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.

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 compilation 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.

Twenty-nine of the institutions are maintained by private benevolence; 11 did not report on this point; while one was reported as maintained partly by private means and partly by public appropriation.

Forty-three of the institutions mentioned distribute milk, 23 of them to infants only, and 20 to both infants and adults. At some depots the milk supplied is for expectant or nursing mothers, thus contributing indirectly to the welfare of the children.

Of the 36 institutions furnishing information as to the average age of the children fed, in the majority the children are under 1 year of age, and in practically all they are under 3 years.

At 30 of the institutions reporting, literature on infant hygiene is distributed with the milk; one of the circulars is issued in seven languages. Twelve institutions distribute no literature, and one institution distributes practically none.

Every institution which reported except one takes special measures for the education of mothers in infant hygiene. These instructions are given by physicians and nurses or by means of literature or by both. In 2 cases the educational work was carried on in the homes; in 2 only at central stations; in 38 both in the homes and at central consultations.

The letters received by the Children's Bureau indicate a number of cities of the class named having milk stations in 1912, or intending to establish them in 1913, not in this tabulation. Salem, Mass., for instance, has conducted a certified milk station for four summers and continues it for 1913. During the 60 days of 1912 in which it was operated, 35,863 feedings were dispensed to an average of 66 cases per day. Of course, a large number of cities under 50,000, and many, like Montclair, N. J., under the 25,000 class, have excellent milk stations and are doing splendid work along many child-saving lines. It is the intention of this Bureau to obtain, so far as possible, complete returns from all cities and towns having more than 15,000 inhabitants and to present the result of the investigation in tabular form in next year's bulletin.

The magnitude of the movement in New York City is shown in the report on "Milk Stations" issued by the Clean Milk Association. In nothing is the importance of cooperation between the municipal health office and private philanthropies and civic associations so apparent as in this matter of summer milk supply. Where municipal milk stations and municipal milk supply are impossible it is nevertheless usually possible to organize a local charity that will supply the needed funds for a sufficient number of pure-milk stations. The experience of Utica, N. Y., previously referred to in this report, could no doubt be duplicated in scores of cities from which reports have not yet been received. The frequent and persistent publication of the

local infant death rate and its relation to the nature of the milk supply will sooner or later arouse sufficient public interest in any locality to insure to the health office sufficient funds and cooperation to apply the remedy.

NOT A MEANS OF ENCOURAGING BOTTLE FEEDING.

Usually the first step taken toward a summer campaign for saving babies' lives, whether by a municipal health department or by private benevolence, is to establish a pure-milk station. Since the largest part of the summer infant mortality comes from bottle-fed babies and is traceable to dirty milk, the pure-milk station suggests itself as the most obvious and direct remedy. From a number of sources, however, comes a warning that the pure-milk station as a separate institution must not be too much accentuated. The danger comes from the fact that it deals only with bottle-fed babies. Since a bottle-fed baby has only one-tenth the chance to live that a breast-fed baby has, it is perfectly natural that preventive efforts should first be directed toward the most potent causes of high death rate, but there may be and in some places there have been certain attending dangers where the furnishing of milk has been the only thing attempted. On this account in many, if not most, milk stations positive proof is required that the mother either can not or ought not to nurse her baby before she can get the pure milk, and this precaution has been found necessary in order to prevent an increase in bottle feeding in the community as a result of the feeling of greater safety which the puremilk station gives to mothers who, while perfectly able to nurse their children, would prefer, for insufficient reasons, not to do so. It is never intended that there should be less insistence upon the duty of breast feeding because of the milk station, for while the death rate among the bottle fed is reduced by pure milk, the death rate among the bottle fed from the purest milk possible is still much higher than the death rate among the breast fed, and if there is any perceptible increase in bottle feeding as against breast feeding because of the milk station the latter might thus become an agency to increase rather than decrease infant mortality.

INSTRUCTION OF MOTHERS A NECESSARY FEATURE.

It has been the experience of practically all milk dispensaries that it is useless to send pure, clean milk into a dirty home to be handled by an ignorant, dirty mother or older child. It is necessary to reach the mothers, and not only to teach them how to care for the baby's milk, but to convince them of the necessity of cleanliness where the baby's food is concerned-convince them of the deadliness of dirt, especially of dirty milk.

In many cities it is believed that the principal good to be derived from milk stations consists in the opportunity given for those in charge to come in contact with the mothers and with the home surroundings of the babies in the high death-rate districts. The nurse and the physician in consultation with the mother thus become a necessary adjunct of the milk station. No milk, however pure or clean, agrees at all times with all babies, and the distribution of modified milk become necessary almost immediately in a number of cases. To modify the milk to serve the needs of a given child that child's case must be studied; hence the child clinic, which almost at once grows out of the necessities of the milk station.

EQUIPMENT AND MANAGEMENT.

A milk station is simply a room from which pure milk is given out for the use of babies that can not be breast fed. The best location is in or as near as possible to the congested part of the city. It is only necessary that the room shall be sufficiently large to accommodate the patrons and the equipment and that it be light and clean. In the case of Utica, N. Y., for instance, the first milk station was opened in a schoolhouse, and it would seem that schoolrooms, thoroughly scrubbed and cleaned, might more generally be turned into this use during the summer vacation. The equipment is simple: A good ice box, large, and kept clean, a desk, some chairs, and a table. The walls and woodwork are usually painted white, and the floor is covered with linoleum, which makes easier the task of keeping it clean.

Signs in large letters and in all needed languages are usually put up, stating that pure milk is furnished at the lowest possible price (sometimes free to the poor), for the use of babies only. Most cities find it better to sell the milk at practically the ordinary price at which milk is sold in the city. This avoids conflict with the dairy interests, and allays the suspicions of the ignorant, that the puremilk station is but a scheme to get higher prices. The following from the report for 1910 of the Babies' Milk Fund Association, of Louisville, Ky., is illustrative of the practices and experiences of all:

At each of the seven stations certified milk was sold below cost for the children of the poor. The regular retail price of certified milk, 12 cents a quart, being prohibitive in our station neighborhoods, we made our price at first 8 cents a quart, meeting exactly the price of the ordinary market milk our patrons had been accustomed to buy, and raising our price to 9 cents later, when market milk was advanced to that price by the retail dealers throughout the city.

We paid 10 cents a quart for this certified milk, and so we lost at first 2 cents, later 1 cent, on every quart sold.

The modified milk, which costs the association about 17 cents a day for each baby, was sold for 10 cents a day.