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20. PASTEURIZATION.

Introduction
The extent of pasteurization --
Changes in milk produced by heating-
Temperature and time of heating---
The bacteria and toxines concerned..
Infant feeding-

Scurvy

Infant mortality-
Home pasteurization.
Commercial pasteurization.

Résụmé-Advantages and disadvantages. 21. INFANT FEEDING

Part I.-Infant mortality.

Death rates of various cities..

Seasonal fluctuations.--.
Part II.-The infants' dietary-

Woman's milk.

Cow's milk.--
Part III.-Infant feeding-

Nutritive requirements of infants.
Methods of feeding-

Maternal nursing

Artificial feeding 22. THE MUNICIPAL REGULATION OF THE MILK SUPPLY OF THE DISTRICT

OF COLUMBIA..

The development of the milk-inspection service--
Organization and duties of the milk-inspection service.
Supervision and control.
Inspection of dairy farms..
Inspection of dairies -
Inspection of milk.--
Contagious-disease service
Cost of milk inspection --
Results of milk inspection service-
Supplementary memorandum government of the District of

Columbia
GENERAL INDEX
AUTHOR'S INDEX
SERIAL PUBLICATIONS-HYGIENIC LABORATORY BULLETIN

Page 589 591 595 595 597 600 605 607 612 614 623 624 629 631 632 636 639 639 644 648 648 649 649 656

677 679 69: 702 703 709 711 714 716 717

720
753
758
760

LIST OF ILLUSTRATIONS, CHARTS, ETC.

ARTICLE No. 2.- MILK AS A CAUSE OF EPIDEMICS OF TYPHOID FEVER, SCARLET

FEVER, AND DIPHTHERIA.

1. Chart showing typhoid fever cases by ages, in 10-year periods, Stamford,

Conn., 1895. 2. (hart showing typhoid fever cases by ages, in 5-year periods, Stamford

Conn., 1895. 3. Chart showing number of cases of typhoid fever reported each day during

the Stamford, Conn., outbreak, 1895. 4. Showing relation of milk routes to fever cases during the typhoid epidemie

at Stamford, Conn., 1895. 5. Showing relation of milk routes to scarlet fever during outbreak at Norwalk,

Conn., 1897. 6. Showing relation of milk routes to diphtheria cases during the outbreak

at Dorchester, Milton and Hyde Park, Mass., 1907. 7. Showing relation of milk routes to typhoid fever cases at Elkton, Md., in the autumn of 1900.

ARTICLE No. 9.-ICE CREAM.

8A. Variations in bacterial content during cold storage of four samples of com

mercial ice creams.

ARTICLE No. 12.—THE GERMICIDAL PROPERTY OF MILK. 8. Chart showing the growth of B, lactis aerogenes in milk at 15° C. 9. Chart showing the growth of B. lactis aerogenes in milk at 37° C. 10. Chart showing the growth of B. dysenteriæ in milk at 15° C. 11. Chart showing the growth of B. dysenteria in milk at 37° C. 12. (hart showing the growth of B. typhosus in milk at 15° C. 13. Chart showing the growth of B. typhosus in milk at 37° C.

ARTICLE No. 15.-SANITARY INSPECTION AND ITS BEARING ON ('LEAN MILK.

14. Dirty flanks.
15. ('leaning cows preparatory to milking.
16. Dirty stable yard.
17. Dirty stable yard.
19. Dirty barn interior.
19. Dirty barn interior.
20. Clean barnyard and well lighted barn.
21. A clean, light, airy barn interior.
22. A good type of milking suit and pail.
23. A blind compliance with the regulation as to windows.
24. Following the letter but not the spirit of the law.
25. Types of milk pails.
26. A good type of inexpensive milk house.

27. The interior of figure 26.
28. A mere pretense of a milk house.
29. A dirty, untidy milk house.
30. A very neat, inexpensive, small bottling room.
31. A milk room with poorly located tank.
32. Children washing milk bottles.
33. Entrance to dairy in basement.
34. Dairy room in cellar.
35. A sterilizing oven.
36. Bottling room in a high-class city dairy.
37. A modern high-class pasteurizing plant.

ARTICLE No. 16.-SANITARY WATER SUPPLIES FOR DAIRY FARMS.

38. Geological formation of artesian wells.
39. Cesspool not polluting well lower down.
40. Cesspool polluting well opening above it.
41. Bad pump surroundings.
42. Good pump surroundings.
13. Good well situation in building.
44. Good natural spring situation.
45. Bad natural spring situation.

ARTICLE No. 17.-METHODS AND RESULTS OF EXAMINATION OF WATER SUPPLIES

OF DAIRIES SUPPLYING THE DISTRICT OF COLUMBIA.

46. Field kit.
47. Shipping box.
48. Alcohol lamp.

ARTICLE No. 21.-INFANT FEEDING.

49. Chart showing deaths from gastro-enteritis in infants, Paris, 1897.

ARTICIE No 22.-THE MUNICIPAL REGULATION OF MILK SUPPLY OF THE DISTRICT

OF COLUMBIA.

50. Chart showing the death rate in the District of Columbia from diarrhea and

enteritis among children under 2 years of age, 1880–1906.

Milk and its Relation to the Public Health.

1. INTRODUCTION.

By WALTER WYMAN,
Surgeon-General, Public Health and Marine-Hospital Serricc.

During the last few years increasing attention has been given to milk in its relation to the public health. This is especially true in the United States, where the more progressive health authorities of the larger cities and many of the States have been instrumental in markedly improving their milk supplies.

The question of sanitary milk is to the American people especially pertinent. Milk is perhaps used to a greater extent in this than in any other country. It holds a peculiar place in the nation's dietary because of its varied applicability. Containing as it does all the essentials of a perfect ration, proteids, carbohydrates, fats, inorganic salts and water, it is capable of almost universal use. Because of this 'and, in addition, its facility of ingestion and comparative ease of digestion, it constitutes an important food for the sick and convalescent.

Of even greater importance is the use of cow's milk as a substitute for mother's milk in infant feeding. It will be perceived that those inost dependent upon this food—the sick and convalescent, infants and children—constitute that part of the community suffering the greatest injury from the use of a food impaired in its nutritive content. This is due to the fact that they are least able to resist the harmful effects of foods contaminated by toxins or pathogenic microorganisms. While improved conditions of living have contributed to a steady decrease of the general mortality in civilized countries, this unfortunately does not apply to the infant population under one year of age. It is recognized that gastro-intestinal disease is the largest single factor determining infant mortality, a condition in great measure due to improper methods of feeding. This enormous loss of potential wealth is of grave concern to the State and worthy of most careful consideration. It is especially for these reasons that the question of sanitary milk and its relation to the public health challenges our best endeavors.

The investigation into the origin and prevalence of typhoid fever in the District of Columbia during 1906 by a board of officers of the Public Health and Marine Hospital Service brought out many facts emphasizing the possible danger of milk as a carrier of this disease. Through the interest of Dr. G. Lloyd Magruder, who had been impressed with these facts, the President, and the Secretary of the Treasury directed that the United States Public Health and Marine-Hospital Service invite the cooperation of the Bureaus of Animal Industry and Chemistry of the Department of Agriculture in an investigation of the milk industry of the District of Columbia from the farm to the consumer in its relation to the public health.

In order to properly study the subject as it exists in the District of Columbia, it was deemed necessary to treat the matter from a broad point of view; that, to study the local aspect of a world-wide problem, the findings and experiences of others must necessarily be considered. In many respects the Federal Government has peculiar advantages for the study of these problems which, strictly speaking, are not confined to any one locality, but are national in scope. It is therefore incumbent on the National Government to assume its responsibilities and attempt the solution of scientific questions of this character influencing the lives and health of its citizens. Because of the relation the Public Health and Marine-Hospital Service bears to the conservation of the public health, it was determined to make this investigation of such a character that, in addition to being of local value, it would also be of assistance to health officers at large, and especially to those not as yet provided with the necessary laboratory facilities and corps of workers such as can be afforded only by the richer and more densely populated centers.

It has been the object to include in this volume all available data showing the influence of milk as a carrier of infection, its chemical composition, the contaminations found therein, their influence upon it as an article of food, and the measures necessary in its production and handling to prevent such contamination.

Milk in the udder of a healthy cow is rarely sterile, but with proper methods can occasionally be removed in small quantities free from micro-organisms. In this condition it may theoretically be considered normal milk, and as such has been kept for over two years. But this is not the milk of commerce. In the healthy cow, milk may contain organisms while still in the udder, or receive its initial contamination with the omnipresent microphyte in its passage through the ducts of the animal's teats. This may be considered its first point of contact with the outer world, for these organisms in the healthy animal have gained access to the ducts from without. At every other

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