Springfield, Ill.-The Department of Health has done nothing toward the prevention of infant mortality, except very careful inspection and reinspection of dairies for an area of 15 miles about the city.

Seattle, Wash. In all our milk work we have endeavored to raise the standard of milk production along lines somewhat original. We have first sought to make the business profitable by endeavoring, so far as possible, to educate the dairyman how to produce the best stock, how to feed the same, and in general make the occupation of dairying profitable. We have done this primarily so that we might have steady shippers. There is no branch of milk production comparable with this in my judgment. A city must strive to maintain a shipment of milk from dairymen who are well acquainted with the laws and ordinances, who on account of experience can produce milk under the terms of our ordinances. If a city has a number of dairymen changing from one vocation to another, such a milk supply can never be first class.

Schenectady, N. Y.-During the past year we have made radical changes in our milk-inspection work. July 1, 1912, we adopted a new set of rules governing the production, sale, and care of milk in the city of Schenectady, after having studied the milk question thoroughly. At present we are contemplating several further changes, and we hope to get an ordinance which will prohibit milk being dipped on the streets and of enforcing the sale of bottled milk only. In fact, we are trying to get our milk-inspection system as near the ideal as possible. When all is said, perhaps the most important factor of a babysaving campaign is pure milk.

To trace the cases of intestinal diseases from the cow or the dairy farm to the nursing bottle of the infected child, just as was done in the case of diphtheria in the towns of Dorchester, Milton, and Hyde Park, Mass., is a very effective and conclusive method of securing ordinances which permit either the establishment of municipal milk supply or complete control of private sources.1

Cartoons descriptive of well-known local conditions are always good to emphasize local needs. The Chicago Health Department very effectively illustrates the superiority of breast feeding by a cartoon which it calls "The Long and Short Haul," which is reproduced on the opposite page. Local illustrations along similar lines have been made very effective elsewhere.

The larger cities, such as New York, Chicago, Boston, Philadelphia, and particularly Washington, D. C., have made every effort to control the milk supply from its source.

The following quotation from "The Milk Question," by M. J. Rosenau, gives some idea of the problem involved in a survey of the milk supply for large cities:

The extent to which this separation of consumer and producer has taken place in the milk industry is patent when we recall that Boston gets most of its milk supply outside of a 50-mile circle, and some milk starts 243 miles from the city. New York receives practically no milk within 50 miles, and

1 See Monthly Bulletin of the State Board of Health, Mass., May, 1907, Vol. II, No. 5, p. 117; also Bulletin 56 of the Hygienic Laboratory, U. S. Public Health Service, entitled "Milk and its Relation to the Public Health," p. 36.

Chicago Health Department Educational Poster No. 72. Designed by Dr. C. St. Clair Drake.

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some of its supply comes from points as far away as 400 miles. New York City uses about 1,600,000 quarts of milk a day, derived from 40,000 dairy farms.

Most of the milk supply of Chicago is produced within 60 miles of the city. A 100-mile circle about the city would include nearly all the dairies producing its supply. In times of exceptional scarcity in summer sweet cream is shipped 200 miles. The production of Chicago's milk within such a short distance of the city is in marked contrast with conditions in Boston and New York. Chicago uses about 1,000,000 quarts of milk a day. The health commissioner estimates that, in 1910, 120,000 milch cows were necessary to furnish the city supply, making an average production of 6.3 quarts per day per cow.

The District of Columbia consumes about 76,000 quarts of milk a day, or about 0.4 of a pint per capita. This milk is produced on 1,091 dairy farms from 17,688 cows. About one-third is brought in by wagons and two-thirds by steam and electric railroads. The cream is largely received from Philadelphia and New York.

Smaller cities or cities situated in the center of rural districts do not, of course, have a problem so serious as this. Nevertheless, the survey and control of the milk supply is not the province of private philanthropies and should not be expected of them.1

RECOGNIZED GRADES OF MILK.

Beyond milk inspection and survey of the milk supply, the next step is the establishment of milk depots to furnish pure milk for babies who for any reason can not be breast fed. The health department usually examines and certifies the character of the milk. The milk is usually graded in three classes: (1) Certified milk, (2) inspected milk, and (3) pasteurized milk, and these classifications are embodied in the laws or the regulations and enforced by public-health authorities.

The following definitions or specifications for the grades of milk named are taken from a paper on "The Classification of Market Milk," by Dr. A. D. Melvin, chief of the Bureau of Animal Industry, United States Department of Agriculture, published in Hygienic

1 There are, of course, numerous private publications on methods of dairy and milk inspection. Health officers will, however, find most concise and helpful "Twenty Dairy Suggestions with Special Reference to Sanitation," a stable placard obtainable from the Bureau of Animal Industry, United States Department of Agriculture. In "Municipal Ordinances, Rules, and Regulations Pertaining to Public Hygiene," reprint from Public Health Reports, No. 70, of the U. S. Public Health Service, Washington, 1912, will be found ordinances and regulations from a large number of cities (pp. 70-150), from which a satisfactory ordinance could be selected or drafted to suit any locality. The city ordinance of Berkeley, Cal., contains a score card used in grading dairies. Other reports published by the U. S. Public Health Service which health officers will find extremely useful are "Milk and Its Relation to Public Health," issued as Hygienic Laboratory Bulletin No. 56, second edition, 1912, and Methods and Standards for the Production and Distribution of Certified Milk,'" reprint from Public Health Reports, No. 85, 1912. The Bureau of Animal Industry is sometimes able to help raise the standard of local conditions, by sending, upon request of a city or State health officer, an expert to assist in making a survey of the milk and milk supply.

Laboratory Bull. No. 56, second edition, 1912, entitled "Milk and Its Relation to the Public Health," pp. 608-610:

Class 1: Certified milk.-The use of this term should be limited to milk produced at dairies subjected to periodic inspection and the products of which are subjected to frequent analyses. The cows producing such milk must be properly fed and watered, free from tuberculosis, as shown by the tuberculin test and physical examination by a qualified veterinarian, and free from all other communicable diseases, and from all diseases and conditions whatsoever likely to deteriorate the milk. They must be housed in clean and properly ventilated stables of sanitary construction and must be kept clean. All persons who come in contact with the milk must exercise scrupulous cleanliness and must not harbor the germs of typhoid fever, tuberculosis, diphtheria, or other infections liable to be conveyed by the milk. Milk must be drawn under all precautions necessary to avoid infection and be immediately strained and cooled, packed in sterilized bottles, and kept at a temperature not exceeding 50° F. until delivered to the consumer. Pure water, as determined by chemical and bacteriological examination, is to be provided for use throughout the dairy farm and dairy. Certified milk should not contain more than 10,000 bacteria per cubic centimeter, and should not be more than 12 hours old when delivered. Such milk should be certified by public health officers or by some other properly constituted authority.

Class 2: Inspected milk.-This term should be limited to clean raw milk from healthy cows, as determined by the tuberculin test and physical examination by a qualified veterinarian. The cows are to be fed, watered, housed, and milked under good conditions, but not necessarily equal to the conditions prescribed for class 1. All persons who come in contact with the milk must exercise scrupulous cleanliness and must not harbor the germs of typhoid fever, tuberculosis, diphtheria, or other infections liable to be conveyed by the milk. This milk is to be delivered in sterilized containers and is to be kept at a temperature not exceeding 50° F. until it reaches the consumer. It should contain not more than 100,000 bacteria per cubic centimeter.

Class 3: Pasteurized milk.-Milk from dairies which do not comply with the requirements specified for classes 1 and 2 should be pasteurized before being sold, and should be sold under the designation "pasteurized milk." Milk for pasteurization should be kept at all times at a temperature not exceeding 60° F. while in transit from the dairy farm to the pasteurizing plant, and milk after pasteurization should be placed in sterilized containers and delivered to the consumer at a temperature not exceeding 50° F.

All milk of unknown origin should be placed in class 3 and subjected to clarification and pasteurization. No cow in any way unfit for the production of milk for use by man, as determined upon physical examination by an authorized veterinarian, and no cow suffering from a communicable disease should be permitted to remain on any dairy farm on which milk of class 3 is produced, except that cows which upon physical examination do not show physical signs of tuberculosis may be included in dairy herds supplying milk of this class.

This milk is to be clarified and pasteurized at central pasteurizing plants, which should be under the personal supervision of an officer or officers of the health department. These pasteurizing plants may be provided either by private enterprise or by the municipality, and should be located within the city.

By the term "pasteurization," as used herein, is meant the heating of milk to a temperature of 150° F. or 65° C. for 20 minutes, or 160° F. or 70° C. for 10

minutes, as soon as practicable after milking, in inclosed vessels preferably the final containers, and after such heating immediate cooling to a temperature not exceeding 50° F. or 10° C.

Other conditions.-No milk should be regarded as pure and wholesome which, after standing for two hours or less, reveals a visible sediment at the bottom of the bottle.

No dairy farm should be permitted to supply milk of a higher class than that for which its permit has been issued, and each dairy farm supplying milk of a specified class should be separate and distinct from any dairy farm of a different class. The same owner, however, may supply different classes of milk, providing the dairy farms are separate and distinct.

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The term milk" as herein used includes cream.

The New York City Board of Health adopted the following resolutions in regard to the sale of "loose" or "dipped" milk, on September 17, 1912, effective on June 1, 1913:

Whereas the interest of the public health requires that milk should be protected from contamination by human agencies and by dust, dirt, and flies; and,

Whereas many of the premises in the city of New York where milk is sold by dipping from cans are grocery stores in which foods and food products and other commodities not in sealed packages are sold in a manner which causes much dust; and,

Whereas the facilities for proper icing, the proper cleansing of utensils, and the proper protection from flies are often inadequate in such stores, many of which are so arranged that the living rooms open directly into the store: Therefore be it

Resolved, That after June 1, 1913, the sale of milk dipped from cans will be permitted only in milk stores approved by this department, and for which a permit has been issued, or in places in which foodstuffs, other than milk products, are sold in original packages only.

MILK STATIONS.

RECENT INCREASE IN NUMBER.

A constantly increasing number of cities of all sizes are establishing milk stations and dispensing milk, whether pure whole milk, certified, modified, pasteurized, or sterilized milk, to mothers of babies that must be bottle fed. The U. S. Public Health Service, published a compilation1 from schedules received by that Service from certain cities in which such work is being carried on. The report covers 43 institutions located in 30 cities of over 50,000. These cities are Albany, Baltimore, Boston, Buffalo, Chicago, Dayton, Detroit, Hartford, Honolulu, Indianapolis, Kansas City, Mo., Lawrence, Louisville, Lowell, Milwaukee, Newark, New Bedford, New Haven, New York City, Peoria, Pittsburgh, Providence, Rochester, St. Louis, Springfield, Ohio, Washington, D. C., Waterbury, Wilkes-Barre, Worcester, Yonkers.

1" Data Regarding the Operation of the Infants' Milk Depots in the United States." Reprints from Public Health Reports No. 64, U. S. Public Health Service.