after they had already occurred.

This period also saw a shift of responsibility for enforcement from state to municipal health departments, as well as the introduction of new public health actors. By the late nineteenth century, state health departments were less involved in day-to-day health measures, while municipal governments accepted more administrative responsibilities. This change is seen most clearly through the substantial increase in municipal expenditures from 1900 to 1920, as well as several cities’ demands for less state interference in their affairs. Coupled with this transition, the late nineteenth and early twentieth centuries also saw the involvement of new actors who can be roughly divided into two groups: professionals and quasi-professionals with technical or scientific skills, such as sanitarians, physicians, and engineers; and citizens with strong civic and aesthetic values.¹¹

Ultimately, 1873–1912 was ripe with changes regarding methods and solutions to prevent milk adulteration, whether they arose from novel bacteriological discoveries, the professionalization of public health, or the transfer of responsibility from state to municipal agencies. However, it is equally important to recognize enduring continuities, especially the overarching connection between food safety and the health of the nation. Although diagnostic testing technologies and legal frameworks addressing milk adulteration have advanced substantially, the underlying principle that prevention is the best medicine remains the same. Ultimately, to understand the future is to look to the past, and public health is no exception.

References

1. “Per Capita Consumption of Milk, Excluding Butter.” Food and Agriculture Organization of the United Nations. Our World in Data. Last modified March 14, 2024. https://ourworldindata.org/grapher/per-capita-milk-consumption.
2. Azad, Tanzina, and Shoeb Ahmed. “Common Milk Adulteration and Their Detection Techniques.” International Journal of Food Contamination 3, no. 1 (2016). https://doi.org/10.1186/s40550-016-0045-3.
3. Duffy, John. The Sanitarians: A History of American Public Health. Urbana: University of Illinois Press, 1990.
4. Leeds, Albert R. “The Adulteration of Foods.” Public Health Papers and Reports 9 (November 1883): 166-70. Hathitrust. https://babel.hathitrust.org/cgi/pt?id=nnc2.ark:/13960/t1fj53m4r&seq=5.
5. Duffy, The Sanitarians.
6. Morris, J. Cheston. “The Milk-Supply for Our Large Cities: The Extent of Adulteration and Its Consequences: Methods of Prevention.” Public Health Papers and Reports 10 (October 1884): 246-52. Hathitrust. https://babel.hathitrust.org/cgi/pt?id=nnc2.ark:/13960/t9185z31n&seq=7.
7. Melosi, Martin V. The Sanitary City: Environmental Services in Urban America from Colonial Times to the Present. Pittsburgh, PA: University of Pittsburgh Press, 2008.
8. Park, William H. “Report of Committee on Control of Milk Supplies in Large Cities.” Public Health Papers and Reports 30 (January 1905): 176-84. https://babel.hathitrust.org/cgi/pt?id=hvd.hx3bz4&seq=7.
9. Melosi, The Sanitary City.
10. Duffy, The Sanitarians.
11. Melosi, The Sanitary City.