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GEORGE B. MANGOLD, Ph. D.
‘ DEPARTMENT OF RESEARCH — | |
, st. Louis SCHOOL OF SOCIAL ECONOMY. | :
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ASSISTANT. AND DVISER

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CONTENTS.

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_ Chapter I.—Origin and. History of the Milk Supply of
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INTRODUCTION.

The St. Louis School of Social Economy has made an extensive
study of the cause of infant mortality and sickness in St. Louis. The
study included an investigation of all deaths in the second, third and
fourth sanitary districts, of children under five years of age for an
entire year. A special study was also made of sickness among small
children during the summer months, and an additional inquiry was
directed into the character of the summer milk supply. In view of
the large factor which our investigation shows poor milk to be as a
cause of sickness and mortality, this report is offered to the public
with the hope that the needed reforms may be accomplished.

The School of Social Economy wishes to express its thanks to
the St. Louis Pure Milk Commission and the Missouri Botanical
Garden for the generous provision of laboratory facilities for the
work embodied in this bulletin; and to the officials of the Health
Department and the officers of many dairy companies for assistance

in getting much of the information contained therein.

GHAPTERTI.

ORIGIN AND HISTORY OF THE MILK SUPPLY OF
Sh, LOUIS:

Like all large cities, St. Louis draws its milk from a large dis-
trict, surrounding and including the city. By far the most important
part of this district, from a milk-production standpoint, is that in
western Illinois, a zone with numerous dairy centers, extendtug
roughly between 20 and 100 miles from the city. In eastern Mis-
souri dairying is not so important a business, and there are only
a few centers, with a fair number of scattered dairy farms. Then
also there are dairies in and immediately surrounding the city. The
conditions of milk production in all these dairies, together with the
methods of transporting and handling the milk, both in the country
and in the city, are the factors determining whether the milk, which
supplies such a vital need of the city, is good or bad, wholesome or
unsafe. \s far as is possible in a brief account, the more important
of these features, from a sanitary standpoint, are discussed in this
chapter.

City DAIRIES.

It is estimated that about one-fourth of the milk sold in St.
Louis is produced within the city. Approximately 5,000 cows are
kept here, in 175 dairies having from 4 to 150 cows each. Most of
these cows stand in the stable month in and month out, many of them
without even a chance to move about in a barn-yard; and this con-
finement is so hard on them that they can be kept only one season.
So it is emphatically a question whether the cows can give whole-
some milk while living so unhealthy a life. In addition, many of
these dairies feed “brewers’ slop;” and it is plain that this affects
the quality of the milk, for the milk and even the cream from such
a dairy is a ghastly, chalky white that differentiates it instantly from
country milk.

The cows in the “city” dairies are not tuberculin-tested. Pos-
sibly they do come into the city comparatively free from tubercu-
losis, as is claimed; but since that disease is one of the reasons why
cows cannot be kept for any length of time in these places, it does
not seem likely that they all remain free from it during the time
that they are contributing to our milk supply. Whenever a cow
has tuberculosis, there is real danger of the tuberculosis germs
(tubercle bacilli) getting into the milk, and then an ever-present pos- -

3

sibility of their doing serious damage. And in the case of the “city”
dairy, the milk is almost all sold raw.

On the other hand, these dairies are under the supervision of
the Health Department, and most of them are kept decently clean.
The stables are required to have sound floors and white-washed
walls and ceilings; the cows must be kept clean; the milk-room and
all the apparatus must be in decent condition; and the milk must be
promptly cooled with ice. These are not the only necessary pre-
cautions for sanitary milk production; but it is something—in truth,
‘a good deal—to be assured of even so much. Moreover, the milk
from these city dairies gets to the consumer rather promptly, for it
is nearly all peddled out by the producer; and as we shall see, this
is no inconsiderable advantage. This “city” milk is mostly cheap
milk sold from the can; and last summer it was found to contain far
less bacteria than other ‘loose’ milk. This is undoubtedly due to
its greater freshness.

So there is something to be said on both sides of the question,
whether the “city” milk is comparatively good or bad milk. But
in any case, it is a diminishing factor of the whole milk problem;
for both the number of “‘city’ dairies and the number of cows
therein diminish year by year. Dairymen go out of business for
one reason or another; and no new cow-stables are allowed to be
built. Dairying within the city was at one time the main source
of supply for the city; and the dairies which remain are hardly
more than a remnant of an obsolete method of handling the business.

DAIRIES OUTSIDE THE CITY.

Meantime, what of the milk which comes from outside the city ?
In the first place, there is a small amount of milk which is brought
in by wagon from the surrounding country, and often delivered
by the producer. Some of these county dairies are of the best class,
producing milk selling at 15 or 20 cents a quart. Others are of the
lowest order, belonging to the most backward and obdurate of the
city dairymen, who have moved beyond the city limits in order to
get away from the supervision of the Health Department. (Then
they can sell as dirty milk as they please.) And of course there
are other “just ordinary” country dairies in this group.

But the vast bulk of all our milk—the dominating factor in the
situation—is the “shipped” milk: i. e., that which comes into the
city by railroad. Where does it come from? From what sort of
places? What happens to it, both on its way into the city, and after
it arrives?

The “shipped” milk—some thirty thousand gallons a day—
comes from 4,500 or 5,000 farms, scattered over eastern Missouri and
western Illinois, but most of them located in the dairy zone in IIli-
nois, which furnishes from three-fourths to four-fifths of this sup-
ply. Now, to a large extent the character of our milk is determined
on these farms; for dirty milk on the farm can not become clean
milk, nor bad milk good, although the reverse may all-too-easily hap-
pen. What do we know about them? In the first place, that they are

4

subject to practically no sanitary inspection, so that the milk is at
the mercy of the standards of cleanliness of each individual farmer.
The inspection officials of the states of Illinois and Missouri are
without real authority over sanitation; and so far, St. Louis has
done nothing to protect itself. The dairy companies as a rule will
accept pretty nearly any milk that does not smell sour when it
arrives; and there is plenty of opportunity to pass unwholesome
milk through those limits, for milk may be pretty bad from a sani-
_tary standpoint long before it sours or even smells bad.

CONDITION OF THE Datry FARMS.

During this investigation, 64 farms selected at random in eleven
districts in ’ Tlinois and “Missouri were visited.

Some distinctly insanitary conditions were found to be very
common, if not prevalent. For instance, over half of the cow-
stables inspected had dirt floors, most of them without any gutter
or drainage arrangements: it is inevitable that such a floor is more
or less impregnated with manure, and it easily degenerates into an
impossible condition when not well cared for, especially in wet
weather. Tight floors—wood or cement—are required practically
everywhere that there is any sanitary supervision. That cement
floors are not beyond the reach of the farmers of this region is
shown by the considerable number who do have them. Then, a
large proportion of the barns have no windows at all, while only
one-fourth were found to have as much as one square foot of win-
dow-space per cow. The official U. S. standard is four square feet.
Dusty ceilings are very much in evidence; what is surprising is that
no farmer was found who took the simple precaution of whitewash-
ing the inside of his stable, and only a very few who even swept the
cow-webs down from their ceilings—generally the only clean ceil-
ings were the new ones. On nearly half the farms, horses and
cows were stabled along side of each other or at best on opposite
sides of the passage way, which is not a good thing in a milking-
barn. The cows keep pretty clean as long as they are out on pas-
ture; but in the winter dirty cows are so much the general rule that
a farmer who cleans his cows is a shining exception. On the only
inspection trip made in wet weather, every barn-yard was found
knee-deep in mud; of course that is hard to remedy, but it is sure
eventually to transfer altogether too much of that mud by way of
the cows into the milk. Very commonly during the winter the
manure is pitched out of the windows and piled up against the barn,
or at best a few feet away in the yard; that adds to the cleanliness
neither of the barn nor of the barn-yard.

Throughout this investigation, the only farmers who were found
to have had their Cows tuberculin-tested were an occasional owner
of a pure-bred herd. It is impossible without the use of the test to
tell anything about how much tuberculosis there is among the cattle,
for it is only advanced cases that make themselves evident. Un-
doubtedly, there isa good deal of it; it has been estimated that ro

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per cent of the dairy-cattle in Missouri are infected, and where
dairying has been long established without protection through test-
ing, as in Illinois, the disease of tuberculosis, which tends to spread,
is very likely to be still more prevalent.

As to methods of handling the milk—aside from the impossi-
bility of getting clean milk from a dirty cow in the dusty barn—the
first general criticism to be made is that the practice of filling the

nilk-cans inside the stable is much too common. Secondly, it has

been proved in many places that the use of small-mouthed milking
pails is one of the most practicable and effective methods of diminish-
ing the amount of dirt which falls into the milk, especially in dusty
surroundings; but no such pails were seen. Finally, the cooling of
the milk on the farm is distinctly ineffective ; it is the custom to cool
the milk by setting a large 8-gallon can in a tub or tank of well-
water, but this will cool the milk neither quickly enough nor cold
enough to make it really fit to be shipped to the city. When we find
the Boston authorities insisting on “‘a liberal use of ice” by the
farmer, even in the cooler New England climate, we must realize
that we have an unfortunate situation to face, in that we draw milk
from a country where there is no ice on the farms.

This state of things could be improved by an authoritative in-
spection service. Doubtless the improvement would be rather slow,
and naturally “some bad conditions would be more difficult
to remedy than others; but eventually a great deal of good could be
accomplished.

There are other conditions, worse but not so general, which were
found in occasional distinctly “bad” dairies; for example, a stable
floor which in dry weather was a trampled mass of filthy mud, a
wooden floor hidden under accumulated manure or a cement floor
that was a pool of filth, stables where hay and cob-webs can sift their
dust into the milk, unimpeded by any ceiling, cows whose sides and
udders were caked with manure (apparently “for the winter”), milk-
buckets left on the dusty floor of a dirty barn, or cans left unwashed
until afternoon or even the next day and then washed with cold
water at the barn well. Such things are not the rule, but they are
actual cases; and the milk from such farms is mixed with that from
better ones, contaminating it all. For in handling milk, “the chain
is no stronger than its weakest link.” Because there are better
farms is no reason for tolerating the bad ones; on the contrary, it
only shows that the notably bad ones are inexcusable. It is here
that inspection would be most immediately effective, in eliminating
such conditions and practices; and evidently we can trust only to
official inspection to perform this service for us.

COLLECTING STATIONS.

Some of the milk from the farms is shipped directly by the
farmer to a distributing dairy in the city. About three-fifths of the
milk sent to the city (and most of the cream), however, first passes
through the hands of a collecting, station or “creamery at the near-
est railroad station. which buys the milk from the farmer and as-

7

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sumes all further responsibility for its progress toward the city. The
milk is gathered from the farmers in several ways. The farmer
after the milking in the morning may haul his milk directly to the
creamery. Sometimes several farmers join in the establishment of
a route and the men take turns in hauling the milk of the co-opera-
tors. More frequently one farmer on a route is paid by the others
for hauling the milk. Whichever method of collecting is used, the
milk is not under refrigeration while on the way to the creamery.
Frequently the hot sun beats down on the milk cans and hastens the
spoiling of the milk.

Half of these creameries, including the largest ones, are owned
and operated by the large dairy companies in the city; from the
others the milk is bought by contract. At this point the history of
the milk differs. Some of the dairy companies, and some of the in-
dependent creameries, have their milk pasteurized* at the creamery
before it is sent into the city; other creameries rely upon thorough
cooling to keep the milk in good condition, or pasteurize it only dur-
ing hot weather.

Two distinct objects are sought by pasteurization. [rom the
sanitary standpoint, it is a means of destroying the disease-producing
germs in the milk; and to be reliable for that purpose, it must be
thoroughly done, under the supervision of someone who understands
the process. From the point of view of the average dairy-man, ‘it
is a means of reducing the miscellaneous bacteria in the milk and
thereby making it keep longer. Unfortunately a less efficient pas-
teurization seems to serve fairly well for this purpose; unfortunately
also, the dairy-man may and all too often does use the process as
a substitute for carefulness in keeping the milk free from bacteria,
or as a makeshift to enable him to keep the milk longer than it
ought to be kept. In other words pasteurization delays the souring
which is nature’s danger-signal of stale milk. Nearly all the
“shipped” milk in St. Louis is pasteurized. The milk which is pas-
teurized at the creamery, is again pasteurized after reaching the city ;
and to this “double pasteurization” practice there are serious objec-
tions. It is not because the repeated heating injures the milk chem-
ically—it probably does not—but rather because, when the same
milk is pasteurized twice, it means in plain language that that milk
has been allowed to get well on toward the spoiling point TWICE—
that it is raising its third crop of bacteria when it reaches the con-
sumer and is loaded down with the remains of the two previous
crops. If repdsteurization were prohibited, arrangements would
have to be made to deliver fresher milk.

In any case, whether pasteurized or not (but more commonly
when pasteurized), much of the milk remains at the creamery until

_ *Note: Pasteurization is the trade name for the process of heating
milk to a temperature considerably below the boiling-point, 140 degrees
to 160 degrees, in order to kill the bacteria which it contains. The com-
mercial process consists in running the milk through a healing machine
made for the purpose, of which there are several types, and then cooling
it, which is equally important.

the second day. At stations where the milk-train leaves early in
the morning, this can hardly be avoided; but in some cases the train
does not go until 8 or 9 or even 10 o'clock, and still from one-third
to two- thir ds of the milk from that station will not be ready for it,
but must wait until the next day. Where the milk is pasteurized,
the delay is made almost inevitable by the time which that process
requires; but in some instances it is due merely to a lack of insist-
ence on prompt delivery from the farmers. In other cases a pos-
sible afternoon train is not utilized because it would be “incon-
venient” to the dealer to receive milk late in the day.

All the creameries have means of cooling their milk—ice, or
refrigerating machines—and have refrigerator rooms or iced storage
tanks for holding it when necessary. This cooling is generally
efficient, often bringing the temperature of the milk down to 40
degrees. And the milk seems very generally to be handled in a
cleanly manner, though of course some of the creameries are much
better built and equipped than others. One weak point in the sys-
tem is, that in many places the water supply is taken from a shallow
well, located typically along side of the building, or in or near the
railroad ditch, and either uncovered or exposed to surface drainage.
Some creameries provide facilities for the farmers to wash and
steam their cans, and a few require it to be done; it would be well
if this were the case everywhere, as cans so cleaned are in much
better condition than those left unwashed for some time after empty-
ing and then washed without steaming.

TRANSPORTATION.

While milk is being transported to the city, it is subjected to
most unfavorable conditions. For, incredible as it may seem, there
is no cooling or icing of the milk on the cars in transit, even in
summer-time. Our milk comes to us from 50 to 100 miles away
on slow local trains, requiring a journey of two or even three hours,
sometimes in the heat of the day, with no protection from the sum-
mer sun except the roof of the car. This is bad enough for the milk
which starts from a creamery storage room at 40 degrees, but it 1s
even worse for the milk coming directly from the farmer’s well-
tank at a temperature not below 55 degrees or 60 degrees. Indeed
it is a wonder that any of the direct shipments arrive sweet in tlie
summer. This is a condition which would not be tolerated in any
other first-class city ; and it would undoubtedly be remedied promptly
enough if our ordinance requiring milk to be kept cold (below 50
degrees) could be enforced, as in New York, by the confiscation
and destruction of all milk arriving too warm.

DISTRIBUTION.

After the milk reaches the city, it passes for distribution into
the hands of some one of the forty-odd dealers in “shipped” muk.
Fully half of these are men who receive and store a few cans of
milk from a few farmers, and retail it in their immediate neighbor-

10

hood, possibly bottling some of it. Such dealers make their business
very much of a “family affair,” being assisted by members of the
family in washing, bottling and selling, and carrying on these opera-
tions close to the living-rooms. Hence it seems likely that, in com-
mon with the “city” milk handled in similar establishments, this milk
is rather more liable to disease-contamination than that of the larger
plants which is handled in a wholesale way, by machine.

City Mitxk PLANTs.

The larger dealers in “shipped” milk all pasteurize their output,
in the city. As a general thing, the milk which they receive one
morning is pasteurized (and bottled so far as that is done) that
day and delivered to the customers the following morning. Thus,
that part of the supply which, coming through the creameries, has
been already held in the country over one night, is in at least its
third day—48 to 60 hours old—when it reaches us; and in the
winter, when conditions of temperature are better, there is a good
chance of its being 24 hours older still, because then many farmers
deliver their milk to the creamery only every other day. The milk
shipped directly from the farmer is not so old; but on the other
hand it is not so thoroughly cooled before coming to the city.

The plants where the pasteurized milk is handled are of all de-
grees of excellence, and the reverse. A number are located in
unfortunately close proximity to their own stables. There are indi-
cations that in one or two places the incoming milk is tested by the
man in charge sticking his finger into each can and licking the milk
off. There is one plant—not a small one either—where the bottles
are washed out in the driveway, and the pasteurizer, a dilapidated
machine with rusty pipes, most inefficiently operated, is located in
a dark, damp, dirty cellar, opening on the sidewalk, and with the
ceiling encrusted with dirt directly above the open milk-tank. On
the other hand, there are milk-plants which are almost models, and
in which the milk is treated with scrupulous care.

Certainly if the consumers would adopt the habit of visiting the
depots from which their milk comes, such a place as the one de-
scribed above which bears its defects so plainly upon its face
would be put out of business. But meantime, such conditions, and
others not so obvious, ought not to be allowed; and the Health De-
partment (which is fully aware of their iniquity) should be given
the necessary authority to end them. At present about all that
the Sanitary Division officers can do with an insanitary milk-plant
is to adopt a policy of constant nagging; and although within a year
they have had the satisfaction of seeing one of the worst in the city
finally torn down and rebuilt, still they ought to be enabled to take
more peremptory measures.

’ Then too, pasteurization is a process which requires careful and
expert management, to avoid the pit-falls lurking in insufficient
heating, insufficient cooling, and contamination after pasteurization ;
and it is only to be expected that the smaller plants especially lack
trained managers and foremen (but any foreman may become care-

Vial

less or unduly economical) and need supervision. lor instance 1m
one of the smaller plants, in most respects a first-class place, the
pasteurization consisted of momentarily heating the milk to 150-152
degrees, and of then cooling it to about 60 degrees—both steps ther-
oughly inefficient for destroying and preventing the growth of
bacteria. If we are to have “pasteurized milk’ upon whose whole-
someness we can in any way depend, we shall have to provide official
supervision of the process. Otherwise “the last state of the milk
will be worse than the first.”

Each year, a constantly increasing proportion of all our milk
is bottled; and the best dairies bottle all their retail milk. This is
undoubtedly an excellent thing; for bottled milk is almost invariably
found to be in much better condition than “loose” milk from the
same plant. But—to what extent are we protected against infected
bottles, for instance from a case of consumption? There is no gen-
eral enforcement of sterilization, and it is pretty safe to say that
where the bottles are not steamed at all—and in many plants they
are only washed by hand—they are dangerous. This is one of the
important matters which must be strictly looked after, if bottling is
to be the safeguard which it should be.

Of course all these statements must not be taken to apply
universally to all of our milk, or to all of the companies or individ-
uals who handle it on its way to us. Some are liable to very little
criticism; and many are doing the best which they see, to provide
good milk—a hard problem at best. But the evils spoken of do
exist, and are not isolated instances. And in planning to improve
the situation, we must keep in mind the bad conditions, which are
the ones that need reforming. If any dairy conducts its business
according to high standards, surely that dairy will be the last one to
object to the elimination of practices of which it would not be guilty.

To recapitulate: It appears from this investigation that the
chief evils from which the bulk of our milk-supply suffers are—

(1) Uninspected, and hence in many instances insanitary, dairy-
farms. .

(2) Too great delay in delivery to the consumer.

(3) Lack of cooling on the trains.

(4) Unregulated pasteurization.

(5) In some cases, insanitary distributing plants.

12

CHA PEER DE.

CONDITION OF THE SUMMER MILK SUPPLY
ENS FOU:

During the summer of 1910, a number of samples of milk from
thirty different dairies were examined, in order to ascertain the con-
dition and quality of our milk as we get it in the summer. As far
as possible milk was selected which was being used for sick babies,
because it is to them that the condition of the milk is most vitally
important. The samples included all sorts and conditions of milk,
from all sorts of sources—from both the large and the small dairies,
both “city” and “shipped”: milk, both “loose” and bottled milk, both
raw and pasteurized milk. Some of them were bought from the
dairies themselves or from their wagons, others from stores, and
still others from the homes of customers.

CHEMICAL COMPOSITION OF THE MILK.

The first question which was investigated related to the chemical
composition of the milk: (1) whether the milk had been adulterated
by the addition of artificial coloring, or preservatives; (2) whether
it had been skimmed; (3) whether it had been watered—in other
words, whether the customers were cheated out of the amount of
nourishment which ought to be contained in their milk. All these
points are covered by the provisions of our present milk ordinance,
which are effectively enforced by the staff of the City Chemist’s
office as far as its numbers permit; but it is obvious that two in-
spectors taking samples cannot fully control all the milk sold in a
city of the size of St. Louis, from 3,000 stores and 500 wagons.
The officials are continually finding violations; and it is not surpris-
ing that the School of Social Economy did also.

(1) We found artificial coloring once, and formaldehyde once.
Formaldehyde is by far the most commonly used milk-preservative,
so no tests were made for other preservatives. Last summer for-
maldehyde was repeatedly found by the Department of Health in
the milk of one dairy—the same one in whose milk we found it;
but in general it appears that the practice of using preservatives is
largely stamped out.

(2) The St. Louis ordinance requires that milk which is sold
as whole milk shall contain at least 3 per cent of butter-fat. This is
rather a low standard. The requirement in a number of cities is
3.5 per cent; the dairy companies themselves object to taking milk

13

from the farmers which contains less than 3.5 per cent; and the
Missouri State Standard is 3.25 per cent. In case the butter-fat in
a mixed lot of milk from different herds falls below 3 per cent, it
is a good sign that some of the cream has been removed. We
found that practically all the bottled milk samples contained
over 3 per cent of fat, and nearly two-thirds of them, 3.5 per cent
or more. But among the “loose” milk samples, only one-sixth were
above the standard; and one-third were below even 2 per cent.
This means that nearly ail the “loose” milk is partially skimmed,
containing about as much fat as ordinary hand-skimmed milk. This
would be no fraud if the customers knew what they were buying, but
we were never told that it was skim-milk, so presumably other cus-
tomers are likewise left in ignorance. It is difficult to do anything
with such cases, because the seller will invariably tell an inspector
and the court that he was selling skim-milk. There is a municipal!
ordinance requiring the display of skim-milk signs where skim-milk
is sold, but it has been held up for the present by an adverse decision
as to its legality.

During the four months, June to September, 1910, out of the
samples taken by the City Chemist’s inspectors, and declared to be
whole milk, 38 per cent of the store milk and 3 per cent of the
wagon milk contained less than 3 per cent of fat. It is impossible
to judge how much of these two classes was bottled milk. The
most obvious inference is that the wagon-drivers knew enough to
declare their skimmed milk as such, while many of the store-keepers
did not. The figures are practically the same for the eight months,
April to November; since November there has been sufficient im-
provement in the store milk to bring its proportion of milk below the
required standard for eleven months down to 25 per cent.

(3) In the same way that skimming is detected by a decrease
in the percentage of fat in the milk, watering is indicated by a de-
crease in the percentage of the other solid constituents of the milk,
called “solids-not-fat.” The legal requirement for these is 8.50 per
cent—again a fairly low standard, for the average of normal milk
is estimated to be about 9 per cent. A reduction of the solids-not-
fat from 8.5 per cent to 8.25 per cent indicates the addition of 3 per
cent of water; and to 8 per cent, the addition of 6 per cent of water.
The percentages in our samples were as follows:

8.5% and over. Not watered. 20% 32%
8.5% to 8.25% suspicious. 38% 23%
under 8.25% watered. 22% 45%
under 8% much watered. 18% 35%

Thus it appears that although about the same proportion of both
classes—approximately one-third—was all that was above suspicion
as to watering, when we come to the samples that were below sus-
picion—i. e. pretty certainly watered—the bottled milk shows up
decidedly better than the “loose” milk—32 per cent against 45 per

14

cent. And when we come to the figures indicating a. considerable
amount—6 per cent or more—of watering the “loose” milk shows
twice aS many cases. Indeed it is even worse than that, for the
watering of the loose milk is sometimes truly flagrant; we found
four samples which contained less than 6 per cent of solids-not-fat,
or 30 per cent of added water.

This is a decidedly bad showing. It demonstrates that, aside
from sanitary considerations, a quart of “loose” milk for five cents
is not so good a bargain in comparison with bottled milk at seven
cents, as appears on the surface, since the former is probably
skimmed and very likely watered. In other words, the purchaser of
a quart of loose milk gets less nourishment—really less milk—than
if he had bought bottled milk.

Among all the City Chemist’s samples of milk, both whole milk
and skim milk, for the four months—June to September—62 per
cent of the store milk and 17 per cent of the wagon milk—or 22
per cent of all—contained less than 8.5 per cent of solids-not-fat.
Some of these, of course, fell only a little below the standard, and
are hardly to be called watered. The figure for the store milk cor-
responds very closely with what we found in the “loose”? milk—68
per cent. There was some improvement in the average for the eight
months, April-November ; and considerable improvement since then,
so that the corresponding figures for eleven months are 37 per cent
and 14 per cent. This undoubtedly shows a real and substantial
decrease in the amount of watering of the store milk.

Who did this watering, is a difficult question to answer since
the milk passes through so many hands. There is some indication
that at least part of it originated back on the farm. But in any
event, the person who sells the milk to the consumer is legally re-
sponsible ‘for the quality of the milk.

TEMPERATURE.

In investigating the sanitary condition of the milk, there are
many things which cannot be told satisfactorily from any examina-
tion of samples, but only by following its history carefully from the
time it leaves the cow until it reaches the consumer—and after. But
there is at least one important factor in the care of the milk, which
we can easily check up. This is the temperature at which it is kept.
All authorities agree that milk (and most especially milk for the
supply of a large city, which has to make a long and devious journey
before it reaches the consumer) MUST BE KEPT COLD in order
to keep it in even decent condition. And cold in this connection
means below 50 degrees. Accordingly St. Louis, like most other
cities, has a requirement that milk shall be “maintained until deliv-
ered to consumer at or below 50 degrees F.” There are no figures
available as to the temperature of the milk when it arrives in the
city—undoubtedly it is generally too high in warm weather, as ex-
plained in the previous chapter—but our experience indicates that
even after arrival and probable cooling at the dairy, the proper
temperature is seldom maintained.

15

The following table shows the temperature at which our various
purchases of ‘milk were sold to us:

TewpenaTene, pmidanles,| A) Wathcamme. se Samples.
50: degrees or under... 30% ; 10% 21%
BO jtOOOnMeOTees vue ne 52% 55% 54%
60 idegrees| Or ‘overs. 2° 12% 35% 25 70
Overs So idepnees: he 5.3 64% 90% 79%

That is, nearly four-fifths of all samples—and gos per cent of
the “loose” milk—were above the legal temperature when sold, and
one-fourth were 10 degrees or more above the standard. This is one
point which is already covered by the necessary ordinances; and if
it could really be enforced, not only by fines, but also by destruction
of warm milk, it would improve our milk supply more than any
other equally simple step that could be taken.

BACTERIA IN MILK.

The best available criterion of the general sanitary condition of
a sample of milk is the number of bacteria (expressed as the num-
ber per *cubic centimeter) which it contains. This is true for two
reasons: first, because it has been found in practice that the whole-
someness of milk, especially for babies, depends very largely upon
its freedom from bacteria; and second, because the various in-
sanitary influences which may injuriously affect the milk—dirt from
dust, manure, or contaminated utensils, or lack of prompt and et-
ficient cooling, or too-long holding, or any carelessness in handling
—are invariably followed “by an increase in the number of bacteria.
Hence when an unusually large number of bacteria are found, it is
a sure sign that something has gone wrong. We cannot tell what
that ‘ ‘something” was, except in the most general way; that is, we
can make a rough inference as to whether the trouble is due to stale-
ness or keeping too warm, or to excessive dirt-contamination. But
in any case, the milk is deteriorated, so that the distinction as to
cause is not of very great practical importance.

The vast ma jority of the bacteria commonly found in milk are
non-pathogenic; that is, they do not produce any particular disease.
When the bacteria or contagion of specific diseases, as tuberculosis,
typhoid-fever, diphtheria, or scarlet-fever, do get into the milk, they
give rise to the most acute dangers which we have to meet in the
milk supply, and also one of the most difficult to guard against.
Fortunately such infection of the milk (except that with tubercu-
losis) 1s not a common occurrence; and the pathogenic bacteria can
almost certainly be destroyed by thoroughly heating the milk. It is
true that the presence or absence of large numbers" of miscellaneous
bacteria in milk does not prove the presence or absence of specific
pathogenic species. Nevertheless the chances for disease-contami-

*Note: One cubic centimeter equals one-half teaspoonful; or a glass
contains about 200 c. c.

16.

ge eee ;

‘a

“ eal
SE on er
Pe ae Oe Se eS
: og ee ee
ete

WHERE SOME OF OUR MILK COMES FROM

nation are greatest where milk is carelessly handled in any way;
and this is exactly the condition which is betrayed by a high bacterial
count. Hence such milk must be regarded with suspicion. More-
over, experience has shown that it is actually unwholesome in the
sense of being apt to cause digestive disturbances.

Occasionally someone maintains that the bacteria in milk are
of no importance to health because they are all the acid-producing
bacteria, which are not themselves harmful. But this is not so.
Very seldom, except in milk which is sour or getting ready to sour,
are the acid-producing bacteria in even a large majority; in
over half of our samples we found that these bacteria were less than
a majority. The rest are miscellaneous bacteria generally originat-
ing from dirt of some kind; some of them are putrefactive bacteria,
which tend to decompose or “rot” the milk, giving rise to unpleasant
tastes and odors, and making it peculiarly unwholesome.

The numbers of bacteria found in milk are always astounding
to anyone who is not accustomed to them, being for instance out of
all comparison greater than those found in the very worst water.
This teeming bacterial life results both from the circumstance that
it is very difficult to avoid getting dirt—and the “dirtiest” kind of
dirt—into the milk at milking time, and also and especially from
the fact that milk is one of the best known foods for bacteria, in
which they will grow vigorously and multiply enormously, if given
half a chance. This is “why it is so extremely important to keep
milk cold. The very highest grade of milk, produced and cared for
with the greatest precautions, “does well if it shows less than 10,000
bacteria per c. c. by the time it is 24 hours old. In St. Louis the
requirement for Certified Milk is that it shall not contain more than
30,000. In ordinary market or commercial milk the numbers found
are much higher than that, varying from about 100,000 to many
millions. A number of cities have an official standard of 500,000
per c. c. for ordinary milk, any milk containing a greater number
being regarded as suspicious and subject to investigation. In the
largest cities it would probably be necessary, at least in the summer,
to set the standard even higher, because their milk comes from
greater distances and is therefore older; the standard is 1,000,000
in Chicago (in the summer) and in New York. Such a number—
1,000,000 per c. c.—is by no means extraordinary, but with decently-
good, fresh milk, it should not often be exceeded. When the milk
verges toward souring or spoiling, the number of bacteria again
takes an enormous leap up into the hundreds of millions; but such
milk will almost invariably bear an obvious danger- signal in its
taste and odor. If it sours “clean” it is not likely to be so unwhole-
some as milk of an intermediate bacterial count, having in the neigh-
borhood of 10,000,000 per ec. c.

Unfortunately the practice of pasteurizing the milk before sell-
ing it, as is so largely done in St. Louis, makes us less able to judge
of its conditions from its bacterial content. The bacteria not only
exist in the milk, but also “do things” to it; and these changes which
take place in the milk remain after the bacteria are killed. Conse-

18

quently pasteurized milk containing for example 100,000 bacteria
per c. c. cannot be put in the same class with raw milk containing
the same number; for the former when it was raw, probably con-
tained from 1,000,000 to 10,000,000 per c. c., all of whose by-prod-
ucts are still in the milk. This consideration must be borne in mind
in interpreting and comparing the bacterial counts of pasteurized and
unpasteurized milk. (It is not denied in the least that, generally,
milk of commercial grade and miscellaneous origin will be safer and
more wholesome after pasteurization than before.)

In our summer investigation, the numbers of bacteria were de-
termined in all the samples of milk which we examined; these came
from all sorts of sources, as previously explained. In order to give
the information about the commercial-milk samples as briefly as
possible, they have been arranged in groups and the averages for the
different groups are given in the table. In several of the classes
there were one or two samples which had to be thrown out because
there was something abnormal about them, in order to take the
class-averages from a reasonably homogeneous group of samples.
These excluded samples included most of those with very high
counts (because these were sour or verging on sourness), so that
if all had been counted the averages would have been still higher.
Of course the milk from some dairies was far better than the aver-
age, and from others much worse.

Number having

Av. No. nae == Sago a5
CLASS. eee Bacteria ce : 252 z 8g =
pee mottled: milks... : 32 6,000,000 8 13 6 5
Brant dealer... i.) 21 2,800,000 7 10 3 I
aeeeasteurized:..'.) 4 18 2,400,000 6 10 I I
Pepin aw, - 22h) 870-13 3 5,100,000 I O 2 e)
II. From customers 11 12,200,000 I 3 3 4
aereastenrized. 332°. 9 8,300,000 I 8 3 2
atin awe f.c0 sarees ns 2 29,600,000 o) oO O 2
Bee seco@se co milk:. 5025 32° .<)33.200,000 o) 5 8 20
iybromidealérs..3: << $l « <29,500,000 O 5 7 19
ae easteurized |. 2.13 °" 27,400,000 O oO 3 10
pamixaWarts eich «229 17 2 4123,400,000 O 5 4 8
Shipped .... 6 43,000,000 oO O I i:
erGtty milk -73/5 10 6,400,000 O 5 g 2
II]. From customers 2 Re Ne O O I I
AeMeaAsteumized. isc... 01 5,000,009
pre ANNs tp canvas I 180,000,000

_Several interesting points appear in these figures:

(1) The superiority of the bottled milk. Comparing the sam-
ples obtained from the dealer, we find that the “loose” milk con-
tained on the average Io times as many bacteria as the bottled
(29,500,000—2,800.000). Moreover all the samples with less than

19

one million bacteria per c. c. were among the bottled milk, while the
majority of the very high counts came from the “loose” milk. If
we consider only the pasteurized milk, the superiority of bottled milk~
is equally striking, the bacteria being there in the ratio of I to 11
(2,400,000 to 27,400,000). In the case of one dairy from which we
had a number of samples—all pasteurized by the same machine—the
same ratio of 1 to 10 was found to hold between the bottled and
“loose’” milk (1,400,000—14,000,000). The difference in such a
case must arise from development of bacteria in the “loose” milk
after pasteurization, unless possibly an originally poorer grade of
milk is used for it; on either supposition, the figures are impressive
testimony to the sanitary superiority of the bottled milk.

2. The increase of bacteria after the milk gets into the hands
of the consumer. There were too few samples of “loose” milk ob-
tained from customers to give reliable information, and the same is
true of the raw bottled milk; but comparing the pasteurized bottled
milk in the two sub-classes, it appears that the samples “From cus-
tomers,’ which were taken at an average period of four hours after
delivery, contained on the average four times as many bacteria
(8,300,000 per c. c.) as the other samples purchased directly (2,400,-
000 per c.c.). In these cases, since the milk was kept in the bottle,
the bulk of the deterioration undoubtedly arose from allowing the
milk to become, or to remain, too warm. As a matter of fact, eight
out of the eleven samples were above 60 degrees when we found
them; at such temperature the bacteria could easily quadruple inside
of four hours.

3. The fact that the pasteurized bottled milk gave the lowest
average of any group (2,400,000 per c. c.). It should be remem-
bered that this number cannot fairly be compared with the figures
for raw milk, without bearing in mind as explained previously, that
a given number of bacteria in pasteurized milk implies a much larger
number of previous inhabitants. On the other hand, even this much
of an advantage for the pasteurized milk disappears when we con-
sider the “loose” milk, of which the pasteurized samples had actually
a somewhat higher count than the raw ones (27,000,000 against
23,000,000). This rather looks as though the fact that the milk
had been heated, tempts the milk-man to be more careless with it
than with the raw milk.

4. The comparatively low numbers of bacteria found in the
“city”? milk—6,400,000 per c. c. This is much lower than the aver-
age for any other group of “loose” milk samples. All but one of
these samples came directly from the producing dairy; and the
smaller number should be credited to this greater freshness rather
than to any greater cleanliness. Of course it is an advantage in any
case.

Taken as a whole, these figures show a decidedly poor grade of
milk and an unsatisfactory—not to say insanitary—milk supply.
Bearing in mind that our samples included some which had been
subject to pretty bad handling, and many from the class of milk

20

which may be well over 48 hours old when sold, this is not surpris-
ing. In fact the two phases of the investigation, into the history of
the milk, and into the resulting condition thereof, lead to the same
general conclusion. Of course there are exceptions; but THERE
IS ALTOGETHER TOO MUCH POOR MILK. Such milk—
even the bottled milk—is of much too high a bacterial content to be
safe food for babies; and one is tempted to say that most of the
“loose” milk is unfit for human consumption. It is possible to con-
trol the milk-supply sufficiently to remove some of the causes of
this condition, and to improve the situation materially, if we make
up our minds to grapple with the problem. What some other cities
are doing to improve and guard their milk-supply, will be shown in
a succeeding chapter.

From Bull, 56, Hygienic Laboratory.

CLEANING COWS PREPARATORY TO MILKING

GHAP TER SIME
RELATION JOB MILK sO) BABIES:

The social and sanitary conditions of the home and the measures
employed to prevent disease are very important questions, especially
as they relate to the amount of infant morbidity and mortality in a
community. Yet neither of these questions is of greater moment
for this purpose than is the problem of pure milk, a good quality
of which is a fundamental necessity. Without it, little progress
can be made. In fact it is a measure to prevent the spread of
disease.

Maternal nursing as a principle should be encouraged, but when
this is impossible, clean milk should not only be within the reach of
all the people, and especially the poor of our cities, but they ought
to be unable to obtain anything else but clean milk, for other condi-
tions invite disease and death. Although the need for clean milk is
greatest among babies, older children, nursing mothers, invalids and
others are vitally affected by it.

The requirements of good milk for infants are freshness, free-
dom from bacteria, cleanliness and proper temperature. Unclean
milk stands next to parental ignorance as the most important cause
of sickness and death among babies. The two causes are closely
inter-related. Mothers when they find it necessary feed cows’ milk
on their own responsibility and frequently do not know the danger
that lurks in the milk they buy and use. The solution of the prob-
lem requires not only education and knowledge, but pure milk.
Without the latter, education can have but little effect.

The few thousand quarts of certified milk used in our city are
an insignificant portion of the daily consumption of milk, and affect
very few outside of the well-to-do classes. The general milk supply
must be improved. The St. Louis Pure Milk Commission, a phil-
anthropic organization, undertakes to supply many of the poor of
this city a good quality of milk at a low price. The Commission
hopes in this way to lessen the infant mortality of St. Louis. Thou-
sands of dollars are accordingly contributed every year to support
this organization. The permanent solution of the problem, how-
ever, requires such an improvement in the general milk supply of
the city as will make it fit food for babies. The need of such com-
missions is a confession that the city is not doing its duty. Mean-
while hundreds of little children are dying from the consequences
of the use of inferior milk.

MorBIDITY OF CHILDREN,

In the investigation conducted by the St. Louis School of So-
cial Economy in the summer of 1910 into the condition of bottle-
fed babies, nine selected districts studied gave the general condition
of 1,941 children under five years of age in those districts. It was
found that a very large percentage of the whole number of children
who were bottle-fed were being given ordinary dairy milk bought
from adjacent bake shops or groceries or from the wagons selling
loose milk and often from wagons selling a poor grade of milk. Of
the sick bottle-fed cases suffering from digestive troubles it was
discovered on revisitations in September that a very large percent-
age had died. In some districts the number was as high as 50 per
cent of the whole number of cases so studied. And yet when the
visitor found a baby sick, if possible she referred the case at once to
the family physician or the nearest feeding clinic. Even this, how-
ever, was unable to counteract the evil effects of bad milk.

Among the poor throughout the city probably about 20 per
cent of the babies use dairy milk or artificial food. Among the
middle and well-to-do classes, however, the percentage of babies who
depend on dairy milk is much larger, perhaps not more than 40 per
cent being breast fed. Certified milk has some vogue among these
classes, but the great majority depend on ordinary cows’ milk. This
therefore is the chief food of thousands of young children in this
city, although it is one of the most common causes of disease. Adults
likewise may suffer from certain diseases for which milk is a me-
dium. Driven by the unwholesomeness of ordinary dairy milk a
large number of housekeepers boil the milk in order to lessen the
danger of disease. It is well known, however, that such milk
thereby becomes less adaptable as food for babies and often is posi-
tively harmful. Yet boiling may be the lesser of two evils. The
healthfulness of children demands milk which is originally clean and
which need not be subjected to such artificial processes.

In the districts studied, which were comparatively poor sections,
84.5 per cent of the children under one were breast-fed; the re-
mainder, or about one-seventh of the whole, were fed on cows’ milk
and artificial foods. The children over one were, of course, largely
fed on cows’ milk and ordinary table foods. This is especially im-
portant in connection with the diseases of the digestive system which
occur so frequently during the second year of life.

Some of the effects of artificial feeding are apparent in the facts
discovered among the cases canvassed in our investigation. It ap-
pears that the 15.5 per cent bottle-fed babies furnished more than
half of the sickness occurring during the summer months and 74
per cent of the cases of digestive trouble. In other words these
cases were fifteen times as numerous among bottle and artificially-
fed infants as among those nursed directly by their mothers. Recent
investigation in the tenement districts of New York City show the
disproportions to be twelve to one.

Bad milk deteriorates so rapidly in the summer months, if not
properly cared for, that diseases due to such milk are very common.

23

Our investigations showed that last summer in the districts studied
the digestive and nutritional diseases furnished 61 per cent of all
sickness among infants although the proportions for the entire year
are little more than half as large. In other words the disease rate
for digestive and nutritional diseases is almost doubled for the sum-
mer months. The reasons for this are very clear. Milk having a
low bacterial count, such as “‘certified” or ‘Pure Milk Commission”’
milk is but an insignificant carrier of disease. It is the ordinary
dairy milk, which according to our investigations contained almost
countless bacteria, that is the chief factor in causing the digestive
diseases. These bacteria, be it remembered, are present while the
milk is still in the hands of the retailer—before it reaches the con-
sumer. Whether the milk is well cared for by the consumer or not,
the disease germs are already on hand and have rapidly multiplied
owing to the slip-shod methods of producing and handling much of
the dairy milk used by the citizens of St. Louis. The need of good
milk and of intelligent care of the same by producers as well as con-
sumers is therefore only too evident.

Impure milk causes contagious disease. In 1900 Dr. Kober re-
ported to the International Medical Congress that 195 epidemics of
typhoid, 90 of scarlet fever and 36 of diphtheria occurring in the
United States had been directly traced to the use of infected milk.
Unless properly inspected our dairy milk supply constantly threatens
us with disease, especially diseases of children. .

Again the total number of cows contributing to the milk supply
which have been tested for tuberculosis and found free from disease
is very small. St. Louis requires no test of cows either inside or
outside the city. Where tests have been made it has been discovered
that a very large proportion of the milch cows are afflicted with
tuberculosis. That the disease germ is carried by milk no longer
admits of question. It is now recognized that infection with tuber-
culosis through the use of milk is not only possible but occurs to a
considerable extent. Much of this occurs in early life, that is chil-
dren are infected, but the disease may develop at a later age period.

The National Association for the Study and Prevention of
Tuberculosis, has urged the thorough inspection of dairies and
herds and the production and handling of milk under proper sani-
tary conditions in order to reduce the mortality from tuberculosis.
The Association holds that not only pulmonary tuberculosis, but to
some extent other forms of the disease may be of bovine origin.
Accordingly the milk supply needs to be carefully guarded.

MortTALITy OF CHILDREN.

The School of Social Economy investigated the deaths of more
than one thousand children formerly living in the east end of the
city. Of this number 837 lived long enough to have a feeding his-
tory. The remainder died shortly after birth. A total of 372 of
the children having such a history, or 44 per cent, died of digestive
or nutritional disorders—a somewhat higher proportion than that
for the city as a whole. On the other hand, the high proportion

24

of deaths throughout the city from these diseases indicates the uni-
versal presence of common causes. Chief among these causes as
will be subsequently shown is the quality of the milk consumed.

The relation of this mortality to the character of food con-
sumed by the child is a striking illustration of the influence of
various methods of feeding. As shown before the great majority
of babies are breast-fed, but bottle-fed babies are the ones most
subject to disease. More than one-half of the babies dying under
one year of age were bottle-fed. Only about one-fourth of the
children dying from the digestive diseases were being breast-fed
at the time of death, the remainder used .cows’ milk or milk substi-
tutes. In view of this great disproportion, there can be no doubt
of the deleterious consequences of the use of ordinary market milk.

The breast-fed baby of the alley with its many disadvantages
has as good a chance for life during the first nine months as the
bottle-fed baby of the avenue using cows’ milk. The question of
food is all important and only later do the insanitary conditions of
the slums weaken the children of the poor.

The following table shows the total number of deaths of in-
fants under one year and of children under five in St. Louis for the
years 1909 and 1910 and also the deaths from digestive and nutri-
tional diseases:

1909. Ghnases edn | clare rE
Bio redl CA DRS? Pyrdinrs ¢ Sree adeact het ele aN Meee: 2,500
Deaths from digestive and nutritional
RIISCASES IP Sy ets Gee eric: ot ee 720 832
IgI0.
BOPP GC CAENIS Aa eoks cee gece sine wre neat 1,707 2,471
Deaths from digestive and nutritional
RNIB AS CSTE NS CrN ribs Dust tT Lom tky Ls Alas 647 766

It appears from these facts that the last year was somewhat
more favorable than the previous year. The figures in the above
table show that the total deaths in 1909 of infants under one from
the digestive and nutritional diseases constituted 42 per cent of all
deaths among children under one; the deaths of children under five,
33.2 per cent of all deaths among this age group, while in 1910 the
proportion of deaths from these causes fell to 37.8 and 30 per cent
respectively.

Other facts for the babies or children under one year of age
are given in the following table:

Deaths from Digestive and Nutritional Disease During the Months
June to September (inclusive).

Children Proportion of Deaths Proportion of Total Deaths
under from all causes for from Dig. and Nut.
one three months Diseases for entire year
TNGHDS SY ops thts is 0. <i > 398 55-8 54.8
MODs sed Ceara ies 498 52.5 61.0

It appears from this table that while the deaths from digestive
and nutritional disorders were fewer among the babies in 1910 than
in the previous year, the number dying during the summer months
was exactly the same. Consequently the proportionate loss during
the last year was greater than before. Instead of 54.8 per cent of
the deaths occurring during these four months 61 per*cent fell
within this period in 1910. In other words three-fifths of the
deaths last year from two groups of diseases occurred during one-
third part of the year, that is, the death rate was almost exactly
three times as high during the summer months. This applies only
to children under one.

On the other hand, in 1909 49.4 per cent of all deaths under
five during the four summer months were due to these two causes
and the proportion fell in 1910 to 49 per cent. Nearly half of all
children dying under five during these months are victims of dis-
eases depending to a large extent on the quality of milk and food
consumed.

In spite of a cooler summer, and considerable expansion of the
work of the Pure Milk Commission, last year shows but little ad-
vantage over the preceding one. The death rate from these two
groups of diseases was reduced but slightly, whereas the weather
conditions warranted a considerable reduction. When we remem-
ber that poor milk is the largest single cause of these disorders we
realize how important is a good milk supply. The facts also force
us to conclude that the milk furnished the city, has undergone little
improvement during the past year as far as its general cleanliness
is concerned.

The heavy mortality from the digestive diseases during the

summer months needs explanation. It is not the direct effect of
the heat that is so injurious as the effect on the babies food, which
easily spoils, and produces sickness and death. Heat does not kill
the babies. It is cows’ milk improperly handled by dealers, coupled
with the warm weather and ignorant care of this milk by mothers
which is in large part responsible for the digestive diseases. Good
milk is the first step in bringing about a reform. Without it care
in handling milk is but an idle form.

The facts show that deaths from digestive diseases were preva-
lent during the summer months, only among bottle-fed babies.
Out of 237 children in the east end of the city dying during the
four hottest months only 75 had been restricted to breast-feeding,
while the number of breast-fed babies dying showed practically no
change in proportion throughout the year. Although the mortality
among babies using cows’ milk is heaviest in the summer months,
this is not true of babies who are nursed exclusively. In fact our
figures show a slightly smaller proportion among such infants for
the summer months. This indicates that it is not heat, but the
quality of food consumed which largely causes the deaths from these
diseases. Again when we recall that the great majority of babies
are nursed directly, but that 68 per cent of the children dying from
digestive and nutritional diseases during the summer of I909 in

26

CAN GOOD MILK COME FROM THIS DAIRY?

the district studied were being artificially fed, then the argument
for good wholesome cows’ milk becomes invincible. In other cities
similar proportions exist between the fatalities among breast-fed
and bottle-fed babies. For example, statistics taken by Dr. Goler
of Rochester, N. Y., for the months July, August, September, 1908,
show that out of 144 deaths under one, 84 per cent were bottle-
fed. Accordingly there can be no question but that milk is an im-
portant factor in causing disease.

EXPERIENCE OF OTHER CITIES.

The experience of St. Louis: with its milk supply is being dupli-
cated elsewhere. The New York City Department of Health in its
annual report for 1904 gave the following reasons for a decrease
of 62 per cent in its infant mortality from 1881 to 1903:

a. Purer milk secured through increased official watchfulness.

b. Pasteurization of milk by private philanthropies.

In order to lessen its infant death rate the city has taken the
steps discussed in the following chapter. Private philanthropy has
also been very active in supplying good milk to needy mothers with
small babies.

In 1897 Rochester, N. Y., began a series of aggressive meas-
ures in favor of a cleaner milk supply. Attempts were made to
raise the standards of dairies and the quality of milk was consider-
ably improved. The value of good milk was especially shown by
the results obtained from the work of the Health Department -in
providing stations supplied with the best quality of milk. This
milk was recommended to mothers with remarkable results. Not
only were the annual number of deaths among children greatly re-
duced, but the excessive death rate of the summer months was sub-
stantially modified. The disparity between the different seasons
of the year was greatly reduced. In 1909 Chicago began a vigor-
ous campaign to raise the standard of its milk supply in order that
its infant death rate might be reduced. Other cities are doing
similar work, with corresponding reductions in their child mortality.
Why should not St. Louis?

According to a careful estimate made by Prof. Irving Fisher,
of Yale University, 60 per cent of all deaths from the diarrheal
diseases are preventable and the mortality of all children under one
can be reduced substantially one-half. Such proportions applied to
St. Louis indicate that at least 500 children can be saved annually
from death due to digestive troubles and an additional 500 from
other causes. The saving of the first 500 depends largely upon the
success attained in securing a milk supply, free from. impurities
and noxious bacteria. Many of the deaths from the epidemic dis-
eases are also due to milk infected with the fatal germ. In other
cities such cases have been traced and the source of infection has
often been located at one of the dairy farms supplying the city.
The total mortality chargeable to bad milk, therefore reaches amaz-
ing proportions and we cannot remain blind to this needless suffer-
ing and loss of life, especially when the remedy lies close at hand.

28

The brief facts herein presented plainly show how important
is good wholesome food for babies. Feed ordinary dairy milk and
the mortality jumps to enormous proportions. Feed it during the
summer months and hundreds of babies die. Both the rates of sick-
ness and of mortality show this baneful influence. Yet milk is not
intrinsically bad. It is the best substitute food for children. What
then is the difficulty? Simply this, the milk supply of St. Louis
needs to be produced under clean conditions by clean milkmen, be
carried to St. Louis under proper refrigeration and when retailed
meet the required standards of coolness. When a woman once
remarked to Dr. Osler that Providence had taken her baby he re-
plied, Providence had nothing to do with it, it was dirty milk; and
the facts show that he was right. One of the most important.
methods of reducing the death rate and increasing the healthful-
ness of the people of St. Louis is the promotion of a better and
purer dairy milk supply.

29

GHAPTERATLY:

NAIK. REGULATION IN -OTHG@ER Critics:

The following account of the milk regulation of a few Ameri-
can cities, deals only with the sanitary provisions. Practically all
cities, as well as a number of states, prohibit the adulteration, skim-
ming, or watering of milk. The sanitary side of the problem, how-
ever is more difficult; and on these points the methods of protec-
tion adopted in other cities give valuable suggestions, as to what
can be done. This is especially truce or pire larger cities, because in
them the situation—with the milk coming to the customer through
one or two sets of middlemen—closely resembles that in St. Louis.
The necessary precautions for getting a wholesome supply of milk
are essentially the same everywhere :—cleanliness, protection from
contagion, cooling, and prompt delivery. But the difficulty of en-
forcing them varies almost directly with the size of the city. This,
however, is only the more reason why a large city must take vigor-
ous measures to protect itself:

WASHINGTON, D. C.

Washington has a thorough system of dairy inspection, both
within and without the District. The dairies in other States are
controlled by a provision of the law, that no one “shall bring or
send into the District of Columbia for sale any milk without a
permit so to do from the health officer of said District,” and that
the permits shall be issued ‘ton condition that none but pure and
unadulterated milk shall be... brought into said District; that in the
management of said dairy or dairy-farm said applicant shall be
governed by the regulations of the health office:of the District of
Columbia ... issued for dairies and dairy farms in said District .
and that said dairy or dairy farm may be inspected at any time with-
out notice by the health officer of the District of Columbia or his rep-
resentative.” These regulations are enforced by veterinary inspect-
ors living in the country in the districts of which they have charge.

This was one of the earliest provisions for inspection by a city
of dairies located outside of its limits; and it has worked very satis-
factorily. Practically all cities which have such country inspection,
follow a similar plan of requiring a permit for importing milk into
the city. and of making it a condition for the granting of such a

permit that the applicant abide by the requirements of the city in
30

question and agree to admit its inspectors; then a violation of the
requirements is followed by a revocation of the permit and a pro-
hibition of shipments from that source.

\Vashington also requires the tuberculin-testing of all milch
cows in, or imported into, the District of Columbia, and the
slaughter of all which are found to be tuberculous.

NEw YORK.

Milk comes to New York from many states, and through the
hands of collecting creameries as in St. Louis, so that the New
York Health Department has as complicated a situation to deal
with as that of any city; and since the milk comes from greater
distances (as far as 400 miles) than in the case of any other
American city, it is by so much more difficult to secure a satisfac-
tory milk supply. Though this has not been fully accomplished, still
there are a number of excellent points about the New York system
of inspection. Country inspectors are employed (26 in 1908) , who
inspect and report on the dairy farms as well as the creameries,
in all the states which supply the city; where conditions are “notably
insanitary” the company receiving that milk is notified not to ac-
cept it for sale in the city, and the prohibition is maintained until
the bad features are remedied. Especial attention is given to the
dairy water supplies, that they shall be free from contamination ;
also to the exclusion of milk from farms where there is unquaran-
tined contagious disease. In the city there are an almost equal
number of inspectors who make routine examinations of milk sold,
and of the places where it is handled or sold. One of the commend-
able features of the New York regulations is that all milk found
above 50 degrees, as well as milk that is sour, is forthwith destroyed.
Also New York has for three years had rules governing pasteuriza-
tion, which, among other items, forbid repasteurization, and require
that pasteurized milk be placed in sterilized and sealed containers
and sold within 24 hours. ;

There are five official grades of milk in New York ranging from
“milk” to “certified milk,” each of which is produced and sold under
special regulations. The sanitary requirements for plain “milk”
are, that it shall not be taken from cows fed on unwholesome food
(including distillery waste) nor from cows “kept in a crowded or
unhealthy condition,” that its temperature shall not be higher than
50 degrees F., and that it shall not contain “an excessive number
of bacteria.” "(Apparently 1,000,000 bacteria per c. c. or more, is
considered an excessive number ; in 1908 25 per cent of 6,000 sam-
ples fell in that class.) In addition, it is required and enforced that
all milk cans-and bottles must be cleaned as soon as they are
emptied. ;

CHICAGO.

Chicago, of all the large cities, is making the most vigorous
attempt to safeguard its milk supply. It has an elaborate system ot

31

regulations and inspection, protecting the milk from the time it 1s
produced until it is retailed—hampered, however, by an insufficient
number of country inspectors. There are rules for dairy farms,
covering the health and care of the cows, the condition of the barn-
yard, the construction and cleanliness of the stable and milk-house,
methods of milking and of care of the milk, construction and clean-
ing of milk utensils, water supply, and protection against contagious
disease. The rules for milk depots (1. e. handling plants) prescribe
in detail, freedom from contaminating surroundings, the construc-
tion, drainage, ventilation, and cleaning of the building, the condi-
tion and care of apparatus and utensils, the cooling of the milk,
and the exclusion of communicable disease. Milk must not be ex-
posed on the street or in the wagons; if it is bottled, this must be
done at the depot, and if it is sold in bulk, it must be carried in a
special can from which it can be drawn without dipping. Finally,
none but bottled milk may be sold from stores. As the head of
the milk-inspection service says: “We have succeeded in eliminating
the old dipper method of milk-vending in stores and on wagons.”

There is a bacteriological standard for milk on arrival of 500,-
000 per c. c. in the winter and 1,000,000 in the summer; the sale of
milk containing over 3,000,000 per c. c. is prohibited, as is also that
of milk containing any pathogenic bacteria.

The most prominent feature, however, of the Chicago milk
situation, is the campaign against tuberculosis. All milk sold in
Chicago must be either (a) from cows free from tuberculosis, as
shown by the tuberculin test, or (b) pasteurized. The exception,
moreover, extends only until 1914; and the pasteurization process
is regulated and watched by the Health Department in order to
ensure that it shall be efficient—that is, that it shall destroy 99 per
cent of all the bacteria and all the pathogenic bacteria, in the milk.
All continuous pasteurizing machines must be equipped with an
automatic heat-regulator or an automatic temperature recorder.
Pasteurized milk must be cooled to 45 degrees or less.

Chicago is the pioneer among the large cities in taking the
advanced stand of enforcing the tuberculin test. It is stated by the
officer in charge that by last November, one-third of all the cows
supplying the city had been tested.

BOSTON.

Boston’s regulations provide, in addition to requiring a license
for the production and sale of milk within the city, that “no milk
which is not produced or handled in a manner satisfactory to the
Board of Health, shall be brought into, kept, delivered, distributed,
sold or offered for sale in said city.” The city has relied upon the
State Board of Health for farm inspection, and confined its efforts
to conditions within the city—the methods of handling the milk,
and its bacteriological condition, for which 500,000 per c. c. is the
standard. Among the rules for the handling of milk are the re-
quirements that cans and bottles be cleaned immediately upon

32

AUYMIVG TAGOW V

[Ing wo1g

ic!

*ALOPRIOGLT DIUVIBAH “9

emptying, that only bottled milk be sold from stores, and that when
- milk is tested by tasting—a not uncommon practice—this shall be
done by means of some implement (other than the hands of the
taster) which shall not be used again until sterilized. The last
matter, with the danger of contagion involved in careless tasting,
is nevertheless one that is too frequently overlooked. Special at-
tention is also given to enforcing thorough cooling.

When a dairy farm is adversely reported upon by the State
Board, the dealer getting the milk from that farm is held responsi-
ble, and is notified to discontinue his purchases until conditions are
improved. In most cases this step suffices to bring about the de-
sired improvements; occasionally it is found necessary to prohibit .
importation from some farm permanently.

The following figures as to the bacteriological condition of the
Boston milk for 1908 are of interest:

Under

No. 500,000 Under Over
Samples. per ¢. ¢. 1,000,000 1,000,000
Milkertonsarnivaliacs.. © seer. 4204 86.4% 92.9% 7.0%
Milk from wagons....... 1275 FEE 85.2% 14.8%
IB Otiled yn Nen ce eens BR ee 75 3G eos eA, soe hae
Gaia a Reece, Set. Core AAR 67.9% omer eee |

Pasteurized milk from

wagons—

Bottledh: ace tyaee 47 Q1.5% 92.0% 6.4%
Caray eh Ae ete ven ic itnens 141 60.3% 83.7% 16.3%
Mau Trom “Stores. (i... tices 281 43.4% 69.7% 30.3%

These last figures, which were obtained before the prohibition
of the sale of can-milk in stores, confirm our finding in St. Louis
that such milk is the worst of all grades of milk. The most striking
feature of the Boston data is the fact of the existence of a consider-
able proportion of pasteurized milk, especially when not bottled,
which contains very large numbers of bacteria. In fact, as in St.
Louis, the “loose” pasteurized milk averages worse than the “loose”
raw milk. It is also mentioned by the inspector that two firms
whose raw milk on arrival showed the highest percentage of high
count samples, are engaged in pasteurizing. This seems to indi-
cate that milk which is pasteurized is apt to have been in worse
condition before pasteurization, than the general average of the
milk.

SAN FRANCISCO.

San Francisco regulates its milk business under the permit
system, essentially as in Washington, permits being required not
only to produce or sell milk within the city, but also to “ship, send
or bring” milk into the city. The applicant must satisty the Board
of Health that “the production, transportation, storage and handling
of the milk is to be under sanitary conditions.” ‘Permits shall
be subject at all times to revocation by said Board of Health in its

34

discretion upon sufficient cause therefor shown,” after a hearing;
any refusal of any licensee to allow official inspection is specifically
made a cause for revocation. San Francisco offers one original
suggestion in the provision that when a permit has been revoked,
no further permit shall be granted to the same person until he
shall file with the Board of Health a bond for $500 for the faithful
observance of the regulations of the law and of the Board.

30

RECOMMENDATIONS.

I. That a system of permits for all branches of the milk busi-
ness be established, and especially that a perma be required to ship —
milk into the city.

II. That it be made a condition of the granting of all per-
mits that the holders sign an agreement to comply with all the
requirements of the ordinances, and of the Board of Health, and
especially that all producers outside of the city who wish to ship —
milk into the city agree to produce and handle their milk in accord-—
ance with the rules of the Board of Health and to admit the Health
Department inspectors; or if the shipper be not the producer that |
he agree to buy milk only from those who produce it under the
above conditions.

III. That permits may be revoked by the Board of Health,
after a hearing, for any violation of the agreement made by the
holder.

IV. That when a permit has been revoked, the same person

(firm or corporation) cannot obtain a new one unless he gives $500 |

bond for the faithful performance of his agreements.

V. That the prohibition of adulteration, skimming, and water-
ing be left in charge of the City Chemist, as at present, but with
an additional inspector.

VI. That the Board of Health be given authority to make all
necessary detailed sanitary rules for all branches of the milk busi-
ness; that the enforcement of the sanitary regulations be placed in
charge of the Sanitary Division, and that in addition to the four
city dairy inspectors at present employed, provision be made for
eight country inspectors.

VII. That the existing requirements that milk be kept below — a

50 degrees F. be maintained, and reinforced by a provision for the
confiscation and destruction of all milk found above 59 degrees.

VIII. That pasteurization be regulated so as to secure better
results, and that double pasteurization be prohibited.

No recommendation is here made as to the elimination of tuber-
culous dairy-cattle, not because the subject lacks importance, but x
because it is so difficult that it seems better to take it up separately. —

36

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