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1250 Annotations ANTIBIOTICS IN MILK ANTIBIOTICS are much used in the treatment of mastitis in cows, and traces of them are present in the animal’s milk for some days after treatment. In January, 1960, the Milk Hygiene Subcommittee of the Milk and Milk Products Technical Advisory Committee decided to undertake a survey to determine how much penicillin and other antibiotics were getting into milk in Britain. The findings are given in a report I published last week. The survey started in January, 1961, in England and Wales, and in February, 1961, in Scotland and continued in each case for twelve months. Milk was sampled and tested at 51 centres in England and Wales and 5 in Scotland, the centres being selected to provide a repre- sentative sample of milk from each area. Penicillin was the antibiotic most commonly found. In England and Wales over 41,700 samples were examined during the year, and 11%, representing 14% of the total milk sampled, contained antibiotics. The lowest incidence (7-7%) was found in October and the highest (16.6%), in January. In Scotland, out of over 2700 samples, 99% (11-6% of the milk sampled) contained antibiotics. The lowest incidence (4-7%) was found in July, and the highest (13-8%) in May. The view of the medical advisers on the Antibiotics in Milk Panel of the Ministry of Health is that the presence in milk of any antibiotic is undesirable because of the possible ill effects on the health of a few individuals in the population. Firstly, there is the danger that the consumption of small quantities of antibiotics may sen- sitise some people, rendering them liable to severe reaction if therapeutic doses of these drugs are required later. Secondly, there is the danger of allergic reaction, par- ticularly skin rashes, in a few people who are already highly reactive to penicillin. Thirdly, as a result of treatment with penicillin, strains of penicillin-resistant staphylococci that cause bovine mastitis are alleged to be increasingly common and there is a danger that any illness such organisms may cause in man will not respond to treatment with penicillin. The report recommends that manufacturers of anti- biotics should be asked to provide formulations suitable for the treatment of most cases of mastitis and having an excretion-time of less than 48 hours; and that manu- facturers should label their preparations to show the minimum length of time that milk from treated animals should be withheld. Veterinary surgeons could help to reduce the amount of antibiotics likely to be present in milk by restricting the quantity they leave with farmers. They could also impress upon farmers the importance of keeping back milk from treated animals for the period stated on the label. Notification to the buyer that anti- biotic treatment had been given would also be helpful, since it would enable a check to be kept on milk from that farm. The British Veterinary Association has been asked informally whether its members would cooperate in this way and has indicated that it could not agree with the suggestion regarding notification which would, in its view, be a breach of professional etiquette. The Association has agreed, however, to do everything possible to see that farmers are reminded of their obligations with regard to disposal of milk from treated animals. 1. Antibiotics in Milk in Great Britain. H.M. Stationery Office. Pp. 10. Is. 3d. Buyers are recommended to carry out periodic checks on incoming milk; and the other Milk Marketing Boards should consider introducing a system of price penalties for milk found to contain antibiotics, on the lines proposed by the Scottish Milk Marketing Board. Food and drugs authorities should be encouraged to sample and test ex-farm milk for the presence of antibiotics and to take appropriate action. The subcommittee would also like to see a publicity campaign to ensure that producers are constantly reminded of the necessity to observe all pre- cautions in order that the milk supply shall be free from traces of antibiotics. SIC TRANSIT WE have probably witnessed the last major experiment in simple orbital flight, which may be expected to become part of the training syllabus for astronauts and technicians rather than the goal. The next phase, already begun by Russia, is to prove the means of rendezvous in flight and the transfer of men and stores from one orbiting vehicle to another-matters which are mainly technological. Beyond is the prospect of the habitable artificial satellite, from which to launch true Space travel; and there are many uncertainties upon the health, welfare, and safety of the men who will one day set out to explore the infinite. Some of these uncertainties have to do with what are, broadly speaking, physiological factors: the consequences to the circulatory, muscular, and nervous systems of prolonged weightlessness and inactivity; how to maintain body metabolism for months when storage space is severely restricted; by what means to provide for respiratory exchange and to control the environment of temperature, pressure, and humidity; and how to limit exposure to ionising radiations. Some of the uncertain factors are both physiological and psychological: the effects of dis- orientation during manoeuvre; the clouding of conscious- ness when normal stimuli are suspended; fear of the unknown, as time slowly passes in isolation. All these we now recognise to be the preoccupations of Space medicine; but when long voyages are undertaken, older and less esoteric complications will be encountered. As the astro- naut loses his exclusiveness, becoming one of a small crew, there will be the personality clashes inevitable among men under constant stress at very close quarters. There will also be the risk of illness, which could, as in the long voyages of exploration in the days of sail, bring disaster on a well-found enterprise. An attack of infectious hepatitis, for example, between Earth and Mars, is unpleasant to contemplate, and the disease is not so rare that the possibility can be ignored. It is, indeed, the infectious diseases of viral origin which seem the most difficult to provide against, partly because they are not easy to treat and partly because the incubation period is generally long. A month’s complete isolation before the launching would be a tedious start. Sudden incapacitating illness-for example, coronary thrombosis-as a cause of aircraft accidents is always in the mind of those who investigate unexplained crashes. As a rule, it has to be set down as one of several possi- bilities, because there is no evidence either way; for disasters to aircraft with a single pilot are nearly always catastrophic. Though in a young, fit population the risk must be small compared with the occupational physio- logical hazards such as anoxia, it is real enough to direct the interest of those responsible for the care of aviators

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Annotations

ANTIBIOTICS IN MILK

ANTIBIOTICS are much used in the treatment ofmastitis in cows, and traces of them are present in theanimal’s milk for some days after treatment. In January,1960, the Milk Hygiene Subcommittee of the Milk andMilk Products Technical Advisory Committee decided toundertake a survey to determine how much penicillin andother antibiotics were getting into milk in Britain. Thefindings are given in a report I published last week.The survey started in January, 1961, in England and

Wales, and in February, 1961, in Scotland and continuedin each case for twelve months. Milk was sampled andtested at 51 centres in England and Wales and 5 in

Scotland, the centres being selected to provide a repre-sentative sample of milk from each area. Penicillin wasthe antibiotic most commonly found. In England andWales over 41,700 samples were examined during theyear, and 11%, representing 14% of the total milk

sampled, contained antibiotics. The lowest incidence

(7-7%) was found in October and the highest (16.6%), inJanuary. In Scotland, out of over 2700 samples, 99%(11-6% of the milk sampled) contained antibiotics. Thelowest incidence (4-7%) was found in July, and the

highest (13-8%) in May.The view of the medical advisers on the Antibiotics in

Milk Panel of the Ministry of Health is that the presencein milk of any antibiotic is undesirable because of the

possible ill effects on the health of a few individuals inthe population. Firstly, there is the danger that the

consumption of small quantities of antibiotics may sen-sitise some people, rendering them liable to severe reactionif therapeutic doses of these drugs are required later.

Secondly, there is the danger of allergic reaction, par-ticularly skin rashes, in a few people who are already highlyreactive to penicillin. Thirdly, as a result of treatmentwith penicillin, strains of penicillin-resistant staphylococcithat cause bovine mastitis are alleged to be increasinglycommon and there is a danger that any illness such

organisms may cause in man will not respond to treatmentwith penicillin.The report recommends that manufacturers of anti-

biotics should be asked to provide formulations suitablefor the treatment of most cases of mastitis and having anexcretion-time of less than 48 hours; and that manu-facturers should label their preparations to show theminimum length of time that milk from treated animalsshould be withheld. Veterinary surgeons could help toreduce the amount of antibiotics likely to be present inmilk by restricting the quantity they leave with farmers.They could also impress upon farmers the importance ofkeeping back milk from treated animals for the periodstated on the label. Notification to the buyer that anti-biotic treatment had been given would also be helpful,since it would enable a check to be kept on milk from thatfarm. The British Veterinary Association has been askedinformally whether its members would cooperate in thisway and has indicated that it could not agree with the

suggestion regarding notification which would, in itsview, be a breach of professional etiquette. TheAssociation has agreed, however, to do everything possibleto see that farmers are reminded of their obligations withregard to disposal of milk from treated animals.1. Antibiotics in Milk in Great Britain. H.M. Stationery Office. Pp. 10.

Is. 3d.

Buyers are recommended to carry out periodic checkson incoming milk; and the other Milk Marketing Boardsshould consider introducing a system of price penaltiesfor milk found to contain antibiotics, on the lines proposedby the Scottish Milk Marketing Board. Food and drugsauthorities should be encouraged to sample and test

ex-farm milk for the presence of antibiotics and to take

appropriate action. The subcommittee would also like tosee a publicity campaign to ensure that producers areconstantly reminded of the necessity to observe all pre-cautions in order that the milk supply shall be free fromtraces of antibiotics.

SIC TRANSIT

WE have probably witnessed the last major experimentin simple orbital flight, which may be expected to becomepart of the training syllabus for astronauts and techniciansrather than the goal. The next phase, already begun byRussia, is to prove the means of rendezvous in flight andthe transfer of men and stores from one orbiting vehicle toanother-matters which are mainly technological. Beyondis the prospect of the habitable artificial satellite, fromwhich to launch true Space travel; and there are manyuncertainties upon the health, welfare, and safety of themen who will one day set out to explore the infinite.Some of these uncertainties have to do with what are,

broadly speaking, physiological factors: the consequencesto the circulatory, muscular, and nervous systems of

prolonged weightlessness and inactivity; how to maintainbody metabolism for months when storage space is severelyrestricted; by what means to provide for respiratoryexchange and to control the environment of temperature,pressure, and humidity; and how to limit exposure toionising radiations. Some of the uncertain factors areboth physiological and psychological: the effects of dis-orientation during manoeuvre; the clouding of conscious-ness when normal stimuli are suspended; fear of the

unknown, as time slowly passes in isolation. All these wenow recognise to be the preoccupations of Space medicine;but when long voyages are undertaken, older and lessesoteric complications will be encountered. As the astro-naut loses his exclusiveness, becoming one of a small

crew, there will be the personality clashes inevitable

among men under constant stress at very close quarters.There will also be the risk of illness, which could, as inthe long voyages of exploration in the days of sail, bringdisaster on a well-found enterprise. An attack of infectioushepatitis, for example, between Earth and Mars, is

unpleasant to contemplate, and the disease is not so rarethat the possibility can be ignored. It is, indeed, theinfectious diseases of viral origin which seem the mostdifficult to provide against, partly because they are noteasy to treat and partly because the incubation period isgenerally long. A month’s complete isolation before thelaunching would be a tedious start.Sudden incapacitating illness-for example, coronary

thrombosis-as a cause of aircraft accidents is always inthe mind of those who investigate unexplained crashes.As a rule, it has to be set down as one of several possi-bilities, because there is no evidence either way; fordisasters to aircraft with a single pilot are nearly alwayscatastrophic. Though in a young, fit population the riskmust be small compared with the occupational physio-logical hazards such as anoxia, it is real enough to directthe interest of those responsible for the care of aviators