Physicians welcome a veterinarian to problem-solve on tuberculosis: One Health meetings in Edinburgh, Scotland, in 1888

One Health Newsletter: Volume 11 Issue 1

Introduction

The second half of the nineteenth century—a watershed period for new understandings of microbiology, epidemiology, and public health science—provided a kind of metaphorical “stage” on which several actors (physicians and veterinarians amongst them) played their parts in what one might term a “One Health Drama.” To extend the metaphor, this “drama” featured a number of dramatic and interesting “acts” that, when reflected upon, are both entertainingly action-packed and illuminatingly lesson-filled. The historical drama included noteworthy actions that represent a “One Health” commitment—that is, a commitment to two philosophical and scientific concepts: (a) that disease problems are best understood and addressed via holistic and multidisciplinary approaches, and (b) that collaborations across public health professions (e.g., microbiologists, physicians, veterinarians) are good and appropriate for the sake of community, or public, health. In North America and Europe, these “One Health” efforts included those aimed to tackle the human illness trichinosis (and its associated international trade complications) through veterinary inspection of pigs and microscopic inspection of pork products (Gignilliat 1961; Hoy & Nugent 1989), the deployment of veterinarians and meat inspectors to deal with microbiological contamination of meat products destined for human consumption (Koolmees 2000, pp. 55-56), and—the focus of this paper—a novel instance of cooperation between physicians and veterinarians to problem-solve on how to prevent the transmission of tuberculosis via milk products.

An Emerging Consensus-of-Alarm, Across Professions, About the Safety of Milk

The title of an 1881 report authored by one Medical Officer of Health announces, precisely, one quintessentially “One Health” question contemplated by public health practitioners: “What diseases are communicable to man from diseased animals used as food?” (Vacher 1881). The report’s author, Francis Vacher of Birkenhead (in Liverpool, England, near ports through which livestock were routinely imported and increasingly inspected), undertook to distinguish those animal diseases that posed a zoonotic and, therefore, human disease threat from those that were not of human health concern. In 1881, scientific consensus on many microbiological and public health questions was elusive, but there was a coalescing agreement that humans could indeed contract tuberculosis through the consumption of milk from cows infected with tuberculosis. The next year, Vacher authored a separate report that conveyed his and others’ contemporary understanding of the threat. His report mentions animal-to-animal transmission studies as well as anecdotal observations made by the well-renowned and highly respected veterinarian George Fleming:

"The sum of our knowledge as regards the infectiousness of tuberculous milk appears to be that it can, by being used as food, induce tuberculosis in many animals…Besides this there are a few isolated cases in which children have developed the disease after having been fed on milk from affected cows; e.g., [George] Fleming, in a recent tract on tuberculosis, says: ‘…a child five years old, who had been allowed to consume, for a somewhat long period, the uncooked milk of a tuberculous cow…died from tuberculosis.’” (Vacher 1882, pp. 6-7)

In addition, Vacher’s report cited a U.S.-based tuberculosis death, also reported to Fleming, in which an American physician had been warned by a veterinarian about “the danger of giving [a tubercular] cow's milk as food, but the warning was unheeded,” and one of the physician’s children died of tubercular meningitis (Vacher 1882, pp. 7). This ironically emblematic episode in the “One Health” story of tuberculosis involved public health conversations between members of two health professions that were, to some degree, alienated from one another (Fisher 1993). While veterinarian-physician cooperation is routinely witnessed and celebrated over a century later in One Health meetings, publications, and campaigns, we must remember that it was comparatively rare in the 19th century.

Despite inter-profession scientific, cultural, and social differences, the veterinary and medical communities would be drawn together through the rapid emergence of new scientific understanding of tuberculosis. Illustrating just how quickly scientific understanding about tuberculosis was unfolding, the year in which Vacher authored the second of the reports above (1882) was also the year that Robert Koch identified the organism Mycobacterium tuberculosis, which is closely resembled by M. bovis. While the latter’s natural host is cattle, both are competent, causative pathogens for human tuberculosis (Myrvik & Weiser 1988, pp. 376, 395). Through the rest of the 1880s, Francis Vacher and George Fleming would certainly not be alone in their belief in “the transmission of bovine tuberculosis by means of milk to the human subject” and the importance of “endeavouring to exclude it from the market if possible” (Vacher 1882, pp. 7). As it turned out, milk—a symbolically charged and economically important commodity in such societies as that of Victorian Britain—would necessitate a genuinely “One Health” collaboration between physicians and veterinarians. This was not only due to tuberculosis concerns. One historian studying a different milk-borne illness (typhoid fever) aptly observes that milk was both a nutritive staple for children and the wealthy and a “symbol of purity” in “an increasingly urbanized world” (Steere-Williams 2010, pp. 518). Whether it was typhoid or tuberculosis, the specter of disease being spread via the milk supply was troubling and propelled the careers of epidemiologists who “were put into contact with local physicians, chemists, veterinarians, farmers, politicians, and business owners, not to mention…cowsheds” (Steere-Williams 2010, pp. 518-519).

“One Health” Collaborations on the Problem of Milk Safety, and the Events of 1888 in Edinburgh

It is difficult to identify a particular date in history when this “One Health” collaborative around milk safety was birthed. While the 1880s represent a period of intense activity, the historical record shows that veterinarians and medical doctors in Britain had begun to gravitate to one another as early as the 1870s to discuss the tuberculosis burden. Some, but not all, members of both professions agreed that this disease was zoonotic and that something needed to be done. For their part, British veterinarians had known for some time that the disease was infectious; indeed, in 1865 (and as alluded to by Vacher, above) French army surgeon Villemin established the infectious nature of human and bovine tuberculosis through animal studies involving rabbits and guinea pigs (Myrvik & Weiser 1988, pp. 376). As explained by distinguished historian Michael Worboys,

“From the late 1870s some veterinarians and medical practitioners agreed that tuberculosis in humans and bovines was the same disease and inter-communicable. Thus, Koch's identification of the tubercle bacillus in 1882 was not unexpected in the veterinary context. That tuberculosis was an infectious disease was already widely discussed by British veterinarians… [and they] called for tuberculosis to be…stamped out [through legislative and regulatory efforts].” (Worboys 1991, pp. 324-325)

Worboys observed that veterinarians viewed Medical Officers of Health (like Vacher) as allies with whom they proclaimed the health hazards posed by contaminated milk (Worboys 1991, pp. 325). While veterinarians called for regulation and the control of tuberculosis (e.g., through removal of tuberculous cows from the marketplace), physicians and bacteriologists were more laboratory-focused in their efforts, devoting their energies to research studies. Yet a few British veterinarians were involved in both regulatory activism and scientific research; among these was John M’Fadyean, one of Britain’s most bacteriology-minded veterinarians (and also the holder of a medical degree), who pursued bacteriological studies (Worboys 1991, pp. 325). In addition, Thomas Walley, a Scotland-based veterinarian and professor conversant in a range of tuberculosis-related bacteriological studies, would soon be invited to a meeting with physicians in Edinburgh. It would prove to be one of the most visibly “One Health” gatherings of the late 19th century.

During the early evening of January 4, 1888, the leadership of a club of physicians and medical practitioners (that is, the Medico-Chirurgical Society of Edinburgh) gathered to plot their agenda and activities for the new year. Meeting in the home of their president, John Smith, just a few blocks north of Princes Street (and not far from the Gothic monument celebrating the author Sir Walter Scott), the leadership council reviewed a proposal submitted to them by a local veterinarian Thomas Walley. Dr. Walley, also the principal at Edinburgh’s Veterinary College, had written to the Society offering to deliver a presentation (and paper) on one of two topics: (1) regarding the public health purpose of slaughterhouses, “Public Abattoir in Reference to Human Food,” or (2) regarding the transmission of tuberculosis from tuberculous cows, “Animal Tuberculosis in relation to consumption in Man” (Smith 1888, fo. 28r). According to the council minutes of the Edinburgh Medico-Chirurgical Society, “The latter was selected” and “to give full time for the subsequent discussion it was resolved to hold a special meeting on Wednesday, February 15th for the consideration of Professor Walley’s paper” (Smith 1888, fo. 28r).

It was a truly remarkable “One Health” gathering, even if it only featured one veterinarian. On February 15, 1888, the Edinburgh Medico-Chirurgical Society warmly welcomed Dr. Thomas Walley. During the meeting, the highly respected and highly respectable (and an inspiration for Arthur Conan Doyle’s literary creation, Sherlock Holmes) Dr. Henry Littlejohn complemented the Society’s president Dr. Smith and, significantly, conveyed respect to the veterinary profession:

“Mr President, I think you and the Council deserve great credit for having asked a distinguished member of the sister profession to address us on this important subject. In fact, I think it would be of great importance if there was more complete union in such debates between the two professions of medicine and veterinary science...” (Walley 1888, pp. 142)

Dr. Littlejohn’s kind words came after much of Professor Walley’s presentation, which provided a robust overview of microbiological science related to tuberculosis. Walley touched on innumerable scientific pioneers (e.g., Rene Laennec, George Fleming, Jean Antoine Villemin) to whom they were all indebted for understanding the disease, provided personal stories of milk consumers contracting tuberculosis from milk, and challenged the group of physicians to join him and his veterinary colleagues in the fight against tuberculosis:

“It is for such bodies as the one I now have the privilege of addressing to take up this question, and pronounce an opinion upon its gravity without fear or favour; you equally with us are the natural guardians of the health of the community. What are you doing now?” (Walley 1888, pp. 129)

There was, largely, a consensus and agreement that Dr. Walley was right. Dr. Littlejohn, widely seen to represent the practitioners of medicine in Edinburgh, acknowledged, “I think it cannot be doubted that this formidable disease is communicable from those lower animals to man” (Walley 1888, pp. 142. Dr. Walley continued to persuasively highlight the science of bovine tuberculosis, including inoculation and epidemiological studies, and the real threat posed to human health from the milk supply. At the same time, members of the Society, including Dr. Littlejohn, added to their belief that “something must be done”, yet argued there were two practical barriers to taking action: (1) questions prevailed about the exact extent to which tubercular cows were spreading tuberculosis to humans through the milk supply, and (2) there remained a challenge of correctly diagnosing (symptom-less) cattle carrying the bacillus. Another distinguished member of the Edinburgh Medico-Chirurgical Society, William Smith Greenfield (a professor of pathology and clinical medicine at the Edinburgh Medical School), lamentably remarked, “Until a veterinary surgeon is prepared to assert that an animal has tuberculosis, I do not see what is to be done” (Walley 1888, pp. 146). Yet others in the Society agreed with Dr. Walley and called for local and/or national legislative action. In a moving statement recorded in the Society’s meeting minutes, a Mr. A.G. Miller, declared (perhaps passionately, given that he refers to his own children) the following:

“I do not agree… [that] we should not do anything. We should diminish it [tuberculosis] in any way we possibly can...I cannot say that I have listened to Principal Walley’s paper with pleasure. I certainly have listened with very great attention—and profit, I hope; but it certainly is a most unpleasant paper to listen to when one has got a number of children at home, who are every morning taking milk along with their porridge and every night taking it in tumblerfuls.” (Walley 1888, pp. 150)

The Society’s meeting with Professor Walley ended late on February 15, 1888, but the Society was stirred to action. The very next month, on March 23, 1888, the Medico-Chirurgical Society formally petitioned the Secretary for Scotland to call for action by Britain’s Government (specifically, the Privy Council, then the regulatory home for national disease-control efforts related to economically troublesome livestock diseases, most notably contagious bovine pleuro-pneumonia). The following formal statement was issued by the Society:

“The Medico-Chirurgical Society of Edinburgh having had the subject of animal tuberculosis in its relation to man under consideration and discussion along with that of other bovine diseases alleged to be prejudicial to the safety of the community, would most respectfully approach your Lordship, in order to express their sense of the serious nature and momentous importance of these matters. The Medico-Chirurgical Society is composed of the medical practitioners of Edinburgh, as well as of other non-resident medical men, and numbers among its members many who are cognisant not only of the evil which has been clearly traced to these sources, but deeply impressed with the necessity for some active measures being adopted for their prevention. The Society would therefore earnestly pray your Lordship to use your influence and the powers with which you are invested to bring into operation the statutes and enactments of the Government towards the prevention of those evils, and, if necessary, for the introduction of additional means for the regulation and supervision of the whole traffic in milk and in butcher’s meat…John Smith, President [of the Medico-Chirurgical Society].” (Ritchie 1889, pp. 3)

Epilogue and Inspiration

As hoped, the Secretary for Scotland passed the communique on to the Privy Council in London, and on April 26, 1888, the Privy Council invited two of the Society’s members (Dr. Henry Littlejohn and Dr. R. Peel Ritchie) to provide scientific testimony before a Privy Council departmental committee examining regulatory options for both contagious bovine pleuro-pneumonia and bovine tuberculosis. That departmental committee would go on to lay important regulatory groundwork to help remove diseased livestock from British herds and Britain’s meat and milk supply chain. Of course, it would not be until the widespread adoption (decades later, in the early 20^th century) of pasteurization that real public health victory in the milk sector would come.

The events of 1888 in Edinburgh, Scotland, are inspirational and, indeed, represent some of the earliest recorded “One Health” inter-professional discussions of the modern era. The humility of Dr. Walley to approach the medical establishment embodied in the Edinburgh Medico-Chirurgical Society, the willingness of the likes of Drs. Smith and Littlejohn to warmly embrace him and his scientific expertise, and the routinization of regular meetings to discuss scientific matters of community health importance are all to be commended. Today’s “One Health” leaders ought to heed the example, and remember that today’s physician-veterinarian cooperation has a richer heritage than they may have previously thought!

Bibliography

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4. Koolmees, P. (2000). Chapter 4: Veterinary inspection and food hygiene in the twentieth century. In D. F. Smith & J. Phillips (Eds.), Food, science, policy and regulation in the twentieth century (pp. 53-68). New York: Routledge.
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7. Smith, J. (1888). Meeting of Council of the Medico-Chirurgical Society held at the residence of the President...on Wednesday, January 4th, 1888 at 5 o'clock P.M. In Medico-Chirurgical Society of Edinburgh (Ed.), Minutes of Council: Medico Chirurgical Society (folios 27 verso - 28 recto). Edinburgh: Medico-Chirurgical Society of Edinburgh.
8. Steere-Williams, J. (2010). The perfect food and the filth disease: milk-borne typhoid and epidemiological practice in late Victorian Britain. Journal of the History of Medicine and Allied Sciences, 65(4), 514-545.
9. Vacher, F. (1881). What diseases are communicable to man from diseased animals used as food? London: T. Richards.
10. Vacher, F. (1882). On the transmission of disease by milk. London: T. Richards.
11. Walley, T. (1888). Animal tuberculosis in relation to consumption in man. In W. Craig (Ed.), The Transactions of the Medico-Chirurgical Society of Edinburgh: Session 1887-88 (Vol. VII (New Series), pp. 110-153). Edinburgh: Oliver and Boyd.
12. Worboys, M. (1991). Germ theories of disease and British veterinary medicine, 1860-1890. Medical History, 35, 308-327.

Authors

Justin Kastner, MSc, Ph.D.
Corresponding author and Associate Professor
Department of Diagnostic Medicine/Pathobiology, Kansas State University

Josh Haynes, BS
Veterinary student, Kansas State University College of Veterinary Medicine, class of 2022

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