( Originally Published 1939 )
Most of the conditions described in the preceding chapter are brought about through accident or a lack of knowledge on the part of food operators. However, many cases are due to culpable ignorance and also to cupidity. Very likely none are caused by actual viciousness. Some of these conditions will gradually decrease as the public at large, and the industry in particular, become better educated as to the factors involved in illness from food, and learn that the continuance of such practices militates against the public health and profitable business. But the ranks of food handlers are being steadily recruited by novices who have to Iearn proper practices from experience. To this class must be added the hard-heads who do not want to do any better. Both groups need the supervision of control officers—the one to be educated and helped, and the other to be punished. The industry needs supervision not only as insurance to maintain public confidence but also to keep competitors from taking unfair advantage by rounding the corners of carefulness in technology and of honesty in labeling.
OFFICIAL CONTROL AGENCIES
Federal. The most highly organized federal food-control services are in the U. S. Department of Agriculture, where the Food and Drug Administration enforces the Food and Drugs Act (and since June 25, 1939, the new Food, Drug, and Cosmetic Act), the Tea Act, and the Import Milk Act, and also where the Bureau of Animal Industry en-forces the Meat Inspection Act, the Imported Meat Act, and the Horse Meat Act. The U. S. Treasury Department enforces the Quarantine Law and various federal statutes relating to taxes on oleomargarine and treated butter, and collaborates with state officials in water and milk sanitation control. The Federal Trade Commission enforces the recently amended Federal Trade Commission Act relating to false advertising.
Food and Drug Administration. The U. S. Food and Drug Administration is primarily engaged in the enforcement of federal acts which are designed to promote purity and truthful labeling in foods (except meat) It endeavors to protect the health of the consumer by preventing the sale of foods that are poisonous, pathogenically infected, or otherwise directly deleterious to health. It serves the economic welfare by preventing fraud (such as misbranding and sale of substandard products) and by strengthening the market for commercial food products through the enforcement of standards and correct labeling.
The personnel consists of approximately 530 members including administrative officers, chemists, bacteriologists, physicians, veterinarians, entomologists, plant pathologists, microscopists, pharmacologists, inspectors, and other specialists, together with the necessary library and clerical staff and the general service. In order to facilitate the ad-ministration of the several acts which are assigned to it for enforcement, the country is divided into an eastern district with headquarters in New York, a central district with headquarters in Chicago, and a western district with headquarters in San Francisco. Located strategically throughout these districts are sixteen branch stations to supervise the interstate shipments and importations of foods, and to cooperate with local officials in control problems which prevail in their respective territories. The general headquarters are located in Washington where a staff of about 200 members is engaged in the executive offices and technical laboratories.
The amount and variety of food shipments which come within the purview of the Administration are so great that the whole range of foodstuffs is grouped into classes: canned foods, cereal products, fruit and fruit products, cattle foods, and many others. The program of work in each such class is called a project. This system concentrates attention to needed places and times, restricts field and laboratory expenses to budget allotments, and enables the executives to maintain close supervision over staff activities as well as industrial developments.
In order that the Administration may have direct knowledge of trade practices as a basis for its interpretation of the analytical data obtained by the examination of samples of food collected by the field men, it is necessary that its trained inspectors visit factories in operation, accompany fishermen in their various sea-food enterprises, inspect food-handling during production and transportation, and in general acquaint themselves by direct observation with the latest developments in the industry. Many commercial firms are glad to assist the officials in these investigations, and often make valuable contributions to the aggregate information on a given subject. This assistance may take the form of preparing experimental batches of food under varying conditions, or calling the attention of the inspector to some new developments in the food-packing art, or according him the use of the plant laboratory, or otherwise extending the intelligent help without which a field inspector is handicapped in his investigations.
The execution of food-control laws involves so much scientific and technological knowledge that their enforcement is rendered difficult without the availability of specialists with well-equipped laboratories and highly trained staffs. New food products are continually entering the market, new manufacturing processes are being applied to staple commodities, and there still remain unscrupulous dealers who do not hesitate to apply new information to perpetrate fraud. By studying the effect of different conditions of season, agronomy, geographical location, methods of production and manufacture, conditions of transportation, and effects of storage, it is possible to adopt standards of strength or quality that can be attained by a proper technology.
On the basis of the policy that prevention is better than cure, the Administration freely accords advice to inquirers as to the legality of their declared intentions.
FEDERAL FOOD, DRUG, AND COSMETIC ACT. The Federal Food and Drugs Act of June 30, 1906 (originally sponsored by Dr. H. W Wiley), was superseded on June 25, 1939, by the more comprehensive Federal rood, Drug, and Cosmetic Act. This contains all the useful provisions of the older act, and is much broader in its scope and effectiveness.
The new Federal Food, Drug, and Cosmetic Act was approved June 25, 1938, to become generally effective one year thereafter, al-though certain provisions became immediately effective in order to facilitate orderly enforcement.
The Secretary of Agriculture is authorized to promulgate regulations for the efficient enforcement of the act, except that the procedure for handling imported foodstuffs shall be regulated jointly by the secretaries of Agriculture and the Treasury. The collection of the necessary technological information and its formulation into effective food definitions and standards will be handled by a food standards committee. This consists of two members each from the Association of Official Agricultural Chemists, the Association of Dairy, Food, and Drug Officials of the United States, and the Food and Drug Administration. The Secretary is required by law to issue public notices that hearings will be held at a given time and place on proposed standards to accord any interested person or his representative an opportunity to be heard or to submit a written statement. The record of this proceeding becomes the formal basis for all subsequent review. Any new standard must be based on the evidence as presented, and becomes effective no sooner than 90 days after it is issued. Controversy regarding the reasonableness of such a standard may be made by appealing to the Circuit Court of Appeals. Review is con-fined to the basis of the record of the original hearing on which the standard was based.
A summary of the act is printed on pages 491 to 496.
TEA ACT. The Federal Tea Act 2 was enacted to prevent the dumping of the world's worst tea into this country. Each year the Secretary of Agriculture appoints a board of tea experts who fix uniform standards of quality and select samples of these standards for sale to tea merchants and for distribution to the tea examiners at the ports of entry. Teas which do not conform to these standards are refused entry. Appeal from the actions of the custom officials may be made to the Board of Tea Appeals, a committee of three members of the U. S. Department of Agriculture.
IMPORT MILK ACT. The Import Milk Act" enacted in 1927 uses the permit system to control the sanitary quality of milk and cream offered for entry into this country, mainly from Canada. The Secretary of Agriculture issues permits to applicants who can show that their milk or cream comes from healthy cows free from tuberculosis, and from farms or plants which score at least 50 on the score cards of the U. S. Bureau of Dairy Industry. A staff of veterinarians and inspectors cooperates with the Canadian government in examining the conditions on the premises of the applicant. Samples are examined at the port of entry for compliance with the bacterial limits of 300,000 organisms per cubic centimeter.
MC NARY-MAPES AMENDMENT. The so-called McNary-Mapes amendment to the Food and Drugs Act 4 enacted by Congress on July 8, 1930, provides that a canned food which falls below the quality standards promulgated by the Secretary of Agriculture may be sold if the name of the article is accompanied by the legend "Below U. S. Standard" and an explanatory statement, both of which must be en-closed in a rectangular box with solid border. Both the type and border are required to be on a sharply contrasting, uniform background. Standard requirements for the labeling of different kinds of canned foods have been published.
SEA-FOOD AMENDMENT. In 1934 Congress enacted the Sea-Food Amendment to the Food and Drug Act.' This instrument, sponsored by the shrimp canners, authorizes the Secretary of Agriculture, on voluntary application of any packer of sea food that is to be shipped in interstate commerce, to assign inspectors to the applicant's plant to supervise his packing operations. All the costs of this inspection service are borne by the packers themselves. This type of inspection is distinguished by its correction of conditions at the source.
Bureau of Animal Industry. This organization of approximately 2400 employees is engaged in the enforcement of the acts which govern the interstate shipment of meats and meat products. It functions differently from the Food and Drug Administration by virtue of the action of Congress in forbidding the interstate shipment of any meat or meat products unless the immediate establishment is licensed by and complies with the enforcement rules and regulations of the Bureau of Animal Industry.' This authority enables the bureau to enforce sanitary standards in all such establishments and to station inspectors where they can examine every animal before and after slaughter, and every dressed carcass and all manufactured meat products before they leave the establishment. The great emphasis of this food-control service is on the prevention of the entry of unsound meat into the markets rather than on the attempt to catch illegal shipments here and there as they can be found.
The Imported Meat Act 6 was enacted October 3, 1913. It provides that imported meats must comply at entry with the rules and regulations of the Secretary of Agriculture, and that after entry they shall be treated as domestic meats under the Meat Inspection Act and the Food, Drug, and Cosmetic Act.
The Horse Meat Act 6 was enacted July 24, 1919, to require that all equine meat offered for import, export, or shipment in inter-state commerce must be labeled "Horse-meat" or "Horse-meat Product" under rules and regulations prescribed by the Secretary of Agri-culture, and subject to the same penalties which obtain for the slaughter of other food animals.
Bureau of Dairy Industry. This bureau supervises the sanitation of process- and renovated-butter factories, has charge of the marketing and certification of renovated butter, and controls all other dairy products for export.
Bureau of Agricultural Economics. The Secretary of Agriculture is authorized under the farm products inspection law to grade fruits and vegetables, poultry, butter, eggs, and other perishable food products "for class, quality, and/or condition." This service is not mandatory, but is available on application to the Secretary of Agriculture through this bureau. Grading is done at certain designated markets by licensed graders at fixed fees.
Public Health Service. This division of the U. S. Treasury Department has been engaged for a long time in the examination and certification of interstate drinking-water supplies. Lately, pursuant to an increasing recognition of the need for an effective control of the sanitary conditions in the shellfish industry, the Public Health Service has collaborated with state officials in the certification of non-polluted fishing areas and plants, but it does not exercise direct control. Milk sanitation became a definite part of the work of this Service as a result of the success of the State of Alabama in 1922 in improving the quality of its milk supply by the enforcement of an ordinance which had been prepared by the Office of Milk Investigations under the leadership of Mr. Leslie C. Frank. The effectiveness of the work in Albama attracted the attention of so many other communities that this milk ordinance gradually became known as the Standard Milk Ordinance. It has been adopted in modified forms by 670 towns and cities ranging in population from hamlets of 1000 persons up to cities like St. Louis and Chicago.
Bureau of Internal Revenue. The Commissioner of this bureau of the U. S. Treasury Department enforces the various federal statutes relating to taxes on oleomargarine, adulterated butter, and process or renovated butter. He publishes regulations which define the enforcement procedure, and a weekly bulletin of information on the ingredients and current production of oleomargarine.
Federal Trade Commission. This organization is empowered to enforce the provisions of the amendment to the Federal Trade Commission Act, approved March 21, 1938, which declares that the dissemination of any false advertisement of foods by publication, radio broadcasting, or other advertising medium is unfair or deceptive, and that advertisement of a commodity that is injurious to health or intentionally fraudulent is a misdemeanor. The advertising medium or agent himself is not liable if he furnishes to the Commission the name and address of the person or firm who engaged the service. False advertisement is defined as one that is misleading in a material respect in statement, word, design, device, or sound, and moreover one that fails to reveal pertinent facts concerning the possibly harmful effects of the use of the commodity that is advertised. The Commission may issue a cease and desist order against the unfair or deceptive act, and may prosecute (through the Attorney General) for fine and imprisonment for the misdemeanor.
State. Food control by state official agencies resides in the police power of government to enact and enforce laws, within constitutional limitations, to protect and to promote the health, safety, morals, order, comfort, and general welfare of the people. The executive branches of the state government which are responsible for the enforcement of food laws are usually the health or the agriculture departments, although the sanitary engineer may be the enforcement officer. Some of the states have enacted food laws which are modeled on the United States Food and Drugs Act and the U. S. Public Health Service Milk Ordinance. Usually the effectiveness of their direct regulatory control is handicapped by an inadequate enforcement personnel. This tends to confine the activities of the state organization to general supervision of the food of backward or small communities which have no protection of their own, and to educational efforts for improving official inspection, commercial operations, and consumer appreciation. Most attention is usually devoted to milk control, then ice cream, and in certain sections to canning and inspection of fruit.
Municipal. Municipal corporations, being political subdivisions of the state, have the police power to exercise jurisdiction over all matters affecting the health and safety of their people. Tobey writes:
In many states the public health control of milk is delegated by the state directly to local boards of health which are somewhat independent units of the municipal government. . This power may also be delegated to a district board of health, organized in accordance with a state law. . Although municipal boards of health are administrative branches of local governments, they also have quasi-legislative functions and thus may adopt ... rules and regulations to carry out the intent of state laws...
Several general models of suggested municipal ordinances for milk control have been issued by different states, federal bureaus, and private welfare or professional groups. Probably the briefest is proposed by the Committee on Administrative Practice of the American Public Health Association:
An ordinance based on and including the provisions of the state statutes should be in force, which prescribes the safeguards with which milk should be surrounded on the farm, at the pasteurization or milk plant, and during delivery. In order to enable the health officer to secure compliance with these requirements, it is advisable that the ordinance include either, and preferably both, of the following enforcement devices:
1. All producers and distributors should be required to hold permits which may be revoked by the health officer for violation of any item of the ordinance.
2. All milk supplies may be graded, and, if so, the health officer should be authorized to lower the grade of any supply if any item of sanitation is found violated. Efforts should be made to eliminate the lower grades as rapidly as improvement makes this possible.
The most comprehensive and detailed model is suggested in the general form of the Public Health Service Milk Ordinance and Code.
Although these powers are broad and include the right to supervise the handling of all foodstuffs, as a matter of fact the municipalities are concerned chiefly with the control of milk. This requires a larger, more expensive, and different type of control service as compared with that adequate to enforce compliance with the conception of "pure foods" in general. Its justification lies in the unhappy experiences of many communities with serious milk-borne epidemics. It is this immediately demonstrable relation between a contaminated milk supply and disease which has directed the attention and furnished the financial and public support for a type of food inspection which experience has taught to be the most effective in preventing disease. This is the permit system. Meat inspection and shellfish control also are based on this procedure.
In general, municipal inspectors enforce mostly those regulations which govern permit administration, spoilage of perishable food, direct infection of food, and food-poisoning outbreaks. All these re-quire immediate and quick regulatory and condemnatory action which is not so readily effected by food-control headquarters in some distant city. As a result, the municipal officials leave the field of general food adulteration and misbranding largely to the states and, in these days of improved transportation and interstate commerce in food, especially to the federal authorities, who are better equipped to function in this field.
The food-control officer in municipalities is almost always the health officer or his deputy.
Private control agencies. Although the official food-control agencies have been chiefly responsible for bringing the food industry as a whole to its present high level of sanitary quality, the trail has of-ten been blazed by private or non-official organizations. The incentive usually was the belief that government lacked jurisdiction, detailed information, or interest in the special problem.
American Medical Association. The great success of the program of the Council on Chemistry and Pharmacy in bringing a degree of dependability and professional recognition to the proprietary medicine industry encouraged the movement for some similar control over the exaggerated claims of food manufacturers. The American Medical Association then organized its Committee on Foods for the promotion of wholesome foods of declared nutritional values, and for the encouragement of truthful and instructive food advertising. The Committee adopted an official seal which it permitted food manufacturers to use on their products when their advertising complied with the Committee's requirements"
The present Council (changed from a committee status) confines its considerations to packaged foods or to foods that have been treated by various means to improve their nutritive qualities." The foods which comply with the Council's requirements are published in the regular issues of the Journal of the American Medical Association to provide information of the composition, manufacture, chemical analysis, microorganism content, special food values, vitamin content, and warranted claims of these accepted foods. Rejected foods are likewise published, together with the reason for their rejection.
Good Housekeeping Institute. The purpose of the program of this organization is to acquaint consumers with those products which are free from adulteration and satisfactory in performance. For example, a flour is analyzed for its compliance with recognized standards and is tried in tested recipes. If a product submitted for approval is found unsatisfactory in certain particulars which could be corrected by the manufacturer, this information is given him. The work of this Institute is discriminative and also constructively corrective. In general, it does not operate to tell the public what is unsatisfactory to buy but rather what is found to be satisfactory in quality and what its experience indicates that consumers will like.
National Dairy Council. This organization is a professional group of educators and publicists whose activities are financed by voluntary public subscriptions from the dairy industry. Its primary function is to publicize the nutritional excellence of dairy products by furnishing educational material and other information to civic groups, schools, and other interested inquirers. It aims to improve the quality of dairy products by voluntary efforts of the dairy industry itself. Its headquarters is in Chicago and there are branch Councils, as they are called, in many of the larger cities.
American Association of Medical Milk Commissions. Medical milk commissions are responsible to their immediate medical societies for the supervision of the production and handling of certified milk. They are collaboratively associated in a national organization with headquarters in New York. They are strictly non-political and non-commercial. They have shown the public, the health officials, and the industry that pure milk can be commercially produced.
Commercial control agencies. National Canners Association. Among the trade associations which have been most active in the field of quality control and improvement is the National Canners Association. The function of its research laboratories in Washington, D. C., is to conduct investigations on the fundamental principles of canning to improve the quality of the product and overcome the causes of spoilage. Much of its program is devoted to helping individual canners in their packing difficulties and to improving quality. An-other part of its organization bridges the gap between the agricultural research institutions and the crop-producing interests represented by canners and by farmers who grow canning crops.
Dairy industry. The International Association of Ice Cream Manufacturers took the initiative about fifteen years ago in drawing attention to the need of official regulatory control of sanitary conditions in the ice-cream industry. It has published its recommendations in its Sanitation Manual for Ice Cream Plants, Special Bulletin 38 (1932). The International Association of Milk Dealers, the American Butter Institute, and the Dry Milk Institute have all been active in the quality improvement of their respective products. The Evaporated Milk Association has been particularly interested in sponsoring clinical investigations on the nutritional value of evaporated milk.
Other agencies. Other trade associations in the different branches of the food industry have their research committees or other forms of organized effort to improve the quality of their products. One of the most powerful aids in this work has been the trade journals. Their staff reporters attend meetings of scientists, physicians, and food-control officers to bring the latest developments in regulatory control and quality production to their readers. Several commercial agencies furnish information to private subscribers regarding the quality and value of a wide variety of articles including food.
In addition to all the above agencies at work for the improvement of our food supplies, the food manufacturers and dealers themselves have been among the most aggressive. However, educational material from these sources must be taken with all due allowance for the commercial bias which may actuate some of them. Although the industrialist is in business to make money, the great majority are conscientious citizens who have pride in their products and want to make them wholesome and safe. They maintain highly organized laboratory staffs and spend large sums of money to improve their methods of producing quality products. Their success impels competitors petitors to come up to their level.
Several commercial food control organizations engage to supervise the operations of food dealers, certify to the quality of their products, or render technological assistance. By this means many small companies are able to secure expert assistance at reasonable expense.
OFFICIAL REGULATORY PROCEDURE
Legal. The legal aspects of food control rest upon two general types of regulatory procedure, namely, the direct laws and the license system. Under the first are the laws which specify standards of strength and quality, as, for example, the provisions of the U. S. Food, Drug, and Cosmetic Act, the act defining butter and providing a standard therefor, and the general laws which prohibit the sale of adulterated food. The license system is based on the police power of the responsible health or other administrative officer to issue licenses to firms to engage in the food business without jeopardy to the public health. Examples are the U. S. Meat Inspection Act, the Import Milk Act, and most of the municipal milk control ordinances. Infringement of the laws renders the violator subject to direct court action, usually involving the loss of the product and the payment of a fine, sometimes followed by criminal prosecution. Violations under the license system place the dealer or producer in jeopardy of losing his permit with consequent closing of his business by the police.
Food control by the United States government may be exercised over only those commodities which are shipped in interstate commerce, imported into this country, or produced and handled in the District of Columbia and the federal territories. By collaboration with state and city officials, the federal inspection force is made more effectual by the complementary jurisdiction of municipal, state, and federal laws, as well as by the increased and intensified work of the combined personnel.
Food products that are offered for importation must be accompanied by certificates which are attached to the invoices and issued by the consular agents abroad. Customs officials at the ports of entry notify the food-control officials of the arrival of food shipments, and withhold release until the lading has been examined. If it is considered desirable to take samples for analysis, the entire shipment is held pending the results. When the product does not comply with the standards, and the show-cause hearing given the importer does not justify the admittance of the product, the collector of customs refuses entry. Appeal may be made to the Secretary of Agriculture.
Under the license system, the applicant for a food-handling permit fills out a form supplied by the regulatory officer, usually the health department. This furnishes the names of the responsible proprietors or operators, the nature of the business, the source of the supplies, and other data according to the type of business. A small fee may be charged. The application is then usually referred to the inspection division. If the inspector finds that conditions at the premises comply with the local rules and regulations, he will approve the application, and in due time the applicant receives his permit. The permit usually lasts for one year, and is revocable for cause. From time to time, inspectors visit any part of the operations of the business to ascertain whether the legal requirements are being properly followed. If a violation is discovered, the inspector gives the operator a written notice of the offense, sometimes setting a date for full compliance. It is then reinspected.
Educational. Although the food-control officer usually has enough legal authority to prosecute in the courts almost any kind of case that is a real hazard to the public health, he has recourse to two other very effective means for forcing compliance with current standards of quality, namely, the grading system and publicity.
The grading system has been mostly developed for use in the control of milk and sanitary conditions in restaurants. As applied to milk, its effectiveness depends on the enforcement of proper labeling in conformity with the requirements of two or more grades or levels of sanitary quality, one grade selling at a higher price than the other. If samples of the higher grade (selling at a higher price) are found to be below the requirements of the grade as claimed on the label, the control officer may order the degrading of the milk to the next lower grade (selling at a lower price). An economic stimulus is at once operative to induce the operator to use every effort to correct the cause of this action. (See page 91 for more extended discussion of this system.)
Another device that has been found to be effective in milk control is the publication of the sanitation ratings of milk sheds. This procedure has been found by the Public Health Service to be very effective in demonstrating to communities their standing relative to other communities in the quality of their milk supplies. Such publicity is embarrassing, to say the least, to backward localities, and often provides the stimulus necessary to effect corrective measures. (See page 92 for more extended discussion.)
Inspection. Effective food control requires constant and intelligent inspection of the food-handling operations. Inspectors must make visits to the premises to observe whether the rules and regulations under the laws and ordinances are being followed. Casual observation is not effective. The inspector should be so thoroughly trained that he knows what kind of infractions to look for, how to correct them, and, most important of all, how to prevent them. The inspector does most effective work when he knows more about the process than the operators do.
This inspection of premises and food-handling operations is necessary because some types of violations cannot be ascertained merely by the examination of samples of the products. For example, the requirement that toilets should not be located in food-processing rooms, or that the premises should be kept free from flies and rats, or that the personnel should be free from communicable disease could never be discovered by only the laboratory examination of samples from the plant which violates these requirements. Inspection may reveal unsafe plumbing connections." Plants should be screened to exclude flies, and systematic efforts should be directed to rid the plant of such flies as succeed in gaining entrance.
Rats and mice are believed to have carried infection in many out-breaks of disease. Their infestation is indicated by their foot tracks, droppings, gnawed wood, and torn paper. Rat holes should be closed and the animals exterminated. Traps may catch a few, but poisoned bait is the most effective exterminator. Red squill has been found to be poisonous to rats but harmless to man and to most domesticated animals." The best defenses against such vermin are the rat-proofing of the plant, keeping food stored where rats cannot get to it, and setting traps or bait at regular intervals.
Roaches are another disgusting invader of food plants. Poisoned bait should be spread near their hiding places, and all food should be kept covered and inaccessible. Poisoned bait can be mixed with large amounts of methylene blue, so that if amounts of the mixture as small as one-tenth of the toxic dose for humans should accidentally become mixed with human food, the blue color of the dye would re-veal its presence. However, at best the practice is undesirable, and possibly is hazardous. The danger of accidental contamination of the plant products is minimized if the food-bait should be spread on small boards.
Air may be polluted with cinder, dust, soot, and other miscellaneous debris. Food manufacture and processing should not be exposed to contamination from the polluted atmosphere, from the drippings of condensed moisture and pipe leaks, or from the nasal discharges of the plant operators and visitors. Air conditioning is being installed in an increasing number of plants.
Examination of food handlers. The physical examination of food handlers is quite generally required. However, there is great diversity of opinion as to just what this examination should comprise. The practice has grown up of requiring that each food handler must carry a card signed by the local health officer (or a duly accredited physician) that within a year he has been medically examined and found to be free of communicable disease. The undependability of such examinations, the absence of demonstration that as usually conducted they have any public-health prophylactic significance, and the great monetary expense and administrative effort involved in enforcing this provision have contributed to discounting its public-health value. The tendency now is to require that milk, ice cream, and sea-food operators be medically examined yearly, submit two or more fecal samples, undergo Widal and Wassermann tests, and show by their medical history that they are not a hazard to the public health by reason of their possibly being carriers from previous communicable illness. A very practical means of effecting such a supervision is to incorporate it in the comprehensive medical examination for industrial insurance.
Establishments dispensing food and drinks. It is not possible to estimate the amount of disease that is actually spread by eating and drinking utensils, although Lynch and Cumming, and Cumming, have reported that the influenza rate was much higher among those army men whose dishes were not adequately cleansed. Further studies have demonstrated that the microbic load on eating utensils can be very greatly decreased by proper cleansing. (The word sanitization has been suggested to describe the sanitary cleansing of cutlery and tableware because it connotes also the removal of dirt whereas disinfection and sterilization may destroy disease germs without any cleansing.) The mere dipping of unwashed beverage glasses in chlorine solutions is not effective because the organic matter in the beverage adhering to the glass soon utilizes all the available chlorine. Hand washing requires rinsing off the organic food particles in running hot water, washing in alkali cleanser (e.g., trisodium phosphate or preferably sodium hexametaphosphate), and immersing in a chlorine solution. The use of washing machines cannot be left to the indifferent attention of low-paid workers because thorough scraping, proper loading, temperature control, adequate functioning of wash and rinse sprays, and a clean machine are necessary for efficient operations.
Many communities have adopted regulatory measures to correct this health hazard. The city of Dayton, Ohio, has devised a program of inspection, laboratory examination, and instruction comprised in a rating given to each establishment and published monthly; and the city of Hartford, Connecticut, has adopted an inspection and score card which has proved to be useful as an administrative aid as well as a stimulus to the proprietors of eating establishments to improve their sanitary practices. However, all such programs require education of the food handlers as well as the public in the correct principles of handling food.
Handling of samples. The proper taking and handling of samples is important in food control. The purpose of this is to determine whether the food standards are complied with or violated. There-fore, great care must be exercised that the sample taken for analysis is truly representative of the entire batch of food under consideration. Any action in court which involves the results of analytical examination of samples may be expected to hinge on their representative character. Some statutes require that duplicate samples must be given to the dealer so that he can make his own analysis in defense. Furthermore, the samples must be handled properly so that between the time they are taken in the field and analyzed in the lab-oratory they have not undergone change. The inspector must seal them so that the analyst can testify that his results represent the condition of the original sample which has not been tampered with.
Hearings. When a food dealer is found to have violated the standards, he is notified of the infraction. Repetition of the offense is usually followed by a warning that he is in jeopardy of court prosecution or revocation of license. Before prosecution proceedings are instituted or before a license is summarily revoked, the dealer may be, and in some cases is required by law to be, given an opportunity to appear before the enforcement officer and make any statement in explanation or defense. This show-cause hearing does not limit the freedom of action of the enforcement officer as to whether he will take further action, but it usually serves as a final warning that repetition risks prosecution.
Prosecution. A federal case develops somewhat as follows. From various leads such as information furnished by employees in the particular trade, or by local inspectors, or by headquarters, or from his own knowledge of conditions in the food industry, an inspector sends a sample which is suspected of being in violation of the food law to the branch-station laboratory for examination. If the analysis shows that a violation exists, and if further careful review of all the pertinent facts indicates that action is warranted, the presumable violator is cited to submit a written or oral statement as to why the government should not prosecute the case. In the meantime, a seizure action has been instituted in order to protect the consumer by removing the of-fending goods from the market. This is a civil suit, charging adulteration or misbranding against the consignment of food, in the U. S. court in whose jurisdiction the shipment happens to be located, and requesting condemnation. The court orders the goods seized by the U. S. marshal pending the decision of the claimant as to whether or not he will contest the government's charges.
If a dealer possessing illegal food has obtained a written guaranty signed by the wholesaler, jobber, or other party from whom he purchased the product that it complies with the food laws, and also if he does not refuse to furnish full information to the regulatory officials concerning the transaction, he is exempt from prosecution in this particular case under the Federal Food, Drug, and Cosmetic Act, and he may be reimbursed by the seller for his loss.
If the court finds for the plaintiff, the seized food is disposed of according to the direction of the court. The results of the trial are published in official "Notices of Judgment." Further action may be brought under the criminal section of the law against the person or firm responsible for the shipment of the food found to be in violation of the act. The original libel against the goods and the criminal action against the owner or claimant constitute separate actions which await their respective turns on the court calendars.
After a decree of condemnation has been issued, the product may be destroyed by the U. S. marshal, or it may be released to the owner under bond subject to certain conditions. For example, the charge may have been misbranding, so that relabeling corrects the violation. The expense of such reclamation is borne by the claimant under the supervision of official inspectors. State and municipal cases usually are handled in the police courts. The city solicitor (municipal counsel) prosecutes for the regulatory officer and presents the evidence as to the nature of the infraction. This evidence must always contain direct information about the illegality of the product or the possible danger of the insanitary situation to health, with specific details as to the violation.
The food control that is exercised by the states and municipalities may follow this slower action of court trials or the more summary action of immediate seizure of the suspected foodstuff and its destruction by the health officer. In the former action, the owner of the product has the opportunity of defending it, whereas in the latter one, the product is destroyed at once. Such destruction of private property may lead to a suit by the owner for recovery of damages. However, the courts have upheld the health officer when he could show that he had reasonable grounds for believing that the food in question was dangerous to the public health. This doctrine- holds that the health officer does not actually have to prove that the food was deleterious to health; but he must clearly show that he had convincing evidence which inspired his belief in the harmfulness of the product.
In many of the municipalities, questions of food adulteration which involve no immediate health hazard are left largely to the enforcement program of the federal and state officials; and likewise, harmfully infected and poisonous foods are almost exclusively handled by the municipalities.
The handling of foods under insanitary conditions and conducting business without a permit (when this is required) are punished by fines administered by police magistrates.
PROCEDURE IN FOOD-POISONING OUTBREAKS
When the food-control officer learns of a food-poisoning outbreak, he should make an immediate investigation for the purposes of preventing its spread, if possible, of ascertaining whether there has been culpable negligence or law violation, and of learning the cause so as to prevent a recurrence. Unfortunately, the circumstances surrounding most outbreaks are not such that the health officer can learn much about them. Often the illness may come several hours after partaking of the meal so that the food has been cleared away and samples can-not be found. The patients may have scattered to their homes, and the attending physicians may have neglected to save samples of vomitus and stools.
It is important to make the epidemiological inquiry before any time is spent studying environmental factors. The uninitiated is inclined to concentrate his attention on the milk supply, the water supply, the sanitary condition of the hotel kitchen, for example, and, because of the fear of more illness, to issue orders before getting facts. However, only in few instances is there a tendency for infection or food poisoning to continue to occur after the first outbreak.
When an outbreak is reported, a field investigation is immediately made by previously designated members of the staff. Information is sought from the patients along the following lines:
What foods were eaten by each patient in the last two or three meals before the onset of illness.
When and where they were bought.
Where they were kept and how they were prepared and handled. What their condition was when purchased and eaten.
What the possible sources of contamination in the home were.
What the symptoms and diagnosis were, as revealed by the medical attendants.
Whether there was any immediately prior illness in the family.
Samples of food and also of the patient's vomitus and stools are secured in sterile containers for chemical and bacteriological analysis if necessary.
In autopsies, cultures are secured from the spleen, liver, small and large intestine, mesenteric lymph nodes, and kidney for bacteriological laboratory examination, if necessary.
Samples of the patient's blood (in cases of bacterial food poisoning) are taken not earlier than 7 to 10 days after the illness for serological examination, if necessary.
At the source of the outbreak, further information is sought as follows:
How much of the food was sold or prepared, and has all of it been accounted for?
Have complaints been received from other customers?
Do conditions on the premises yield any clew as to possible sources of infection or other mishandling?
What were the methods of preparation and handling?
Have there been any illnesses among the food handlers?
After it has been ascertained what foods were eaten in common, and then by study of the data the incriminated one has been identified, the remainder of the batch is condemned immediately to prevent its further use. Study of the investigators' reports and the laboratory findings indicates what steps are necessary in the further handling of the case. Sometimes such outbreaks reveal the need for specific regulations to cover some previously unrecognized need.
When milk is the vehicle of the infection, the outbreak is characterized by a preponderance of cases on some particular route. A sudden or "explosive" increase in the number of cases with attendant sharp increase in the morbidity rate of an infectious disease points strongly to milk or water as the agent. However, some milk-borne outbreaks are not explosive, and many lack explosiveness at their be-ginning. As soon as the incriminated dairy is located, the workers are all medically examined and interrogated as to any illness in their respective families; the operations of the plant are carefully inspected to ascertain whether pasteurization has been properly practiced; and if the milk is raw, then the investigation is carried back to the farm to locate the sick person or the infected cow.
In the rare instance in which a pasteurized milk supply may appear to be a medium of infection, the investigator should find what defect occurred in the pasteurization process. There has never yet been an authentic instance in which disease-producing bacteria have survived the legal pasteurization temperature. The milk may have become infected after it was pasteurized, and before it was capped.
The investigator should be cautioned against ending his investigation by the finding of an unsanitary environmental condition, such as a dirty manufacturing plant, a milk supply with a high total bacterial count, or a manufacturing process in which contaminated water was used. These findings are not the source of infection, and are by no means the proved medium. In cases of communicable disease such as typhoid fever, a healthy carrier or a clinical case represents the only true source of the infection.
In New York City, food-poisoning outbreaks are reported immediately to a specially assigned inspector in each borough on reserve duty subject to call at all hours. A physician makes the field investigation to collect the medical information, and a food inspector assembles the sanitary and food technological data. The supervisor in charge of food-poisoning investigations reviews the data and consults with the department epidemiologist who correlates all the data obtained by both physician and inspector."
In order to facilitate the collection of all the pertinent information that a given outbreak can be made to yield, the Baltimore Health Department has organized a special "team" or squad of investigators to function as a unit whenever an outbreak is reported. This group consists of a physician, a chemist, a bacteriologist, and such other specialists as may be required. As soon as an outbreak is reported, one or more of the squad makes an immediate field investigation. The attending physicians are contacted for the diagnosis. Patients are interviewed for information as to what they ate and other pertinent facts. If not too late, samples of the foods are obtained and, if possible, vomitus and stool specimens are collected. All the facts obtained are then laid before the squad, who decide what sample shall be examined in the chemical and bacteriological laboratories. The advantage of this procedure is that it provides a systematic program which can function on short notice, it increases the possibility of finding the cause of the outbreak by using specialists in the several fields involved, it precludes flooding the laboratories with samples of many irrelevant products, and it enables the several responsible officials to take quick regulatory action where indicated.
Laboratory examination. When a sample of food suspected of being poisonous is submitted to a laboratory for examination, the analytical procedure does not follow a definite schematic system of analysis which is universally applicable to all samples alike. It is a waste of time to examine a sample blindly by applying all possible tests, even if the sample provided enough material—which it rarely does. The analyst must select his tests in the light of whatever col-lateral information can be obtained as a guide. Valuable leads are the case histories, the symptoms, the diagnosis, the size and condition of the sample, and any suggestive circumstances of the case. In general, the sample is examined bacteriologically, physically, and chemically, as the situation warrants.
Bacteriological examination. The following suggested procedure for the bacteriological laboratory examination of a suspected food is abstracted from Koser's excellent paper.
A. First examination.
1. Prepare a stained smear (Gram stain) from the foodstuff.
2. Streak a loopful on 2 meat infusion agar plates and another on 2 plates of either Endo or eosin-methylene-blue agar, and incubate for 18-24 hours at 37° C.
3. Inoculate a tube of meat infusion broth with a small amount of sample, and incubate at 37° C.
4. If botulism is suspected, inoculate 3 tubes of ground meat or beef heart medium at pH of 72-7.6 with 1 gram of sample, and heat 2 of these samples to 80° C. for 20 minutes to destroy vegetative cells. Incubate anaerobically or under vaseline layer at 35°-37° C.
5. Test for toxin in sample by injecting subcutaneously 0.5-1.0 cc. of the food into 2 guinea pigs or 2 white mice. If death occurs repeat with antitoxin of types A and B.
B. Subsequent examination.
1. Microscopic examination of the smear gives an idea of the morphological types and abundance of bacteria present.
2. If suspicious-looking colonies resembling the paratyphoid, typhoid, or dysentery groups are found on the Endo or the e-m-b plates, then fish several to either Russell medium or fermentation tubes of dextrose, lactose, and sucrose broths. Identification whether organisms belong to Salmonella or dysentery groups is made by procedure in Section C.
Make Gram stains from the nutrient agar plates, and note whether staphylococci or streptococci colonies are numerous.
3. If A2 and B2 are negative, streak this enrichment tube of broth on Endo or e-m-b plates and on nutrient agar plates. Examine as under B2.
4-5. (If suspected botulism.) The condition of the animals is noted for preliminary evidence of presence of botulinum toxin. Incubate meat medium tubes of A4 for 3 to 4 days. Examine for evidences of growth, prepare Gram stains, and examine character and sporulation. Make toxicity test on tube as per A5 to confirm test with original food sample.
C. Examination for Salmonella or other intestinal types.
A detailed procedure of checking by means of sugar fermentation reactions, agglutinating sera, and morphological studies is necessary to identify these organisms. They are Gram-negative, medium-sized non-sporulating rods. The most important species are Salmonella aertrycke, Salmonella enteritidis and Salmonella cholerae-suis (suipestifer). S. enteritidis serum is specific; S. schottmiilleri serum will also cause clumping of S. aertrycke and to a lesser extent S. suipestifer. These two sera should determine whether the organism is one of the three Salmonella types most frequently found in food poisoning. All Salmonella types ferment with gas and acid production, maltose, rhamnose, mannitol, and sorbitol. Xylose is fermented by all types except S. suipestifer.
The differentiation of the Flexner and Sonne dysentery types is difficult except by the rather specific agglutination reactions.
Examination of feces and necropsy material.
The examination of feces as well as necropsy material is often of marked value in the study of food-poisoning outbreaks. If possible, feces should be examined bacteriologically only during the acute stages of the illness. The spleen, mesenteric lymph nodes, and colon are often of some diagnostic value. Positive cultures are usually not obtained from the blood. In botulism the toxin can sometimes be demonstrated by animal injection of blood or bowel contents. Before injection the bowel contents should be filtered or centrifuged to remove extraneous bacteria.
Physical examination. A sample of the suspected food should be given a careful macroscopic and microscopic examination. Items to note are its appearance, texture, color, odor, and structure. Its taste is possibly helpful, although this may be dangerous to the analyst if pathogenic bacterial infection has not been eliminated. Pensa of the New York City Department of Health points out that it is particularly significant to note what is abnormal about the sample, because this very property may indicate the kind of foreign agent involved. Careful microscopic examination may also give a clew. This may reveal a crystalline texture, a recognized microchemical structure, an admixture of foreign substance, a bacterial infection, or other leads for specific tests.
Chemical examination. Nearly all the common poisons can be placed in three general groups. This classification is based on their behavior under different chemical treatments which simplify the task of locating the particular poison by removing extraneous material and narrowing the number of possible poisons.
Group I. Poisons volatile without decomposition when distilled with steam from an acid solution of tartaric or sulphuric acids. The distillates contain yellow phosphorus, hydrocyanic acid, carbolic acid and the cresols, chloroform, chloral hydrate, iodoform, certain benzene compounds, carbon disulphide, the possible alcohols, formaldehyde, and formic acid.
Group II. Non-volatile substances which do not distil with steam from an acid solution. They are extracted with hot alcohol containing tartaric acid. This group contains alkaloids, many glucosides and bitter principles, and certain synthetic dyes.
Group III. All poisonous metals.
In testing an unknown solution, it is first divided into three approximately equal portions. One is steam distilled. The distillate is used to determine the products in Group I; the non-volatile residue is used for the determination of metals in Group III. The products in Group II are tested directly, although they seldom are present in ordinary cases of food poisoning; each product is identified by a specific test."
A direct test should be made for the presence of strychnine be-cause of its possible use as a vermicide in the food-handling plant. Thallium salts, appearing as pink incrustation on cereal grains, have been used as raticides. Often the incriminating chemical can be identified by the odor of the steam distillate.
Interpretation. It should be borne in mind that the examination may be fruitless. Symptoms of acute gastrointestinal illness can rarely, if ever, be reproduced in laboratory animals by feeding. Results obtained by injection are not entirely satisfactory and are usually of questionable value. If a member of the Salmonella group has been isolated from the suspected food, it can be assumed beyond reasonable doubt that it is the causative agent, because it is not ordinarily encountered in foodstuffs. In respect to the staphylococci, one cannot be so sure of his ground. A causative role for all staphylococci cannot be claimed, and the strains associated with food-poisoning outbreaks cannot be distinguished from others by any definite criterion. Animal-feeding tests are of no value. It is usually necessary to depend upon circumstantial evidence afforded by the finding of considerable numbers of staphylococci in the interior of the food-stuff in order to implicate these organisms in a food-poisoning out-break. In botulism, there is direct evidence in the injection and feeding of animals and the protection of specific antitoxic serum.
It would seem advisable that any bacterium found in large numbers on implicated foods should be suspected of being the causative organism until laboratory studies prove it to be harmless.
As Jordan points out, there have been many attempts to find some relation between the numbers of bacteria present and the quality of various foods. Many experiments have shown that products with high bacteria counts were organoleptically satisfactory, and vice versa. Chemical data have indeed shown that decomposition can be followed by the types of products formed, but it has not been practicable to set standards whereby these data of themselves can determine whether a given product is or is not edible. The results of such bacteriological and chemical examinations can be interpreted definitely only in the light of the sanitary history of the food in question, together with its organoleptic quality and its etiological relationship.
1. The Food and Drug Administration of the United States Department of Agri-culture, U. S. Dept. Agr. Miscel. Publication 48, 1931.
2. "Regulations for the Enforcement of the Tea Act," Service and Regulatory
Announcements, Tea, 1, U. S. Dept. Agr., slightly revised, 1931.
3. "Regulations for the Enforcement of the Federal Import Milk Act," Service
and Regulatory Announcements. Import Milk, 1, U. S. Dept. Agr., 1937.
4. Amendment of July 8, 1930, to Federal Food and Drugs Act and Requirements Thereunder, Service and Regulatory Announcements, Food and Drug, 4, U. S. Dept. Agr., 1935.
5. Report of the Chief of the Food and Drug Administration, 1935, U. S. Dept. Agr., 1935.
6. "Regulations Governing the Meat Inspection of the United States Depart-ment of Agriculture," B. A. I. Order, 211, revised. Issued Dec. 2, 1922.
7. Regulation No. 9 Relating to the Taxes on Oleomargarine, Adulterated But-ter, and Process or Renovated Butter, revised April, 1936, Bur. Internal Revenue, U. S. Treasury Dept., 1936; Internal Revenue Bulletin, U. S. Treasury Dept.
8. J. A. TOBEY, Legal Aspects of Milk Control, International Association of Milk Dealers, Chicago, Ill., p. 10,.1936.
9. "Public Health Service Milk Ordinance and Code," U. S. Treasury Dept. Public Health Service Bul., 220, 1935.
10. Rules and Regulations of the Committee on Foods of the American Medical Association, Chicago, Ill., 1932.
11. "Statement on Scope of Considerations of the Council on Foods," J. Am. Med. Assoc., 107, 431 (1936).
12. The Facts about Certified Milk, Am. Assoc. Medical Milk Commissions, New York, 1936.
13. "Scientific Research Applied to the Canning Industry," Bul. 103-A, National Canners' Association, Washington, D. C.
14. J. A. TOBEY, Am. J. Pub. Health, 27, 1124 (1937).
15. L. C. FRANK, A. W. Fuel's, and W. N. DASHIELL, Public Health Repts., 53, 1386 (1938).
16. W. S. JOHNSON, Am. J. Pub Health, 26, 229 (1936) ; see also J. Milk Technol., 1, (3) 3 (1938).
17. R. MOORE, Am. J. Pub. Health, 27, 62 (1937) ; see also ibid., p. 883.
18. J. C. MUNCH, J. SILVER, and E. E. HoRN, U. S. Dept. Agr. Tech. But. 134, 1929.
19. C. L. MARLATT, U. S. Dept. Agr. Farmers' Bul. 658, 1928, and Bul. 740, 1930.
20. "Report of Committee on Examination of Food Handlers," Am. Pub. Health Assoc. Yearbook, 1935-6. See also: W. H. BEST, Am. J. Pub. Health, 27, 1003 (1937).
21. K. MARDEN, J. M. CURRY, L. J. HOROWITZ, and B. J. HORNING, Am. J. Pub. Health, 28, 1277 (1938).
22. W. C. Cox, ibid., 174.
23. Regulatory Measures Concerning the Sanitization of Eating and Drinking Utensils in Public Places, Cup and Container Institute, New York, 1938. See also: J. G. BAKER and R. M. STONE, Sanitization of the Drinking Glass, National Association of Sanitarians, Inc., Los Angeles, Cal., 1938.
24. A. E. LEACH and A. L. WINTON, Food Inspection and Analysis, John Wiley & Sons, New York, 4th ed., p. 9, 1920.
25. F. W. ERDE, Quarterly Bulletin Assoc. Dairy, Food and Drug Officials of the United States, 2, (3) 3 (1938).
26. S. A. KOSER, Am. J. Pub. Health, 24, 203 (1934).
27. W. AUTENRIETH (translated by W. H. WARREN), Laboratory Manual for the Detection of Poisons and Powerful Drugs, P. Blakiston's Sons and Co., 6th ed., 1928. See also: W. D. McNALLY, Toxicology. Industrial Medicine, Chicago, Ill., 1937.
28. F. J. JIRKA, Food Poisoning, Illinois Dept. Pub. Health, Springfield, Ill.
J. A. ToBEY, Public Health Law, The Commonwealth Fund, New York, revised 1939.