feeding, and perhaps the most important factors in swelling the mortality rates of our helpless babes, viz., milk sediments (dirty milk) and their effects on premature acidity.

MILK SEDIMENTS OR DIRTY MILK.

Every consumer of milk has doubtless observed the presence of more or less foreign matter at the bottom of the bottle in which it is kept; indeed, it is a matter of such common occurrence that it hardly excites our attention, and many are disposed to look upon it as a matter of course. Professor Soxhlet, of Munich, was perhaps the first to point out that these deposits are largely made up of excrementitious matter from the cow, which, adhering to the udder of the animal, gained access to the bucket during the act of milking. If these sediments are subjected to microscopical examination we will find that they are composed of epithelial debris, hairs of the cow, organic and inorganic dust particles, excrementitious matter, vegetable fibres, bacteria, fungi and spores of every description; fully 90 per cent of the germs are fecal bacilli— all of which is not only disgusting but extremely suggestive of danger. The number of micro-organisms is largely increased and we know that under a suitable temperature bacterial development and consequent decomposition are materially hastened in such a medium.

The greatest danger from milk of this class is the possible presence of ptomains or toxins produced by certain saprophytic germs acting on the albuminoids of the milk. Professor Vaughan, of Ann Arbor, Michigan, in 1885 isolated a poison called tyrotoxicon, which is one of the causes of the toxic symptoms in some cases of milk poisoning, cheese and ice cream poisoning. The presence of the very filth referred to, a summer temperature, and the pernicious habit of placing the milk before cooling in cans and bottles perhaps dirty besides, constitute favorable environments for the development of this and analogous poisons.

Germ development and acidity of the milk are influenced by temperature. Milk when it leaves the udder of the cow contains very few germs; the majority gain access during unclean handling, especially when the milking is done in a dirty stable, or from excrementitious matter adhering to the udder and teats of the animal. These germs multiply with astonishing rapidity whenever the temperature of the milk is above 50 degrees F., and if disease germs are present their proliferation augments the chances of infection. A temperature of 58 or 60 degrees F. will not subserve the interest of public health. So, for example, Petruschky has shown that at the room temperature a streptococcal content of 300 per cubic centimeter may increase in 24 hours to one of 10,000,000,

but the same milk kept at 50 degrees F. yielded but 30,000, or but three one-thousandths as many.

Von Freudenreich ("Dairy Bacteriology," London, 1895) exposed a sample of milk containing 153,000 bacteria per cubic inch to a temperature of 59 degrees F.; one hour after it contained 539,750 bacteria per cubic inch; two hours after, 616,250; four hours after, 680,000; seven hours after, 1,020,000; nine hours after, 2,040,000; twenty-five hours after, 85,000,000.

Bryce, of Toronto, has made similar investigations. All of which indicates the extent of germ development which must go on in milk transported over long distances during the summer months, when the mercury ranges from 85 to 95 degrees and the cans are allowed to stand in the sun without ice; and we can appreciate why even 100,000,000 of bacteria per cubic centimeter have been found in samples of Washington milk, far exceeding the number usually found in the sewage of cities. Other cities are, however, similarly afflicted, and nothing short of clean, decent habits in handling the milk and keeping it at a temperature of 50 degrees F. will prevent the mischief. Dr. H. C. Plant, of Leipsig, found, as a rule, that in warm weather the so-called fresh milk delivered in the morning is unfit for young children, and of 47 infants whose milk supply was carefully investigated by him 18 developed serious digestive and intestinal diseases and six died. One of the chief reasons why there are less deaths from infantile diarrhea in the country than in towns and cities, in proportion to the population, is that the milk used is comparatively fresh, contains fewer germs and less toxins. Without doubt dirty and sour milk, or milk which is on the point of turning, are the chief causes of diarrheal diseases in bottle-fed children, and in the more acute cases we have the phenomena of cholera infantum, due most likely to a toxic character of the milk. These views have steadily gained ground and have resulted in great sanitary reforms in our milk establishments, the fruits of which are already apparent in the decrease of deaths from infantile diarrhea in this city. (See page 92.)

PRODUCTION OF PURE MILK.

The Washington market milk compares favorably with the supply in other cities; there is no evidence to show that it is worse, but there is abundant evidence to indicate that stale, dirty and infected market milk is everywhere responsible for a needless sacrifice of human life, and it is clearly the duty of the State to take what precautions it can to prevent sickness and distress.

Those who are familiar with the surroundings of our milk farms and the habits of the average dairy employee need no arguments for the necessity for sanitary reforms, and the principles which ought to be carried out should be embodied in effective laws and accepted and enforced in a practical sense. Honorable men will not object to regulations calculated to promote the purity of their product and the health of their customers, and as many of the most serious faults in the milk business are the result of ignorance rather than of intentional neglect, the difficulties will be materially lessened by proper education and trade competition.

Pure natural milk can only be secured at dairies with sanitary buildings, a pure water supply, healthy, well-fed and well-cared-for cows, a well-equipped and well-kept milk room, provisions for thorough cleanliness, intelligent and conscientious people in charge and clean methods throughout.

CERTIFIED MILK.*

It was in consequence of a just appreciation of these principles that the so-called "certified milk" came into existence about ten years ago. Responsible bodies of citizens interested in an improved milk supply organized in different cities milk commissions. Such commissions usually select and secure the advice and assistance of four experts-a veterinarian, a physician, a bacteriologist, and a chemist-all more or less familiar with the conditions and possibilities on dairy farms. The commission sends to each dairyman who supplies milk to the city a circular naming all the particular conditions which should be found on every farm where milk is produced for city use, and announcing that where any dairyman notifies the commission that he is fully conforming to the conditions specified, or endeavoring to do so, his dairy will be inspected, and, if it is found to comply in letter and spirit to all the requirements, his name will be placed upon an approved list and he will receive official indorsement to the effect that his dairy farm and the herd thereon have been thoroughly examined and found to comply with the conditions recommended by the commission. These conditions include a healthy herd, the use of pure feeds, appropriate stabling and care, pure water, and clean and prompt handling of the milk, which is of good composition and quality and so free from pathogenic and unnecessary bacteria as reasonable safeguards can provide. The attendants are cleanly and free from commu

*Extract from a Report of the Committee on Sanitary Relations to a conference appointed by the Commissioners of the District of Columbia to consider and report upon the local milk supply. The writer was chairman of the sub-committee which submitted the Report.

nicable diseases, and all milk is promptly cooled, immediately after milking, to a temperature of 50 degrees F. Every intelligent dairy farmer insists upon cooling his milk as soon as the bucket is full.

The inspections are made unannounced and at irregular intervals, so as to insure maintenance of the prescribed standard. Any neglected condition is immediately reported to the commission, which decides whether or not the cause is sufficient to withdraw and cancel the last certificate issued.

PASTEURIZED MILK.

It must be apparent that it will require time and education to secure compliance with even reasonable safeguards, and it is equally evident that the number of dairy farms now in a position to live up to sanitary requirements will supply but a small percentage of the population, although it is hoped that such dairy farms will be stimulated into existence by trade competition and the refusal of the public to buy dirty milk at any price. Until this is accomplished, the committee, in the interest of public health, strongly advocates clarification and pasteurization of all milk. This, to be sure, will not make bad milk good, but it will at least destroy its power to transmit disease germs.

PASTEURIZING PLANTS OR MILK DEPOTS.

Your committee also believes that this object can be most efficiently and economically secured by the establishment of a pasteurizing plant provided by the District government, or preferably by private enterprise, which plant should be under the supervision of the Health Department.

There is every argument from a commercial and sanitary standpoint in favor of a central plant, erected within reasonable distance from the union depot, where all the milk for the city should be received and prepared for distribution. Such a step would result in the creation of suitable conditions for the proper handling and storage of milk, sterilization of milk cans and utensils; and the efforts of the local milk dealers to provide decent facilities for their 150 or more dairies scattered over the city, all more or less liable to infection, could be concentrated in one plant with a decided saving of expense.

Milk should never be sold by grocery stores or milk shops unless it has been delivered to such establishment in original sealed bottles, and then only when there is provision for maintaining the milk at a temperature of 50 degrees F.

ADVANTAGES AND DISADVANTAGES OF PASTEURIZED MILK.

Your committee is aware that there is a difference of opinion among medical men as to the wholesomeness of pasteurized milk. The advantages and disadvantages have been exhaustively studied by Dr. M. J. Rosenau, Director of the Hygienic Laboratory of the United States Bureau of Public Health and Marine Hospital Service, and in his opinion the advantages so far outweigh the disadvantages that he "unhesitatingly recommends compulsory pasteurization of all milk not certified under class 1 or class 2 of Dr. Melvin's classification."*

Your committee is so strongly impressed with the manifold dangers connected with the milk supply that until the needful reforms in dairy methods are accomplished it recommends to the public the following as immediate safeguards:

1. Do not patronize a milk dealer, at any price, whose milk after standing for two hours reveals a visible sediment at the bottom of the bottle. It is evidence of dirty habits, extremely suggestive of danger, and entirely preventable by clean, decent methods, without greatly increasing the

cost.

2. Subject all your milk to home pasteurization by simply bringing it to the boiling point, and after cooling keep the milk on ice. This will destroy germ life and reduce the chances of milk-borne diseases to a minimum.

Dr. H. W. Wiley's committee submitted the following recommendation:

"1.That the milk which is supplied to infants under the age of three years in the District of Columbia should be certified by the Health Office. Milk should contain not more than 5,000 bacteria per cm. ; should be not more than 12 hours old, and should be delivered in artificially cooled packages.

"2. That the Health Officer of the District be authorized to advertise for dairies which will be willing to so modify their barns, stables, etc., if necessary, as to secure a license from him for the production of certified milk under the most improved sanitary conditions.

*The classification referred to is as follows: Class 1, certified milk for infants, as hereinbefore described. Class 2, clean raw milk from healthy cows, as determined by the tuberculin test and veterinary physical examination; the cows to be housed, fed and milked under good conditions, but not necessarily equal to the conditions provided for in class 1; pure water, as determined by chemical and bacteriological examination, to be provided; the bacteriological count of the milk not to exceed 100,000 bacteria per cubic centimeter, at the time the milk reaches the city, at any season of the year, as determined by the Health Department at frequent intervals; milk to be delivered to the customer in sterilized containers to be filled upon the dairy farm, and the temperature of the milk not to exceed 50 degrees F. until delivered to the customer.