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DISEASE IN MILK

THE REMEDY
PASTEURIZATION

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COMPILED

FOR MY HUSBAND

AT WHOSE SIDE IT HAS BEEN

MY PRIVILEGE TO LABOR

FOR MANY YEARS FOR

THE SAVING OF

LIVES

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TABLE OF CONTENTS

PAGE

FOREWORD 1

INTRODUCTION 3

MILK ORDINANCE OF THE DEPARTMENT OF HEALTH, APRIL,

1912 7

DESCRIPTION OF PASTEURIZATION AND MODIFICATION 8

ILLUSTRATION OF MODIFICATION TABLE 9

RECIPES 10

ILLUSTRATION— MILK HEATER— SEPARATOR— BOTTLE FILL-
ING MACHINE 11

PASTEURIZING OVENS 12

ILLUSTRATION OF BALCONY AND BOTTLE FILLING MACHINE. 14

ILLUSTRATION OF BOTTLE WASHING MACHINE 14

ILLUSTRATION OF THE INTERIOR OF THE STERILIZING OVEN 15

DELIVERY AUTOMOBILE 16

LABORATORY BUILDING 16

WEEKLY REPORT OF THE MEDICAL SOCIETY OF THE COUNTY

OF NEW YORK 17

MILK DISPENSED BY THE GLASS 18

ILLUSTRATIONS OF STATIONS 19-20

PASTEURIZATION AT HOME 21

DIRECTIONS FOR MANUFACTURING THE HOME PASTEURIZER. 23

MEDICAL ASSISTANCE IN CONNECTION WITH THE MILK

DEPOTS 24

SCHEDULE OF PHYSICIAN'S OFFICE HOURS AT DEPOTS 25

ADVICE TO MOTHERS 26

DEPARTMENT OF HEALTH DEATH RATE STATISTICS 28

DIPLOMAS AWARDED 29

HOW THE NEW YORK DEATH RATE WAS REDUCED 33

lioprintfd from "The Forum" of N()V«'ml»t'r, l.Sl)4

LETTER SENT TO THE MAYORS OF THE PRINCIPAL CITIES

OF THE UNITED STATES AND CANADA, JUNE 8, 1895.... 42

HOW TO REDUCE INFANT MORTALITY 45

Circular letter sent to the Presidents of the Health Bo.nrds of American
cit'.cs and Canada. March 22. 1807

PAGE

THE INFLUENCE OF A PURE MILK SUPPLY ON THE DEATH

RATE OF CHILDREN. . . , 57

Paper read before the National Conference of Mayors and Councilmen
at Columbus, Ohio, September 29, 1897

WHY THE DISTRIBUTION OF PASTEURIZED (STERILIZED)
MILK SHOULD BE A FUNCTION OF EVERY MUNICIPAL-
ITY (November 15, 1900) 69

INFANTS' MILK DEPOTS 73

Paper read before the British Medical Association at its Annual Meeting,
July 24th to 28th, 1905, at I>?icester, England

PURE MILK OR POISON? 83

Address to the Milk Conference at the New York Academy of Medicine,
November 20, 1906

THE AMERICAN SOLUTION OF THE MILK PROBLEM 89

Paper read at the Second International Congr^s des Gouttes de Lait,
Brussels, September 12, 1907

STRIKING AT THE CAUSE OF TUBERCULOSIS 97

MILK-PASTEURIZATION AN ECONOMIC AND SOCIAL DUTY... 103

Address delivered to the Students of Political Economy in the Uni-
versity of Heidelberg, July 24, 1908

THE DIFFERENCE BETWEEN REAL PASTEURIZATION AND

COMMERCIAL PASTEURIZATION (November 28, 1908) 118

AMERICA'S LATEST CONTRIBUTION TO THE MILK QUESTION. 119

A Review by Nathan Straus of the United States Government Report
"Milk and Its Relation to Public Health"

NECESSITY FOR PASTEURIZATION OF MILK AND BENEFITS

ATTAINED THEREBY 135

Paper presented to the International Congress of Applied Chemistry,
at London, May, 1909

THE WHITE PERIL: HOW IT MAY BE AVOIDED 139

Paper presented to the International Dairy Congress, Budapest, June,
1909

OPEN LETTER TO THE NATIONAL ASSOCIATION FOR THE
STUDY AND PREVENTION OF TUBERCULOSIS, WASH-
INGTON, D. C, 1909 141

REPORT MADE TO THE INTERNATIONAL CONFERENCE AT
STOCKHOLM ON THE INFECTION OF CHILDREN BY
MILK FROM TUBERCULOUS COWS, 1909 145

PREVENTION OF INFECTIOUS DISEASES CAUSED BY MILK. . . 151
Address to the International Medical Congress at Budapest, 1909

SAVING CHILDREN FROM MILK-BORNE DISEASES 157

Address to the ."iSth Annual Meeting of the American Public Health
Association, Milwaukee, September, 1910

PROGRESS MADE IN AMERICA IN THE PROTECTION OF CHILD

LIFE 159

Address to the Third International Congress for the Protection of
Infants, Berlin, 1911

TWENTY YEARS' PRACTICAL EXPERIENCE IN MODIFYING

AND PASTEURIZING MILK FOR INFANT FEEDING 169

Address to the Third International Congress for the I'rotectlon of
Infants. Berlin, 1911

PAGE

OFFICIAL REPORT OF THE THIRD INTERNATIONAL CON-
GRESS FOR THE PROTECTION OF INFANTS, HELD IN
BERLIN, SEPTEMBER 11 TO 15, 1911, AS SUBMITTED TO
PRESIDENT TAFT 175

PROGRESS MADE IN AMERICA IN THE PREVENTION OF

TUBERCULOSIS 181

Address to the Seventh International Congress against Tuberculosis,
Rome, April. 1912

THE FUNCTION OF VOLUNTARY ORGANIZATIONS IN THE
CAMPAIGN FOR THE BETTERMENT OF MILK PRODUC-
TION AND DISTRIBUTION 195

Address to the Fifteenth International Congress on Hygiene and Demog-
raphy, Washington, September, 1912

SECRETARY OF STATE KNOX'S LETTER 207

Dated — Department of State, Washington. August 17, 1911

WORK ON TWO CONTINENTS 209

OTHER PHILANTHROPIC WORK 217

FOREWORD.

The presentation to the public of this
book has a definite purpose, and is animated
by a single hope. In calling the attention of
others to the life work of my husband I trust
that beneficent spirits may be stimulated to
go and do likewise and achieve greater things
for humanity. My husband's philanthropic
service for the last three decades can in all
literalness be said to have been dedicated to
the one thought of saving human life. From
the time when Mr. Straus made his first gift
in the fight against tuberculosis, by presenting
a small cottage to the Trudeau Sanitarium in
the Adirondacks, nearly thirty years ago, until
his recent conception of the idea of a PRE-
VENTORIUM against tuberculosis — all
through his consistent and energetic warfare
against impure milk and his championship of
the PASTEURIZATION OF MILK, the ideal
which was the guiding star of his career was
PREVENTION. This ideal led him to un-
dertake the extension of his propaganda all
over the world. And this ideal called forth
from Professor Abraham Jacobi in a letter
of June 5, 1895, the following encouraging
words: "I trust you will be able to extend
the blessings conferred by you still further,
not only over the city but outside also. I be-
lieve a call over your name will suffice to
arouse the humanitarian interest of practical
philanthropists in other large communities
with the same salutary results obtained by
you in New York." May this compilation of
the record of my husband's work prove such
a "call" in the most comprehensive sense. And
the more all co-operate in this divine work of
saving life the sooner will be realized the law
of universal human brotherhood.

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"I DRINK TO THE GENERAL DEATH OF THE WHOLE TABLE."
This cartoon was awarded first prize by the American Medical Association.

INTRODUCTION.

aOW'S milk has always been recognized as
a desirable food for adults and an es-
sential one for infants. It is a desirable
food for adults because it contains in the highest
degree of any food known a perfect balance of
proteid, carbohydrates and fat. In addition, it
is easily digestible. It is an essential food for
infants because sooner or later — sooner with the
poor, later with the rich — there comes a time
when the mother cannot supply the right quality
or quantity of milk for her baby. The ideal way
of bringing up a baby until this time is always
from the breast; but when this period is reached,
whether it is after nine days or nine months, pas-
teurized milk steps in.

Milk, then, in its pure state, is a most desirable
food ; but conditions to-day make it almost impos-
sible for the person of average means to ob-
tain such milk. Congestion in population, which
prevents cows being pastured near by, makes the
cities dependent upon milk sometimes two to
three days old. The high cost and the difficulty
of securing even at high wages dairy hands of
scrupulous care and fidelity exclude the possi-
bility of cleanliness in stable and dairy. The im-
possibility of efficient supervision of the health
and cleanliness of the dairy hands and of the
herd causes the constant peril of disease germs
in the milk. All these conditions tend to make
milk as it comes from the farm to-day an unsafe
food. Under present conditions milk as it is
brought to the market and to the consumer is
full of bacteria more or less dangerous to life.

"It is not possible to over-
state the far-reachins: im-
portance of the question of
the reduction of intant mor-
tality. Every man and every
woman of every civilized
country should feel a deep
and personal interest in it.
It affects not only the hap-
piness of the home, but the
welfare of the Nation and
the future of the race." —
From letter from President
Taft to the American Asso-
ciation for the Study and
Prevention of Infant Mor-
tality, November 9, 1910.

"Of 1,324,660 deaths in the
United States in 1909, 280,-
000 were of babies under one
year, and 113,000 of these
deaths were from intestinal
disorders, due to improper
feeding, and from infectious
diseases, due often to disease
germs conveyed to the ba-
bies in the milk."

"Begin the attack upon
infant mortality with the
prevention of the Diarrhoeal
Diseases of Infancy. * * *
The prevention of these dis-
eases — which are pre-emi-
nently Filth Diseases — will
wipe out one-fourth of the
total number of deaths of
babies under two years of
age." — From pamphlet pre-
pared by the Bureau of the
Census, November 9, 19 10.

Every effort should be made to have milk pro-
duced in a sanitary way. But that even the best
milk obtainable is not suitable for use in a raw
state is believed by most physicians. Dr. North
of the Commission on National Milk Standards

Dr. Sims Woodhead, of
the British Royal Commis-
sion on Tuberculosis, writes:
"Every tuberculous cow is
either an actual or potential
centre of infection. We can-
not get rid of the great
White Plague until we take
bacilli of bovine origin into
consideration."

Dr. Schroeder, of the U.
S. Agricultural Experiment
Station, says: "Mil^ is fre-
quently infected with liv-
ing, virulent tubercle bacilli.
There is nothing hypothet-
ical, circumstantial or infer-
ential about this. It is a
fact, a plain, experimentally
demonstrated fact."

said on January 12, 1912: "Certified (highest
recognized grade of tuberculin-tested milk) does
not insure immunity from other diseases of the
cow besides tuberculosis, or from diseases (in-
cluding tuberculosis) which the dairy attendants
themselves are likely to convey to milk, which is
so sensitive to bacterial influence. Only pasteur-
ization can absolutely guarantee this protection."
Prof. W. H. Conn, of the department of biology
of Wesleyan University, said: "All we bacteriol-
ogists agree that even the best obtainable milk
supply is not absolutely safe for babies without
pasteurization. For adults the danger is less. Get
it as good as you can and use it freely. Pasteurize
it if you want to. For my own use I certainly
want it pasteurized."

The great German scien-
tist. Prof, von Behring, to
whom the world is indebted
for the finding of Diphtheria
and Tetanus Antitoxin, said:
"The milk fed to infants is
the chief cause of tubercu-
losis,"

Dr. William H. Park, Di-
rector of the Research Lab-
oratory of the New York
Health Department, said
(Jan. 27, 1912) : "More cases
of typhoid come from milk
than from any other source,
and the only actual safety
for the consumer lies in pas-
teurization. Fifty per cent,
of the children fed on cows'
milk who die from tubercu-
losis got the disease from
the milk."

Dr. John F. Anderson, director of the Hygienic
Laboratory at Washington, examining 223 sam-
ples from the Washington milk supply, after the
Agricultural Department had diligently weeded
out tuberculous cattle, found 6.72 per cent, con-
tained tubercle bacilli. At the annual meeting of
the American Medical Association held in Denver,
June, 1911, the Committee on Standard Measures
of Procedure for the Control of Bovine Tuber-
culosis in Relation to the Milk Supply decided:
"That milk must come from cattle tested once a
year with the tuberculin test, or subjected to
careful physical examination every three months,
or it must be pasteurized."

Bulletin No. 41 of the Hygienic Laboratory in
Washington, "Milk and Its Relation to Pub-
lic Health," by various authors, quotes in a hun-
dred pages epidemics of diseases which were
entirely traceable to milk. Here you will find
summarized the essential details of 317 outbreaks
of typhoid, 125 of scarlet fever, and 51 of diph-
theria, all owing their origin to infected milk,
though it is admitted that not all the statistics
available from foreign sources have been in-
cluded.

There then presents itself the necessity of ren-
dering this milk coming from the average farm
safe for human consumption. The problem is
how to destroy the noxious germs without de-
stroying the milk.

Heating to various degrees has for years been
the recognized means of procedure.

The first is boiling. Boiling means raising the
milk to an exceedingly high temperature (212°)
for a short period. This destroys the pathogenic
organisms in the milk, but at the same time im-
pairs its nutritive qualities and renders it difficult
of digestion.

The second is pasteurization. Pasteurization
gets its name from one of the greatest scientists
of this century, Louis Pasteur, of Paris, France.
Pasteurization consists in heating the milk to a
temperature of from 140 to 157 degrees Fahren-
heit and holding it at this temperature for twenty
minutes and then rapidly cooling it. This process
destroy)s the pathogenic organisms quite as jully as boil-
ing without in any toa'y impairing the nutritive qualities
in the milk and without tending to make it indigestible.

"The most important thing
in the care of infants," said
Professor Abraham Jacobi,
"is just this, *Use no raw
milk.' "

"I hold in the near future
it will be regarded as a
piece of criminal neglect to
feed young children upon
milk that has not been ster-
ilized (pasteurized). Milk
is not always good in pro-
portion to the price paid for
It, nor free from the germs
of contagion because it has
come from cattle of aristo-
cratic lineage. The latter
quality, as recent experi-
ence has shown, carries with
it special susceptibility to tu-
berculosis."— Nathan Straus
in "The Forum," November,
1894.

The late Dr. Walter Wy-
man says: "Pasteurization
prevents much sickness and
saves many Hvcsl"

Cows' milk pasteurized is then a perfect food
for adults; but cows' milk needs something fur-
ther to make it an ideal food for infants. Their
immature organs are capable only of digesting
the ingredients in such proportions as they are
found in mother's milk. Again science steps in,
and by a process called "Modification" makes
cows' milk all that baby's system and condition
require.

Milk, then, in order to be suited to a baby's
needs, must meet with these three requirements:
It must be as pure as possible, it must be pas-
teurized, and it must be properly modified. The
Nathan Straus Pasteurized Milk Laboratory
solves these problems in the following way:

"Virulent tubercle bacilli
were found in 17 among 107
specimens, that is, in 16 per
cent, of the milk retailed
from cans in New York
City." — Dr. Alfred Hess, in
the Journal of the American
Medical Association, March
27, 1909.

"Only one of the many
important steps in the uni-
versal adoption of pasteur-
ized method s," said Dr.
North, "was the award made
by the Board of Health last
week to the Dairy Demon-
stration Company to furnish
pasteurized milk for the
fifty-seven milk depots taken
over recently by the city." —
January 26, 1912.

"There are often more
germs in a drop of milk
than in a drop of sewage."
— United States Bulletin, p.
421.

Dr. John R. M o h 1 e r
recommends, as a veterinary
authority, "That all milk
* * * shall come from * * *
tuberculin - tested cattle,
which shall be re-tested at
least once a year, or be sub-
jected to pasteurization under
the supervision of the health
department in case the herd
is not tuberculin-tested."

First in regard to the raw milk. Only "Certi-
fied Milk" is used. Certified milk is the highest
grade of milk obtainable. It is certified by the
County Medical Society to contain not more than
10,000 bacteria per cubic centimeter. At first
glance this does not seem very pure ; but when
we consider that only one per cent, of the city's
supply of milk measures up to this standard and
that ordinary milk frequently has millions of
bacteria per c.c, we realize that certified milk is
comparatively pure. This purest milk obtainable
is modified and pasteurized in the laboratory, at
348 East 32d Street.

The following page shows an *' Extract from the Sanitary Code and Rules and
Regulations Relating to the Sale of Milk-**

DEPARTMENT OF HEALTH

CITY OF NEW YORK.

EXTRACT FROM THE SANITARY CODE
AND RULES AND REGULATIONS RELAT-
ING TO THE SALE OF MILK. APRIL, 1912.

Sec. 56a. All milk held, kept, offered for sale or sold and delivered
in the City of New York shall be so held, kept, offered for sale or sold
and delivered under either or any of the following grades or designations
and under no other, and in accordance with such rules and regulations
as may be adopted by the Board of Health, namely:

Grade A.

1. CERTIFIED—

Certified Milk is milk certified by a milk commission
appointed by the Medical Society of the County of New
"Vork, or the Medical Society of the County of Kings,
or as being produced under the supervision and in conform-
ity with the requirements of that commission as laid
down for certified milk. The Commission has fixed upon
a maximum of 10,000 bacteria to the c.c.

GUARANTEED—

Guaranteed milk shall not contain more than 30,000
bacteria per c.c. when delivered to the consumer, or at
any time prior to such delivery.

2. INSPECTED MILK (RAW)—

The milk shall not contain more than an average of
60,000 bacteria per c.c. when delivered to the consumer,
or at any time prior thereto.

3. SELECTED MILK (PASTEURIZED)—

The milk shall not contain more than 50,000 bac-
teria per c.c, when delivered to the consumer, or at any
time after pasteurization.

Grade B : For Adults.

1. SELECTED MILK (RAW)—

The milk shall not contain an excessive number of
bacteria when delivered to the consumer, or at any time
prior thereto.

2. PASTEURIZED MILK—

No milk containing an excessive number of bacteria
shall be pasteurized.

Grade C : For Cooking and Manufacturing Purposes Only.

RAW MILK NOT CONFORMING TO THE REQUIREMENTS
FOR GRADES A & B.

CONDENSED SKIMMED MILK.

CONDENSED OR CONCENTRATED MILK.

DESCRIPTION OF PASTEURIZATION AND

MODIFICATION.

Dr. Lederle, Health Com-
missioner of New York City,
says: "No inspection can
make milk entirely safe for
infants. Compulsory pas-
teurization and the classifi-
cation of all milk will enable
us really to safeguard the
milk supply."

The Second International
Congress for the Protection
of Infants (Gouttes de
Lait), held in Brussels, Sep-
tember, 1907, resolved "That
milk for children should be
boiled, sterilized, or pas-
teurized— not to be used in
its raw state."

"In pasteurization only,
supplemented by conscien-
tious and thorough inspec-
tion, will be found a solu-
tion of the problem of a
pure milk supply." — N. Y.
Medical Record.

Dr. Leslie L. Lumsden
writes that "to prevent the
spread of typhoid infection
in the milk supply of cities
* * ♦ pasteurization of the
milk * * * is the best meas-
ure."

^^^ ^ORK starts at 10 o'clock P. M.
^ W J Water is filtered and boiled to scald
\y\r and sterilize all milk utensils, such
as filling machines, milk tanks, modifying cans,
pails, etc. The floors of the building are all tiled
and the walls are enameled, which makes it pos-
sible to steam and flush every part, which is
done before the work begins. The windows are
kept closed during this process. When it is done
they are thrown open both top and bottom to air
and cool the room. The tanks are chilled to re-
ceive the milk.

Water is now filtered and boiled again, and
drawn off in sterile cans, which are placed in
large pasteurizers, cooled by chilled water and
cold air. This time the water is used for modi-
fication, which means the preparing and mixing
of the milk with other ingredients to suit the age
and condition of the child.

Water is filtered and boiled a third time to
prepare barley water and oat water, which are
used in modification. The barley and oatmeal are
prepared in 20-gallon steam kettles and are boiled
for two hours in order to bring them to the de-
sired consistency. They are drawn from the
boilers by a faucet through sterile cheese cloth
into sterilized cans and kept until used. One
man gives his entire attention to these prepara-
tions, weighing carefully all ingredients — sugar,
barley and oat flour.

The milk arrives at 12 o'clock midnight. The
outsides of the cans are all washed off before
being placed on the elevator to be taken up to
the laboratory floor. As many cans as can be
handled at one time are then brought up for
modification; the remaining ones are placed in
cold storage for use as more milk is needed as
the work goes on.

The modification starts immediately. The milk, which must be de-
livered at a temperature of not more than 40° F., is now poured into
one of the tanks on the balcony and through a silver-lined pipe run
into a heater which warms it to about blood heat (85° to 90°). The
heater is also connected by pipes with a "Separator," which separates
the milk into its parts of milk and cream. Then it is re-combined
in different proportions for the different formulas. Each formula is
now made up in its separate turn on the modification table, where each
ingredient is measured and weighed.

MODIFICATION TABLE.
Shewing how Milk Sugar, Oatmeal, Barley Flour and Cane Sugar are kept,

weighed, measured and mixed.

The formulas are made up according to the following prescriptions :

RECIPES.

Formula by Dr. A. R. Green for
1st to 4th Week :

34 ounces of 16% Cream.

3
19

IK2

Full Milk.

Water.

" Lime Water.

Milk Sugar.

This mixture fills 8 bottles — each to
contain 3 ounces. Feed 2% hours
apart.

Formula by Prof. R. G. Freeman
for 1st to 3d Month :

1% ounces of 16% Cream.
3 " Full Milk.

13 " Water.

H " Lime Water.

1 " Milk Sugar.

This mixture fills 6 bottles — each to
contain 3 ounces. Feed 3 hours apart.

Formula by Prof. R. G. Freeman
for 2d to 6th Month:

18 ounces of Full Milk.

161^ " Water.

lYz " Lime Water.

iy2 " Milk Sugar.

This mixture fills 6 bottles — each to
contain 6 ounces. Feed 3 hours apart.

Formula by Prof. A. Jacobi for
3d to 7th Month:

18 ounces of Full Milk.

18 " Barley Water.

1 *' Cane Sugar.

20 grains of Table Salt (less than

% teaspoonful).

This mixture fills 6 bottles — each to
contain 6 ounces. Feed 3 hours apart.

Formula by Dr. Alfred Hess for
7th to 9th Month:

30 ounces of Full Milk.

10 " Oat or Barley

Water,

lYz " Cane Sugar.

30 grains of Table Salt (about %

teaspoonful).

This mixture fills 5 bottles — each to
contain 8 ounces. Feed 4 hours apart.

After 9th Month :

Full pasteurized Milk, 8 ounces
every four hours.

To make one quart of Oat or
Barley Water. — Boil 2 tablespoon-
fuls of the flour in a quart of
water until it is reduced to half
the quantity; then add sufficient
water to make up the quart.

The cans, which are marked to correspond with
the formulas, are now filled with these mixtures,
which are poured through strainers and several
layers of sterile cheese cloth into the correspond-
ing reservoirs on the balcony. The reservoirs
are set in tanks which are cooled by the cold
storage system to keep the milk at the low tem-
perature of 40° to 45" while the work is going on.
The tanks are connected with silver lined pipes,
which run into three, six, eight and sixteen ounce
filling machines. These filling machines work
automatically and just fill the bottles to the re-
quired quantities. There is a truck with the
bottles (42 bottles to the crate) at one end of the
filling machine, with one man to feed, and on the
opposite side another man to receive and place
the crates with the filled bottles on the table for
corking. The corks are made of china and metal
connected by a rubber washer, which closes her-
metically through expansion in the process of
pasteurization. These rubber washers are fre-
quently replaced by new ones.

"The fight won by Dr.
W. A. Evans, formerly Com-
missioner of Health in Chi-
cago, that all milk not sup>
plied from tuberculin tested
cows should be pasteurized
is merely another indication
of the widespread recogni-
tion being given to the im-
portance of pasteurization."

Addressing the Canadian
Medical Association, at Ot-
tawa, on Wednesday, June
10, 1908, Dr. Hastings, of
Toronto, made the following
remarkable statement: "If
the truth were known,
15,000 children of the 30,000
who die in Canada annually
might justly have the epi-
taph, 'Poisoned by impure
milV.' placed on their grave-
stones."

(a) MILK HEATER; (b) SEPARATOR; (c) BOTTLE FILLING

MACHINE.

The crates are then placed on trucks, each truck holding nine crates,
and are rolled into the pasteurizing ovens, each pasteurizer holding
three trucks.

The steam is admitted until the temperature in the pasteurizer
reaches 157° F. This temperature is maintained for twenty minutes.
Then the bottles are cooled; first by the admission of cold air (to take
the greatest heat out of the milk and prevent the bottles from cracking)
and then by a spray of very cold water. By this method they are cooled
in ten minutes to below 50° F.

When the milk is sufficiently cooled in the bottles the trucks are
rolled out and taken down the elevator, and each formula placed in its
own ice box, where it is left until delivered to the various stations.

So much emphasis is put on the cooling process as it is just as
important as the heating. The low temperature prevents new germs
from developing and also preserves the milk in the best condition for
a longer time.

This finishes the process of pasteurization and the milk is now ready.

From September 1, 1911, to September 1, 1912, two million two
hundred and seven thousand (2,207,000) bottles were thus prepared
and dispensed at the various stations.

PASTEURIZING OVENS.
12

All this work of modifying and pasteurizing is carried on at the
laboratory. This building was erected for the work with the advice
of the best architects and scientists. The milk is sold at eight depots
in Winter and at eighteen depots in Summer. The price is nominal,
a mere fraction of the cost of production. This has always been the
practice, to avoid pauperizing those who use it. But in the case of
those who cannot afford even the small price asked, the milk is dis-
pensed free. The physician in charge of the depots recommends many
such cases. Throughout the city physicians, settlement and other char-
ity workers are supplied with free coupons to distribute among their
charges. These coupons (as below) are honored at any of the depots.

NATHAN STRAUS PASTEURIZED MILK.

WINTER DEPOTS. 104

SERIES 1912
THIS COUPON IS GOOD AT ANY OF THM FOI,I,OWING DEPOTS:

348 E. 32d Street. 54 Market Street. 402 W. 37th Street.

303 E. I nth Street. 322 E. 59th Street. 38 Macdougal Street.

Tompkins Square Park, 7th Street and Avenue A.

Mount Morris Park. ii6th Street near Madison Avenue.

AND AT TH:E FOI^LOWING SUMMER STATIONS:

Battery Park East 3rd Street Pier

City Hall Park East 24th Street Pier

Central Park East 112th Street Pier

Seward Park West Barrow Street Pier

Educational Alliance West 50th Street Pier

Roof Garden

FOR—

Five 6 oz. bottles, Formula No. i. Eight 3 oz. bottles. Formula No. 3,

or Five 6 oz. " " No. 2, or Eight 3 oz. " '• No 4,

or Two 16 oz. bottles Pasteurized Unmodified Milk,
or Four 8 oz. bottles Pasteurized Unmodified Milk.

Deposit required on bottles from everyone : 3 cents on each 16 oz. bottle;
a cents on each 6 or 8 oz. bottle; i cent on each 3 oz. bottle; 2 cents on each
stopper. This deposit is refunded on return of the bottle.

THIS TICKET IS GOOD FOR ONE DAY'S FEEDING.

The delivery men arrive at six o'clock in the morning and sort out
the orders which have been received from the various stations the even-
ing before. They place the crates on trucks and roll them into automo-
bile delivery wagons. These wagons are built as ice boxes, with ice on
top, and have been cooled the night before, so as to be ready to receive
the milk. In Summer, in addition to this, chopped ice is put on the tops
of crates. In Summer also, ice is supplied to the people who call for milk
in order to enable them to keep it cool until they reach their homes.

BALCONY AND BOTTLE FILLING MACHINES.
(Showing pipe connection.)

BOTTLE WASHING MACHINE.

INTERIOR OF STERILIZING OVEN.

(Showing crates with empty bottles.)

On the return trip the drivers bring back all the empty bottles and
china corks from the different stations. The bottles are assorted as to
size and formula, and washed in a wyandotte solution in an automatic
bottle washing machine (see page 14) and rinsed with live steam. After
they are washed and sterilized they are taken to a large baking oven
(see above) on the pasteurizing floor and left there at a temperature
of 200^ F. until they are used in the night. The corks are soaked in a
solution of soda preparatory to sterilization and baking before being
used again. The cans also are washed in a solution of wyandotte and
sterilized with live steam before again being used.

DELIVERY AUTOMOBILE.

The work is car-
ried on at night
only; but the lab-
oratory is open day
and night for in-
spection and for
instruction in the
method of pas-
teurization. Num-
bers of people from
all parts of the Uni-
ted States and Can-

€f^

ada, High School
classes, trained
nurses and others
interested in babies'
welfare avail them-
selves of this oppor-
tunity until now the
Laboratory has be-
come a veritable
training school for
Milk Pasteurization.

NATHAN STRAUS PASTEURIZED MILK LABORATORY

348 East 32nd Street, New York.

This Is One of the Recent Weekly Reports Showing the

Bacteria of the Certified Milk Before and

After Pasteurization.

The Medical Society

County of New York.

MILK COMMISSION.

MSMBKBS OK TBB MlLK COMMISaiOK.

CHAiBMAN, £. K. Dunham, M.D.

338 East 26TH St

SECRETAkY, Rowland G. Freeman M.D

311 WEST 57TH ST.

OFFICE OF INSPEC5TOR.

RESEARCH LABORATORY.
Foot or Kast IAtm Strcet.

£li Long, M.D.
H. D. Cbafin. M.D.
Henry Koplik. M.D.
A. Jacobi, M.D.

W. P. NOHTHRUP M.D.

W. H. Park, M.D.
Walter L. Carr, M.D.
Thos. S. Southworth. M.D
G. M. Swift. M.D.

J. E. M'INTEBS. M.D.

Mr, Nathan Straus, New York. December 2, 19l2

Sir;-

The counts of the raw milk taken at your Laboratory last week for exan
inatlon are as follows:-

Howell Cans, No. 1-^ — ^---' 100 colonies per cubic centimeter.

2-«-.^ ,^^-^ 700

3-^^.^..^...^.. 400

4-^^. .^....-..-1^400

5—^..,.^ 300

6-^.^-^- 2,000

7—----- — — -^ 100

8 1,B00

9 100 •

10 2,200

11— 400

12-^^ 200

13-^^ 3,600

14-^^^.^.,....^-.. 2,800

15- 300

: 16—-.-- 3,000

17 — -- 1,200

18 - 200

19-..^-...-,^,.-- 1,100

20 3,000

21--- 300

The counts of the Modified, Pasteurized Milk are as follows :-

Formula No.l no growth in l/lOO

2 100

2B 100

3 no growth in l/lOO

4 100

Whole Milk, 200 ,f

MILK DISPENSED BY THE GLASS.

^^^^V ILK properly pasteurized is supplied by the glass during the
■ IB Summer at stations in parks and on recreation piers, at a
- ■ ^ ^ charge of one cent a glass. In this way healthful food, free
from any possible infection, is brought within the reach of children who
play in these recreation centres, and the eagerness with which they
throng the stations to get this milk is evidence of the need for such
institutions. Park Commissioners and others interested in making the
parks and recreation piers really beneficial to the children agree that
there is no way in which the good done by these play centres can be
better supplemented than by this provision for supplying wholesome
pasteurized milk at a nominal charge.

In addition to the glass milk the pasteurized modified milk in nurs-
ing bottles is also dispensed at these stations. As there is provision for
heating the bottles the mothers are not compelled to return home at
feeding time, but can spend the day in the open with their children.

But it is not only the children and mothers who are cared for by
the dispensing of milk by the glass. These depots are also eagerly
sought by growing lads and full grown men, who find in a glass of
pasteurized milk better refreshment than is afforded by the corner
saloon, and at one-fifth of the cost of a glass of beer, or one-tenth the
cost of a drink of spirits. In this way this work has had a decided
influence in promoting temperance — not by preaching but by the sub-
stitution of a nourishing and wholesome drink for that which dulls the
brain and undermines the health.

During the past Summer 1,326,100 glasses of pasteurized milk were
served at these stations and in the twenty-one years of the work over
17,000,000 gallons of milk was thus dispensed.

INTERIOR OF TOMPKINS SQUARE PARK STATION.

STATION AT 348 EAST 32nd STREET.

TOMPKINS SQUARE PARK
Milk Booth (South Side) Where Glass Milk Is Dispensed.

Miik Station— City Hall Park.

PASTEURIZATION AT HOME.

' J ^T'S ^^^ number of people supplied with milk at the Straus Labo-
^^^M ratory increased it became evident that there were a large
^^ M^ number who would be glad to use the pasteurized modified
milk, but were too proud to come to the laboratory to obtain it. In
addition there is, of course, a large class who can well afford to pas-
teurize at home — those who do not care to share in the charity of buying
milk of the laboratory. For these two classes, then, it was felt that an
apparatus for pasteurizing in the home was needed. The apparatus
then on the market for this purpose were all of complicated manipula-
tion and most of them heated the milk to a temperature far in excess
of that needed to destroy the bacteria. Months of experience were needed
to develop the Straus Home Pasteurizer to its present high degree of
perfection and to make it what is popularly called "FOOL-PROOF."
It was during a prolonged residence in Heidelberg, Baden, Ger-
many, where for some time the pasteurization work was carried on,
that experiments were made. They were conducted by inserting a
thermometer through the top of the can while pasteurization was going
on so that the mercury of the thermometer was in the actual milk in
the bottle. The temperature registered on this thermometer was noted
every minute for twenty minutes of pasteurization. The proportion of
boiling water and cold milk to be pasteurized was exactly determined
upon after hundreds of such tests.

The Home Pasteurizer consists essentially of three parts, as shown
in the illustration. A can (b), a rack (a) to hold the bottles of milk,
and a top for the can (c). The bottles are filled to the neck, the patent
corks are snapped on and the bottles are placed in the rack. The rack
is then set in the can in such a position as to be supported by three

projections on the inside of the can. The bottoms of the bottles are
then some four or six inches above the bottom of the can. Boiling water
is then poured into the can until it reaches a certain mark just below
the bottoms of the bottles. The cover is then placed on the can and
the bottles are left in this position for five minutes to heat them thor-
oughly through. When five minutes have passed the cover is taken off,
the rack is given a half turn so that it is no longer supported by the
projections on the inside of the can, and it sinks slowly to the bottom
of the can. The cover is then replaced on the can. It is advisable to
perform this operation as rapidly as possible. The whole is then al-
lowed to stand for twenty-five minutes. The can is then uncovered, the
rack lifted out, the hot water is partially emptied out of the can and
cold water is poured in its place. When the bottles are cool enough so
that they will not be cracked by contact with ice, ice is added to chill
them as thoroughly and quickly as possible.

By this process pasteurization is accomplished with a degree of
exactness that is almost unbelievable unless one has seen the experiment
performed one's self with the thermometer. For the first five minutes
that the bottles rest in the water the milk reaches a temperature of 157°
F. The milk then remains at exactly this temperature without variation
of more than two degrees for the remaining twenty minutes that the
bottles remain in the hot water.

The cost of the Nathan Straus Home Pasteurizer is nominal. It
can be obtained at any of the stations with bottles and stoppers com-
plete in any size for $1.50. In fact, any tinsmith can make it by fol-
lowing the directions for manufacturing which are given at the labora-
tory free of charge (see cut page 23).

The utility of the Nathan Straus Home Pasteurizer, because of its
absolute simplicity, is very wide. In cases of epidemics, where there is
dire need for immediate pasteurization of all the milk in nurseries, hos-
pitals, etc., the Home Pasteurizer steps in as a makeshift until a large
pasteurizing plant can be installed. As the whole pasteurization process
with the Home Pasteurizer takes about forty minutes, it can easily be
seen that sufficient milk for dozens of babies can be pasteurized with
one fixture in one day.

Directions For Manufacturing Honne Pasteurizer-
System Nathan Straus

INSIDE

SECTION

SHOWING

BRACKET

FOR

TRAY

SIZE I SIZE II SIZE III

Eight 3 oz. Bottles Eight 6 oz. Bottles Six Pint Bottles

Height of Pan 10>^ in. lOj^ in. Uj^ in.

Diameter of Pan lOj^ in. 10>^ in. 10>^ in.

Distance of Top of Bracket from Bottom of Pan 3^V i"* "^H ^^' ^H ^^'

Amount of Water 5 quarts (i^ quarts 9 quarts

MEDICAL ASSISTANCE IN CONNECTION WITH

THE MILK DEPOTS.

J ^^T the outset it must be said that no important step has ever
^h^m been taken in connection with the Nathan Straus Pasteurized
^^ M^ Milk Laboratory without the advice or approval of the most
eminent children's physicians in the country. These physicians have also
supplied all the formulas. To carry out further the idea of complete
medical supervision a doctor is attached to the laboratory. This experi-
enced children's physician meets the mothers who buy the milk regu-
larly at the various depots. His schedule of hours is so arranged that
he is at each of the depots two or three times a week (see page 25).
Any mother who wishes to have either directions as to the care and
feeding of her child or directions how to treat it in case of illness can
obtain this advice gratis from the physician. By attending each one
of the stations regularly he is able to keep in constant touch with each
baby fed on the Straus milk and to prescribe at what time it is best to
change from a formula suitable for a younger child to a formula suited
to an older one. The physician keeps a written record of the condition
and weight of each child that comes under his care and the progress is
noted from time to time.

It is the object of this laboratory to put up such formulas as will
meet the needs of nine hundred and ninety-nine out of a thousand
babies. In view of the great quantity prepared daily it is impossible
to prescribe individually, and the experience has been that one of the
formulas usually suits every case. In addition to the oral advice, in-r
structive leaflets in several languages are distributed at each one of
the depots (see page 26).

It is always the endeavor of the Nathan Straus Pasteurized Milk
Laboratory to secure whatever advice can be obtained both in the
preparation of its formulas and in the application of the same to the
individual needs of the children. But all this explanation would be
incomplete if due credit were not given to Professor Abraham Jacobi,
dean of the American medical profession, that greatest of all specialists
on infant feeding. To his guidance and to the cordial co-operation and
assistance of Dr. Rowland G. Freeman much of the success of pas-
teurization is due. It has been a long and often bitter fight against
ignorance and prejudice. But the light has dawned and exact science
and practical experience agree that by pasteurization, and only by
pasteurization, can disease germs surely be destroyed and milk made
safe to feed to young and old.

"One serious difficulty heretofore has been that we have not under-
stood thoroughly the science of pasteurization. This has been removed
and objections to pasteurization with it. Rapidly the opposition to the
methods for which Mr. Straus has fought so long is disappearing. It
can be safely said MR. STRAUS HAS WON HIS FIGHT" (Dr.
Charles E. North, Consulting Sanitarian, Member N. Y. Milk Com-
mittee, to the Commission on National Milk Standards, Jan. 23, 1912).

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LEAFLET DISTRIBUTED AT ALL THE STATIONS IN SEVERAL

LANGUAGES.

PASTEURIZED MILK LABORATORIES

Founded 1892

NO. 348 EAST 32d ST., NEW YORK.

ADVICE TO MOTHERS.

BRING the baby to the milk depot and the doctor will decide,
according to its age and general health, with which mixture
it should be fed.

During the first month give the bottle every three hours, later every
four hours. Never any sooner because the baby cries. It does not cry
because it is hungry; on the contrary, it probably feels uncomfortable
because it has had too much, or because it is soiled, or because it is
sleepy.

Wash out each bottle, as soon as the child has finished, with hot
water in which some soda has been dissolved, then fill it with clear
water. After each nursing wash the nipple and leave it in fresh water.

Let the baby sleep from six to ten hours during the night without
a feeding.

If you have no bath tub, give the baby daily a sponge bath from
head to foot and dry it carefully with a warm towel. Also wash it off
each time you change the diaper.

The diapers must always be washed when soiled or wet; otherwise
the baby will get chafed and sore.

Keep the bottles of milk in a cool place and warm each one, just
before use, by immersing it, still corked, in hot water. Never pour the
milk into another vessel, but let the child nurse from the bottle in which
it comes. Do not add anything to the milk.

Shake the bottle, so that the cream or barley water, as the case may
be, becomes mixed with the milk.

Then remove the cork, rub off the neck of the bottle with a clean
cloth, and put on the freshly washed nipple.

Let the baby nurse slowly — it should take from ten to fifteen min-
utes for a feeding. Raise the child several times during nursing, so
that the gases can escape.

Give the child

During first month —

8 three-ounce bottles a day, 1 every 2^/2 hours.

From first to third month —

6 three-ounce bottles a day, 1 every 3 hours.

From second to sixth month —

6 six-ounce bottles a day, 1 every 3 hours.

From third to seventh month —

6 six-ounce bottles a day, 1 every 3 hours.

From seventh to ninth month —

5 eight-ounce bottles a day, 1 every 4 hours.

After nine months —

4 eight-ounce bottles pasteurized full milk, 1 every 4 hours.

Do not let the baby have anything but milk.

If baby does not seem perfectly well or does not digest the milk
properly, consult a physician at once.

348 East 32d Street
54 Market Street
402 West 37th Street
38 Macdougal Street

Battery Park
City Hall Park
Central Park
Seward Park

DEPOTS.

OPEN ALL YEAR

322 East 59th Street
303 East 111th Street
Tompkins Square Park, 7th Street
and Avenue A
Mount Morris Park

OPEN IN SUMMER

Recreation Piers

East 3d Street
East 24th Street
East 112th Street
Barrow Street

Educational Alliance Roof Garden

West 50th Street

Tables compiled from the official statistics of the Department of
Health, showing the infantile death rate of the old City of New York,
now the Boroughs of Manhattan and the Bronx, in the year preceding
the opening of the Nathan Straus Pasteurized Milk Depots, and during
the twenty years in which that work has been systematically directed
to the saving of infant lives.

POPULATION, DEATHS AND DEATH RATE OF CHILDREN UNDER FIVE

YEARS OF AGE

PER ANNUM

DEATH RATE

YEAR

POPULATION

DEATHS

PER THOUSAND
PER ANNUM

1891

188,703

18,224

96.5

1892

194,214

18,684

96.2

1893

199,885

17,865

89.3

1894

205,723

17,558

85.3

1895

212,983

18,221

85.5

1896

217,071

16,907

77.9

1897

221,339

15,395

69.6

1898

225,804

15,591

69.1

1899

230,480

14,391

62.5

1900

235,585

15,648

66.4

1901

242,747

14,809

61.0

1902

250,153

15,019

60.0

1903

257,813

14,402

53.3

1904

265,738

16,137

60.7

1905

273,938

15,287

55.8

1906

282,424

15,534

55.0

1907

291,208

15,645

53.7

1908

301,417

14,910

49.4

1909

309,852

14,940

48.2

1910

319,809

14,672

45.8

1911

329,170

13,765

41.8

POPULATION, DEATHS AND DEATH RATE OF CHILDREN UNDER FIVE

YEARS OF AGE

FOR THE MONTHS OF JUNE, JULY AND AUGUST.

DEATH RATE

YEAR

POPULATION

DEATHS

PER THOUSAND
PER ANNUM

1891

188,703

5,945

126.4

1892

194,214

6,612

136.1

1893

199,886

5,892

117.0

1894

205,723

5,788

112.6

1895

212,983

6.183

116.1

1896

217,071

5,671

104.5

1897

221,339

5,401

97.6

1898

225,804

5,047

89.4

1899

230,480

4,689

81.4

1900

235,585

4.562

77.4

1901

242,747

4,642

76.5

1902

250,153

4,389

70.2

1903

257,813

4,037

62.6

1904

265,738

4,805

72.3

1905

273938

4,892

71.4

1906

282,424

4,426

62.7

1907

291,208

5,030

68.6 .

1908

301,417

4,336

57.5

1909

309,852

4,067

52.5

1910

319,809

4,426

55.3

1911

329.170

3.673

44.6

REPRINTS of CIRCULAR
LETTERS to MAYORS and
PRESIDENTS of HEALTH
BOARDS : : ADDRESSES
DELIVERED at CON-
GRESSES, and VARIOUS
OTHER PUBLICATIONS

How the

New York

Death

Rate

Was

Reduced

HOW THE NEW YORK DEATH RATE
WAS REDUCED.

Reprinted from The Forum of November, 1894.

^^^^^ Y efforts to do something to lessen the appalling sum of human
M ■ ■ suffering and sorrow which the figures of infant mortality in
_T ^ ^ New York but faintly indicate were begun in the summer
of last year, when I opened a depot where pure milk, both in its natural
and sterilized form, was sold. From this experiment I received such
striking demonstration of the good that could be accomplished by rais-
ing the standard of the milk supply of the poor that I resolved, if it
were at all possible, to resume the work on a greatly enlarged scale this
year. For the protection of the children of the poor, the milk must be
sterilized before being sold.^ I believed that if this could be done on a
scale large enough to make an impression on the supply, the sum of
infant mortality in New York might be sensibly reduced. I determined
to make the attempt, at least, and in opening six milk depots at the
beginning of the past Summer deliberately addressed myself to the
task of reducing the death rate of the city.

There is a great deal of waste in the world, but none quite so reck-
less as that of human life. Here in New York the lives of thousands of
children are sacrificed every Summer, simply and solely because they
are fed with impure milk. Of people who die in the State of Maine every
year, children under five years of age count for less than 20 per cent. ;
of those who die in New York City, over 40 per cent, are children under
five years of age.

It is the mortality of June, July and August that chiefly accounts for
the large percentage of this annual harvest of death. Within a radius
of twelve miles from the New York City Hall, three children die during
the heated term for every adult ; and certainly two out of every three
represent a sacrifice which is a disgrace to our civilization to allow.
Within the area of what may be called the metropolitan district, the
record of one week showed the total mortality to be 1,038, of which 713
deaths were under five years, 664 under two years, 529 under one year,
and only 325 over five years of age. Here was 64 per cent, of one week's

^Here let me say that the penalty of disease and death, paid for the neglect of simple pre-
cautions in the use of milk, is by no means paid exclusively by the poor. Milk is not always
good in proportion to the price paid for it, nor free from the germs of contagion because it has
come from cattle of aristocratic lineage. The latter quality, as recent experience has shown, carries
with it a special susceptibility to tuberculosis. In milk intended for infant nutriment perfect
sterilization is an absolutely essential precaution ; but, simple as the process is, it is not always
certain, even in the homes of the rich, that it will be properly done. I hold that in the near
future it will be regarded as a piece of criminal neglect to feed young children on milk which has
not been sterilized.

death-roll composed of babies under two years, who drank but little
water, and were almost wholly dependent on milk for their nutriment.
Could the "destruction that wasteth at noon-day" have been more pal-
pably present than death in these children's milk-bottles?

The conditions of a wholesome milk supply are simple, but, like a
good many other simple things, difficult of attainment. These conditions
are healthy cows, clean stables, clean and careful processes of milking,
and prompt transfer of the milk, in perfectly clean and close vessels,
from the cow to the consumer. In the milk supply of all great cities
every one of these requisites is flagrantly violated. The inspection of
cow-stables to detect the presence of disease is neither careful nor con-
stant; milking is done in most cases under conditions indescribably
filthy, and most of the milk consumed by the children of the poor is
at least thirty-six to forty-eight hours old before it reaches them. It
is a simple matter to understand — as Professor Sedgwick of Boston
puts the case —

" — how this rich animal fluid — sterile at the start, but drawn by unclean hands
into half-clean pails, and meanwhile sprinkled from above by the dust of the
stable, by hairs, dandruff, dirt, and particles of excrement from the skin and
udder of the cow vigorously shaken by the milker or brushed by his hat — be-
comes infested with organisms. That these multiply swiftly and enormously in
the warm and rich fluid, well aerated by the act of milking, is also a natural con-
sequence of favorable conditions; and if we allow time also, the wonder is, not
that it contains so many germs, but rather that it is still potable at all."

Mr. William M. Babbott, of New York, who has issued an instruc-
tive little monograph on the connection between milk supply and dis-
ease, uses still stronger language in regard to the character of the milk
sold in New York and Brooklyn. He says:

"If milk gave the same outward appearance of decomposition or fermentation
as is shown by vegetables, fish or meat, more than three-quarters of all the milk
consumed in the metropolitan district would be condemned as unfit for human
food; if its pollution could be perceived, it would be loathed; and if the disease
germs could be as plainly seen as a pest-house, the death-dealing milk would be
as soon dreaded and shunned."

It is unquestionably true that no plague by which the city was ever
ravaged has yielded so plentiful a crop of deaths as that which is reaped
from the seeds of contagion deposited in the infant system every Sum-
mer by millions of noxious bacteria developed in milk.

The sterilizing laboratory which I established last year was this
year very much enlarged, and every preparation was made to meet the
demands likely to be made on it. The cows from which the milk was
obtained were examined by the veterinary surgeon of the New York
Board of Health, and the stables and dairies made a subject of careful
inspection. The milk was iced in transportation and kept on ice till
it was turned into the bottles for sterilizing. The apparatus used for

the purpose was made under the direction of Dr. R. G. Freeman, of New
York. The milk is exposed for twenty minutes to a temperature of 167°
Fahrenheit. It has been demonstrated that tubercle bacilli die at 158°
Fahrenheit, when submitted to that temperature for ten minutes. It
is therefore reasonably certain that by this process all noxious germs
in the milk are completely destroyed, while the nutritive qualities of this
most perfect of nature's foods have not been in the slightest degree
impaired. In the preparation of modified milk for infant feeding, two
formulae were adopted, one by Dr. R. G. Freeman, and the other by Dr.
A. Jacobi. Both of these have been, and will during the Winter continue
to be, sterilized in six-ounce bottles, sold at a cent each. In addition to
these modified milk foods, barley flour was sold. This was intended to
meet a want, keenly felt by the poor, of wholesome nutrition at a price
within their means, for children beyond the infantile stage.

During the hottest part of the Summer the laboratory was kept
running to its full capacity, night and day, to prepare sufficient sterilized
milk to meet the demand. This was so active and so constant as to
exhaust the stock in the depots daily, but it was a rigidly observed
rule that, without respect to demand, no bottle of sterilized milk should
be sold twenty-four hours after it had been sterilized. The Health
Board's free doctors, the dispensaries, the ''World's" free doctors, and
nearly all the hospitals and charitable organizations took an active
interest in educating the people as to the value of sterilized milk. Order-
books containing a hundred of the following coupons were placed without
cost, and without restriction as to quantity, at the disposal of any
physician giving his services freely to the poor, or to any charitable
organization applying for them:

This coupon is good at an^ of the following depots:

Foot of East Third St.; 317 East Ninth St.; 147 Eldridge St.; 22 Market St.;
201 West 63d St. and 324 East 59th St.
for
5 6-oz. bottles Milk and Barley Water, Formula No. 2; or
5 6-oz. bottles Milk and Lime Water, Formula No. i; or
4 8-oz. bottles Sterilized Pure Milk; or
2 16-0Z. bottles Sterilized Pure Milk; or
One-half pound Barley Flour and 2 8-oz. bottles Sterilized Pure Milk.

Deposit required on bottles from every one; 3 cents on each 6 or 8-oz. bottle;
5 cents on each 16-oz. bottle.

NATHAN STRAUS.

This Ticket is good for only one of the foods.

By permission of the Dock Department I erected on the pier at
the foot of East Third Street, within a few feet of the milk laboratory,
a large pavilion provided with comfortable seats, which were given to
the unrestricted use of women and children. I also placed benches
under the pavilion erected on this same pier by the Dock Department.
My purpose in this was to furnish a free fresh-air resort for mothers
who could not get through with their home duties early enough to catch
a boat which sailed on schedule time. The tent was open all day up
to midnight, so that at any hour a mother could bring her child and
enjoy the fresh sea air without having tired herself out in a rush to
catch an excursion and probably unfitted herself for the proper care
of the child. The central depot being situated on this pier, all the re-
sources were at the command of those who used the rest and shelter
provided. A physician assigned by the Board of Health was constantly
in attendance. On hot days a thousand women and children could be
found at almost any hour enjoying the shelter, and so impressed have I
been with the benefit thus afforded that I have determined to use all
my influence to have such outing places, protected from the sun, erected
on the piers that belong to the city. This can be done without inter-
fering with traffic facilities, by putting benches on the roof of the
pier, and covering them with an awning.

Free lectures under other auspices were given twice a week by
experienced physicians, on the proper care and feeding of infants, and
every opportunity was taken to bring home to mothers the knowledge
that the best possible food for their children could be obtained at a
nominal price. The sale of sterilized milk for babies at the six depots
aggregated, up to the end of September, 280,000 bottles, or over 2,500
bottles a day. No record was kept of the number of sick children for
whom sweetened and diluted sterilized milk in bottles was prescribed,
but it was estimated that a daily average of 700 babies were fed on
this modified milk. It is safe to say that some thousands of children,
who were sick, owe their recovery during the Summer to its use. On
this point the returns of the Bureau of Statistics present eloquent testi-
mony, as the following comparison between the number of deaths of
children in New York under five years of age, this year and last, will
show:

1894 1893

January, February and March 4,508 4,108

April, May and June 4,521 4,386

July 2,560 2,796

August 1,559 1,686

September (to the 13th) 317 386

The Summer of 1894 was a much more trying one for children than
that of 1893. The average temperature of the latter part of June, of the

whole of July, and a part of August was unusually high, and all con-
ditions tending to the increase of the intestinal disorders which are
chiefly accountable for infant mortality were correspondingly aggra-
vated. As a matter of fact, the sanitary condition of the city had under-
gone no radical change, and the system of tenement-house inspection
was not less thorough last year than this. Sick-children's funds, and
other forms of charitable effort for the benefit of the poor, were not
less liberally supported in the Summer of 1893 than in that of 1894.
All the external conditions, in short, led to the expectation of a higher
death rate in the Summer of 1894 than in the one preceding; and, even
had other things been equal, the increase of population would, without
an increase of the rate, have been accompanied by a larger number of
infant deaths. But it will be seen that since the opening of the pure
milk depots the number of deaths among children has sensibly decreased.
During the first quarter of the year there was an increase, as compared
with 1893, of nearly 10 per cent. — considerably in excess of a normal
percentage — in the deaths of children under five years of age. For the
second quarter, forty days of which were covered by the distribution of
pure milk, the increase over 1893 was only a little more than 3 per cent.
For the month of July there was a decrease, as compared with July,
1893, of nearly S% per cent., in the number of infant deaths ; for August
the decrease was 7^ per cent., and for September 18 per cent. Allowing
3 per cent, as the normal average of increase under the most favorable
conditions, it will be seen that there has been a reduction of over 10
per cent, in the Summer mortality of infants in this city.

Further analysis of the figures show results even more striking.
The month of June started in with an exceptionally high mortality of
children under one year. In 1893 this month showed 878 of the infant
deaths; in 1894 the number rose to 1,076 — an increase of 22^ per cent.
Of children over one year and under two years of age, the deaths for
June, 1893, numbered 247, and for June, 1894, 267 — an increase of over
8 per cent. Necessarily, it took some time to make the existence of the
pure-milk agencies known to those for whose benefit they were in-
tended, and to educate mothers into the necessity of having recourse to
them. For July, when the system was fairly in operation, and its ad-
vantages generally known, the deaths of infants under one year num-
bered 1,918, as compared with 2,063 for the corresponding month of
1893 — a decrease of over 7 per cent. In the same month the deaths over
one year and under two years of age were 381, as compared with 440
for July, 1893 — a decrease of over 11 per cent. For August the figures
are equally suggestive, there being a decrease in the one-year class from
1,152 to 1,086, and in the two-year class from 402 to 265. This last

decrease represents a ratio as high as 34 per cent., and as every mother
knows the dangers attending the second year of infant life, the figures
have a very direct bearing on what I must call the preventable average
of infant mortality. I think I may safely claim that much of the dimin-
ished aggregate of children's deaths which happily distinguishes the
Summer of 1893 from that of 1894 has been due to the establishment of
the pure-milk depots, and the very large decrease in August of deaths
among children between one and two years of age would be quite unin-
telligible without this explanation. I make these assertions, not for the
purpose of claiming personal credit for a work which has yielded me
more pleasure than I can well describe, but with the hope that others
may be tempted to enter the same field. It .is much too large a field
for any one man or organization to fill, but I have written to very little
purpose if I have not shown it to be one in which there may be gathered
a most abundant return for well-doing.

By way of divesting the public mind of the idea that sterilized milk
was a medicated compound, and in order to supply poor people with a
wholesome and strengthening Summer beverage, I obtained permission
to open booths for its sale in the public parks. There were nine of
these, and soon I found that the demand for sterilized milk at a cent
a glass was so great as to transcend the resources of my laboratory.
This I had occasion to reinforce by the provision of another apparatus
elsewhere for the preparation of one of the infant foods; but even then
I was compelled to have recourse to the Appleberg Company for a
supply of sterilized milk for sale at the park booths. Desirous as this
company was to second my enterprise, the demand exceeded all possible
supply by fully one-half, and what was lacking in the sterilized product
had to be furnished in the form of raw milk from the dairies. At all of
the regular depots I also sold raw milk in sealed cans. My purpose
was to give a practical demonstration of the fact that pure milk can be
obtained and sold at low prices. The demonstration has, I trust, been
a convincing one, and its effect has undoubtedly been to elevate the
standard of milk sold by small grocers throughout New York City.
With the advent of cool weather the depots were closed, but the ster-
ilizing laboratory will be maintained during the year, so that any one
desiring to obtain the sterilized milk, either in its simple or modified
form, during the winter, can do so.

At the Park depots there were sold (up to September 30) 572,150
glasses at one cent each, and in the height of the season the number of
people employed was 58. The sales of milk in all of the places (depots
and booths) aggregated 400,000 quarts.

I have been frequently asked as to the possibility of placing such
an enterprise as the one I have outlined on a commercial basis, that is,
of conducting it at least without loss. I must say that my experience
sheds but little light on such a question. I set out with the definite
purpose of reducing the infantile death rate of the city, and that could
be done only by dismissing all considerations of trouble or expense.
Every new depot that was added necessarily increased the cost of the
business, for the expense of distributing the sterilized milk for babies
to the branch depots was about as much as the price charged for it.
The work, in short, as conducted, was one in which the only possible
gain was that of human lives ; but that is surely a gain to which all com-
mercial and economical considerations must be held to be subordinate.

My work could undoubtedly be duplicated at a very much lower
cost than it entailed. I had but little experience to guide me in ar-
ranging the details of the business, and the high price of milk which
was a consequence of the Summer drought, no less than the unexpected
magnitude of the demands made by my customers, contributed to the
increase of expense, which in the future might be avoided. Pure milk
in its natural form could probably be sold without loss from one great
depot situated close to the point of delivery by rail or steamer, at prices
slightly higher than those which I established. Milk in the sterilized
form, put up in bottles for use in the nursery, would cost, on a com-
mercial basis, quite double the prices paid for it at my depots.

I beg leave to repeat here what I have elsewhere said, that I consider
the furnishing of pure milk the most important benevolent undertaking
with which I have been connected, and I may be pardoned for referring
with some personal satisfaction to the fact that my New York experi-
ment has been in all of its details repeated with most satisfactory results
in Yonkers and Philadelphia.

^y^^^Ss^C^ ^^^"iucc^

Nathan Straus.

Sixth Avenue and Fourteenth Street.

New York, June 8, 1895.

To His Honor,

The Mayor.*

Dear Sir: <

I have received so many letters of inquiry from municipal authorities,
physicians and others throughout the country in regard to my work in provi-
ding pure milk nutriment for the sick children of New York, that I have "been
prompted to prepare the following items of general information for the
guidance of those whose public position or personal sympathies may give them.
a special interest in trying to reduce the sum of infant mortality. It is a
fact which unfortunately requires no demonstration, that many thousands of
infant lives are annually sacrificed for the lack of a pure milk diet The
harvest of death le especially abundant in Summer when intestinal complaints
are most prevalent among children under- five years of age. The infant
nourishment commonly accessible to the poor- ia in hot weather so of ten replete
with the germs of disease that it is the rule rather than the exception to find,
in the food relied on to sustain- life the. instrument of death.

This yearly "slaughter of the innocents" goes on in small communities atf
well as in great cities. A neglect of simple precautions in the use of
infants' food will produce the same results everywhere. I have long held t"hat
the day is not far distant when it will be regarded as a piece of criminal
neglect t,o feed young children on milk that has not been sterilized. I have
addressed myself during the last two years to the task of placing within the
reach of every poor family in this city absolutely pure forms of infant
diet. These have been either milk carefully sterilized without admixture, or
in combination with barley water and a little sugar. Of course due pre-
cautions are taken to see that the milk is drawn in the first instance from
healthy cows kept in stables of a proper standard of cleanliness ►

^Letter sent to the Ma}fors of the principal cities of the United States and
Canada.

The best poBsible evidence of the value of this work in saving life is to
be found in the impression which it rade en the infant death rate of New York
last Summer. In presence of a Icng and exh-iusting period rf very hot weather
favorable to an increased mortality among tl-e children of the poor, there was
a decrease in the month of July, as compared with the Corresponding month in
1893, of 7 per cent, in the deaths of children under one year, and of 11 per
cent, in the deaths over one and urtder two years. For August the decrease
of deaths in the one year class was 6 per cent. , while in the two year class it
reached as high as 34 per cent. Considering the well-known dangers attending
the second year of childlife, these figures bear very eloquent testimony to
the possibility of greatly lowering the average of infant mortality. Taking
the deaths in New York from diarrhoeal diseases alone, of which 89 per cent.
are those of children under five years of age, and there is found to be a
decrease of 454 in 1894, as compared with 1892. But, allowing for the in-
crease of population,^ there should have been in ordinary circumstances 420*/
more deaths from this group of infantile complaints in 1894 than in 1892.
This saving of 874 children's lives has been largely due to the institution
of my sterilized milk depots. The application of similar methods have been
productive of satisfactory results in Philadelphia, Pittsburg, Cincinnati and
Yonkers, and no phase of public hygiene is at present attracting so much
attention in Europe. It is simply impossible for any man of ordinary feeling
^o study the simple appliances of a work like this, and to note their efficacy
in fighting the forces of disease and death, without being prompted to
engage in it himself

I am^frequently asked for estimates derived from my own experience of
the cost of placing sterilized milk at a nominal price within the reach of
those who in a given community need it most. This is difficult to do for
several reasons. I set out with the definite purpose of reducing the infan-
tile death rate of the city, and all considerations of expense were held
subordinate to that main object. In bringing the work to its present stage
of developsnent I have spent a good deal more money than I would were it to
be done over again in the light of acquired experience. Then, the conditions
of no two localities as to transportation, distribution and handling can be
•quite alike, and these figure largely in the element of cost. While, there-
fore, I may safely claim to be able to speak with authority as to the best
processes of preparation, bottling, etc., I should hesitate to give an
opinion as to the number of bottles that could be filled for a given exi>en-
diture. Some practical details will -be found . embod led in a little pamphlet
which 1 am fcaving printed and of which I shall serft you a copy, but I know of

no absolute standard by which the cost of such a work can be ascertained
in advance.

The fact is that much good can be done by a very simple plant and by tne
most modest expenditure. A more or less elaborate equipment is, of course,
necessary for doing the work on a large scale, but it is, perhaps, better
that this should be a growth from tentative efforts confined within a limit-
ed area than that it should be adopted at the start. Any person of moderate
intelligence can become thoroughly farailar with the methods and processes of
my Sterilized Milk Laboratory In less than a week, and c'an readily apply the
knowledge thus acquired to the duplication of its work on any scale that
may be attempted. I shall be glad to give any such person, duly accredited
to me by some responsible authority, free access to every department of my
now completed system of preparation and distribution, and all possible data
needed to guide him in adapting the work to different conditions. I know of
no other way in which a satisfactory trial of its benefits can be secured
than by such personal investigation and preparation as I have indicated.
Should there be a desire to make such a trial in the municipality of which
you are the head, I beg that you will consider all I am able to show of the
practical working of the system entirely at the service of any one whom you may
be pleased to designate. I am so deeply impressed with the benefit which work
of this kind is fitted to confer on humanity, that my freedom in addressing
you on the subject may be, held not to require apology.

I I have the honor to be,

Ycups respectfully,

^^^^^^-^<^i^^^^^<^

NATHAN STRAUS Sixth Avenue and Fourteenth Street,

New York, March 22, 1897.

HOW TO REDUCE INFANT MORTALITY*

To the Board of Health.

Gentlemen :
^*^OME eighteen months ago I took the liberty of addressing a
jhMk letter to the Mayor of every city in the United States, setting
^"^ forth at some length my conviction of the absolute necessity
of making the supply of sterilized (pasteurized) milk for the children
of the poor an object of municipal solicitude. I received sympathetic
responses from so many quarters that I am encouraged to believe in the
existence of a widespread interest in the subject. I feel it, therefore, to
be my duty to supplement the appeal then made by a more complete
and exact statement of the reasons which prompt me to believe that
there is no field of public effort whose neglect admits of so little excuse.
I address this communication to you as the agency of local government
whose purpose it is to provide against all preventable loss of human life
and to enable the people, from childhood to age, to live under sanitary
conditions alike as to their food supply and their surroundings.

It is hardly necessary to call your attention to the fact that the
most thorough system of public inspection of milk is almost solely di-
rected to the correction of two abuses — skimming and adulteration with
water — and to cutting off the supply of one kind of diseased milk — that
drawn from tuberculous cows. The latter duty is usually performed by
State officers; the former is an exclusively municipal function. The
public inspection of milk in the United States is thus directed mainly to
the prevention of fraud, and rarely, if ever, to the discovery of pollution.
Except as to the stamping out of tuberculosis, considerations affecting
the public health receive only incidental attention. As Prof. Sedgwick
said some years ago in regard to Boston, "Public milk supplies may not
be legally watered, but they may be stale, or polluted, or infected."
May I be permitted to echo his query as to whether the time has not
come when we should no longer be satisfied with chiefly preventing the
cheating connected with the adulteration of milk or its dilution with
water?

The statement is made on the excellent authority of Dr. Shake-
speare, of Philadelphia, that nearly if not quite one-half of the deaths

^Letter sent to the Presidents of the Health Boards of American cities and
Canada.

in the cities, towns and villages in this country are due to the class of
diseases which are known to be preventable. He adds that the present
annual mortality from the ordinary preventable diseases fails to impress
the public mind, partly because it is so common, but mainly because of
the customary and long continued inaction of the medical profession in
matters relating to public sanitation. Chief among this preventable class
of diseases are the diarrhoeal disturbances of young children, and the
prime agent in the production of these is impure milk. These disturb-
ances prevail among infants pretty much in the proportion in which
such milk constitutes their food. They are related to a group of symp-
toms which medical science has declared to admit of no other satisfac-
tory explanation than that they are of toxic origin, due to the absorp-
tion from the intestines of ptomaines produced by bacteria. The causa-
tive factor, in short, of these disturbances is bacteria, and these act in
most cases by inducing changes in the food. It is nonsense to argue
that because healthy adults may drink polluted and stale milk without
injury, invalids and infants may do the same. Milk is babies' proper
food, but the milk with which they are fed is too often a fluid in which
the germs of disease and death have taken the place of Nature's most
perfectly combined elements of nutrition. Samples of average city milk,
perfectly good according to all the customary tests of color, taste, smell,
and the galactometer, have been found to contain 2,350,000 bacteria to
the cubic centimeter, or more than twice the amount of the bacterial
contents of the same quantity of city sewage.

Thus a fluid possessing almost ideally perfect qualities for the pres-
ervation of health and nutrition may by easy and rapid stages of pollu-
tion become a deadly agent in the propagation of disease. Were the
precautions taken to secure cleanliness in cow stables and in the cloth-
ing and persons of the milkers tenfold greater than they are, a wide
mouthed pail held under the shaken udder would be necessarily a re-
ceptacle for many impurities. What actually takes place in almost
uniform practice is that this rich animal fluid, sterile and presumably
wholesome at the start, but drawn by unclean hands into half-cleaned
pails, and meanwhile sprinkled from above by the dust of the stable,
by hairs, dandruff, dirt, and particles of excrement from the skin and
udder of the cow shaken from the milker or brushed by his hat, becomes
infested with organisms. That these multiply swiftly and enormously
in the warm and rich fluid, well aerated by the act of milking, is also a
natural consequence of favorable conditions; and if we allow time, as
has been well said, the wonder is not that it contains so many germs,
but rather that it is still potable at all.

I hold, therefore, that there is practically no milk delivered for gen-
eral consumption in cities that is fit to be fed in its natural state to
young children. There is no system of tests capable of application that
can alter this fact, and the tests in actual use do not touch it at all. If
proof of this assertion were needed, a glance at the abnormal infant
death rate of any of our great cities would amply bear it out. In New
York City, the recorded births of the three years, 1890-'92, were 135,602.
Allowing for the fact that only five-sixths of the whole are believed to
be reported to the Board of Health, the actual number may be placed at
162,721. During the same period, the deaths of children under five years
of age were 52,213, or over thirty-two per cent, of the whole number of
births. That one child out of every three that were born should die
before attaining the age of five, is in itself a most significant and alarm-
ing fact. The further fact that from fifteen to eighteen per cent, of all
these deaths occurred in the five weeks between July 3d and August 6th
indicates the true source of the trouble. In 1891 the number of infant
deaths in these five weeks was 2,658 ; in 1892 it was 3,440, an increase of
782. Coming down to the specific causes, we find that diarrhoeal dis-
eases accounted for nearly one-half of the whole. In the five weeks in
question, the deaths of children under five from this cause were 1,209 in
1891, and 1,617 in 1892.

Here, then, was evidence of a steadily increasing infant mortality
in the hottest season of the year, traceable to a cause usually associated
with the poisons bred in cow's milk more abundantly at that season
than at others. It was not a violent assumption that much of this mor-
tality was preventable, and that the most direct and effectual method of
prevention was to put milk suited for infant nutriment within reach of
the poorest. After making a thorough examination of the subject, and
taking counsel with physicians at home and with some who were ac-
cepted as authorities in Europe, I began to experiment in 1893 as to
what could be done with one milk depot. I found medical testimony
absolutely unanimous as to the requirement of perfect sterilization (pas-
teurization) for all milk intended for infant food in cities. A steriliz-
ing laboratory was accordingly established, and the sale of pure milk,
both in its natural and sterilized form, was begun in one of the most
thickly populated districts of the city. The system of sterilization (pas-
teurization) adopted was that prescribed by Dr. Rowland G. Freeman,
of New York, in which are combined the preservation of the nutritive
qualities of the milk and the complete destruction of all noxious germs.
The first year's experience showed me that the indirect results of my
efforts were quite as valuable as those that could be directly traced to
them. The standard of quality of the milk supply of the poor had been

raised within the whole area adjoining my depot, the people being quick
to discern the superiority of the pure article furnished at a low price
over the more or less tainted, and also more costly, one they had been
accustomed to use. During the hot term I also sold milk in its natural
state at a cent a glass, in booths which I was permitted to erect in
the public parks. The visiting physicians of the Board of Health and all
physicians doing charitable work among the poor have been, from the
beginning of my work, supplied by me with all the sterilized and modi-
fied forms of milk which they required free of expense.

It was found, as the result of the first year's experiment, that the
use of sterilized milk was a matter of education. There was at first a
suspicion of medication about it in the minds of the poor people for
whose babies its use was most urgently needed, and the fact that the
doctors began to recommend it tended to associate it in their own mind
with drugs. This prejudice has, however, entirely disappeared. I had
a special preparation for babies' food made according to a formula sup-
plied by Dr. Freeman. To this I added another in the following year
from a formula supplied by Dr. A. Jacobi, and both have been sold in
my depots ever since in six ounce bottles at a cent apiece. In addition
to these modified milk foods, barley flour has been sold. This is in-
tended to meet a want, keenly felt by the poor, of wholesome nutrition
at a price within their means for children beyond the infantile age. The
milk is iced in transportation and kept on ice till it is turned into the
bottles for sterilizing. It has been a rigidly observed rule that, without
respect to demand, no bottle of sterilized (pasteurized) milk should be
sold twenty-four hours after the process of sterilization. Experience
has taught my staff not a little as to the details to be observed in the
effort to secure the most perfect results, but these are the main lines on
which the business has been conducted.

In 1894, preparations were made to supply natural, pasteurized, and
modified milk on such a scale and at as many different depots as might
make a distinct impression on the milk supply in New York and so re-
duce the sum of its infant mortality. The character of the summer was
well calculated to put the experiment to a severe test. The average
temperature of the latter part of June, of the whole of July, and of part
of August was unusually high, and much higher than that of the pre-
ceding year. For the first quarter of the year, the mortality of the chil-
dren under five showed more than the proportionate increase which
might be expected from the increase of population, which was about
three per cent, per annum. There were 4,108 children's deaths in the
first quarter of 1894, or ten per cent, increase. For the second quarter,
the deaths in 1893 numbered 4,386, and in 1894, 4,483, and, as in the

last half of the quarter my six milk depots were open, I was encour-
aged to believe that the arrested increase might in part be due to their
influence. The mortality statistics for July and August confirmed me
in this belief. For July, 1893, the deaths of children under five num-
bered 2,796, while for the same month of 1894 they were only 2,562.
In August, 1893, they numbered 1,686, declining in the same month of
1894 to 1,559. Thus, instead of the increase of ten per cent, in the mor-
tality of children with which the year had started, the two most fatal
months of the year showed a decrease of 8.3 per cent. The deaths under
five years for July and August, which, had they followed the rate of
increase established in the first quarter of the year, would have num-
bered 4,930, were only 4,111. Here was an apparent saving of 819 lives
in two months, or a decrease of the toll levied by death on the children
of New York of sixteen out of every hundred.

In the experimental season of 1893, my one depot was open from
June to November, and from it were sold 34,400 bottles either of pas-
teurized milk or of the modified mixture for infant feeding. In 1894
the six depots were opened on May 14th, and were kept open to the end
of the hot term. From one of them the supply was at the disposal of
the public till the end of the year. The service was thus made a con-
tinuous one, and has been one since so maintained, with six depots, in
addition to the booths in the public parks, open during the hottest period
of the year, and the central depot open all the year round. The sales
for 1894, between May 14th and December 31st, aggregated 306,446 bot-
tles of the pasteurized milk and its modifications. In 1895, between
January 1st and December 31st, the sales were 589,064 bottles, and in
1896 the total for the year was 658,064 bottles. In the year before the
work was seriously begun, 1893, the deaths of children under five during
the two hottest months of the year were, as we have seen, 4,482 ; for the
year just closed, 1896, they were 4,126. Meanwhile the population of
the city had increased from 1,758,000 on July 1, 1893, to 1,934,077 on
July 1, 1896. That is to say, there had been an increase of the popula-
tion equal to fully ten per cent., and a decrease of children's deaths in
the two most fatal months of the year equal to eight per cent. Had the
deaths for July and August of 1896 been in the same proportion as those
for the same months of 1893, they would have numbered 4,930 instead
of 4,126, a clear saving of 804 lives, or sixteen out of every hundred, in
two months. As the rule in the past has been that this class of deaths
increased more rapidly than the population, even these figures do not
tell the entire story.

The experience of Brooklyn is, if possible, more significant of the
value of the pasteurized milk food as a preventive of infant disease and

death than that of New York. Ten years ago, Brooklyn had a decided
advantage over New York in the possession of a much lower rate of
infant mortality. This advantage became gradually less till it not only
disappeared, but left New York, apparently, a more wholesome abode
for children than its twin city across the East River. In 1894, the pro-
portion of deaths of children under the age of five to the whole number
of deaths was 42.6 per cent, in New York and 43.6 per cent, in Brooklyn.
The disparity was not decreased in 1895, and with the opening of the
summer of last year the Brooklyn Board of Health became still more
impressed with the tendency of children's deaths in New York to show
a decrease on those of previous years, while with them the tendency ap-
peared to be the other way. In searching around for reasons to explain
the lessened infant mortality of New York, they concluded that it was
mainly due to the use of pasteurized milk nutriment. They accord-
ingly applied to me for help and advice. As the most practical way of
answering their appeal, I offered to supply them, free of charge, a thou-
sand bottles a day of pasteurized milk and its modifications, leaving
them to provide the machinery of distribution. In point of fact, in the
thirty-eight days from July 29th to September 4th, in which they dis-
tributed these milk foods, they received, in all, 42,739 bottles from my
New York laboratory.

The result is indicated in the report of the board for 1896, as fol-
lows: "The milk was distributed in the various stations of the Diet
Dispensary, of which there are five in the city, and was supplied gratu-
itously to the poor on prescription, precedence being accorded to orders
emanating from members of the summer corps, who used a special form.
Although this work was not begun until the end of July, and was termi-
nated on the 4th of September, upward of 40,000 bottles of pasteurized
milk were dispensed, with the result, as indicated by statistics, of sub-
stantially reducing the death rate from infantile diarrhoea." In the
same connection the following sentences from the report on vital statis-
tics of Dr. George E. West, the secretary of the board, will be found
suggestive: "The only notable increase of deaths during the present
year, as compared with the previous one, was due to the intense heat
of the first half of August, the deaths ascribed directly to this cause hav-
ing reached the unprecedented number of 333, of which 215 were re-
ported during the single week ending August 15th. In spite of the al-
most intolerable heat, the deaths from diarrhoeal diseases in infants di-
minished markedly in August, which fact is significant when it is re-
membered that the gratuitous distribution of sterilized milk was begun
at the end of July."

From more detailed statistics furnished by Dr. West it appears that
in the four weeks from June 30th to July 28th the deaths of infants un-
der two years of age from diarrhoeal diseases had been at the average
rate of 148 a week, rising in the third week of the month as high as 184
deaths. In spite of the "intolerable heat" of the first half of August, the
number of infant deaths fell in the first week of the distribution of steril-
ized milk to 82, and in the next to 86, and in the five and a half weeks
during which the distribution was kept up the weekly average of infant
deaths was reduced to 73, or less than half what it was in the cooler and,
for the last year at least, less fatal month of July. The results are no less
remarkable when the deaths of children under two from diarrhoeal dis-
eases are compared with the total number of deaths at all ages and from
all causes. Beginning with the last week of June, these infant deaths
accounted for twenty-two per cent, of the whole mortality of the city.
They were twenty-three per cent, in the first week of July, twenty-eight
per cent, in the second, twenty-seven per cent, in the third, and twenty-
one per cent, in the fourth. The percentage fell to eighteen with the
introduction of pasteurized milk in the first terrible two weeks of Au-
gust, dropped still lower, to thirteen per cent., in the second two weeks
of the month, and was eleven and twelve per cent, respectively in the
last two weeks in which the milk was distributed.

These figures are more eloquent than any words of mine can make
them. They show, I think, conclusively the very intimate connection
between the supply of a pure milk diet and the arrest of the process of
needless infant slaughter that is permitted to go on every summer in
every populous community of the land. When a few cases of cholera
find their way into one of our ports, there is a great outburst of public
excitement, and money is lavishly spent to ward oft the danger. Yet
there is eminent authority for the statement that there are more deaths
from the preventable diseases of children occurring each year in any
city in this country than the total number of deaths caused by Asiatic
cholera, in the same city, from the first visitation of Asiatic cholera to the
last — that is to say, during a period of sixty-four years. Hundreds of
thousands of dollars are readily spent to ward off a plague that hap-
pens to inspire people with terror; yet, here among the little ones is a
most deadly form of disease, numbering its victims all the year round,
but attaining in the summer months a degree of virulence unmatched by
any epidemic, for the most effective remedy to which not a dollar is,
so far as I know, appropriated by any city in the United States.

It is to draw attention to this anomaly, and to ask your co-opera-
tion in trying to remove it, that I have addressed this communication
to you. The fact that the appeal is made on behalf of humanity must be

my apology for troubling you with it. To the practical question of how
much it would cost to place pasteurized milk and its modifications at a
nominal price within the reach of those who in a given community need
it most, it is difficult to give a satisfactory answer. I have merely to
repeat what I said on this subject in a former communication to the
mayor of your city. I set out with the definite purpose of reducing the
infantile death rate of the city, and all considerations of expense were
held subordinate to that main object. In bringing the work to its pres-
ent state of development I have spent a good deal more money than I
should were it to be done over again in the light of acquired experience.
Then, the conditions of no two localities as to transportation, distribu-
tion and handling can be alike, and these figure largely in the element
of cost. While, therefore, I may safely profess to be able to speak with
authority as to the best processes of preparation, bottling, etc., I should
hesitate to give an opinion as to the number of bottles that could be
filled for a given expenditure.

The fact is that much good can be done by a very simple plant and
by the most modest expenditure. A more or less elaborate equipment
is, of course, necessary for doing the work on a large scale, but it is,
perhaps, better that this should be a growth from tentative efforts con-
fined within a limited area than that it should be adopted at the start. Any
person of moderate intelligence can become thoroughly familiar with the
methods and processes of my sterilized milk laboratory in less than a
week, and can readily apply the knowledge thus acquired to the duplica-
tion of its work on any scale that may be attempted. I shall be glad to
give any such person, duly accredited to me by you, free access to every
department of my now completed system of preparation and distribution,
and all possible data needed to guide him in adapting the work to dif-
ferent conditions. I know of no other way in which a satisfactory trial
of its benefits can be secured than by personal investigation and prep-
aration. Should there be a desire to make such a trial under your
auspices, I beg that you will consider all I am able to show of the prac-
tical working of the system entirely at the service of any one whom
you may be pleased to designate.

I think I have shown that, as a means to the saving of human lives,
there is no form of sanitary precaution comparable to the general use of
pasteurized milk for infant food. As I am addressing a body of men
who count every diminution of the death rate as the most convincing
demonstration of their usefulness, it should need no argument to con-
vince them that this is a legitimate field for them to occupy. It can
hardly be a fact indifferent to any of us who have the common instincts
of humanity that there should exist within reach of our efforts of pre-

vention a vast aggregate of constantly recurring suffering and death.
The tragedy of needless infant slaughter, desolating so many homes and
wringing so many hearts, lies like a dark shadow on our boasted civiliza-
tion. It is nothing more or less than permitted murder, for which the
responsibility must lie at the door of the agencies of government that
fail to recognize its existence and demand its prevention. The neces-
sity is too great to be adequately met by private effort. Nothing short
of an organization as broad as the area of milk consumption will meet
the case, and this only public authority can supply.

I have the honor to be, yours respectfully,

i^^^^ ^(^6^^^^^

The following letters may serve to support and illustrate the con-
clusions reached in the preceding communication :

Nathan Straus, Esq.

New York, June 7, 1895.

My Dear Sir: It gives me pleasure to express to you my appreciation of the
valuable services you have rendered this city by supplying to the infants and
sick children of its poor, at a nominal charge. Pasteurized milk and modified
Pasteurized Milk.

Before the existence of your milk depots, physicians practicing among the
very poor could never be sure that their little patients who were not breast-fed
were getting a clean and sterile food. Through your charity it is possible now
to be sure that they have a sterile food, and moreover that they are taking it
through a sterile nipple, since such a nipple is furnished with each bottle.

Your milk depots have undoubtedly saved many lives and a charity has been
established by you on a large scale which may prove an example for philanthrop-
ists in other cities to follow.

Believe me, very truly yours,
(Signed) ROWLAND G. FREEMAN, M. D.

HEALTH DEPARTMENT
OF THE CITY OF NEW YORK.
PRESIDENT'S OFFICE.

New York, January 22, 1897.

Charles G. Wilson, President and Commissioner.

Nathan Straus, Esq.:

Dear Sir — The distribution of sterilized milk to the poor through the depots
established and maintained by you for that purpose undoubtedly contributed
to the remarkably low death rate among children during the past summer. The
Medical Inspectors of this Department are unanimous in their testimony to the
usefulness of your charity to the preservation and promotion of the public
health, and the Summer Corps of physicians distributed among the poor over
7,000 of your tickets, entitling them to a supply of sterilized milk upon presen-
tation to your agents. The Board of Health greatly appreciates your charitable
efforts in this direction for the comfort, relief and help of the sick and desti-
tute, and hopes that you and others may continue this good work during the
present and the following years.

With great respect, Yours very truly,

(Signed) CHARLES G. WILSON, President.

DEPARTMENT OF HEALTH.

Commissioner's Office,

38 and 40 Clinton Street.

Z. Taylor Emery, M. D., Commissioner. Geo. E. West, M. D., Secretary.

R. M. Wyckoff, M. D., Dep'y Com'r. Albert R. Moore, Counsel.

Brooklyn, N. Y., January 25, 1897.
Hon. Nathan Straus,

Sixth Avenue, 13th to 14th Streets, New York City.
Dear Sir — I take pleasure in informing you that the experiment begun in
this city in the summer of 1896 of supplying sterilized milk to the sick children
of the poor has been markedly successful in lowering the death rate from diar-
rhoeal diseases in infants, and it is my intention to prosecute this good work
with vigor during the coming year.

Trusting that you will succeed in having this experiment repeated in otner
cities, I remain,

Yours respectfully,

(Signed) Z. TAYLOR EMERY, M. D.,

Commissioner of Health.

Mr. Nathan Straus,

New York City.

110 West 34th Street,

New York, June 5th, 1895.
Dear Sir: There is nothing so instructive as a success, and a single prac-
tical proof speaks louder than any number of volumes. By your sale of milk,
of sterilized milk, and of two varieties of simple infant food — both of them
based on scientific facts and proved by long observation to be reliable — you have
benefited large numbers in New York City, and presented an example for
greater imitation in other cities. It is true that it is impossible to statistically
count the lives saved by your timely interference; it is easy, however, to make
an estimate when one knows that the principal danger to health, and the great
mortality of infants and small children are the direct results of bad food, principally)
had or spoiled milk. Indeed, the dangers of the "second summer" mean nothing
else but bad food and consequent digestive disorders.

I trust you will be able to extend the blessings conferred by you still fur-
ther, not only over the city but outside also. I believe a call over your name
will suffice to arouse the humanitarian interest of practical philanthropists in
other large communities with the same salutary results obtained by you in New
York.

Very respectfully yours,

(Signed) A. JACOBI, M. D.

Received through a friend.

29 East 24th Street,

New York, September 12th, 1894.

Dear Sir — Having practiced medicine among the crowded tenements of the
East Side during the past fourteen years, and served as physician to the out-
patients of hospitals during that period, I have abundant opportunity to test the
practical efficiency of the various schemes for the amelioration of the condition
of the poor. Of these plans, the one put in operation by Mr. Nathan Straus for
providing sterilized milk for infants and children stands easily at the head.
Noble in its conception, its execution has been generous, and the benefits de-
rived therefrom immediate and striking.

In my opinion, and while not underrating the efforts of official and private
charities, Mr. Straus's philanthropy has been the direct cause of reducing infant
mortality during the recent hot season to a greater degree than that of all other
factors combined.

Respectfully yours,

(Signed) CHAS. E. NAMMACK, M. D.

THE INFLUENCE OF A PURE MILK SUPPLY ON
THE DEATH RATE OF CHILDREN.

PAPER READ BEFORE THE NATIONAL CONFERENCE OF MAYORS AND
COUNCILMEN AT COLUMBUS, O., SEPTEMBER 29, 1897.

' J ^MONG all the forms of waste in the world, there is none so
^^^m reckless as that of human life. In every great city in this
^ ^^JL^ country, the lives of thousands of children are sacrificed
every summer simply because they are fed with impure milk. The con-
ditions of a wholesome milk supply are not very complex, but they are
somewhat difficult of attainment. These conditions are healthy cows,
clean stables, careful processes of milking, and prompt transfer of the
milk in perfectly clean and close vessels from the cow to the consumer.
In the milk supply of all great cities every one of the requisites is
flagrantly violated. The inspection of cow stables to detect the presence
of disease is neither careful nor constant; milking is done in most cases
under conditions indescribably filthy, and most of the milk consumed
by the children of the poor is at least thirty-six or forty-eight hours old
before it reaches them.

It is hardly necessary to call your attention to the fact that the most
thorough systems of public inspection of milk are almost solely directed
to the detection of two abuses — skimming and adulteration with water —
and to cutting off the supply of one kind of diseased milk — that drawn
from tuberculous cows. The latter duty is usually performed by State
officers; the former is an exclusive municipal function. The public in-
spection of milk in the United States is thus directed mainly to the
prevention of fraud, and rarely, if ever, to the discovery of pollution.
Except as to the stamping out of tuberculosis, considerations affecting
the public health receive only incidental attention. As Prof. Sedgwick
said several years ago in regard to Boston, "public milk supplies may
not legally be watered, but they may be stale, or polluted, or infected.'*
May I be permitted to echo his query as to whether the time has not
come when we should be no longer satisfied with merely preventing the
cheating connected with lowering the nutritive qualities of milk, and
whether some systematic effort should not be made to restrain its in-
fluence in the propagation of disease? It is nonsense to argue that be-
cause healthy adults may drink polluted and stale milk without injury,
invalids and infants may do the same. Milk is the proper food of chil-

dren, but the milk with which they are fed is too often a fluid in which
the germs of disease and death have taken the place of nature's most
perfectly combined elements of nutrition.

I hold that there is practically no milk delivered for general con-
sumption in cities that is fit to be fed in its natural state to young chil-
dren. There is no system of tests, capable of general application, that
can alter this fact, and the tests in actual use do not touch it at all. No
plague by which a city was ever ravaged has yielded so plentiful a crop
of deaths as that which is reaped every Summer from the seeds of con-
tagion deposited in the infant system by millions of noxious bacteria
developed in milk. When this subject first engaged my attention I
found as to New York City the following state of facts: The recorded
births of the three years, 1890-92 were 135,602 ; allowing for the fact that
only five-sixths of the whole are believed to be reported to the Board
of Health, the actual number may be placed at 162,721. During the same
period the deaths of children under five years of age were 52,213, or
over thirty-two per cent, of the whole number of births. That one child
out of every three that were born should die before attaining the age of
five seemed to me like part of a system of permitted murder. The fur-
ther fact that from fifteen to eighteen per cent, of all these deaths
occurred in the five weeks between July 3 and August 6 indicated the
true source of the trouble. In 1891 the number of infant deaths in these
five weeks was 2,658; in 1892 it was 3,440, an increase of 782. Coming
down to the specific causes, it was found that diarrhoeal diseases ac-
counted for about half of all this infant mortality. In the five weeks in
question the deaths of children under five from this form of disease were
1,209 in 1891, and 1,617 in 1892.

Here was the evidence of a steadily increasing infant mortality in
the hottest season of the year, traceable to a cause usually associated
with the poisons bred in a cow's milk more abundantly at that season
than at others. It was not a violent assumption that much of this mor-
tality was preventable, and that the most direct and effectual method of
prevention was to place milk suited for infant nutriment within the reach
of the poorest. After making a thorough examination of the subject, and
taking counsel with physicians both at home and abroad, I began to
experiment in 1893 with one milk depot. More than a thousand sick
babies were fed on the pasteurized and modified milk preparations as to
whose necessity for infant food I found medical testimony absolutely
unanimous. Most of the children were ill with cholera infantum and the
benefit due to the improvement in their food was immediate and amaz-
ing. The system of pasteurization adopted was that prescribed by Dr.

Rowland G. Freeman of New York, by which the milk is exposed for
twenty minutes to a temperature of 167'' Fahrenheit. It has been demon-
strated that tubercle bacilli die at 158' Fahrenheit, when submitted to
that temperature for ten minutes. It is therefore reasonably certain that
by this process all noxious germs in the milk are completely destroyed,
while the nutritive qualities of the most perfect of nature's foods are not
in the slightest degree impaired. I had a special preparation for babies'
food made according to a formula supplied by Dr. Freeman. To this
I added another from a formula supplied by Dr. A. Jacobi, and both have
been sold in my depots ever since in six ounce bottles at a cent apiece.
In addition to these modified milk foods, barley flour has been sold.
This was intended to meet a want keenly felt by the poor, of wholesome
nutrition at a price within their means for children beyond the infant
stage of growth.

The first year's experience showed me that the indirect results of
my efforts were quite as valuable as those that could be directly traced
to them. The standard of quality of the milk supply of the poor had
been raised within the whole area adjoining my depot, the people being
quick to discern the superiority of an article furnished at a low price
over the more or less tainted and also more costly one they had been
accustomed to use. During the hot term, I also sold milk in its natural
state at a cent a glass, in booths which I was permitted to erect in the
public parks. The visiting physicians of the Board of Health and all
physicians doing charitable work among the poor have been, from the
beginning of my work, supplied by me with all the pasteurized and mod-
ified forms of milk which they required, free of expense. It has been
my effort from the first to have the milk sold at my depots so drawn,
handled, and transported as to reduce to a minimum the chances of
pollution. The milk is cooled thoroughly before shipment, kept cool in
the process of transportation, and on arrival at New York it is at once
taken to the main laboratory and placed on ice preparatory to being
turned into the bottles to go through the process of pasteurization. Be-
fore this, however, it is run through a separator for the purpose of free-
ing it from all mechanical impurities. It has been a rigidly observed rule
that, without respect to demand, no bottle of pasteurized milk should be
sold twenty-four hours after its preparation. Experience has taught my
staff not a little as to the details to be observed in the effort to secure the
most perfect results, but these are the main lines on which the business
has been conducted.

In 1894 preparations were made to supply natural, pasteurized and
modified milk on such a scale and at as many different depots as might

make a distinct impression on the milk supply of New York, and so
reduce the sum of its infant mortality. The character of the Summer
was well calculated to put the experiment to a severe test. The average
temperature of the latter part of June, of the whole of July, and of part
of August was unusually high, and much higher than that of the pre-
ceding year. For the first quarter of the year, the mortality of children
under five showed more than the proportionate increase which might be
expected from the increase of population, which was about three per
cent, per annum. There were 4,108 children's deaths in the first quarter
of 1894, or ten per cent, increase over the same period of 1893. For the
second quarter the deaths in 1893 numbered 4,386; and in 1894, 4,483.
As in the last quarter my milk depots were open, I was encouraged to
believe that this arrested increase might in part be due to their influence.
The mortality statistics for July and August confirmed me in this belief.
For July, 1893, the deaths of children under five numbered 2,796, while
for the same months of 1894 they were only 2,562. In August, 1893, they
numbered 1,686, declining in the same month of 1894 to 1,559. Thus,
instead of the increase of ten per cent, in the mortality of children with
which the year had started, the two most fatal months of the year showed
a decrease of 8.3 per cent. The deaths under five years for July and
August, which, had they followed the rate of increase established in the
first quarter of the year would have numbered 4,930, were only 4,111.
Here was an apparent saving of 819 lives in two months, or a decrease
of the toll levied by death on the children of New York of sixteen out
of every hundred.

The year 1895 was one of relatively high mortality in New York,
the death rate being 23.11 per thousand, against 22.76 per thousand in
1894. But it is a striking fact that while the total increase in the number
of deaths was 2,245, the increase in the deaths of children under five years
of age was only 663. As these latter accounted for 41.9 per cent, of the
total number of deaths, and for only 29.5 per cent, of the increase, the
evidence seems conclusive that decided progress had been made in the
saving of infant lives. In 1896, the death rate was 21.52 per thousand,
the number of deaths decreasing over the previous year by 1,798. Of this
decrease, 1,414, or over 78 per cent., were due to the reduced number of
deaths of children under five years of age. During the three months of
June, July and August, there was a decrease of 512 deaths of children
under five, as compared with the previous year. Still more striking has
been the decrease in the number of children's deaths in 1897. While for
the eight months ending in August the deaths under five were 12,734
for 1896, and 13,287 for 1895, they were only 10,962 for the present year.
For June, July and August, the deaths under five years of age numbered

5,041 this year, against 5,671 in 1896, a decrease of 630, or about 11 per
cent. The comparatively cool summer has had, of course, something to
do with this sudden fall in the infant death rate, and the improved sani-
tary conditions of the city must be accorded their fair share of credit.
But, as every physician knows, neither a slight fall in the average sum-
mer temperature nor cleaner streets and better regulated tenements will
greatly abate the prevalence of infant diarrhoea, if the feeding bottles
contain the germs of disease.

In point of fact, the decrease in the mortality of children in New
York, which has reached so satisfactory a stage this year, is merely part
of a continuous improvement which began in 1893, and which I believe
I am right in identifying with the placing of pasteurized milk food
within the reach of the children of the poor. The following table, com-
piled from the vital statistics of the Board of Health, will illustrate the
continuous process of improvement during the last four years. The pop-
ulation of children under five years of age is estimated at 11.37 per cent,
of the whole population of the city — a proportion which a careful com-
parison of successive census records fully bears out.

POPULATION, DEATHS AND DEATH RATE OF CHILDREN UNDER FIVE.

Death Rate Per Thou-

Year.

Population.

Deaths.

sand Per Annum.

1891

191,805

18,224

99.0

1892

196,485

18,684

95.1

1893

201,164

17,865

88.8

1894

205,843

17,558

85.3

1895

213,664

18,221

85.3

1896

219,905

16,807

76.5

Making the comparison between the first seven months of 1897
and the corresponding seven months of the five previous years brings
out the progress of this improvement still more strongly.

DEATHS AND DEATH RATES OF CHILDREN UNDER FIVE YEARS OF
AGE, FROM JANUARY TO JULY, INCLUSIVE, 1892-97.

Year 1892 1893 1894 1895 1896 1897

Deaths 12,877 11,290 11,553 11,347 10,902 9,447

Death Rate per thou-
sand per annum. . 113.4 96.6 96.0 90.8 84.8 71.4

A similar comparison of the deaths and death rates of children under
one year of age, of which the estimated population is equal to 2.8 per
cent of the total population of the city, shows with equal clearness the

continuous reduction in the rate of infant mortality, and demonstrates
even more convincingly the degree to which it is possible to arrest the
culpable and heedless sacrifice of infant life.

DEATHS AND DEATH RATES OF CHILDREN UNDER ONE YEAR OF
AGE, FROM JANUARY TO JULY, INCLUSIVE, 1892-97.

Year 1892 1893 1894 1895 1896 1897

Deaths 7,464 7,003 6,848 6,999 6,661 6,077

Death Rate per thousand

per annum 266.9 243.3 231.1 227.5 210.4 186.4

Confining the comparison to deaths from diarrhoeal diseases during
the two most fatal months of the year, July and August, we find the
following state of facts. For the three years 1890-92 the total number
of deaths from diarrhoeal diseases during the months of July and August
was 6,122 ; for the three years 1894-96 the total number during the same
two months was 5,262, showing a saving of 860 deaths in presence of an
increase of average population from 1,700,000 to 1,970,000.

The experience of Brooklyn is, if possible, more significant of the
value of the pasteurized milk foods as a preventive of infant disease and
death than that of New York. Ten years ago, Brooklyn had a decided
advantage over New York in the possession of a much lower rate of
infant mortality. This advantage became gradually less till it not only
disappeared but left New York apparently a more wholesome abode for
children than its twin city across the East River. In 1894 the proportion
of deaths of children under the age of five to the whole number of deaths
was 42.6 per cent, in New York and 43.6 per cent, in Brooklyn. The
disparity was not decreased in 1895, and with the opening of the Summer
of last year the Brooklyn Board of Health became still more impressed
with the tendency of children's deaths in New York to show a decrease
on those of previous years, while with them the tendency appeared to
be the other way. In searching around for reasons to explain the les-
sened infant mortality of New York, they concluded that it was mainly
due to the use of pasteurized milk nutriment. They, accordingly, applied
to me for help and advice. As the most practical way of answering their
appeal, I offered to supply theni, free of charge, a thousand bottles a day
of pasteurized milk and its modifications, leaving to them to provide the
machinery of distribution. In point of fact, in the thirty-eight days from
July 29th to September 4th, in which they distributed these milk foods,
they received in all 42,739 bottles from my New York laboratory.

The result is indicated in the report of the Board for 1896, as fol-
lows: "The milk was distributed in the various stations of the Diet
Dispensary, of which there are five in the city, and was supplied gratu-
itously to the poor on prescription, precedence being accorded to orders
emanating from members of the Summer corps, who used a special form.
Although this work was not begun until the end of July, and was ter-
minated on the 4th of September, upward of 40,000 bottles of pasteurized
milk were dispensed, with the result, as indicated by statistics, of sub-
stantially reducing the death rate from infantile diarrhoea." In the
same connection, the following sentences from the report on vital statis-
tics of Dr. George E. West, the secretary of the Board, will be found
suggestive: "The only notable increase of deaths during the present
year, as compared with the previous one, was due to the intense heat of
the first half of August, the deaths ascribed directly to this cause having
reached the wholly unprecedented number of 333, of which 215 were
reported during the single week ending August 15th. In spite of the
almost intolerable heat, the deaths from diarrhoeal disease in infants
diminished markedly in August, which fact is significant when it is re-
membered that the gratuitous distribution of sterilized milk was begun
at the end of July."

From more detailed statistics furnished by Dr. West it appears that
in the four weeks from June 30th to July 28th, the deaths of infants
under two years of age from diarrhoeal diseases had been at the average
rate of 148 a week, rising in the third week of the month as high as 184
deaths. In spite of the "intolerable heat" of the first half of August, the
number of infant deaths fell in the first week of distribution of pasteur-
ized milk to 82, and in the next to 86, and in the five and a half weeks
during which the distribution was kept up, the weekly average of infant
deaths was reduced to 73, or less than half what it was in the cooler
and, for the last year at least, less fatal month of July. The results are
no less remarkable when the deaths of children under two from diarrhoeal
diseases are compared with the total number of deaths at all ages and
from all causes. Beginning with the last week of June, these infant
deaths accounted for twenty-two per cent, of the whole mortality of the
city. They were twenty-three per cent, in the first week of July, twenty-
eight per cent, in the second, twenty-seven per cent, in the third, and
twenty-one per cent, in the fourth. The percentage fell to eighteen with
the introduction of pasteurized milk in the terrible first two weeks of
August, dropped still lower, to thirteen per cent, in the second two weeks
of the month, and was eleven and twelve per cent, respectively in the
last two weeks in which the milk was distributed.

The following letter sufficiently describes the experience of Brooklyn
with the distribution of pasteurized milk food during the present year.
The work was done entirely under the supervision of the Board of
Health, the money to purchase the raw milk having been furnished by
private subscription, and the plant and steam for pasteurization being
provided in premises owned by the city.

DEPARTMENT OF HEALTH.
COMMISSIONER'S OFFICE,

38 and 40 Clinton St.
Z. Taylor Emery, M. D., Commissioner. Geo. E. West, M. D., Secretary.

R. M. Wyckoff, M. D., Dep'y Com'r. Albert R. Moore, Counsel.

Brooklyn, N. Y., September 20, 1897.
Hon. Nathan Straus.

Dear Sir: — In reply to your request for statistics demonstrating the utility
of pasteurized milk tor the purpose of diminishing deaths from diarrhoeal dis-
eases, I take pleasure in supplying you with the following table, which, it seems
to me, is quite eloquent:

DEATHS FROM DIARRHOEAL DISEASES, CHILDREN UNDER TWO

YEARS OF AGE, FOR 38 WEEKS.

Rate

Year.

Population.

Deaths.

Per 100,000.

1890 ,

854,000

1,331

156

1891

890,000

1,320

148

1892

928,000

1,512

163

1893

973,000

1,492

153

1894

1,045,000

1,382

132

1895

1,100,000

1,507

137

1896

1,125,000

1,338

119

1897

1,160,000

1,170

101

As the use of pasteurized milk is confined principally to infants under two
years of age, I have used the number of deaths from diarrhoeal diseases of those
infants as a basis of comparison. Further, as only thirty-eight weeks of the
present year have expired, I have confined myself for purpose of comparison
to the first thirty-eight weeks of each of the other years, which period prac-
tically covers the season during which diarrhoeal diseases occur in large num-
bers. The last column of my table is obtained by dividing the number of deaths
from diarrhoeal diseases of children under two years, as shown in the third
column, by the estimated population of the city for the corresponding year,
which I consider the fairest basis of comparison possible.

The experiment of using pasteurized milk was begun in this city about the
middle of the summer of 1896, and was followed up during the present summer
more vigorously and commenced at an earlier date.

Trusting that you will find the table of service to you, I remain,

Yours respectfully,

GEO. E. WEST, M. D.,

Secretary.

I have always maintained that from the work in which I have been
engaged the most satisfactory results at the lowest average cost could
be secured in a city of moderate size. This conclusion is amply borne

out by the testimony of Dr. S. E. Getty in regard to the effect on infant
mortality of pasteurized milk distribution in Yonkers. This is a city
having a population of 38,000, situated just across the northern boundary
of New York. It has a large tenement population composed of people
of many nationalities — Hungarians, Irish, Russian Jews and Italians —
all ignorant of the first rudiments of the proper care and feeding of
infants. Here the work of preparing and dispensing pasteurized milk
foods was begun, on the lines previously laid down in my New York
dispensary, at St. John's Riverside Hospital in July, 1894. The first
season's work was mainly experimental, and according to the testimony
of Dr. Getty the milk furnished by local dairymen both in 1894 and 1895
left a good deal to be desired. Those in charge of the work realized the
necessity of controlling a dairy where every effort would be made to
produce pure milk, drawn from healthy and properly fed and groomed
cows. So much of the success of the work depending upon a pure milk
being obtained at the source of the supply, it was decided before the
opening of the season of 1896 to obtain entire control of a dairy. As a
sample of the precautions which a medical expert regards as essential to
a perfect milk service for children, the following statement of Dr. Getty
is worth quoting:

"The cows selected were a cross between Holsteins and natives, and
Guernseys and natives, and they were all given the tuberculin test and
found to be free from tuberculosis. The stables were critically examined
in regard to light, air-space and drainage, and found to be models of
their kind, and were kept in a perfectly hygienic manner. The water
used by the cows for drinking purposes, also that used for washing the
milk pails and cans, was analyzed and proved satisfactory. The pastures
were gone over carefully to detect noxious weeds. The greatest care
was taken at milking time to keep the milk free from dust and dirt;
before each milking the cows were groomed and the udders thoroughly
wiped, and after this duty was performed the milkers washed their hands
and put on their milking suits. After being drawn, the milk was rapidly
cooled, and all care taken to keep it cool and free from contamination
until ready for shipment. Only the afternoon's milk was sent to us.
The one thing feared was the railroad journey at night of one hour in the
refrigerator car, but no ill effects were discovered from it. The train
was met on its arrival by the dispensary wagon and, after a short drive,
the milk was immediately transferred to a refrigerator. Pasteurization
began at 5 A. M. and at that time the milk was thirteen hours old."

In the four Summer months of 1895, 64,000 six and eight-ounce
bottles were dispensed in Yonkers, and in the season of 1896 the number

was increased to 78,300 bottles. Owing to the limited size of the town
the effects could be closely observed and the individual cases carefully
studied. A study of the vital statistics of the city reveals the fact that
the average number of deaths of children under five in the months of
June, July, August and September in the years 1892, 1893, 1894 and 1895
was 162. In the same period in 1896 the number was 135, a decrease of
27 deaths, or seventeen per cent. The average number of deaths for
the four years from digestive troubles was 91, while in 1896 the number
was only 48, a decrease of 43 deaths, or forty-seven per cent. The in-
crease of population in Yonkers from 1880 to 1890 was seventy per cent.,
and there is every reason to believe that the same ratio has been main-
tained since 1890. The other causes of death among children show an
increase of thirty-seven per cent, and the number of deaths among
persons over five years of age shows an increase of twenty-two per cent.
These increased percentages would represent about the increase of popu-
lation in five years, so that not only is there apparently traceable to the
use of pasteurized milk foods an arrest of the ordinary increase of
mortality among children, but there has been established a positive de-
crease in face of a rapidly growing population. Confining the comparison
to digestive troubles alone, there has manifestly been a saving of forty-
three lives in the short space of three months in a town of less than
40,000 people. It is the testimony of Dr. Getty that there has been no
material change in either the hygienic condition or the milk supply of
Yonkers during the summer of 1896 as compared with that of previous
summers.

By way of bringing out more clearly the significance of the reduced
death rate in Yonkers, the statistics of the neighboring cities of Hobo-
ken, Long Island City, and Newburgh have been tabulated by Dr.
Getty. The following is a summary of the tabulation:

1 — Hoboken. The average number of deaths among children under
five for the four summer months of the years 1892, 1893, 1894 and 1895,
was 289. In the same period in 1896 the number reached 352, an increase
of twenty-two per cent. The number of children dying from digestive
troubles averaged 104; in 1896 the number was 110, an increase of 5.8
per cent.

2 — Long Island City for the same period shows an average of 225
deaths among children under five; in 1896 the number was 257, an in-
crease of 32, or fourteen per cent. The deaths from digestive troubles
averaged 90, while in 1896 they reached 115, an increase of 28 per cent.

3 — Newburgh for the same period shows an average of 75 deaths
among children under five; in 1896 the number was 72, a decrease of
four per cent. The deaths from digestive troubles averaged 30 ; in 1896
they numbered 43, an increase of forty-three per cent. It should be
noticed that Newburgh has 12,000 less of population than Yonkers, and
that the milk supply is excellent, as it is the largest town in a noted
dairy county, and the milk is brought in fresh twice a day in farmers'
wagons.

In these three cities the average number of deaths among children
was 589 from 1892 to 1895, while in 1896 the number was 681, an in-
crease of 92 deaths, or fifteen per cent. The deaths from digestive
troubles averaged 224; in 1896 the number reached was 268, an increase
of 44 deaths or twenty per cent. This increase of twenty per cent, is
about equivalent to the normal increase due to the growth of the cities;
while in Yonkers, with a rapidly expanding population, there is a de-
crease of seventeen per cent, in deaths among children, and a decrease
of forty-seven per cent, from digestive troubles, more than offsetting the
increased percentage of other causes of death under five years of age.
As Dr. Getty puts it, "there is no need for further argument — these
figures speak for themselves."

I think I have fairly demonstrated the proposition that many thou-
sands of infant lives are annually sacrificed by the neglect to supply for
the nutriment of children milk which has been subjected to the process
of pasteurization. I hold that neglect to be criminal, and I leave it to
you to fix the responsibility for it. We punish murder with the penalty
of death, and yet we allow murder to be committed by the wholesale in
every populous community of this land, with no thought of its punish-
ment, and little thought of its prevention. I have advocated these ideas
for years, though I am free to say that I have found nowhere less atten-
tion paid to them on the part of pubUc authorities than in the City of
New York, where I have done most to prove the sincerity of my belief
in them. There is no reform which has not to encounter obstacles, some-
times from the ignorance or indifference of the people for whose benefit
it is intended, and sometimes from the narrow selfishness of those who
regard it as an interference with their opportunities for making money.
But the most exasperating of all forms of opposition to public well-doing
is that which comes from those who pervert the trust of public office to
the satisfaction of a personal grudge, or the pursuit of a temporary par-
tisan advantage. I have had enough experience of this in New York
to force me to the conclusion that the man who sets himself to the task
of doing good must be schooled into indifference against the shafts of
obloquy and misrepresentation.

The work which I have outlined is legitimately public work, and to
do it on a scale fully commensurate with the wants of a community like
that of New York transcends the ability of any one individual who has
not very great wealth at his disposal. I may add that no organization
sustained by combined individual liberality could do it so well as that
branch of the municipal government which is charged with the care of
the city's health. The fact that some sinister caprice has moved the
New York Board of Health to attempt to embarrass and discredit my
work does not alter the fact that it is to them that the duty of taking
up and carrying out this work belongs. A similar obligation rests on
every municipal Board of Health in the country, and I am happy to
say that all of them with which I have communicated, outside of New
York, frankly recognize this fact. I regard it as more than sufficient
reward for all the trouble which this work has brought me that it has
not only been instrumental in saving many lives but has directed wide-
spread attention to a necessity which has been too long neglected, and
has commanded that most sincere of all forms of praise — imitation.

I appeal to you gentlemen who are charged with the responsibilities
attending the government of cities, great or small, to study the conditions
under which this work is done, and carefully note the results which at-
tend the doing of it. I appeal to you as if you were standing beside a great
river in whose current were constantly swept past hundreds of drown-
ing infants. This stream is a very real thing if people would but recog-
nize its existence, and all its yearly tribute of death is paid because of
the public neglect of some of the simplest precautions for the saving of
children's lives. You, gentlemen, have the means under your control by
which these drowning babies can be saved. I ask you. Will you not apply
them? Men are found capable of acts of heroism in presence of danger
less threatening and less surely fatal. All that I plead for is the exten-
sion of the activity of local boards of health into a sphere which is legit-
imately theirs, but which they have, so far, lacked the conviction and the
courage to occupy. I shall not have spoken in vain if I have succeeded
in impressing you with the fact that the dictates of humanity and of
public duty combine in demanding that this backwardness should exist
no longer.

NATHAN STRAUS Sixth Avenue and Fourteenth Street,

New York, November 15, 1900.

WHY THE DISTRIBUTION OF PASTEURIZED

(STERILIZED) MILK SHOULD BE

A FUNCTION OF EVERY

MUNICIPALITY.

OUR schools and universities are the finest in the world. We spend
millions of dollars annually to prevent intellectual incapacity.
Why not treat physical ailments in the same manner?

Prevent them.

Prevent helpless infants developing from a puny, sickly childhood
into a diseased, v^^eakened and helpless manhood and womanhood, and
save, in so far as possible (and a great deal is possible), the enormous
sum paid annually for the maintenance of hospitals and like institutions.

Since it is one of the functions of our government to provide means
of curing disease, why is it not within its province to furnish the agents
of its prevention?

Milk is the one article of food in which disease and death may lurk
without giving any suspicion from its taste, smell or appearance.

If the Pasteurizing of the entire milk supply were made the function
of the municipality, it would be an exceedingly clever business invest-
ment, for the money expended would be returned a hundred fold. This is
looking at it from a practical, commercial standpoint, besides which, from
a humanitarian point of view, the amount of suffering and disease which
would be prevented is incalculable.

"It is estimated that one-third of the children die before they are three years
"old, and one of the leading causes of infant mortality is impure milk."

U. S. DEPARTMENT OF AGRICULTURE.

"Numerous outbreaks of typhoid fever have been reported where there was
"no doubt about the milk supply being the carrier of the germs. Outbreaks of
"diphtheria have been traced to milk from farms where diphtheria has been
"known to exist in the families of the attendants. The same is reported of
"scarlet fever and cholera. Pasteurization or sterilization of milk is the only
"safeguard against such dangerous diseases, as this process destroys all the
"disease germs."

U. S. DEPARTMENT OF AGRICULTURE.

Thousands of infants' lives are needlessly sacrificed annually by
impure milk. No system of milk test or examination now in operation
or capable of being generally applied is sufficient to protect the lives of

young children against the noxious germs present in a large portion of
the milk delivered in its natural state in cities.

Dr. Shakespeare, of Philadelphia, an eminent authority, states that
nearly, if not quite, one-half the deaths in cities in this country are due
to that class of diseases which are known to be preventable. Chief
among these preventable diseases are the diarrhoeal disturbances of
young children, and the prime agent in the production of these is im-
pure milk.

This state of affairs was brought to my attention in 1892. After
making a thorough examination of the subject and taking counsel with
physicians at home and some who were accepted as authorities in
Europe, I began to experiment as to what could be done to bring ab-
solutely pure milk, and milk fitted for infant consumption, within the
reach of those who needed it, particularly the poor. I found medical
testimony absolutely unanimous as to the requirement of perfect steri-
lization (Pasteurization) for all milk intended for food in cities. I ac-
cordingly established a sterilizing laboratory, and began the dispensing
of pure milk, both in its natural and sterilized form, from one booth in
one of the most thickly populated districts of this City. The system of
sterilization adopted was that of Dr. Rowland G. Freeman, of New
York. This system combines the preservation of the nutritive qualities
of the milk and the complete destruction of all noxious germs.

This work was begun in 1892, when 34,400 bottles were distributed,
and each succeeding year enlarged and widened in scope, until the
present year, up to date, 596,677 bottles have been dispensed and 812,921
glasses of milk drunk on the premises. Its results can be more elo-
quently told by the statistics of the Health Department than by any
words in my vocabulary. The following table gives the population,
deaths and death rate of children under five years of age, and shows that
the death rate per thousand was gradually decreased from 96.5 in 1891
to 62.8 in the year just passed.

POPULATION, DEATHS AND DEATH RATE OF CHILDREN UNDER FIVE.

Death Rate

Year.

Population.

Deaths.

Per Thousand
Per Annum.

1891

188,703

18,224

96.5

1892

194,214

18,684

96.2

1893

199,886

17,865

89.3

1894

205,723

17,558

85.3

1895

212,983

18,221

85.5

1896

216,728

16,807

77.5

1897

220,641

15,395

69.7

1898

224,736

15,591

69.4

1899

229,029

14,391

62.8

Statistics of the deaths and death rate for the three hottest months
of the year, June, July and August, when the peril to child life is greatest,
and, consequently, the distribution of sterilized milk the largest, demon-
strate more convincingly to what degree the culpable sacrifice of infant
life may be arrested.

DEATHS AND DEATH RATE OF CHILDREN UNDER FIVE YEARS OF
AGE FOR THE MONTHS OF JUNE, JULY AND AUGUST.

Sfear.

Population.

Deaths.

Death Rate,

1891

188,703

5,945

126.0

1892

194,214

6,612

136.1

1893

199,886

5,892

117.9

1894

205,723

5,788

112.6

1895

212,983

6,183

116.1

1896

216,728

5,671

104.7

1897

220,641

5,401

91.3

1898

224,736

5,047

89.8

1899

229,029

4,689

81.8

1900

233,537

4,562

78.1

The rate of infant mortality is here shown to have continuously de-
creased since the establishment of the Pasteurized (sterilized) milk
booths from 136.1, in 1893, to 78.1, in the present year. These cold fig-
ures are fluent and powerful evidence of the beneficence of this work of
placing Pasteurized (sterilized) milk within the reach of every poor
family in Manhattan, and of its efficacy in routing the forces of disease
and death.

Confining the comparison to deaths from diarrhoeal diseases during
the two most fatal months of the year, July and August, we find the
following state of aff^airs: For the three years 1890-1892 the total num-
ber of deaths from diarrhoeal diseases during the months of July and
August was 6,122; for the three years 1894-1896 the total number dur-
ing the same two months was 5,262, showing a saving of 860 deaths in
the presence of an increase of average population from 1,700,000 to 1,-
970,000 ; for the three years 1897-1899 the total number during the same
two months was 4,050, showing a still further saving of 1,212, with a
still greater population.

As a mere hint of what might be accomplished by municipal owner-
ship and municipal operation of plants for the Pasteurization of the milk
supply of cities, the results of the establishment of a plant in the Infant
Asylum at Randall's Island, New York City, may be quoted:

In 1897 the death rate amongst the waifs picked up in the streets of
New York and taken to this hospital was 44.36, a rate so high as to be-
come a matter of grave concern to those in charge. I asked permission

to supply the Asylum with all the Pasteurized milk they required. This
offer was declined, and the appalling death rate continued. Finally, in
1898, I secured permission from President John W. Keller, of the De-
partment of Charities, to install in this asylum a complete plant for the
Pasteurization of milk foods. The following statistics, furnished by the
Department of Charities, show the result of the first attempt at munici-
pal proprietorship and operation of a milk Pasteurizing plant:

1895 Children treated 1216

Deaths 511

42.02%

1896 Children treated 1212

Deaths 474

39.11%

1897 Children treated 1181

Deaths 524

44.36%

The Pasteurizing plant was installed in the early part of 1898, and
the death rate immediately dropped as follows:

1898 Children treated 1284

Deaths 255

19.80%

1899 Children treated 1097

Deaths 269

24.52%

What may we call this heedless, needless, sacrifice of infant life?
In the face of these facts, is it too strong to call it MURDER, PER-
MITTED MURDER? When the news of a railroad wreck and accom-
panying loss of life is telegraphed across the continent, it is followed
by a shudder of horror, and if any life-saving precautions have been
lacking there is raised a cry of vengeance against the "soulless" cor-
poration, whose duty it is to provide every safeguard for life. But what
of the thousands of infants whose lives pay the penalty of lack of pre-
caution? No shudder of horror passes over the land; no cry for reform
is raised, yet just as surel]^ as the proper precaution would have prevented that
railroad catastrophe, just so surely would the lives of the thousands of these help-
less infants be saved did our municipal authorities adopt the preventive measures
here shown to he effective.

INFANTS' MILK DEPOTS.

PAPER OF NATHAN STRAUS, OF NEW YORK, READ BEFORE THE

BRITISH MEDICAL ASSOCIATION AT ITS ANNUAL MEETING,

JULY 24th TO 28th, 1905, AT LEICESTER, ENGLAND.

/-^* "^ HE conditions of a wholesome milk supply, though sufficiently
A ^^ simple, are extremely difficult of attainment. These condi-
^^^ tions are: healthy cows, clean stables, careful processes of
milking, and prompt transfer of the milk in perfectly clean and close
vessels from the cows to the consumer. When I first became interested
in this subject, thirteen years ago, I found all of these requisites fla-
grantly violated in the milk supply of the great cities of this country.
The inspection of cow stables to detect the presence of disease was
neither careful nor constant; milking was done, in most cases, under
conditions indescribably filthy, and most of the milk served to families
was from 36 to 48 hours old before it reached them. The systems of
milk inspection which were then adopted were directed almost solely to
the detection of two abuses — skimming and adulteration with water, and
to cutting off the supply of one kind of diseased milk, that drawn from
tuberculous cows. The latter duty has usually been performed by State
officers; the former is an exclusively municipal function. The public
inspection of milk in the United States was thus, up to a recent date,
directed mainly to the prevention of fraud, and rarely, if ever, to the
discovery of pollution. Except as to the stamping out of tuberculosis,
considerations affecting the public health received only incidental atten-
tion. As Professor Sedgwick said, some twelve years ago, in regard to
Boston, "public milk supplies may not legally be watered, but they may
be stale, or polluted, or infected."

It appeared to me, as it had to previous investigators in this
field, that the time had come when we should be no longer satisfied with
merely preventing the cheating connected with lowering the nutritive
quality of milk, and that some systematic effort should be made to
restrain its influence in the propagation of disease. It needed no expert
knowledge to recognize the fact that polluted or stale milk carried with
it the seeds of disease and death. While we have in pure, sound milk
nature's most perfectly combined elements of nutrition, I found that
there was practically no milk delivered for general consumption in Amer-

ican cities that was fit to be used in its natural state. It needed but
little reflection to be impressed with the fact that no plague by which
a city was ever ravaged had yielded so plentiful a crop of deaths as that
which is reaped every year from the seeds of contagion deposited in the
infant system by millions of noxious bacteria developed in milk.

When this subject first engaged my attention, I found as to New
York City (forming the present boroughs of Manhattan and the Bronx
in the greater city) the following state of facts : The recorded births of
the three years 1890-92 were 135,602; allowing for the fact that only
five-sixths of the actual number are believed to be reported to the Board
of Health, the real total may be placed at 162,721. During the same
period, the deaths of children under five years of age were 52,213, or over
thirty-two per cent, of the whole number of births. That one child out
of every three that were born should die before attaining the age of five
seemed to me like part of a system of permitted murder. The further
fact that from fifteen to eighteen per cent, of all of these deaths occurred
in the five weeks between July 3d and August 6th indicated the true
source of the trouble. In 1891, the number of infant deaths in these five
weeks was 2,658 ; in 1892 it was 3,440, an increase of 782. Coming down
to the specific causes, it was found that diarrhoeal diseases accounted
for about half of all this infant mortality. In the five weeks in question,
the deaths of children under five from this group of diseases was 1,209
in 1891, and 1,617 in 1892.

Here was the evidence of a steadily increasing infant mortality in the
hottest season of the year, traceable to a cause usually associated with
the poisons bred in cow's milk more abundantly at that season than at
others. It was not a violent assumption that much of this mortality
was preventable, and that the most direct and effectual method of pre-
vention was to place milk suited for infant nutriment within reach of the
poorest. After making a thorough examination of the subject, and taking
counsel with physicians both at home and abroad, I began to experiment
in 1893 with one milk depot. More than a thousand sick babies were
fed on the Pasteurized and modified milk preparations, as to whose
necessity for infant food I found medical testimony practically unani-
mous. Most of the children were ill with cholera infantum, and the
benefit due to the improvement in their food was immediate and amaz-
ing. The system of Pasteurization adopted was that prescribed by Dr.
Rowland G. Freeman, of New York, by which the milk was exposed for
twenty minutes to a temperature of 167° Fahrenheit. It has been demon-
strated that tubercle bacilli die at 158° Fahrenheit, when submitted to
that temperature for ten minutes. It is therefore reasonably certain
that by this process all noxious germs in the milk are completely de-

stroyed, while the nutritive qualities of the most perfect of nature's foods
are not sensibly impaired. I had a special preparation for babies' food
made according to a formula supplied by Dr. Freeman. To this I added
another from a formula supplied by Dr. A. Jacobi, and both have been
sold in my depots ever since, as follows, at a uniform price of five cents :

5 — 6 oz. bottles Formula No. 1, or

5—6 oz. " " No. 2;

8—3 oz. " " No. 3, or

8—3 oz. " " No. 4, or

2 — 16 oz. bottles Pasteurized Unmodified Milk.

In addition to these modified milk foods, barley flour has been sold.
This was intended to meet a want keenly felt by the poor of wholesome
nutrition at a price within their means for children beyond the infant
state of growth.

It has been my effort, from the first, to have the milk sold at my
depots so drawn, handled and transported as to reduce to a minimum
the chances of pollution. The milk is cooled thoroughly before shipment ;
kept cool in the process of transportation ; and, on arrival at New York,
is at once taken to the main laboratory and placed on ice, preparatory to
being turned into the bottles to go through the process of Pasteurization.
Before this, however, it is run through a separator for the purpose of
freeing it from all mechanical impurities. It has been a rigidly observed
rule that, without respect to demand, no bottle of Pasteurized milk
should be sold twenty-four hours after its preparation. Experience has
taught my staff not a little as to the details to be observed in the effort
to secure the most perfect results, but these are the main lines on which
the work has been conducted.

In 1894, preparations were made to supply natural. Pasteurized, and
modified milk on such a scale and at so many different depots as might
make a perceptible impression on the milk supply of New York, and so
reduce the sum of its infant mortality. The character of the Summer
was well calculated to put the experiment to a severe test. The average

temperature of the latter part of June, of the whole of July, and of part
of August was unusually high, and much higher than that of the preced-
ing year. For the first quarter of the year, the mortality of children
under five showed more than the proportional increase which might be
expected from the increase of population, the ratio of which was about
three per cent, per annum. There were 4,108 children's deaths in the
first quarter of 1894, or ten per cent, increase over the same period of

1893. For the second quarter, the deaths in 1893 numbered 4,386, and
in 1894, 4,483. As in the second quarter my milk depots were open, I
was encouraged to believe that this arrested increase might in part be
due to their influence. The mortality statistics for July and August con-
firmed me in this belief. For July, 1893, the deaths of children under
five numbered 2,796, while for the same month of 1894 they were only
2,562. In August, 1893, they numbered 1,686, declining in the same
month of 1894 to 1,559. Thus, instead of the increase of ten per cent,
in the mortality of children with which the year had started, the two
most fatal months of the year showed a decrease of 8.3 per cent. The
deaths under five years for July and August, which, had they followed
the rate of increase established during the first quarter of the year would
have numbered 4,930, were only 4,111. Here was an apparent saving of
819 lives in two months, or a decrease of the toll levied by death on the
children of New York of sixteen out of every hundred.

The year 1895 was one of relatively high mortality in New York,
the death rate being 23.11 per thousand, against 22.76 per thousand in

1894. But it is a striking fact that while the total increase in the number
of deaths was 2,245, the increase in the deaths of children under five
years of age was only 663. As these latter accounted for 41.9 per cent,
of the total number of deaths, and for only 29.5 per cent, of the increase,
the evidence seemed conclusive that decided progress had been made in
the saving of infant lives. In 1896, the death rate was 21.52 per thou-
sand, the number of deaths decreasing as compared with the previous
year by 1,798. Of this decrease, 1,414, or over 78 per cent., was due to
the reduced number of deaths of children under five years of age. Dur-
ing the three months of June, July and August, there was a decrease of
512 deaths of children under five, as compared with the previous year.
Still more striking was the decrease in the number of children's deaths
in 1897 ; while for the eight months ending August, the deaths under five
were 12,734 for 1896, and 13,287 for 1895, they were only 10,962 for 1897.
For June, July and August, the deaths under five years of age numbered
5,041 in 1897, against 5,671 in 1896, a decrease of 630, or about 11 per
cent. A comparatively cool summer had something to do with this sud-
den fall in the infant death rate, and to the improved sanitary conditions

of the city must be accorded their fair share of credit, but, as every
physician knows, neither a slight fall in the average summer temperature
nor cleaner streets and better regulated tenements will greatly abate the
prevalence of infant diarrhoea, if the feeding bottles contain the germs
of disease.

The following table shows that even the comparatively low level of
infant mortality reached in 1897 has been considerably improved on in
more recent years :

POPULATION, DEATHS AND DEATH RATE OF CHILDREN UNDER FIVE.

Year.

Population.

Deaths.

Death Rate per th(
sand per annum.

1891

188,703

18,224

96.5

1892

194,214

18,684

96.2

1893

199,885

17,865

89.3

1894

205,723

17,558

85.3

1895

212,983

18,221

85.5

1896

218,544

16,907

76.9

1897

222,387

15,395

69.2

1898

226,515

15,591

68.8

1899

230,842

14,391

62.3

1900

235,386

15,648

66.5

1901

240,166

14,809

61.6

1902

245,201

15,019

61.2

1903

250,518

14,402

54.8

1904

256,137

16,137

63.0

Assuming, as I think I have some right to do, that the steady de-
crease above indicated in the infant mortality of New York during the
last eleven years has been closely related to the work of my milk depots,
it is instructive to note that, while in 1893, the year before my service
was on a sufficiently large scale to be a recognizable element in the milk
supply of New York, the death rate of children under five was 89.3 per
thousand, it had been reduced by 1897 to 69.2 per thousand. The re-
duction continued somewhat irregularly since that year and reached its
lowest figure in 1903, when the rate fell to 54.8 per thousand. But per-
haps the most impressive demonstration of the saving of infant lives
which has been effected in New York since the beginning of my work
is to be found in the fact that while the average mortality among chil-
dren under five for the quinquennial period 1891-5 was 90.6 per thousand
per annum, the rate for the five years 1900-4 was 61.2 per thousand — a
reduction of 32.4 per cent, or, to put the case in another way, the in-
crease in the infant population of the city, on the average of the two
periods compared, was 22^^ per cent., but while the annual average of

deaths in this population in the five years 1891-5 was 18,110, it was only
15,203 in the five years 1900-4. Obviously had the ratio of deaths to
population in the first quinquennial period represented the mortality of
the last one, we should have had an average of 22,185 infant deaths per
annum, so that the saving of infant lives effected in the ten years during
which my infant's milk depots have been fully equipped and organized
is not less than 6,982 per annum. By pushing the comparison back to a
period antedating any effort to improve the milk supply of New York,
a still more striking saving of life could be shown. There has, of course,
been a continuous improvement in the sanitary conditions of the city
during the period under review, but I think I am right in the assumption
that these are insufficient to account for the results I have summarized
in the absence of any successful effort to place Pasteurized milk food
within reach of the children of the poor.

This assumption becomes invested with a certainty of a demon-
stration when the following table is examined of the infant deaths and
death rate for the three hottest months of the year, June, July and
August, when the peril to child life is greatest and the distribution of
Pasteurized milk has been on the largest scale.

DEATHS AND DEATH RATE OF CHILDREN UNDER FIVE YEARS OF AGE.

FOR THE MONTHS OF JUNE, JULY AND AUGUST.

Year.

Population.

Deaths.

Death Rate,

1891

188,703

5,945

126.0

1892

194,214

6,612

136.1

1893

199,886

5,892

117.0

1894

205,723

5,788

112.6

1895

212,983

6,183

116.1

1896

218,544

5,671

103.8

1897

222,387

5,401

90.7

1898

226,515

5,047

89.1

1899

230.842

4,689

81.2

1900

235,386

4,562

77.5

1901

240,166

4,642

77.3

1902

245,201

4,389

71.6

1903

250,518

4,037

64.5

1904

256,137

4,805

74.5

It will be perceived that in the year before I began the systematic
prosecution of my work, the infant death rate for the summer quarter
reached the appalling figure of 136.1 per thousand of the population
under five years of age. Last year the ratio was reduced to 74.5 per
thousand. In other words, had the infant mortality of the same quarter
of 1892 been reproduced, relatively to the population, in 1904, the num-

ber of deaths would have been 8,725, instead of 4,805. I do not think
it is a hasty induction from the facts to claim that the most important
element in the saving of these 3,920 infant lives has been the improve-
ment of the character of the milk food supplied to the children of the
New York poor.

An interesting and very convincing illustration, on a small scale,
of the good results attending the Pasteurization of milk food for children
is furnished by the history of the establishment of a plant in the Infant
Asylum at Randall's Island, New York.

In 1897 the death rate amongst the waifs picked up in the streets of
New York and taken to the hospital of this institution was 44.36 per
cent., a rate so high as to become a matter of grave concern to those in
charge. I asked permission to supply the Asylum with all the Pas-
teurized milk they required. This offer was declined and the appalling
death rate continued. Finally, in 1898, I secured permission from Presi-
dent John W. Keller, of the Department of Charities, to install in this
Asylum a complete plant for the Pasteurization of milk foods. For the
three years preceding this installation, the ratio of deaths to the number
of children under treatment was as follows :

1895 Children treated: 1,216

Deaths : 511

42.02 per cent.

1896 Children treated: 1,212

Deaths: 474

39.11 per cent.

1897 Children treated: 1,181

Deaths : 524

44.36 per cent.

The Pasteurizing plant was installed in the early part of 1898, and
the death rate immediately dropped as follows:

1898 Children treated: 1,284

Deaths: 255

19.80 per cent.

1899 Children treated: 1,097

Deaths : 269

24.52 per cent.

1900 Children treated: 1,084

Deaths : 300

27.68 per cent.

1901 Children treated: 1,028

Deaths : 186

18.09 per cent.

1902 Children treated; 820

Deaths : 181

22.07 per cent.

1903 Children treated: 542

Deaths : 101

18.63 per cent.

1904 Children treated: 345

Deaths : 57

16.52 per cent.

In short, had the same ratio of deaths to the number of children
treated been maintained in this institution during the last seven years
which was established during the preceding three years, the number of
deaths would have been 2,604 instead of 1,349. It would be difficult to
find a more impressive demonstration of the value of the use of Pas-
teurized food in the feeding of infants. The demonstration was all the
more striking because no other change whatever had been made in
respect to either diet or hygiene in the management of the institution.

If it be conceded that the direct and indirect influence of my milk
depots has had a perceptible influence in lowering the annual infant
mortality of New York, it must follow that the work of these depots so
extended as to include practically the whole milk supply of the infant
population of the city would make a much more decided impression on
the death rate. An organization so comprehensive as this would require
belongs to the sphere of municipal rather than of private effort. I am
at present engaged in the building and equipment of a new laboratory,
with a Pasteurizing plant of much larger capacity than that which I now
employ. That the limit of the capacity of my present establishment is
being rapidly reached may be inferred from the subjoined figures, show-
ing the increased monthly demand of the present year as compared with
the corresponding months of 1904. The figures represent the various
sizes of bottles, and are thus merely a general indication of the amount
of milk consumed :

BOTTLED MILK DISPENSED FROM THE STRAUS DEPOTS.

1904 1905

BOTTLES BOTTLES

January 162,903 198,928

February 153,274 196,579

March 178,813 238,313

April 171,617 244,665

May 172,196 261,387

June to 15th 79,219 133,058

As there is a fractional loss on every bottle of milk sold, taking no
account of the thousands distributed to families who are unable to pay
for them, it is obvious that the work in which I am engaged must, at the
present rate of expansion, shortly transcend the bounds of private effort.
No better proof of its utility could be given than the remarkable elasticity
of the demand now fairly established for my milk foods. The tenement
house population of New York have learned their value in the saving
of children's lives, and I contemplate with dismay the time when any
organization which I am able to provide will be inadequate to supply the
demand for them. I can only trust that before that time arrives the
city itself may be prepared to accept the obligation, which no other
agency can so well discharge, of making the supply of a wholesome milk
food for infants a municipal function, and so stamping out the seeds of a
plague more destructive than any that is to be dreaded under the con-
ditions of our modern civilization.

PURE MILK OR POISON?

REMARKS BY MR. NATHAN STRAUS.

Addressed to the Milk Conference held at the New York Academy of Medicine,

November 20, 1906.

^^^^^OST of you gentlemen are professional men and your time
■ ■ ■ here is limited, and I am not going to waste it by talking to
J ^ ^ you about things you know already. I have, however, pre-
pared a little statement which I will hand to you and you can read it at
your leisure. What I am anxious to accomplish at this meeting is to
get your co-operation in securing legislation that shall deal in a more
practical way than we have j^et been able to do with this question of
pure milk. It must be obvious to you that the resources now at the
command of the State Board of Health, or any other Department that
may be invested with the required powers, are entirely inadequate to
the purpose of stamping out tuberculosis among cows.

It must be equally plain that were these resources amply sufficient
for the requirements of our own State, they would have to be provided
and applied by the neighboring States which contribute so largely to
the milk supply of this city.

Then, as to Federal supervision, milk demands, as an article of in-
terstate commerce, a kind of inspection which even the sweeping re-
quirements of the Pure Food Bill do not provide.

All this will doubtless be accomplished in time, but until that time
does arrive, it seems to me that the City or the State should provide
pasteurization for the entire milk supply, without any cost to the pro-
ducer or the consumer. With the co-operation of you gentlemen, this
can be done.

I HAVE TRIED PASTEURIZATION, TRIED IT PRAC-
TICALLY, AND UNTIL YOU CAN SHOW ME SOMETHING BET-
TER I MAY BE PARDONED FOR BELIEVING THAT PAS-
TEURIZATION IS THE THING.

Then let us arrive at some definite conclusion, and let us do it with
all the more resolution because whatever we do here in New York will
be copied in every City and State of the Union.

I ought to know something about milk. I have been working at the
practical end of it for a good many years now. At the outset, I ad-

dressed a public who had hardly begun to realize the waste of human
life due to the use of milk carrying with it the germs of disease.

Had I been a man of scientific attainments, so that my statements
would carry the weight of scientific authority, I should probably have
accomplished more than I have done. But I have at least had the satis-
faction of contributing to a great awakening of public interest in this
vitally important question.

Partly, at least, because of mp orvn efforts, I have seen State and Municipal
Boards of Health address themselves seriously to the primary requirements of a pure
mill^ supply. I have even had the satisfaction of seeing hasty scientific conclusions
in regard to the harmlessness of the bovine tubercle bacillus in the human system
proved inaccurate. Finally, I have had the satisfaction of seeing the death rate
among the children of the City of New York under five years of age reduced
from 96.5 per 1 ,000 to 63 per 1 ,000 per annum.

I need not enlarge on the harm wrought by some of the mistaken
conclusions reached by men of science among people who are only too
prone to be lulled into a false security. But I am sure that I address
to-day a body of men as fully impressed as I am with the importance of
this question, and I am encouraged to believe that this meeting will
reach a conclusion calculated to advance the problem a long step nearer
to solution.

STATEMENT.

The greatest task confronting humanity to-day is the conquering of
disease.

We have met to discuss what we can do in our feeble way in the
direction of solving a question of vital importance, and I say to you that
the phase of the problem which we are to consider has not received the
attention its surpassing needs deserve.

I have been criticised for preaching the danger of our milk supply,
for saying that the most destructive of all agents of disease and death is
the common, ordinary milk offered for consumption in our cities. I
welcome this criticism, because it is only through discussion and agita-
tion that the public is aroused.

I think it requires no argument to prove that our milk supply, even
with all the precautions thrown around it, needs further and radical re-
form, but I do not believe that it is generally understood to what degree
it is responsible for suffering and death, particularly among young
children.

You know that in this country one child out of every three that are
born dies before the age of five is reached, and I claim that the majority
of these deaths are preventable.

I can conceive of no work that should appeal more strongly to a
people or to a government than the saving of infant lives.

Scientists are devoting their best efforts throughout the world to
finding remedies for the prevention and cure of the world's greatest
scourge, the most dreaded and deadly of diseases — Consumption, well
named the "White Plague."

Last year in the International Tuberculosis Congress held in Paris,
Professor von Behring expressed the opinion that one of the most useful
results of the Congress was the acceptance of the fact by all the dele-
gates that bovine tuberculosis is transmissible to human beings, the
bovine bacilli being more dangerous even than are the human bacilli.

Fourteen years ago I lived in the Adirondacks, and to be sure of
having pure milk for my family, we kept our own cow. One day the
cow fell sick and died suddenly. We thought she had been poisoned
and called in a veterinary surgeon. He found the cause of her death
easily enough — her lungs had been eaten away with consumption.

So you see that when we thought we were drinking pure, whole-
some milk, we were taking into our systems the germs of disease. From
that time, no more raw milk was used in our family.

That was fourteen years ago. Now I will tell you of a recent ex-
perience to prove to you the correctness of my convictions. I met one
of our prominent butchers a short time ago, and we talked about pure
food. I asked him to tell me something about the condition of the cows
slaughtered for this market. He told me that out of a herd of one hun-
dred and eleven that he recently bought, twenty-seven were found to
have diseased lungs — were far gone in consumption. He also said that
about ten per cent, of all cows bought for slaughter in this market were
afflicted with the same disease.

I asked his permission to use this information, and though for
obvious reasons he did not wish me to use his name, he sent me a letter,
which I have as proof of the statement.

Another fact which has come to my knowledge is that in one of
the greatest dairy farms of this State, stocked with high-bred, registered
cows, last year over one hundred had to be killed because they had de-
veloped consumption. This occurred on a farm where to my personal
knowledge the most scrupulous cleanliness prevails, and where every-

thing is conducted on the most thorough scientific principles of sanita-
tion. If I had been asked, "Is there any milk brought to this market fit
for use in its raw state?" I should have unhesitatingly recommended the
milk from this farm as the best.

Not long ago I had a letter from a very wealthy resident of this
city, a man whose name you all know. He wrote me that to prevent
any possibility of the milk provided for his little son being impure, he had
built a new cow barn at his country place, and at great trouble and ex-
pense selected eight of the finest and best bred young cows, registered
Alderneys, for his private use. One of the cows took sick shortly after,
and he had her killed. A post-mortem developed that the cow had
tuberculosis. He then had the remaining cows tested by a representa-
tive of the State Agricultural Department, and he pronounced five of
the remaining seven cotps tubercular.

And he cried out to me : "Where and how can I get milk fit to give
my child?"

Thirteen years ago I was asked by the Editor of the Forum to
write an article for his publication on the necessity for pure milk.

I did so, and my article was returned to me with the request that I
eliminate a certain paragraph — he said it was too radical, too daring.
The paragraph was as follows, which was finally printed as a foot note :

"Milk is not always good in proportion to the price paid for
it, nor free from the germs of contagion because it has come
from cattle of aristocratic lineage. The latter quality, as recent
experience has shown, carries with it a special susceptibility to
tuberculosis."

Thirteen years ago I believed that the pasteurization of milk was
the only remedy. To-day I KNOW IT.

In June, 1895, Dr. Jacobi, in endorsing the use of pasteurized milk,
wrote me : "There is nothing so instructive as a success, and a single
practical proof speaks louder than any number of volumes." Therefore,
I will cite the case of a public institution where the death rate of the
children was so high that it became a public scandal. This was on
Randall's Island. Though the city had their own herd of cows, which
were kept on the Island, carefully tended and apparently in perfect
health, they did not succeed in reducing the death rate below forty-four
per cent. At that time I was President of the Health Board, and the
institution came under my direct charge. I had a chance to study the
appalling conditions that still prevailed there. After I had resigned

from this office, encouraged by the results I had already obtained in the
city, I installed on the Island a complete plant for the pasteurization of
milk. In the very first year of its operation, the death rate of the chil-
dren made the astonishing drop of from 44 per cent, to 20 per cent.
Remember, there was no other change made either in diet, hygiene or
management of the institution. The rate was later reduced to the still
lower figure of 16.5 per cent.

Just think of the enormous saving of lives if pasteurization were
generally adopted.

I have done as much as one man could to establish and promote
the use of pasteurized milk everywhere, but all that has been accom-
plished is merely a fraction of the good that could be done were the
supply of pure milk made a municipal function as much as the supply
of pure water. There can be no question but that the supply of milk
everywhere should be pasteurized, not only that intended for infants,
since the use of raw milk for adults is almost equally fraught with
danger.

It has been said that the pasteurization of milk will not destroy the
tubercle bacillus, but this assertion must have been made by some one
not familiar with the process of pasteurization, or not familiar with the
proofs on the subject.

Scientists agree that a temperature of 165 deg. for twenty minutes
will destroy the tubercle bacillus. Dr. Smith, of Boston ; Pearson of the
University of Pennsylvania; Bang, of Copenhagen; Russell of the Uni-
versity of Wisconsin; Moore of the New York State Agricultural De-
partment and Ravenel, of Philadelphia, all eminent scientists, are a unit
in agreeing upon this. And as in the process of pasteurization the milk
is heated to a temperature of 165 deg., and kept there for twenty minutes,
it follows that the tubercle bacillus must be destroyed.

If it were possible to secure pure, fresh milk direct from absolutely
healthy cows in any large city, there would be no necessity for
pasteurization.

If it were possible to establish a system of public inspection and
examination of milk which would prevent the supply of polluted milk,
there would be no cause for pasteurization.

If it were possible by legislation to obtain a milk supply from clean
stables, after a careful process of milking, to have transportation to the
city in perfectly clean and close vessels, then pasteurization would be
unnecessary.

But I am compelled to conclude, after years of study that these
conditions are absolutely impossible of attainment.

Corrective laws have been passed, medical societies have directed
their energies to a betterment of conditions, but I do not think it will
be denied that a very large proportion of the milk now sold in New
York City is unfit for consumption.

No agitation for a better milk supply, by whatever methods at-
tempted, can be without good result, but I have preferred to direct my
work to the attainment of positive results, and these I know can be
attained by pasteurization only.

While efforts directed toward the prevention of contamination at
the source of supply are attended by many difficulties, and the net re-
sults, therefore, are extremely small, such efforts should not be aban-
doned. On the contrary, even though milk be pasteurized, and I believe
the time will come when the entire milk supply of all large cities will
be pasteurized, there should be no relaxation of vigilance to prevent
initial contamination.

In the course of years human ingenuity may have found a means
of entirely eliminating disease ; it is for us to do our share with the light
that is given us.

Scientists play their part in adding to the sum total of human hap-
piness, but the layman has no unimportant role. I believe the solution
of the question before us is not scientific but practical. It is not cure — •
it is prevention.

Public opinion is the greatest force in human achievement to-day,
and when the public have been sufficiently aroused to the fact that the
prevention of disease is quite as essential as the erection and mainte-
nance of hospitals for the cure of disease, we shall have the first requisite
for intelligent legislation on this subject. Since the fact can easily be
demonstrated that the conditions surrounding the milk supply of our
city entail an appalling penalty of suffering, disease and death, surely
prejudice, ignorance and criminal neglect of obvious precautions must
have had their day.

THE AMERICAN SOLUTION OF THE MILK PROBLEM.

PAPER BY MR. NATHAN STRAUS.

SECOND INTERNATIONAL CONGRES DES GOUTTES DE LAIT,

BRUSSELS, SEPTEMBER 12, 1907.

J ^"T the last Congres International des Gouttes de Lait I was a
^^^m solitary voice from America declaring that child life should
^^ ^\ be protected from infected milk by pasteurization.

To-day I come with the same message indorsed by the most dis-
tinguished scientists of my country and formally and officially promul-
gated by the Government of the United States of America.

Two years ago, at the Congress at Paris, I argued and pleaded for
a policy that would save lives by the hundred thousand; to-day I have
the honor and satisfaction to report most substantial progress toward
the acceptance by my country of the milk programme then outlined.

For fifteen years I have sounded in America the warning that raip

milk kills. In an article contributed to The Forum, of November, 1894,

I made the following emphatic declaration:

"Here let me say that the penalty of disease and death, paid for the neglect
of simple precautions in the use of milk, is by no means paid exclusively by the
poor. Milk is not always good in proportion to the price paid for it, nor free
from the germs of contagion because it has come from cattle of aristocratic
lineage. The latter quality, as recent experience has shown, carries with it a
special susceptibility to tuberculosis. In milk intended for infant nutriment per-
fect sterilization is an absolutely essential precaution; but, simple as the process
is, it is not always certain, even in the homes of the rich, that it will be properly
done. I hold that in the near future it will be regarded as a piece of criminal
neglect to feed young children on milk which has not been sterilized."

These statements whose justice will be recognized by >ou, fellow
members of this Congress, were received with incredulity in the United
States. I was called an alarmist. The dangers to which I pointed were
minimized by medical men of standing. For years Prof. George M.
Kober, of Georgetown University, stood almost alone in declaring and
proving the dissemination of scarlet fever, typhoid, and diphtheria by
means of infected milk. No longer ago than May of this year, a medical
commission characterized the danger of tubercular infection through
milk as "Slight," but this was the dying gasp of the opposition to the
pasteurization of the milk supply, which has crumbled away as ignorance
has given place to knowledge.

While I persisted in warning against the use of raw milk, I provided
pasteurized milk for the babies of New York City. This was regarded

as an amiable benevolence. The virtue of the enterprise, in the eyes of
most people, was that it provided food for the poor at less than cost, or
for nothing.

However, as the infantile death rate of New York City went steadily
down, from 96.2 per 1.000 in 1892 to 55 per LOOO in 1906, coincident with
the increased use of pasteurized milk, the significance of my work be-
came apparent, and the conviction spread that the virtue of the Straus
milk was not its low cost, but the fact that the milk was pasteurized.

While this demonstration was going on in New York City, epidemics
of infectious diseases in various parts of the country, especially in Boston
and Chicago, were directly and indisputably traced to the use of raw
infected milk, emphasizing the urgent need for action. Scientific men,
studying the milk problem, were forced to decide that public safety de-
manded pasteurization, and in a notable statement of the problem as
affecting New York City, Dr. Ernst J. Lederle, former Commissioner
of Health, declared that pasteurization should be insisted upon in all
cases in which there was no proof that the dairy herds were free from
tuberculosis.

Investigations by Government experts, to which I shall make further
reference, made clear the fact that the peril of tuberculosis in milk was
jar greater and jar more frequent than had been generally understood.
The studies of Prof. M. J. Rosenau, of the Public Health Service, proved
that the advantages of pasteurization far outweighed the disadvantages,
if there are any.

Finally, early this summer, the President of the United States be-
came so convinced of the dangers of raw milk that he ordered a thorough
official investigation of the whole problem, with a view to legislation by
the Federal Congress.

These steps toward the protection of the people, and especially of
the children, were the consequence of an awakening of the public in-
telligence and a stirring of the popular conscience. The people stood
aghast at the revelation of millions of babies left daily at the mercy of
disease germs hidden in the ordinary market milk.

INFANT MILK STATIONS.

In five American cities infant milk stations are now maintained and
are achieving remarkable results in reducing infantile mortality.

■ ' In New York City, my own work has extended from one central
station to seventeen depots and the output of pasteurized milk has in-

creased from 34,000 bottles in 1893 to 3,140,252 bottles and 1,078,405
glasses in 1906. A total of at least 3,500,000 bottles and 1,500,000 glasses
is already indicated for this year. In addition, more or less efficient
pasteurization is being done by dealers to the extent of about 300,000
quarts a day.

Early this summer the municipal government of New York adopted
a forward policy in setting apart public funds for the building of model
milk stations in the public parks in the congested tenement districts, but
the city will depend upon private philanthropy to provide the supplies of
milk to be dispensed at these stations. Several years ago, I gave the first
impetus to the work in Chicago by the donation of a pasteurizing plant,
and now the Milk Commission of the Children's Hospital Society, a
private charity, maintains ten infant milk depots, from which 400,000
bottles of pasteurized milk were dispensed in 1906. But the good effect
of this work, so far as it could be shown in the vital statistics of the city,
was obscured by the ravages of epidemics of scarlet fever and diphtheria,
caused by the infection of a large part of the city's daily supply of raw
milk in two big dairy centers and by the neglect of the Health Authorities
either to exclude this milk or to require that it be pasteurized.

In Philadelphia I was able to supply the means to make a practical
demonstration of the value of pasteurization in preserving infant lives
and have had the satisfaction of seeing that nine infant milk depots, main-
tained by the Modified Milk Society, in 1906 distributed 991,166 bottles
of pasteurized milk, and that the percentage of mortality of children
under five years has been reduced from 62 per cent, in 1901 to 47 per cent,
in 1906. In like manner, as a direct result of my donation of a pas-
teurizing plant to St. Louis, the Pure Milk Commission of that city now
maintains 15 depots and distributed 600,000 bottles of pasteurized milk
in 1906.

Jersey City has adopted the infant milk depot plan as a municipal
enterprise. Mayor Mark M. Pagan, recognizing the duty of the city to
protect the lives of the children, has established a pasteurization plant
and has opened four infant milk depots, all maintained at the public
expense.

In Paris, in 1905, I said to the Congres International des Gouttes
de Lait:

"It is milk — ran> mil^, diseased milJ( — which is responsible for the largest per-
centage of sickness in the world. Milk is the one article of food in which
disease and death may lurk without giving any suspicion from its taste, smell,
or appearance.

"Why, then, use it in its raw form? Why ever trust it without due precau-
tion?

"I hold that the only safe rule is — Pasteurize the entire milk supply and
make it a function of the municipality."

This statement, I believe, received the cordial assent of the scientific
men of the Congress. I had been saying the same thing in America for
thirteen years in the face of interested and persistent opposition, in the
face of indifference and seemingly hopeless ignorance.

But I kept on saying this, with renewed courage, after the Paris
Congress, and I now have the gratification of reporting to you that there
is substantial agreement in America to-day, among all informed scientific
men and public health officials, as to the perils of raw milk and the
necessity for pasteurization.

One phase of the raw milk danger — and the most serious phase of
all — the fact that raw milk is the common cause of tuberculosis — has
been especially illuminated by the work of American scientific men.

Professor von Behring was a prophet when, in 1903, he said : "The
milk fed to infants is the chief cause of consumption." Four years ago
this statement savored of hypothesis: now it is proved scientific fact.

The announcement by Koch, that tuberculosis was not com-
municable to man from bovine sources, was followed by renewed investi-
gations in various countries. Eminent investigators reviewed previous
experimental work, repeated and extended researches upon this im-
portant point, with the unanimous conclusion that tuberculosis is com-
municable from animals to man, and from man to animals. Clinical
operation affords abundant proof to confirm these results of experimental
research.

I will not weary you with a recitation of the well-known conclusions
of the British Royal Commission on Tuberculosis, which demonstrated
the transmission of tuberculosis from the cow to the human being
through milk, nor will I cite to you the similar findings of the German
Imperial Health Office.

But I will briefly call your attention to the investigations of the
Bureau of Animal Industry of the United States Government into the
modes of tubercular infection. Thorough practical experiments and
exhaustive tests made by Drs. E. C. Schroeder and W. E. Cotton, at the
Experiment Station at Bethesda, Md., have proved that the presence of
tubercle bacilli in milk is far more frequent than has been supposed to
be the case. These experts have absolutely disproved the idea that the
udder of the cow must be diseased in order to infect the milk, and they
have demonstrated that the presence of a single tuberculous animal in
the herd is sufficient to cause the infection of all the milk of that dairy.

The tremendous significance of this demonstration is apparent when
we consider the estimate that from thirty to forty per cent, of the dairy
cattle are tuberculous and recognize as probable that no untested herd
is free from tuberculosis.

It is necessary at this point to quote only two paragraphs from Dr.
Schroeder's work. He says:

"The presence of a single tuberculous cow in a dairy stable may be respon-
sible for the introduction of infectious material into the milk of healthy cattle.**

"Observations definitely show that the frequency with which milk contains
tubercle bacilli is greatly underestimated, especially when it is milked in the
customary way from tuberculous cows with healthy udders, or from entirely
healthy cows in a tuberculous environment."

Dr. A. D. Melvin, Chief of the Bureau of Animal Industry, indorses
the conclusions of Drs. Schroeder and Cotton in these words:

"The work as a whole shows that the general condition or appearance of a
tuberculous animal gives no indication as to the time when it will begin to dis-
tribute tubercle bacilli and become dangerous; that the milk from all tuberculous
cattle, irrespective of the condition of their udders, should be regarded as dan-
gerous, and that even the milk of healthy cows, if it is drawn in the environ-
ment of tuberculous cattle, may contain tubercle bacilli.**

This work of Dr. Schroeder was made public at about the time when
the United States was startled by the disclosure by the Census Bureau
of the fact that tuberculosis caused more deaths than any other disease,
and Dr. Schroeder joined with Schloszmann and von Behring in the
belief that tuberculosis, at whatever age it makes its appearance, may be
due to tubercle bacilli introduced into the body through the intestines
during the milk-drinking period of life.

It is the testimony of eminent surgeons of wide experience that
abdominal tuberculosis (involving peritoneum, mesenteric glands and in-
testines) is more common among people living in the rural districts
where ran? mi7^ is a universal article of daily food than among the in-
habitants of cities, where raw milk is more costly and less easily pro-
cured.

Coincident with this advancing appreciation of the perils of tuber-
culous milk, the National Capital had an outbreak of typhoid fever that
was traced to the milk supply and the U. S. Military Academy at West
Point had eradicated typhoid from among the cadets by pasteurizing all
the milk used at the cadets' mess. These circumstances led to the ap-
pointment of a joint committee, composed of experts of the Public Health
Service and of the Department of Agriculture, to make a thorough in-
quiry into the sanitary relations of the milk supply of the District of
Columbia.

The result of this inquiry was thus flatly stated in the committee's
report :

**The committee, in the interest of public health, strongl}) advocates clarification
and pasteurization of all milk.''

The establishment of pasteurization plants by the District Govern-
ment, or by private enterprise under the direction of the public health
authorities, was urgently recommended, and the committee, "being so
strongly impressed with the manifold dangers connected with the milk
supply," recommended, for the meantime, until milk should be pas-
teurized at central stations, that housekeepers subject all milk used to
home pasteurization by simply bringing it to the boiling point.

This report, adopted by the Secretary of Agriculture and indorsed
by the Chief of the Bureau of Animal Industry, embodies the official
policy of the United States Government in dealing with the milk
problem.

For the purpose of putting this policy into force, the District of
Columbia, the seat of the National Government, has adopted a classifi-
cation of milk as follows :

Class I. Certified Milk, produced under ideal conditions from herds
proved free from tuberculosis by the tuberculin test, handled by persons
free from infection, put into sterilized bottles, delivered within twelve
hours from the time of milking, and not to contain more than 5,000
bacteria to the cubic centimeter.

Class II. Inspected Milk, produced from cows proved free from
tuberculosis, but under less perfect conditions than Class I, and not to
contain more than 100,000 bacteria to the cubic centimeter.

Class III. Pasteurized Milk. All milk of unknown origin or which
does not come up to the requirements of Classes I or II to be pasteurized
by heating to 150° Fahrenheit (65° c.) for twenty minutes, or 160°
Fahrenheit (70° c.) for ten minutes.

Thus a practical milk reform programme has been adopted for the
District of Columbia, the seat of the National Government, and an ex-
ample has been set for the other cities of the country.

Time will be required to extend this policy to the other centers of
population, but the work inaugurated by the Federal authorities is being
pushed by competent experts under the direction of Surgeon-General
Walter Wyman, of the Public Health Service, and Assistant Surgeon-
General Kerr, and I am warranted in believing that the pasteurization of
milk, especially in the cities, will soon be required by Federal statute.

That this will mean a steady reduction in the infantile death rate,
I can assert from experience ; that it will mean an enormous decrease in
the number of new cases of tuberculosis annually reported, I can assert
on the authority of such names as von Behring, Schloszmann and
Schroeder, and I think that none will venture to contradict me when
they consider that pasteurization means the eviction of the tubercle
bacilli from the milk bottles.

While the agitation for milk reform has to be kept up, we are no
longer talking into deaf ears ; mountains of prejudice have been removed.
The light of knowledge has been shed upon the subject, and the people
are concerned about the necessity of securing safe milk for their babies
and themselves.

In America, though the Federal Government has indorsed our cam-
paign for pasteurized milk supplies in an authoritative utterance, we
have still to make this policy effective by securing mandatory legislation
and by bringing health officers to the point of requiring the pasteurization
of all doubtful milk.

The prevalence of misinformation respecting pasteurization, and the
efforts of interested parties to confuse the public mind by disseminating
misleading assertions, induced me this summer to open a bureau of in-
formation in the City of New York. Here I have gathered such statistics
bearing upon the milk question as were readily accessible, and to these
I hope to add reports of all new developments. I have begun corre-
spondence with the various health departments of the civilized world and,
also, with leading medical and scientific authorities, and have arranged
for an exchange of information which should prove mutually profitable.
The records gathered in this manner, and by the personal investigations
of competent agents, will be at the service of members of this Congress,
as well as other interested persons, and prompt and careful attention
will be given to any communications from responsible sources. The
official address of this bureau is, "Nathan Straus Depots For Pasteurized
Milk, New York City."

I come from America to this Congress for the sole purpose of help-
ing along a work in which I am deeply interested. As an evidence of
that fact, I stand ready to supply pasteurizing plants, up to the number
of twelve, for service in any place or places where the need of one is
pressing and the means are lacking to provide it.

STRIKING AT THE CAUSE OF TUBERCULOSIS.

BY NATHAN STRAUS.

m ^1 ^HEN American cities take the proper steps to compel the
^ W J pasteurization of all milk used within their confines, the
V^X greatest victory in the battle against "The White Plague"
will have been won. It is a dictum of medical and chemical science that
while the properties of milk are of such a character as to endow it, on
one hand, with almost ideally perfect qualities for the preservation of
health and for nutriment, it may, on the other hand, become a terrific
energy for the propagation of disease.

Milk is one of the most perfect "culture fluids," and the bacteria
which get into it from external sources, after it is drawn, increase with
almost miraculous rapidity. But it is not only from external sources
that milk may be polluted. It may be drawn from cows already infected
with the germs of tuberculosis, or whose organs show the ravages of
the disease. Calves may be born tubercular because they are the prog-
eny of tuberculous mothers and should they attain years of maturity,
their milk must be highly impregnated with the tubercle bacillus.

Since no thoroughly efficient means of discovering the existence of
this disease in milch cows has yet been provided by law, and since the
thorough inspection of all the cows which contribute to the milk supply
of a great city is next to impossible, the only path of safety in the use
of natural milk is to see that the noxious microbes which it contains are
killed. The process known as commercial pasteurization does not ac-
complish this, and the only way to have it satisfactorily performed is
to expose the milk for twenty minutes to a temperature of 167° Fah-
renheit.

This is not literally a precept of boiling. But li is better to hoil the
milk ihan to take it in its natural state.

The duty of pasteurizing or boiling all milk for consumption is an
imperative one, and one that has been too long shirked.

We spend millions of dollars for our hospitals to cure disease, and
we spend millions of dollars for our schools to educate the people. Why
not devote a few millions to eliminating conditions which help so
largely to fill our hospitals, and which, in so many cases, bring to an
untimely end the lives of the graduates of our schools before they can
take advantage of the benefits which they have received?

It is against the law in New York, and in most cities, to sell milk
adulterated with water, even though the water may be pure. But while
public milk supplies may not legally be watered, they may be stale or
polluted or infected. That is to say, milk may be sold without detec-
tion bearing innumerable microbes fitted to breed tuberculosis, typhoid
and scarlet fever. Whether through inefficiency, or lack of power, the
health authorities of New York City do but little to furnish an effective
check to the greatest known cause of infant mortality. This, too, in
spite of the fact that the conditions are well known to them through
reports and other information which I know have been brought to their
attention.

The State law for the discovery and extirpation of cattle infected
with tuberculosis is lamentably deficient. There is really nothing to
check unscrupulous farmers from continuing the lives of diseased animals
or from selling the milk which they yield in the regular market. Yet
no less an authority than Professor von Behring, of the University of
Marburg, and the discoverer of antitoxin, in his work on "The Suppres-
sion of Tuberculosis," says: 'T/ie milk fed to infants is the chief cause of
consumption.*^

Sir Frederick Treves, of the National Health Society of London
(England), affirms in a recent lecture that "the absolutely reckless use
of raw, unpasteurized milk is little short of a national crime, for which
we are paying very heavily in ill health, disease and death."

Dr. Bryan Bramwell, of Edinburgh, asserts that "infection of milk
is the most important source of tuberculous disease.*'

In his latest book, "The New Hygiene," Elie Metchnikoff, the suc-
cessor of Pasteur, emphatically confirms the above statements.

In our own country and State we have Professor Abraham Jacobi,
who after studying the question for more than fifty years, entirely agrees
with the findings of these foreign scientists. In a recent course of
lectures before the students of Johns Hopkins University he lends his
authoritative voice to the absolute necessity of pasteurization. When I
began my work in New York, fifteen years ago, it was to Professor
Jacobi that I went for advice, and he has lent me his professional and
moral support ever since. I owe to him one of the formulas for the
preparation of the modified milk which I am still using with the best
results.

If it be true that "an ounce of prevention is worth a pound of cure,"
our cities would pursue a policy of enlightened economy by compelling
milk pasteurization, for they would be making possible great reductions
in their appropriations for the support of hospitals, to say nothing of
raising the general standard of public health.

No one questions the duty of the commonwealth to spend millions
of dollars to counteract the evils of popular ignorance, but is it not
equally a public duty to prevent helpless infants from developing from
puny, sickly childhood into diseased, weakened and helpless manhood
and womanhood?

Milk is the one article of food in which disease and death may lurk
without giving any suspicion of the fact in its taste, smell, or appearance.
As a competent authority said years ago: "If milk gave the same out-
ward appearance of decomposition or fermentation as is shown by
vegetables, fish or meat, more than three-quarters of all the milk con-
sumed in the metropolitan district would be condemned as unfit for
human food ; if its pollution could be perceived, it would be loathed ; and
if the disease germs could be as plainly seen as a pesthouse, the death-
dealing milk would be as soon dreaded and shunned."

Why, then, use milk in its raw form? Why ever trust it without
due precaution?

If you have no facilities for pasteurizing milk, boil it.

The only safe rule is to pasteurize the entire milk supply and make
it a function of the municipality.

Do not run away with the idea that milk is necessarily good in pro-
portion to the price paid for it or free from the germs of contagion be-
cause it has come from cattle of aristocratic lineage. The latter quality,
as recent experience has shown, carries with it a special susceptibility to
tuberculosis.

In milk intended for infants, perfect sterilization is an absolutely
essential precaution, but, simple as the process is, it is not always certain
that it will be done properly, even in the homes of the rich. There will
be a time in the near future when it will be regarded as a piece of criminal
neglect to feed young children on milk that has not been pasteurized.

It is the testimony of medical science that nearly, if not quite, one-
half the deaths in the cities of this country are due to the class of dis-
eases which are known to be preventable. Chief among these pre-
ventable diseases are the diarrhoeal disturbances of young children, and
the prime agent in the production of these is impure milk.

One-third of all the children born die before they are three years old,
and the excessive rate of mortality expressed by this statement is trace-
able to the imperfections of the milk supply.

It is unquestionably true that no plague by which any community
was ever ravaged has yielded so plentiful a crop of deaths as that which
is reaped from the seeds of contagion deposited in the infant system
every summer by millions of noxious bacteria developed in milk.

The United States Department of Agriculture has added its tes-
timony to that of many physicians that pasteurizing or sterilizing of milk
is the onl^ safeguard against the diseases of which milk is the most common
vehicle.

It is the testimony of medical experts that at least fifty per cent,
of all the children who die have been infected with tuberculosis through
their infant nutriment, and that one-seventh of all deaths, infant and
adult combined, are due to tuberculosis.

If, then, pasteurization of milk is conceded to be effective in ex-
terminating the germs of the fatal disease of which milk is the chief
carrier, and if by this process the fifty per cent, of dead children, or any
considerable fraction of it, could have been saved from the bane of tuber-
culosis, no further argument should be required to demonstrate its im-
perative necessity. If thousands of lives, both of children and adults,
can be saved, and if an untold aggregate of suffering and sorrow can be
averted by the simple process of pasteurization, there ought surely to
be no question about its general adoption.

Here in New York I have been conducting pasteurized milk depots
for fourteen years. I began the experiment with one depot in 1893, and
the result was so satisfactory that I was encouraged to enlarge the scope
and area of the work. While my practical demonstration of the benefits
of pasteurization has been confined to New York, the educational value,
I may be permitted to say, has been widespread. Now we have many
depots in operation not only in New York, but in Philadelphia, St. Louis
and Chicago, although they are not pushing the work ^s energetically as I
would wish.

The milk is exposed for twenty minutes to a temperature of 167°
Fahrenheit, and as it has been demonstrated that tubercle bacilli die at
158° Fahrenheit, when submitted to that temperature for ten minutes,
it is reasonably certain that by the process of pasteurization all noxious
germs in the milk are completely destroyed. At the same time, the nutri-
tive qualities of this most perfect of nature's foods have not been at all
impaired.

All milk at my depots is so drawn, handled and transported as to
reduce the chances of pollution to a minimum. The milk is cooled be-
fore shipment; is kept cool in the process of transportation; and on
arrival in New York is at once taken to the main laboratory, where it is
placed on ice before being treated and turned into the bottles. All the
milk used in the laboratory is known as "certified," having been certified,
according to the requirements prescribed by the County Medical Society,
as to its purity and cleanliness. Before granting the certificate, the in-

100

spectors must be satisfied that the milk is drawn from healthy cows,
stabled according to the most advanced sanitary requirements and milked
under proper conditions of cleanliness.

The result of the work done here is shown in the steady drop in
the number of deaths of infants reported to the Board of Health. In
1892, the death rate of children, under five years of age, in Manhattan
and the Bronx, was 96.2 per thousand of the population. Since that
time it has been gradually scaled down until low-water mark was reached
in 1903 with a percentage of 53.3 per thousand. In 1905, the rate was
55.8 per thousand. Even more eloquent are the returns of the death
rate of children under five years of age during the months of June, July
and August. For the two metropolitan boroughs above named the rate
was 136.1 per thousand in 1892, and it was only 62.7 per thousand in
1906.

My milk depots were established in the thickly congested sections
of the then City of New York, but the standard of quality of the milk
supply of the poor was raised throughout the entire area. The people
were quick to discern the superiority of an article furnished at a low
price over the more or less tainted, and also the more costly, article they
had been accustomed to use.

In addition to selling the milk below cost to the poor, the visiting
physicians of the Board of Health and all physicians doing charity work
among the poor, have from the beginning of my enterprise been freely
supplied with all pasteurized and modified forms of milk which they
required in their practice. It has also been a rigid rule with me that no
pasteurized milk should be sold later than twenty-four hours after its
pasteurization. The milk is distributed in round bottles so that they
cannot be left uncorked and the milk exposed to contamination.

In the first year of my depots, 1893, a total of 34,400 bottles of pas-
teurized milk was dispensed. In 1906, a total of 3,140,252 bottles was
dispensed and 1,078,405 glasses of pasteurized milk were drunk on the
premises.

If it be conceded that the direct or indirect influence of my depots
has had a perceptible influence in lowering the annual infant mortality of
New York, it must follow that the work of these depots, if extended so as
to include practically the whole milk supply of the infant population of
the State, would make an even more decided impression on the death
rate. The limit of the capacity of my present establishment is being
rapidly reached, and, to be at all adequate to the demands made upon it,
must very shortly reach a point where it belongs to the sphere of
municipal rather than private effort.

101

Then, too, there is a loss on every bottle of milk sold, taking no
account of thousands of bottles distributed to families unable to pay for
them. In the budget of a government this cost would be but a small
item, but when it is merely a question of individual effort and private
means, it may readily be conceived that the cumulative increase of such
a business may create a burden too heavy to be borne.

As I have already intimated, the value of my work has been very
largely educational. The area of my efforts has been necessarily a re-
stricted one, and their indirect results must be held to be of more
value than the results directly traceable to them. It is something to
have been largely instrumental in awakening public intelligence through-
out the country to the dangers latent in an unregulated milk supply. It
is something to have been able to concentrate public attention in this
city and State on the necessity for pasteurizing the entire milk supply.
The fight is not yet won, by any means, and it has been a fairly arduous
one from the start. The fact that I have lived to see a total change in
the point of view, alike of men of science and the public generally, in
regard to this whole question, encourages me to believe that the final
steps of legal precaution will be neither halting nor long-deferred.

102

Mi Ik- Pasteurization an
Economic and Social Duty

Address by

to the Students of Political
Economy in the University
:: of Heidelberg ::

At the Invitation of Professor Ebehard Gothein

SYNOPSIS.

Page

I. Infant Mortality: Milk the Source of the Evil 106

II. The Scourge of Tuberculosis: Milk again the Source of the Evil 107

III. The Milk Supply: Present Conditions 109

IV. The Milk Supply: Ideal Reforms 112

V. Pasteurization the Immediate Remedy 114

BIBLIOGRAPHICAL NOTE.

von Behring, E. 1. Tuberkulosebekampfung. (Vortrag gehalten auf der 75.
Versammlung von Naturforschern und Aerzten am 25. Sept. 1903 in Kassel.)
Marburg, 1903.

2. Tuberkulosetilgung, Milchkonservierung und Kalberaufzucht. (Veroffent-
lichungen der Landwirtschaftskammer fiir die Rheinprovinz, No. 3) Bonn,
1904.

3. Tuberkuloseentstehung, Tuberkulosebekampfung und Sauglingsernahrung.
(Beitrage zur experimentellen Therapie, Heft 8.) Berlin, 1904.

4. Bekampfung der Tuberkulose beim Rindvieh und hygienische Milcherzeug-
ung. Von Professor Dr. von Behring und Professor Dr. Dammann.
Sonderabdruck aus dem „Archiv des Deutschen Landwirtschaftsrats.")
Berlin, 1906.

Dammann, See von Behring (4).

Kindermann. K. Die Versorgung Heidelbergs mit Milch und speziell mit Saug-
lingsmilch. (Heidelberger Tageblatt, 27 September 1906.)

[Milk Bulletin.] Milk and its Relation to Public Health. By various Authors.

(Hygienic Laboratory: Bulletin No. 41.) Washington, 1908.

Spargo, J. The Common Sense of the Milk Question. New York, 1908. [A
popular but reliable work, containing precise references and statistics. For
the sake of convenience I have often quoted from it.]

Straus, N. Amerika's jiingster Beitrag zur Milchfrage. [Heidelberg, privately
printed, 1908.]

104

ADDRESS.

DELIVERED AT THE UNIVERSITY OF HEIDELBERG, JULY 24, 1908.

IT is not so very long ago since, in some countries at least, Political
Economy was supposed to require little more of the student than
the possession of a certain amount of common sense. This naive
misconception of a most difficult science has, I am sure, been effectually
banished from your minds — if it ever was there — or you would not be
making a visit to an experimental laboratory for the pasteurization of
milk. Such a visit betokens that the days of the old, abstract, arm-chair
Political Economy are ended. The fact that the establishment you are
to visit is not a commercial undertaking, but an effort of private enter-
prise to awaken the public conscience, is again evidence of the change
that has come over the rigid, almost inhuman methods of the oldest
school of economists. At the present day the study of economics im-
poses a heavy burden upon its followers ; they must possess much
positive knowledge, and are often called upon to make temporary excur-
sions into remote fields; and the common sense once thought to be the
one thing needful must never desert them. I rejoice that the subject to
which I am about to invite attention is eminently one to be judged by
common sense. It is true that it is a subject fraught with immensely
complicated side-issues, but the main argument is, I venture to think, as
simple as could well be desired.

105

VALUE OF INFANT LIFE.

Every modern economist, I believe, no matter what view he might
take of the population question, would admit the obligation of society
to preserve the lives of all its members. The obligation is recognized as
especially binding in the case of infants. Once born into the world in a
civilized state, the morsel of humanity has established its right to
existence.

DECLINING BIRTH RATE.

Not to mention any higher motives, the mere desire to prevent
economic waste suggests that not a life should be needlessly lost. The
suggestion comes with special force at the present time. From all parts
of the world, though most strikingly from Australia, we have the same
remarkable evidence of a special decline that is going on in the birth
rate. In ten years, from 1891 to 1900, the birth rate fell in England and
Wales from 31.4 to 28.7 per 1,000 ; in the German Empire from 37.0 to
35.6; in France from 22.6 to 21.9 [Spargo, p. 8]. These figures to some
extent at least indicate a physiological deterioration of the race. They
show how the value of the human baby, always of late years highest in
France, is steadily going up in other countries as well.

THE WASTE OF LIVES.
Upon every consideration, public and private, ethical as well as
economic, the death of a little baby is a calamity to be avoided at all
costs. And yet, as you are aware, the annual loss of infant lives is
enormous. In the German Empire, for instance, something like 2,000,000
children are born every year, and of these about 400,000 die within the
first year of their lives [Dammann, p. 23 |. That is at the rate of about
200 deaths to 1,000 births, and there are few countries in Europe, except
Russia, that have to deplore so high an infantile death rate as this. Here
are the statistics of some of the great towns:

Births

DoAths

Death

Percentapre

July 1, 1905

unci 61* 1

rate per

Diar hoeal

of deaths

1000

death rate

due to

June 30, 1906

year of age

Births

(iiarrhoea

Barmen

4597

605

132

47.64

36.20

Berlin

49708

9933

200

87.99

44.03

Chemnitz

8314

2253

271

135.67

50.07

Cologne

15373

3266

212

93.60

44.06

Frankfurt a. M.

9335

1446

155

53.13

34.30

Hamburg

20471

3538

173

70.98

41.07

Karlsruhe

3052

565

185

86.17

46.55

Leipzig

14734

3273

222

121.49

54.69

Mannheim

5170

1053

204

86.46

42.45

Munich

15787

3432

217

95.33

44.14

106

MILK THE SOURCE OF THE EVIL.

Those figures, which I take from the United States Government
•'Milk Bulletin" (p. 635), show the extent of the evil and also one of the
principal causes. Between Barmen with its 132 per thousand and Chem-
nitz with its 271 there is a great difference, but even at Barmen 36.20
per cent, of these early deaths are due to gastro-intestinal disease. In
some of these towns one out of every two of the poor babies falls a
victim to this complaint. The rate of such deaths is heaviest during the
summer months, and the reason of this is that the milk on which the
children are fed favors the growth of noxious bacteria more readily at
summer temperatures. The heat itself lowers the vitality and resisting
powers of the infants to begin with, and then comes the milk with its
increased bacterial content. I need hardly remind you that milk is an
almost ideal medium for the growth of micro-organisms at any time,
but especially in summer. In a town like Berlin more than two-thirds
of the babies have to be bottle-fed (v. Behring, Bekaempfung der Tuber-
kulose beim Rindvieh, etc., Berlin, 1906, p. 3), and these are just the ones
to perish of intestinal troubles. It was actually found in France that of
20,000 infants who died from this cause four-fifths were bottle-fed
[ Spargo, p. 38 I . Again, there are official German statistics to show that
the mortality in the first year among artificially fed infants may be 51
per cent, as against only 8 per cent, of those nursed exclusively at the
breast [Spargo, p. 39 |. But the milk of mothers who themselves are
underfed and who perform severe physical labor all day can hardly be a
suitable diet for a baby. Sooner with the poor, later with the rich, there
comes a time when the mother cannot supply the needful quantity or
the desired quality of milk. It is here that pasteurized, modified cow's
milk steps in. Pasteurization minimizes the dangers of a second sum-
mer. (See Professor Jacobi's letter at end of this pamphlet.)

II.

THE SCOURGE OF TUBERCULOSIS.

I wish now to direct your attention to another great scourge of man-
kind, namely. Tuberculosis, a disease which in its advanced stages, when
the lungs are affected, is but too familiar under the name of Consumption
or Phthisis. I am unable to give you German statistics on the subject,
but in 1905, 12 per cent, of the total deaths registered in the United
States were due to tuberculosis [Milk Bulletin, p. 239]. It is estimated
that 150,000 or 160,000 deaths occur every year in the United States
from this cause alone [ibid.; Spargo, p. 122].

107

HUMAN AND BOVINE TUBERCULOSIS IDENTICAL.

The disease is not confined to mankind. Cattle are peculiarly liable
to be attacked by it, and it is a constant menace to the breeder and
dairy-farmer. There is no longer any doubt that the disease is essentially
the same both in man and in animals, and may be communicated from
one to the other. The specific bacillus was discovered by Robert Koch
in 1882. Moreover, the uncertainty caused for a time by the great
bacteriologist's assertion in 1901 that bovine and human tuberculosis
were distinct has now been removed. The vigilance of meat-inspectors
is now clearly recognized to be by no means unnecessary, since the meat
of tuberculous animals, if not thoroughly cooked, would expose the con-
sumer to the risk of infection.

TUBERCULOUS MILK.

Not only the meat but also the milk of tuberculous animals contains
tubercle bacilli. This discovery, made by the Danish Prof. Gustav Bang
in 1890, is of the very greatest importance. There are perhaps com-
paratively few cows suffering from acute tuberculosis, recognizable by
the ordinary methods of physical examination, and yet furnishing milk
for human food. But the meat-inspectors at the slaughter-houses can
find internal traces of the disease which would give rise to no anxiety
while the animal was alive. Here I may mention, by way of illustration,
some results of the meat-inspection here and at Mannheim. The per-
centage of cows slaughtered at Heidelberg found to be tuberculous was
38, 44, 32 and 42 in the years 1903-6 respectively [Heidelberger Tage-
blatt 20. Januar 1908]. At Mannheim the percentages for 1904-6 were
25, 30 and 33 [Heidelberger Tageblatt 24. Januar 1908]. These cows
were milked, probably, down to the very day of their death, and their
milk, being mixed with that of healthy animals, might convey the germs
of tuberculosis into numerous families.

THE TUBERCULIN TEST.

If we wish to know whether a given milk cow is tuberculous or not
it is fortunately not necessary to slaughter her. Koch's tuberculin, a
glycerin-extract of tubercle bacilli grown in the laboratory, is injected
hypodermically and produces in tuberculous animals (or men) a rise
of temperature sufficiently well marked to constitute an almost infallible
test for even very slight degrees of infection. Only animals which fail
to react to this test can be looked upon as capable of supplying milk
that is above all suspicion of tuberculous taint. The application of
the test by the veterinary surgeon leads to some surprises. It often

108

reveals the startling fact that the sleekest cow in the herd, and the best
milk-producer, is nevertheless tuberculous. Seven or eight years ago in
Hessen-Nassau it was found that where more than 40 or 50 head of
cattle were kept, nearly all of them were infected, whereas in studs con-
sisting of not more than four head the number of tuberculous animals
was as low as 3 or 4 per cent. [v. Behring, Tuberkulosetilgung, etc.,
Bonn, 1904, p. 7]. In Saxony it seems that 30 per cent, of all cattle are
infected | Spargo, p. 136 ] ; 25 per cent, was the estimate made last year
(1907) for all the cows supplying the city of Washington with milk
[Milk Bulletin, p. 493].

HUMAN TUBERCULOSIS: MILK THE MAIN SOURCE OF EVIL.

As regards the origin of tuberculosis in man I may confess at once
that I am a believer in the doctrine of Prof. E. von Behring of Marburg.
According to this eminent authority tuberculosis is contracted not so
much through the nose and lungs as through the mouth and the alimen-
tary canal, not so much by breathing bacilli emanating from tuberculous
persons as by drinking the milk of tuberculous cows. It is part of his
theory that the primary infection takes place in the first year of infancy,
before the mucous membrane of the intestinal tract has become fully
capable of resisting the passage of bacteria. This predisposes the in-
dividual to develop the disease to the full extent if at some future time
he is exposed to constant infection with tubercle bacilli, say through
membership in a consumptive family, or residence in apartments in-
habited by consumptives. Consumption thus caught, say, by a child
from its parents, is not truly hereditary, because not contracted until
after birth. In the majority of cases the disease must be regarded as
lying latent between infancy and the time when it calls for medical
treatment. Post-mortem examinations and tuberculin tests on living
persons alike confirm this. Von Behring sums up his doctrine on the
practical side by saying: 'T/ie milk fed to infants is the chief source of con-
sumption,** (Tuberkulosebekaempfung, p. 25.)

III.

We have thus traced to the use of cow's milk the two principal
losses in our vital statistics, first, the excessive mortality of infants in
their first year, and second, the annual tribute of lives claimed by con-
sumption. It being altogether impossible to give up the use of cow's
milk in the nursery, and most undesirable to banish such a food from the
adult diet, it becomes imperative to seek for means to render the milk
harmless. Let us first glance at the actual conditions at present obtain-
ing in the milk industry.

109

THE COWS.

A large proportion of the cows, as we have seen, are tuberculous.
They are often kept in stalls that give every encouragement to the dis-
ease. They are there in company with other tuberculous animals, and
the amount of light and air available is often very deficient. Rough
walls, damp floors, thatched roofs and unnecessary lumber, all furnish
lurking-places for bacteria. In this part of Germany the cows rarely
have any opportunity to pasture in the open fields. The unenlightened
peasant is usually extraordinarily careless in such matters as storage of
fodder and general attention to cleanliness. There should be no possibility
of animals infecting their own food. The excreta should be easily re-
movable and frequently removed.

MILKING.

How rarely does it happen that the milking is satisfactorily con-
ducted ! The person of the milker often leaves much to be desired. He
comes to his work regardless of the state of his health or the state of his
hands, in the very clothes in which he has, perhaps, just been shoveling
manure. If he washes his hands on what does he dry them? If he
washes his pails in what sort of water does he do it? Does he trouble
to cleanse the udder before beginning to milk? Under ordinary con-
ditions there is so much dirt flying about the air of the stall, so much
filth adhering to the animal's skin and liable to be knocked off by the
milker's hands or clothing, that it would be a miracle if none of it found
its way into the broad-mouthed pails commonly used. As a matter of
fact Renk in 1891 found from a series of thirty tests that a liter of mar-
ket-milk at Halle contained on an average 15 milligrams of cow's excre-
ment; Leipzig, 3.8 milligrams; Berlin, 10.3 milligrams, and Munich 9
[Milk Bulletin, p. 441-2]. "According to some authorities," we are told,
"the citizens of Berlin consume 300 pounds of cow-dung in their milk
daily" [id., p. 395].

TRANSPORTATION.

After the milk is drawn the chief thing is to protect it from dust
and keep it at a low temperature, so that the inevitable bacteria may
increase as slowly as possible. The more shaking the milk receives the
more the clusters of bacteria will be broken up, and the more rapidly
will they multiply. All the mixing and pouring from one receptacle to
another that goes on, sometimes in most incredible situations, before
the milk reaches the consumer, is injurious. Small dealers are unable
to take the necessary measures, by the provision of ice and special cool-
ing-rooms, to keep their milk at a proper temperature. Even big dealers

110

are singularly lax, from an American point of view, in this matter. I see
even superior bottled milk being hauled through the streets with nothing
better than a thin cloth to protect it from the glaring sun. I greatly
fear that in this country less attention is bestowed on the milk than on
the beer. You keep that cool while it is traveling and after reaching the
place of consumption, and leave the milk too often to take care of itself.
Truly there is something to be learned from the brewers and landlords.

BACTERIA IN MILK.

In the absence of proper precautions, milk that on leaving the cow
contained relatively few bacteria may on reaching its destination some
hours later be literally swarming with them. Bacteriologists are able,
by a somewhat troublesome process, to estimate the actual number of
these minute organisms present in a sample of milk. The numbers per
cubic centimeter not uncommonly run to millions. Twenty years ago
the "bacterial content" of the milk sold at Wuerzburg ranged between
222,000 and 2,300,000 per cubic centimeter in winter, and between 1,-
900,000 and 7,200,000 in summer. Munich milk, six hours old, has been
found to contain from 200,000 to 6,000,000 ; Halle milk varied from 6,000,-
000 to 30,700,000 ; and a very high figure was reached at Giessen in May,
1892, namely, 169,600,000, though that is far from constituting a record
[Milk Bulletin, pp. 13, 441-2]. These numbers of bacteria were esti-
mated in one cubic centimeter, a quantity equivalent to about fifteen
drops, or a quarter of a teaspoonful. There are often more bacteria in a drop
of milk than in a drop of servage [Bulletin, p. 421].

DISEASE GERMS IN MILK.

The bacteria present in milk may be of a perfectly innocuous kind,
but it is obvious that if the milk ever comes in contact with the germs
of disease these, too, will be taken up and handed on to the unfortunate
consumers of the milk. Under present conditions there are plenty of
chances for good milk to become infected. The cow may have waded in
water containing typhoid germs; dust may have borne the germs of
typhoid or scarlet fever; an infectious case may have been nursed in
the family of the milker or dealer; perhaps one of these men may have
been suffering himself from, say, diphtheritic sore-throat. Hence it
comes that quite a number of epidemics are traceable to the milk-supply.
The recently published American "Milk Bulletin" contains particulars
of over twenty typhoid epidemics in Germany between 1875 and 1899
that had this origin. At Rostock, for instance, in August, 1893, several
cases of typhoid occurred, and all were traced to milk from a suburban
dairy which was found in a most unsanitary condition. A highly polluted

111

well was used for washing the utensils, and very likely also for adult-
eration [Bulletin, p. 131]. At Rostock again, in May and June, 1885,
there were eight cases of scarlet fever. All the patients were consumers
of milk which was directly traced to a farm where scarlet fever prevailed
and convalescents assisted in milking [Bulletin, p. 137].

The tubercle bacilli that occur in milk do not attract attention by
causing a sudden outbreak of disease. Their action is rather of the
nature of slow poisoning. But their frequency in milk has often been
the subject of inquiry. At Berlin, for instance, Petri found 17 per cent,
of the samples he examined virulent to guinea pigs. By the same method
Rabinowitsch in 1897 showed that 28 per cent, of the samples of Berlin
milk he examined were tuberculous. A research by Proskauer and
others (1907) revealed tubercle bacilli in 55 per cent, of the samples
[Bulletin, pp. 170, 172, 173].

IV.

Such being the actual state of affairs, what are the proposals for
reform? We will begin with the most ideal, and come down to the
most practical.

ENCOURAGE BREAST-FEEDING.

In the first place it is obviously wise to encourage mothers to nurse
their own babies wherever it is physically possible. Hence we hear of
premiums being paid by business firms and municipalities for every child
raised entirely without the use of the bottle. The town of Cologne, for
instance, subsidizes breast-feeding, at least on a small scale.

IMPROVE THE BREED OF COWS.

Heroic measures have also been proposed, and partly begun, with
regard to the cows. A small country like Denmark has already suc-
ceeded in practically stamping out bovine tuberculosis on the plan
recommended by Professor Bang. With the tuberculin test as guide the
only real obstacle is the expense and the danger of depleting the national
stock of cattle by too sudden procedure. Another method deserving of
mention is Professor von Behring's, which has now been some years on
trial, for "bovo-vaccination," or inoculation of cattle with the object of
rendering them immune against tuberculosis. This is a preventive, not
a curative, measure, and has already been applied with Government sanc-
tion in the Grand Duchy of Hessen. Von Behring's plan is gradually
to eradicate tuberculosis among cattle, and thus to cut off the main
source of the tubercular infection of man. It is a grand, masterly idea,
but even on the most sanguine assumptions years must elapse before

112

the goal is attained and tuberculous milk has become an impossibility.
And it is easy to see that this great reform, so profoundly affecting the
agricultural and economic interests of the nation, can only be carried
out with State help. There must be State inspection and State com-
pensation for the farmers.

MUNICIPAL DAIRYING.

But now and always there would be room for the municipalities to
take their part by establishing model dairy-farms, where the very best
milk should be obtained under ideal conditions of cleanliness for use in
municipal hospitals and other institutions, and for distribution at a low
price to the infant children of the poorer classes. This is already being
done at some places in England (St. Helens, Liverpool, Nottingham,
Reading, Birmingham), and I cannot forbear to remind you of a sug-
gestion made less than two years ago by a University teacher of Po-
litical Economy who is still gratefully remembered here. Prof. Karl
Kindermann. He suggested that the town of Heidelberg should estab-
lish its own dairy farm on the airy heights of the Kohlhof and assume
the responsibility for the important work carried out with the aid of
private charity in the Milk Department of the Luisenheilanstalt [Heidel-
berger Tageblatt, 27 Sept. 1906].

I for my part look forward to a time when the whole of the milk
supply will be pasteurized free of charge by the town, just as at present
the town undertakes the supply of gas, water, electricity and street tram-
ways.

THE TECHNIQUE OF PURE MILK.

In order to get milk with a bacterial content of less than 1,000 per
cubic centimeter, such as von Behring regards as a not unattainable
ideal, or even of less than 10,000, which is the standard for "certified
milk" at Rochester, N. Y., you must be prepared to devote money and
careful attention to the problem. The animals must be kept scrupulously
clean. Complete asepsis must be aimed at in milking. The cows' tails
for instance must be cleansed with an antiseptic wash. Before milking
begins it ought to be possible to pass a white kid glove over the cow's
udder without staining it. The milker's hands should be washed with
special precautions before milking each cow, and special milking suits
should be worn. A special cooling-room must be available, and the milk
should be filled into bottles and sealed for delivery as soon as possible.
Always it must be kept cool. The bottles employed must be thoroughly
cleaned and sterilized before the milk comes into them. To say nothing
of the machinery required, it is obvious that all this needs conscientious
work-people.

113

THE PRICE OF PURE MILK PROHIBITIVE.

If all these reforms were universally carried out then we should in-
deed have an ideal milk-supply. On an experimental scale, we may say,
they have been carried out already, so that of the possibility of the
reforms there can be no doubt. But the price of such milk is prohibitive
for all but the rich : 40 to 60 pf . per liter (say 10 to 15 cents per quart)
would be cheap for such milk under present conditions. By municipal
enterprise and wholesale operations the price could no doubt be some-
what reduced, but it is pretty clear that it would always remain much
higher than the present price of ordinary milk. The reform can only
come gradually; there must be improvement before there can be per-
fection. That being so, there is nothing for it but, for the present at
least, to adopt a temporary policy of compromise — which even an ex-
treme idealist like von Behring is forced reluctantly to approve. This
policy, in a word, is Pasteurization.

^ DEFINITION OF PASTEURIZATION.

Pasteurization, so named after the founder of bacteriology, Louis
Pasteur, consists in maintaining the milk at a temperature of 60° -75°
centigrade [140°-167° Fahrenheit] for 20 minutes in a closed vessel,
and then cooling it rapidly. I myself prefer the higher temperature 70°
c. or 158° F. I have always pasteurized at this temperature and the
results have been so satisfactory that I am loath to change it. The
lower temperature is advocated as less likely to destroy the chemical
ferments in the milk, which are supposed, in the absence of definite in-
formation, to be of great value in making the milk digestible. You
observe that the milk is not boiled, and not sterilized. The flavor is
not impaired, the food value remains the same, and yet the amount of
heating is sufficient to kill the disease germs whose presence is most to
be feared in milk — the germs of tuberculosis, typhoid, scarlet fever,
diphtheria, dysentery, cholera, etc. As to the alleged disadvantages of
pasteurization, I will only say that the findings of the experts in the
recent American Government "Milk Bulletin" disprove them all. When
rachitis and scurvy occur, they are the results not of pasteurization but
of some other cause, such as abnormal composition of the milk or im-
proper hygiene. Far from being rendered indigestible by heating, the
pasteurized milk is now claimed to be even more easily digested than
raw milk [Bulletin, pp. 610, 626, 668-9 1.

114

PASTEURIZATION IN PRACTICE.

All this theoretical discussion about the advantages and dis-
advantages of pasteurization interests me, as a practical man, very little.
You must remember that I have been pasteurizing milk now for sixteen
years, and the system has proved disl'mctl]) successful, so that in my mind
there is no room for doubt that the advantages far outweigh the pos-
sible disadvantages.

I first opened my milk-depots in 1893 for the distribution of good
milk in New York. To quote the words of a writer last year in the
"Archiv fuer Kinderheilkunde," edited by Professors Baginsky, Monti and
Schlossmann: "In New York there died in the months of July and
August in the years 1890, 1891 and 1892 13,201 children under 5 years
of age, 6,122 of them succumbing to infant cholera. In the year 1893
Straus's Milk Charity was opened and the mortality sank as if by magic."
The improvement was as a matter of fact remarkable and it amounts to
this : that at the rate of mortality which prevailed in 1892 the number of
deaths in June, July and August, 1906, would have been 9,743, instead of
4,426 as it actually was. This saving of more than 50 per cent, of the
young lives formerly sacrificed in those three hot months has of course
not been effected solely by the distribution of pasteurized milk. Other
hygienic improvements have co-operated, but there can be no doubt that
the milk was the prime factor.

A still more unequivocal example is the case of Randall's Island, a
foundling asylum at New York, where the death rate of the children
was 44.36 per cent, in 1897. Early in 1898 I introduced the pasteurization
system there, and the death rate for that year, although no other change
whatever was made in the diet or hygiene, fell to 19.80 per cent. There
could not be more striking proof than this of the value of pasteurization.

Similar results have followed in other places where my example has
been followed. At Philadelphia, where, as at St. Louis and Chicago,
I installed the necessary plant, the mortality of children under 5 years
was reduced 24 per cent, between 1901 and 1906.

When I came here last winter, anxious to make a practical demon-
stration of the efficacy of pasteurized milk, my attention was drawn to
Sandhausen near Heidelberg. In this village the death rate of children
under one year was 46^^. It had been even higher before, and an im-
provement had already been gained through a Creche, which the Burgo-
master of the village erected. Still 46% seemed a high figure, and
enough to warrant my belief that Sandhausen was a proper field for
demonstration.

Encouraged by my experience at Randall's Island and elsewhere, I
knew and I prophesied that I could reduce the death rate considerably.

115

Accordingly I began on February 1 to supply the village with pasteurized
milk from my Heidelberg laboratory. Since March 1 the milk has been
prepared in a Milk Kitchen, which I installed for this purpose in the
village. The first few months realized my most sanguine expectations,
as the death rate by June 1 had fallen to half what the average had been
for the same months of the five preceding years.

Insinuations were thrown out at this time — doubts were uttered, and
it was hinted very strongly that the summer months alone could show
whether there was any merit in pasteurization. But I knew, and again
prophesied that in spite of summer and heat a still lower death rate
could be attained.

I was working against great disadvantages. Sandhausen is a poor
village, the population consisting almost entirely of factory workers —
men and women alike. The single doctor on whom the people are de-
pendent has to work for a total population of about 4,000. The advice
and guidance of young mothers was out of the question; quick medical
action in case of need was an impossibility.

There is no running water in the village, and accordingly sanitary
arrangements of any kind are entirely wanting. So I erected a bathing
establishment in connection with the Creche, and thereby added another
factor for the saving of infant life to the foremost one of proper feeding.
I had been made timid by unkindly expressed doubts, much as I relied on
pasteurization alone.

We have now the record for June — the first month of the harvesters
of infant lives — and so far my prophecy has come true. In the five
months ending June 30 only seven children under two years died, as
against twenty-four, the average for the same five months of the preced-
ing five years.

Sandhausen is no exceptional case. The same excellent results could
be achieved anywhere else, provided that the local authorities would take
the matter up energetically.

Why do I devote so much energy to demonstrating publicly the
need of milk-reform and the immediate benefits of pasteurization? Into
the personal and private reasons that first induced me to engage in this
work I need not enter here. It is enough to say that it was my own sad
experience which made me so determined to save the lives of other
people's babies.

But I have always only considered how best and quickest to en-
lighten the world in a practical manner. To attain this I sought the help
of the press, and it is due to its ever ready co-operation that my work
and its results have been made known broadcast. Only through publicity
can the advantages of the pasteurization of milk be everywhere realized.

116

I am not a professional man, and I am therefore not bound by profes-
sional etiquette to keep secret what I know to be for the public good.
The unnecessary slaughter of the innocents has appealed to me, and I
have sought and found the remedy to stem the evil, which I am giving to
the world in spite of selfish opposition, in spite of intrigue and all man-
ner of provocation. My impatience as a reformer is, I think, justified
by the crying nature of the evil and the apathy I encounter. At last
in America, after sixteen years of agitation, the time seems to have come
when Congress will take up the question of the milk-supply from a na-
tional point of view. That has been my constant aim, and it is because
I am bound to Germany by old and dear ties that I wish to see the same
public spirit developed here, and in all the countries of the civilized
world.

(REUTER'S AGENCY.)

Ottawa, Wednesday, June 10, 1908.

Addressing the Canadian Medical Association here, Dr. Hastings, of
Toronto, made the following remarkable statement:

"If the truth were known, 15,000 children of the 30,000 who die in
Canada annually might justly have the epitaph, 'Poisoned by impure
milk,' placed on their gravestones."

117

— 'J'^^'ieajjg, C^^tZ.e^<f

PASTEURIZED MILK LABORATORIES

FOUNDED 1892

348-350 EAST 32nd STREET, NEW YORK CITY

THE DIFFERENCE BETWEEN REAL PASTEURIZATION AND
COMMERCIAL PASTEURIZATION.

Real Pasteurization means that the milk is exposed to 157
degrees Fahrenheit for twenty-five minutes (five minutes for reach-
ing the temperature and twenty minutes at that temperature) and then
rapidly cooled to 40 degrees, according to the system of Prof. R. G.
Freeman and other men eminent in the medical world. This process
kills all noxious germs and preserves the nutritious quality.

Many mothers are cheated into the belief that they are get-
ting a safe milk when they buy what is described as "commercially
pasteurized" milk. Such milk should be labeled "NOT Pasteurized."
It is a humbug and a fraud, for it has not been pasteurized at all,
but has been treated by a .process that merely preserves the milk and
keeps it from souring; it does not kill the disease germs. It does
more harm than good, for it enables dealers to keep bad milk and
to market it when it is old and stale. It deceives mothers who know
that pasteurized milk is good for their babies, and who do not know

that "Commercially Pasteurized" milk is preserved milk.

Commercially pasteurized milk is milk exposed to heat for
forty seconds, which does not destroy the pathogenic (disease) germs,
but tends to give them a better chance to propagate. Unfortunately the
so-called "Pasteurized Milk" which is now being sold in this city is
mostly "Commercially Pasteurized." The using of the term "Pasteur-
ized" in conection with such milk should be prohibited by law.

118

Atttprtras

ICatPBt Olnntrtbutton

til ti|p

Milk (^mstxan

A REVIEW

OF THE

U. S. Government Report
''Milk and Its Relation to Public Health '^

(Published in Washington. D. C. 1908)

VIEW OF EMINENT MEDICAL AUTHORITY.

The most that can be hoped for from the most thorough inspection possible
is that the milk supplied to the city shall be microscopically clean — free, that
is, from admixture of manure and other gross impurities — and containing only
a few thousands of ubiquitous bacteria to the cubic centimeter.

Even then there could be no certainty that the milk would be always abso-
lutely sterile as regards the bacilli of tuberculosis, typhoid fever and diphtheria,
to say nothing of occasional accidental contamination with other pathogenic
germs.

With the best inspection possible under existing or any practically con-
ceivable conditions, the great bulk of milk delivered in New York every morn-
ing will only be fit for pasteurization — and even that is as yet far from realiza-
tion.

Nevertheless, our present milk supply can be rendered reasonably safe by pas-
teurization, which kills the existing germs even if it does not destroy the toxins
already formed or prevent subsequent growth when not kept cool and in sealed
receptacles.

The only safety for the consumers of milk in this and other cities through-
out the country lies in municipal pasteurization, conducted under constant super-
vision of the Health Department, of all except an insignificant fraction of the
milk supply.

Even that fraction would be made safer by heating for twenty minutes to
155° Fahrenheit and subsequent cooling of the sealed bottles containing it to 40°.

In pasteurization only, supplemented by conscientious and thorough inspection, ivill be found
a solution of the problem of a pure mil}( supply. — Nen> YorJ^ Medical Record.

120

The following are the names of the gentlemen whose arduous labors
are represented, in part at least, by their contributions to "Milk and Its
Relation to Public Health." They have earned the gratitude of all

who are interested in the milk question: that is, or should be, the pub-
lic at large.

PUBLIC HEALTH AND MARINE HOSPITAL SERVICE.

DR. WALTER WYMAN, Surgeon General
DR. MILTON J. ROSENAU, Director Hygienic Laboratory

DR. JOHN F. ANDERSON, Assistant Director

DRS. J. M. EAGER and J. W. KERR, Asst. Surgeons Gen'l

DR. JOSEPH H. KASTLE, Chief Division of Chemistry

DR. LESLIE L. LUMSDEN DR. GEORGE W. McCOY

DR. J. W. SCHERESCHEWSKY DR. JOHN W. TRASK

DR. NORMAN ROBERTS DR. WM. WHITFIELD MILLER

DEPARTMENT OF AGRICULTURE.

DR. HARVEY W. WILEY, Chief Bureau of Chemistry

DR. A. D. MELVIN, Chief Bureau of Animal Industry

MR. E. H. WEBSTER, Chief of Dairy Division

DR. B. MEADE BOLTON, Biochemic Division

DR. JOHN R. MOHLER, Chief of Pathological Division

HEALTH DEPARTMENT DISTRICT OF COLUMBIA.

DR. WM. CREIGHTON WOODWARD, Health Officer

121

WARNING FROM AN INVESTIGATOR.

Dr. E. C. Schro€der, Superintendent of the Experiment Station of
the Department of Agriculture at Bethesda, Md., thus sums up his
investigations :

"Man is constantly exposed to fresh tuberculous material in a help-
less way through his use of dairy products from tuberculous cows and
cows associated with tuberculous cattle.

"It seems from this array of facts, every one of which is based on
positive experimental evidence, that we should feel no doubt regarding
our plain duty, which is, no matter what other measures we adopt in our
fight against tuberculosis, not to neglect one of the chief, if not the most
important, source of infection — the tuberculous dairy cow." — Bureau of
Animal Industry Bulletin No. 93. See also Bulletin No. 99, by the same
author.

DEATHS FROM TUBERCULOSIS.

The Census Bureau, in a report issued Sept. 15, 1908, shows that in
the registration area, namely, the two-fifths of the country from which
fairly complete vital statistics are obtained, 76,650 persons died from
tuberculosis in 1907. This was 11.2 per cent, of all the deaths. These
figures bear out President Roosevelt's statement that there are 200,000
deaths from tuberculosis in the United States every year.

122

AMERICA'S LATEST CONTRIBUTION TO THE

MILK QUESTION.

J ^T a time when the question of a pure milk supply is engaging
^^^B public attention everywhere, it is of interest to note what
^^^JL^ fruit a similar agitation has borne in the United States. I
have the satisfaction of knowing that it was owing in a great measure
to my efforts that the interest of our government was aroused in a pure
milk supply. Sixteen years ago I started my work in New York City
and extended it gradually to other places. The results which followed
wherever I introduced pasteurized milk were brought to the notice of
the Public Health Department of the United States; and the very ex-
tensive report recently published, "Milk and Its Relation to Public
Health," is the outcome of my agitation.

In the meanwhile I had sent to Mayors of cities and Presidents of
Health Boards letters, urging them to take up this question, which
my experience had taught me to be such a vital one. I demonstrated
practically by the distribution of pasteurized milk the great need and
the great results that can be attained. Coincident with this distribution
the infantile death rate of New York City steadily decreased from 96.2
per 1,000 in 1892 to 51 per 1,000 in 1907. Similar good results followed
wherever pasteurized milk was introduced.

THE NEW BULLETIN AND WHAT LED TO IT.

About the same time that my first milk depot was opened in New
York (1893) Dr. Henry L. Coit organized the first "medical milk com-
mission" in the United States, that is to say, an association of medical
practitioners on the one hand, and a dairyman on the other, for the pro-
duction of milk of especially high quality, known as "certified milk,"
primarily for medical purposes. The spread of these associations and
the opening of infants' milk depots in various cities served to awaken
public interest, until at length in 1904 there began a regular battle for
pure milk in New York, which led to the holding of an important Milk
Conference there in November, 1906.

In the Summer of 1906 there were typhoid outbreaks in the Dis-
trict of Columbia, which, thanks to an efficient inspection service, were
traced to the milk supply. The District of Columbia is only sixty square
miles in extent, but it includes Washington, the seat of the national
government, and the Hygienic Laboratory of the Public Health Depart-
ment of the United States is situated there.

In June, 1907, President Roosevelt ordered a thorough investigation
of the milk problem to be made by the officials of the Public Health

123

Service with the assistance of the Department of Agriculture. With
extraordinary dispatch the results of this inquiry are now laid before us
in a volume of about 750 pages, entitled "Milk and Its Relation to
Public Health" (Bulletin No. 41 of the Hygienic Laboratory, Washing-
ton). The book is full of facts bearing on the milk problem as it exists
in America, in England, or indeed in any other country.

The Bulletin is not the report of a commission. It consists of
twenty-one essays or monographs by the departmental specialists on
various aspects of the milk question, with an introduction in which Sur-
geon-General Wyman briefly alludes to the most striking results of each
of the papers. Without specifying the titles of all the contributions it
is enough to say that a number of authors write on the connection be-
tween milk and disease ; others deal with the chemistry and bacteriology
of milk; others show the requirements that must be met in practical
dairy-farming; there is one masterly treatise on the feeding of infants;
and other papers criticise preventive methods, legal standards and tech-
nical processes at present in use to protect the milk-consumer.

It is unnecessary for me to attempt a summary of the whole book.
I propose to leave for the present the purely scientific sections and those
relating to milk-inspection and dairy-hygiene, while I refer more in detail
to the teachings of the book on the two matters most nearly connected
with my own propaganda, viz., disease in milk, and pasteurization as
the remedy.

GOOD MILK INFECTED SPREADS DISEASE.

I suppose it is well known by this time that the germs of disease
can be carried in milk, and that epidemic outbreaks are often traceable
to that source. Typhoid, scarlet fever, and diphtheria are the diseases
most frequently spread in this way, but we learn from the Bulletin that
Asiatic cholera (p. 241), dysentery (p. 603), and Malta fever are also
communicable through milk. One special subject for inquiry by the
American investigators was the frequency of these "milk epidemics," as
they are called. An enormous amount of statistical material relating to
the last fifty years has accordingly been collected and sifted. Here
you will find summarized the essential details of 317 outbreaks of typhoid,
125 of scarlet fever, and 51 of diphtheria, all orv'mg their origin to infected
milk, though it is admitted that not all the statistics available from for-
eign sources have been included.

These figures appeal directly to British readers, for most of the
statistics come from the United Kingdom. Thus while the United States
furnishes 132 instances of typhoid, 27 of scarlet fever, and 18 of diph-
theria, the United Kingdom can "boast" of 138, 96, and 32 cases re-

124

spectively, the sum-total of all three diseases from other countries being
only 50. This of course does not mean that the sanitary conditions are
worse in the United Kingdom than elsewhere. It is a proof of the
excellent work of your English medical statisticians, but it is also a
terrible warning of the dangers lurking in milk.

TYPICAL INSTANCES OF MILK EPIDEMICS.

Look for instance at the Dublin typhoid epidemic of August, 1899.
No fewer than 66 persons were smitten with the disease, and all of them
were supplied with milk from the same dairy. Now there were cases of
typhoid being nursed at that dairy, and it was probably the handling of
the milk by one of the persons acting as nurse that caused the milk to
become infected.

The very same thing happened on a smaller scale three years pre-
viously in Dublin. In May, 1896, the two children of a small milk dealer
were down with typhoid, and again it was probably the children's sick-
jiurse who infected the milk in the shop. The business being a very
small one, only 14 cases resulted.

Take another typhoid case — from Liverpool. In October, 1897,
twenty-seven children were suddenly seized with typhoid after eating
ice-cream at a stall kept by an Italian whose wife at home was lying
sick of the disease.

Liverpool illustrates also the connection between milk and scarlet
fever. In February, 1904, fifty-nine cases of scarlet fever occurred among
the persons using the milk from a dairy where there was a child recov-
ering from this complaint.

As for diphtheria, take the example of Edinburgh, where in May,
1900, something like fifty persons contracted the disease because they
were consumers of milk from a dairy farm where milkers and others
were found to be suffering from sore-throat which on bacteriological
examination proved to be true diphtheria.

UNHEALTHY COWS— UNHEALTHY MILK.

So far we have been dealing with cases where milk had become
infected on its way from the cow to the consumer. There is of course
another class of cases, in which the milk is already infected when it
leaves the cow. The contempt of precaution is more culpable, perhaps,
when human diseases are allowed to infect the milk, but it is only an-
other degree of neglect which tolerates the sale of milk from diseased
cattle.

125

TUBERCULOSIS.

That negligence must now be branded as criminal which allows an-
imals suffering from tuberculosis to contribute to the supply of milk
destined for human food. It is ridiculous at this late hour to quibble over
any possible difference there may be between bovine and human tuber-
culosis.

Koch, the discoverer (1890) of the specific germ of the disease, had
at first no doubts whatever as to its identity in man and in animals. Ten
years passed before he asserted the contrary (1901), and the assertion
has now been disproved by means of extensive experiments undertaken
at the instance of various governments.

Englishmen will probably be content with the verdict of the British
Royal Commission on Tuberculosis as to this matter, but the doubters in
America and even the Germans themselves have been forced to the same
conclusion, viz., that tuberculosis, whether in animal or man, is essen-
tially the same disease, and is communicable from animal to man in milJf.

This I hold to be a reason of paramount importance for insisting on
public control of the milk supply, or at least on precautionary measures
for securing non-tuberculous mill^ for the innocent children who must have mill^ and
Tvho cannot protect themselves.

THE TUBERCULIN TEST.

One of our greatest debts to Koch is the invention of the tuberculin
test for ascertaining, in cases where merely physical examination fails,
whether or not an animal is tuberculous. Tuberculin, itself a product of
the growth of tubercle bacilli in the laboratory, is injected hypoder-
mically and produces in tuberculous individuals a marked rise of tem-
perature, and this, under proper precautions, becomes an almost infallible
index of the unhealthy condition which it is desired to recognize and
eliminate. The veterinary surgeon can thus say precisely which of the
cows in a herd are to be considered tuberculous, and ninety-seven times
out of a hundred he is right.

Now look at the results of the tuberculin test as applied in America.
More than 1,500 of the cows supplying milk to the City of Washington
were officially tested last year, and nearly 17 per cent, had to be pro-
nounced tuberculous. This inspection was neither universal nor com-
pulsory, so it is fair to assume that only owners who were confident of
the healthy state of their herds submitted them to the test. Had all the
cows in all the herds been examined, no doubt the percentage would have
been much higher, say 25 per cent. (p. 493). The figures are first-hand,
and speak for themselves.

126

THE DANGER FROM DIRT.

The Bulletin mentions incidentally (p. 240) an estimate made in 1906
that at least 8 per cent, of the milk sold in London is the product of
tuberculous cows. The American evidence, however, justifies us, I think,
in assuming that one cow out of every four is, slightly at least, tubercu-
lous. It is possible, perhaps, for some of these cows to give perfectly
healthy milk. This point is not yet definitely settled, but it is perfectly
certain that the dung of such cows may contain the bacilli (pp. 163, 493),
and this is a point of great importance. People do not realize the quan-
tity of solid dirt that gets into the milk-pail in the course of milking.

It is not only that dust flies about in the air of the stall but the
milker's hands or clothing may easily detach portions of dirt from the
skin of the animal, unless those ideal regulations are observed which at
present are only enforced at a few dairies of the very highest class, and
which add so considerably to the cost of the milk as to make it a luxury
except for the rich.

"According to some authorities," says the Bulletin (p. 395), "the
citizens of Berlin consume 300 pounds of cow-dung in their milk daily."
One hardly likes to think what the estimate would be for London ! The
worst of it is that merely mechanical means, such as filtration and centri-
fuging, while removing the foreign bodies, actually promote the growth
of any bacteria present by breaking up the groups in which these minute
organisms live.

TUBERCLE BACILLI IN MILK.

Let us see next what the bacteriologists find who examine samples
of milk as sold in the great towns. In Liverpool, for instance, in 1898-9
six per cent, of the samples from town dairies, and 17 per cent, from
country dairies, contained tubercle bacilli (p. 173). About the same time
9 out of 16 dairies supplying the colleges at Cambridge were found to be
selling them milk that was tuberculous (p. 171). I do not know whether
the undergraduates are still taking their chances with such milk — things
may have improved since then — but if such was the state of the milk
provided for the privileged sons of the well-to-do classes, what was likely
to be the quality of the milk drunk by the poor babies of the London
slums?

The latest research on milk-tubercle is Dr. John F. Anderson's ex-
amination of the Washington milk, full details of which are given in the
Bulletin. The results are summed up in the statement that approxi-
mately 11 per cent, of the dairies whose milk was examined contained
tubercle bacilli virulent for guinea pigs. The test, I ought to say, con-
sists in inoculating guinea pigs with specimens of the milk ; and as some

127

guinea pigs, like some human beings, have better constitutions than
others, and are able to resist the effects of a comparatively weak dose, it
may be said that all the percentages obtained in this way are, if anything,
under the mark as an index of the frequency of tubercle bacilli in the
milk.

THE REMEDY.

It is easy to see the magnitude of the evil, but what is to be the
remedy? Obviously the thing to be aimed at is compulsory examination
of all cows by the tuberculin test and weeding-out of those found to be
tuberculous. This is distinctly recommended in the Bulletin (p. 192),
and it is very wisely suggested that the objectionable cows should be pur-
chased out of a Government compensation fund, as in fact is already
done in Pennsylvania (p. 499).

This is assuredly a most important, if not the first, requirement —
to raise the veterinary standard of the cattle throughout the country to
the highest possible pitch. It is, however, still more imperative to urge
the necessity of improvement in dairy procedure from first to last, so as
to minimize the risk of infecting healthy milk on its way to the con-
sumer. Much of this improvement could be effected without any great
outlay, but, as already hinted, the maximum of scrupulosity entails an in-
crease in the price of the product which places it beyond the reach of
ordinary purchasers.

There remains, therefore, for the present at least, but one rva^ of dealing
with all milk whatever, except in a few special cases where it is procured
under exceptionally favorable conditions — and that is, in my opinion,
pasteurization.

RECOMMENDATIONS OF THE EXPERTS.

The writers in the Bulletin fully agree with me on this point. I am
entitled to congratulate myself a little on the change that has come over
professional opinion, for when I began to interest myself publicly in the
milk question I was almost alone in my demand for universal pasteuriza-
tion— and it could always be said of me that I was but a layman.

It is now more than thirteen years since I wrote in "The Forum"
(November, 1894) : "I hold that in the near future it will be regarded as
a piece of criminal neglect to feed young children on milk which has not
been sterilized" ; and now compare those words with the recommenda-
tions of the specialists in the Milk Bulletin.

Dr. Leslie L. Lumsden writes (p. 159) that "to prevent the spread
of typhoid infection in the milk supply of cities * pasteuriza-

tion of the milk * * '•' is the best measure."

128

Dr. John R. Mohler recommends, as a veterinary authority (p. 506) :
"That all milk •'■ '•' shall come from tuberculin-tested

cattle, which shall be re-tested at least once a year or be subjected to
pasteurization under the supervision of the Health Department in case
the herd is not tuberculin-tested."

Dr. Joseph W. Schereschewsky, writing on "Infant Feeding" (p.
668), says: "During the summer it is better to pasteurize or to sterilize
all milk used in infant feeding."

DR. ROSENAU'S OPINION.

The author of the paper specially devoted to "Pasteurization," Dr.
Milton J. Rosenau, Director of the Hygienic Laboratory, maintains
throughout the judicial attitude of the man of science, but it is not diffi-
cult to see the side toward which the practical man in him inclines.

"We must protect ourselves," he says (p. 606). "We prefer pure
milk, but so long as we cannot obtain it we must purify what we get"
(p. 625). "Special cases may require raw milk, but the general public
should be protected" (p. 627). And after giving us all the arguments
for and against, he concludes with these words :

"Theoretically, pasteurization should not be necessary; practically,
we find it forced upon us. The heating of milk has certain disadvantages
which must be given consideration, but it effectually prevents much dis-
ease and death, especially in infants during the summer months"
(p. 628).

PASTEURIZATION— ITS ADVANTAGES.

The great value of Dr. Rosenau's paper, to my mind, is its unpreju-
diced discussion of the alleged disadvantages of pasteurization. The ad-
vantages are of course thoroughly emphasized also, and they admit of
very simple statement.

The effective pasteurization of milk, or heating of milk as Dr.
Rosenau prefers to call it, consists in maintaining the milk at a tempera-
ture of 140° Fahrenheit for 20 minutes in a closed vessel, and then cool-
ing it rapidly. Exposure to that temperature for that amount of time is
fatal to the germs of tuberculosis, typhoid, diphtheria, dysentery, cholera,
etc. (p. 598), but does not destroy the chemical ferments present in milk,
which are supposed, in the absence of definite information, to be of great
value in making the milk digestible.

Now it is pretty generally admitted that milk heated in the way Dr.
Rosenau describes is a great safeguard against the diseases mentioned,
and that it has a beneficial effect in reducing the risk of infantile diar-

129

rhoea, but there still are doctors who believe that its disadvantages out-
weigh its merits as a food for infants.

The objections are carefully gone into one after another by Dr.
Rosenau, but he and Dr. Schereschewsky between them are able to reply
very satisfactorily to them all.

ALLEGED DISADVANTAGES.

For instance, it has been asserted that scurvy may result from feed-
ing children with heated milk, but our two doctors show that in the rare
instances when it occurs it is very likely due to over-feeding with a milk
that is excessively fat and deficient in potassium salts. In all cases the
scurvy readily yields to simple treatment.

Rickets is another disease that has been attributed to the use of
pasteurized milk, but the general opinion of physicians regards it as
due to other causes — defective alimentation and improper hygiene (pp.
597, 626).

So far from pasteurized milk being more difficult of digestion than
raw milk, as is sometimes asserted, the heated milk is found to be more
completely absorbed than the raw (pp. 610, 626, 669) ; the curd is softer
and will therefore behave in the stomach more like the fine curd of
human milk (p. 669) ; large fat-containing curds are less likely to be
formed in the stomach (p. 668). "The evidence seems clear that the
pasteurization of milk at 60°c. [60° centigrade = 140° Fahrenheit] for
twenty minutes does not appreciably deteriorate its quality or lessen its
food value" (p. 625).*

THE SAVING OF INFANT LIVES.

The alleged disadvantages may therefore be dismissed and we come
back to the manifest benefits of pasteurization. It clearly makes milk
a safer article of diet for all who use it. Above all, it saves the lives of
infants. No better illustration of this fact is known to the writers in the
Milk Bulletin (pp. 237, 612) than the oft-quoted figures relating to the
infants' hospital at Randall's Island, New York, "where the mortality in
1897, with raw milk, was 44.36 per cent., while in 1898, with pasteuriza-
tion of the milk" undertaken at my suggestion in an apparatus that I
presented to the institution, "it was 19.80 per cent."

Speaking generally, the rate of infantile mortality is still every-
where too high. While modern sanitation has been steadily reducing
the general death rate of the whole population of civilized countries, the

*I have always pasteurized at 157° F. for 20 minutes, and this heat has not been found to
destroy the chemical ferments. Experience is better than theory, and my experience has so
demonstrated the success of 157" that I am loath to change my method.

130

mortality of infants under one year of age has failed to fall in the same
proportion (p. 230). The average death rate of such infants for the
whole of England and Wales (1895-1904) is 150 for every 1,000 births.
Out of every 1,000 children born in the country 150 are destined to
die before they are twelve months old, and locally the proportion must
be much higher — in Manchester and Salford, for instance, not far short
of 200 (p. 231). Of course one way to save some of these lives is to
revive the practice of breast-feeding, but much can be done by giving
up the laissez faire policy with regard to the milk supply.

CONCLUSIONS.

The chief reason for the acute state of the milk question at the
present moment, as pointed out by Surgeon-General Wyman (p. 11), is
the high rate of infant mortality, coupled with a declining birth rate.
The milk can no longer be allowed to take care of itself: it calls aloud
for appropriate treatment. Whether that treatment is to be adminis-
tered by some public body, beginning with inspection of the dairy farm,
or whether it is to be left to private management and restricted to the
domestic kitchen, is a question of national temperament and public
finance.

In America, I feel sure, this important Milk Bulletin will before long
be followed by Federal legislation.

England, I am happy to see, has also recognized the importance of
the question, and I cannot believe that she will hesitate to make the
responsibility for a pure milk supply a public charge.

How can nations grudge the money for this great service when taxes
for enormous military and naval expenditure are cheerfully borne?
There is a nobler warfare to which we are called: war against dirt, dis-
ease and death; war in defence of our most precious possessions — the
infant inheritors of the destiny of the world.

Heidelberg, July, 1908.

My experience during a seven months' residence in this city has only
confirmed my previous views. After all it is impossible b}f inspection and
control to insure a pure milk supply.

Official statistics show that 42.42 per cent, of the cows slaughtered
here in 1906 were tuberculous. This figure is probably not higher than
elsewhere, and only testifies to the careful work done by the slaughter-
house authorities.

Despite all the precautions which I know are being taken here, such
cows are milked to the last day ; their milk is mixed with that of healthy
animals, and the entire supply thereby infected.

131

In Sandhausen, near Heidelberg, the death rate of children under
two years of age was 46 per cent. Encouraged by my experience on
Randall's Island, I began on the 1st of February, 1908, to supply this
village with pasteurized milk. During the first month I sent the milk
from my Heidelberg Laboratory. Since the 1st of March the villagers
have prepared the milk themselves with an apparatus supplied by me and
installed in the village by the kind co-operation of Buergermeister Ham-
brecht. And I am happy to be able to announce that in spite of the
unfavorable weather of this spring and a few deaths caused by inflam-
mation of the lungs the death rate, according to the official statistics,
amounts to only one-third of the average death rate of the last five years.

Before sailing for America on August 27 I received this telegram :

Nathan Straus, Passenger Cedric, Queenstown:

Since February 1, 1908, there died in Sandhausen eleven children under two
years of age, against twenty-five for the corresponding months in 1907, and
against thirty-two average for the five preceding years. We use same milk as
before, only pasteurized.

(Signed) FRANZ HAMBRECHT,

Biirgermeister.

^y^^ta<H^ cf^^'itA'^

CHICAGO SAYS MILK MUST BE PASTEURIZED.

Chicago, Aug. 8. — This city, under the leadership of Dr. W. A. Evans, Com-
missioner of Health, has taken the lead in adopting practical measures for the
prevention of tuberculosis, being the first city in the world to take definite steps
to stop the sale of milk containing the germs of consumption.

The City Councils have passed an ordinance requiring that after January
1, 1909, all milk offered for sale in the city shall be pasteurized, unless it comes
from cows that have been tested with tuberculin within a year and that have
been proved to be free from tuberculosis.

Similar ordinances have been passed requiring that no butter or cheese shall
be sold in the city unless made from the milk of tuberculin-tested cows or from
pasteurized milk.

Dr. Evans, in his long fight for the adoption of these measures to prevent
the spread of tuberculosis, cited the demonstrations made in New York City by
Nathan Straus and the proofs given in European cities by the American philan-
thropist.

He pointed out that an American layman had taught the whole world how
to successfully combat the great white plague, and that the most American of
cities ought to take the lead in adopting and enforcing Mr. Straus's practical
and efficient scheme for the saving of human life and the curbing of the most
dreaded of all diseases.

— yVcn> Yot\ Evening Mail.

132

MOTTO

For all who would aid in the fight against the
Great White Plague :

MEDICINES AND HOSPITALS ARE

POSSIBLE CURES

WHILE

PASTEURIZATION IS POSITIVE

PREVENTION.

Ottawa, Wednesday, June 10, 1908.

Addressing the Canadian Medical Associa-
tion here, Dr. Hastings, of Toronto, made the
following remarkable statement:

"If the truth were known, 15,000 of the
30,000 children who die in Canada annually
might justly have the epitaph, 'Poisoned by
impure milk,' placed on their gravestones.'*

NECESSITY FOR PASTEURIZATION OF MILK AND
BENEFITS ATTAINED THEREBY.

PAPER PRESENTED TO THE INTERNATIONAL CONGRESS OF APPLIED
CHEMISTRY AT LONDON, MAY, 1909.

BY NATHAN STRAUS.

1 WT^ epoch in life-saving is marked by the assembling in London
^h^^ of the 7th International Congress of Applied Chemistry, for
^^ ^^ the workers in that branch of chemistry which has to do
with the purity of foods have won the right to celebrate the
triumphs of their science over commercial greed. Even though benzoate
of soda seems to be entrenched in the United States behind a referee
board, it is Dr. Wiley who has won the real victory, for the American
public is with him, and will have none of the preserved foods.

But my interest in the science of applied chemistry is due to the
aid given me by your profession in my life-work of saving the lives of
babies.

For eighteen years I have done what one man could do to stop the
slaughter of children. In 1892 I was convinced that infected milk was
responsible for the excessive infantile death rates and for the persist-
ence of tuberculosis among human beings.

Forthwith I proceeded to put pasteurized milk within reach of the
children of New York City. Instant was the response in decreased
mortality, and conclusive was the demonstration obtained by feeding
the city's waifs on Randall's Island with pasteurized milk, resulting in
the reduction of the death rate from 44% to 19.87^-

Therefore I proceeded to urge both in America and in Europe the
adoption of pasteurization as a practical means of killing pathogenic
germs in milk and thereby saving children from disease and death, do-
ing what I could to facilitate the putting of such milk at the disposal
of mothers.

Instantly my work was bitterly opposed. In those days I could only
point to the babies fed upon pasteurized milk to prove that I was right.
Objections to pasteurization multiplied, based entirely upon ignorance
or hostility at the idea of a mere layman teaching how to save lives.
To all attacks I replied by quoting the advice of that true medical sage,
Prof. Abraham Jacobi, for half a century the leading expert on chil-
dren's diseases, who had guided me in all my work, and by calling upon

135

Dr. Arthur Randolph Green, the medical director of my infant milk
stations, to tell exactly how the babies fared who were fed upon pas-
teurized milk.

However, throughout all these years, with no purpose but to save
lives, I was compelled to meet attacks, and the extension of the benefits
of pasteurization was hindered everywhere by the noisy clamor of those
who did not know and who would not believe. One New York physi-
cian went so far as to declare that his clinic was thronged daily with
babies who had contracted scurvy or rickets from being fed upon pas-
teurized milk. He was challenged to produce one such case. Dr. Green
went to his clinic to see the anomaly. I need hardly tell you that this
belligerent doctor failed to show a single such case, nor need I add that
he has not yet been silenced by this conviction of lack of veracity.

Such was the condition when applied chemistry stepped in to de-
termine scientifically the value of pasteurization and the true weight of
the objections shouted from the house tops by its foes.

I submitted, with perfect frankness, to the Public Health Service of
the United States, in 1907, every objection that I had ever heard raised
against pasteurization, every alleged disadvantage, every criticism, and
I asked nothing but that each of these objections should be carefully
considered, and that a true scientific verdict should be rendered.

The result was given to the world last year in the famous Hygienic
Laboratory Bulletin No. 41, "Milk and Its Relation to Public Health,"
which was a complete and thorough vindication of pasteurization, both
as showing its necessity and as proving scientifically that the heat neces-
sary to kill the germs of disease does not impair the ferments that assist
digestion, does not deteriorate the quality of the milk, does not lessen its
food value, does not alter its chemical or physical qualities — but does
prevent much sickness and save many lives.

In short. Dr. Rosenau, Dr. Kastle, and the other experts working
with the Surgeon General, Dr. Walter Wyman, in the investigation of
the milk problem, experimentally demonstrated the scientific correct-
ness of pasteurization as the practical method of making milk safe food,
confirming my practical experience of eighteen years in two hemi-
spheres.

I, therefore, take this opportunity to express my sense of the obli-
gation that humanity thus owes to applied chemistry for sweeping away
the crude errors that have so long protected the pathogenic germs in
milk and thus enabled them to spread disease and death broadcast.

136

The importance of this addition to the sum of human knowledge
can be appreciated only by one who has tried to stand between disease
and the babies and to shield them from untimely death.

When the results of this American investigation are properly
grasped by the medical profession and by the officers charged with the
protection of the public health, and when the fact of the scientific cor-
rectness of pasteurization is considered with reference to the relations of
bovine and human tuberculosis, as proved by the independent investiga-
tions of the British Royal Commission on Tuberculosis and Drs. Schroe-
der and Mohler, of the American Department of Agriculture — when
these facts are impressed upon the public conscience, it will be held to
be a crime to sell milk unless it has been produced under sanitary con-
ditions from tuberculin-tested herds and delivered uncontaminated in
sterilized containers, or unless it has been properly pasteurized.

Hundreds of thousands of lives will be saved if this Congress will
make a clear and emphatic declaration for pasteurization as the scien-
tifically correct and practically efficient method of saving human beings
from tuberculosis and other milk-borne infections. I sincerely hope
that the great influence of the International Congress of Applied Chem-
istry will be exerted in the cause of health and life and against disease
and death.

137

THE WHITE PERIL: HOW IT MAY BE AVOIDED.

Paper Presented to the International Dairy Congress, Budapest,

June, 1909.

Budapest, June 7. — That time and persistence in present methods
will certainly assure the extinction of the dairy industry and of the
human race, was the alarming statement made to-day by Mr. Nathan
Straus, the New York philanthropist, who has been fighting tubercu-
losis for eighteen years. Mr. Straus had a paper before the Interna-
tional Dairy Congress, in session to-day at the Vigado.

Stating that the great white plague of tuberculosis persists and
spreads among cattle and among people largely because of the white
peril of tuberculous milk, Mr. Straus said:

Tuberculous cows bear healthy calves and straightway infect them
with this disease through the milk that they give to their young, and
when the calves are weaned these diseased cows supply the germs of the
white plague to the human beings who use their milk. Thus we are
inviting the extermination of the dairy industry and of the human race,
for this plague is increasing both among cattle and among men, and it
will increase like the spreading of a fire so long as the milk swarming
with tubercle bacilli is used as food for calves or babies. There is a
mathematical certainty as to this fact.

CHICAGO ONLY CITY PROTECTING BABIES.

But we need not sit down in stupid helplessness and give tubercu-
losis undisputed sway on the dairy farm and in the home. We have the
tuberculin test to detect the infected animals, and the Bang method
of segregating the diseased cows and using those that are only slightly
affected to bear calves, which can be brought up without contracting the
disease by taking them from the cows and feeding them on pasteurized
milk. This will save the dairy herds. And we have the perfectly feasible
method of saving the babies by pasteurizing all the milk that does not
come from tuberculin-tested herds.

Eighteen years ago I declared that it would soon be regarded as a
crime to feed a young child upon milk that had not been pasteurized.

139

I was optimistic. Intelligent farmers now regard it as folly to feed a
calf or a pig with unpasteurized milk unless they know by the tubercu-
lin test that the cow is free from tuberculosis, but Chicago is the only
city in the world that takes such precautions to save its people from
tuberculosis.

To show that he was not exaggerating, Mr. Straus quoted the re-
port of Dr. A. D. Melvin, chief of the American Bureau of Animal
Industry, in which he shows that more than 10 per cent, of the dairy
cattle are tuberculous and that "this disease is undoubtedly on the in-
crease." Mr. Straus also said that Dr. V. A. Moore had found tuber-
culosis in 302 herds out of 421 examined, about one-third of the animals
being affected. Mr. Straus added:

TUBERCULIN TEST RELIABLE.

Yet for the past nineteen years we have had a practically infallible
method of singling out the tuberculous cattle. Dr. John R. Mohler, of
the American Department of Agriculture, has compiled the records of
24,784 applications of the tuberculin test, and has found that in all but
397 of these cases post-mortem examination showed tuberculosis indis-
putably.

As for the consequences of dairymen selling tuberculous milk, Mr.
Straus pointed out that there had been in New York City in two years
an increase of 33 per cent, in the number of new cases of tuberculosis,
a fact which the Health Department of the city tried to explain, but did
not deny. At this rate, he said, within a generation the great wealth of
the American metropolis would be insufficient to provide hospitals for
the tuberculous patients.

Mr. Straus said that bovine tuberculosis now costs the American
farmer $14,000,000 a year, and the immediate killing of all the tuber-
culous dairy cows, if it could be effected, would cost a billion, but that
pasteurization would infallibly kill the germs of tuberculosis and all
other disease germs that might be in the milk.

,.•-4. Jii^'rf-^- /

140

New York, May 12, 1909.

National Association for the Study and Prevention of Tuberculosis,
Washington, D. C:

Dear Sirs — Warmest greetings and enthusiastic praise are due the
National association upon the occasion of its fifth annual meeting, be-
cause of the incalculable service rendered in bringing the International
Congress on Tuberculosis to this country, and because of the multipli-
cation of sanitaria in the United States to more than 200, largely
through the influence of the campaign so vigorously conducted by this
association.

Yet this meeting would be barren and unprofitable if the National
association rested in contemplation of work well done, and failed to
recognize that the methods of prevention urged in its literature do not
strike at one of the greatest causes of the multiplication of tuberculosis
victims.

Increase of population may explain 10,157 deaths from tuberculosis
in New York City in 1908, as compared with 8,883 in 1902, but it does
not justify 23,325 new cases in 1908, where there were only 12,914 in
1902, almost doubling the year's record in six years.

The last two years have seen diligent and thorough application of
the methods of prevention embraced within the scope of the work of
this association, yet the number of new cases of tuberculosis reported
in New York was 19,725 in 1907, 23,325 in 1908, an increase of 18 per
cent., and in the first four months of the present year 8,755 new cases
have been reported, indicating a total of 26,265 for 1909, or 33 per cent,
more than in 1907.

These figures are tragic for the city cited as "leading the whole
world in the warfare against tuberculosis," and their significance must
be duly considered by this association.

Dr. Trudeau, the real pioneer in systematic combat against the
white plague, at the New York exhibition, said: "Prevention offers
the most promising field for effective work."

And we must have prevention that prevents, if we are to cut down
this rapidly increasing roll of tuberculous patients.

Prevention that deals only with infection that may come from the
tuberculous patient, and ignores the mischief wrought by the tuber-
culous dairy cow, is the sort that we have had, and it has failed to pre-
vent a 33 per cent, increase in the number of victims of the disease.

This association would be untrue to the International congress, for
which it was responsible, if it were to rest content with this sort of

141

prevention, for that congress unanimously decreed that "measures are
to be continued against bovine tuberculosis and that its transmission to
man is to be recognized."

That resolution of the delegates from thirty-three nations was a
call to the foes of the great white plague to move forward their battle
lines and to enter upon a yet more fruitful campaign against the most
deadly foe of mankind.

The situation is far too serious for any further pothering over quib-
bles about a microscopic difference in the appearance of the tubercle
bacilli found in man and those found in cows. Dr. Mohler, of the De-
partment of Agriculture, among others, has shown that the two forms
of the bacillus are due to the media in which they live, and that each
type changes to the other when transplanted.

Dr. Schroeder, of the agricultural experiment station, points out that
"if the two types really differ in an important way, it is only that the
type commoner in cattle is of much higher pathogenic virulence than
that commoner in man."

Dr. Ravenel, of Wisconsin, and Dr. Theobald Smith, of Harvard,
have isolated the germs of bovine type in the tissues of children who
have been killed by tuberculosis, and I have before me the records of
63 cases of children in which the bacilli were undoubtedly bovine. If
in some cases of children and in many cases of adults the germs are
found to be of the so-called human type, the variation is probably only
the morphological change that Dr. Mohler has shown to result when the
bovine bacillus dwells long enough in human tissues.

These are now scientific facts, corroborated by a host of scientific
men.

The Bureau of Animal Industry and Prof. Moore, of Cornell, have
shown the extent of tuberculosis among dairy herds, their investigations
indicating that one-third of the cows are affected and two-thirds of
the herds.

Investigations in Washington showed one out of every eighteen
samples of milk taken to be tuberculous, and that one out of every ten
dairies supplied tuberculous milk. Dr. Schroeder has shown that milk
is infected not only when the cow's udder is diseased, but that one
tuberculous cow may infect the milk of the entire dairy.

"Milk is frequently infected with living, virulent tubercle bacilli," he
writes. "There is nothing hypothetical, circumstantial or inferential
about this. It is a fact, a plain, experimentally demonstrated fact." And
he adds, after showing how the inhalation theory of human infection
has been overestimated : "We must not forget the significant fact that
tubercle bacilli in milk are not on floors or on pavements or on places

142

where they may or may not enter our bodies; they are located in
articles of food, to be eaten, in most instances, in a raw state, and there-
fore are inevitably consumed in large quantities."

Every one of these facts has been corroborated by the British com-
mission.

•'Every tuberculous cow," says Dr. Woodhead, of that body, "is
cither an actual or potential center of infection. We cannot get rid of the
great white plague until we take bacilli of bovine origin into consider-
ation."

Dr. Latham, the famous London physician, on April 22 wrote me:

"I agree with you that preventive measures are all important with
reference to tuberculosis, and have watched your work in connection
with the pasteurization of milk with great interest. Unfortunately we
at present devote our attention chiefly to an endeavor to deal with those
who are already afflicted with tuberculosis, but there are signs that the
public is at last waking up to the fact that the only real way of dealing
with the question is a wider one, and that it entails prevention of in-
fection in milk."

In 1895, almost in the beginning of my eighteen years' warfare
against tuberculosis, I wrote : "In the near future it will be regarded
as a piece of criminal neglect to feed young children upon milk that
has not been sterilized." I have demonstrated again and again that
pasteurization reduces excessive infantile death rates at least one-half
and that it kills the germs of tuberculosis.

Science has amply verified my experience. The public health service
thoroughly investigated the whole milk problem and Dr. Wyman and
Dr. Rosenau, with their corps of twenty experts, proved beyond dispute
that pasteurization does kill the germs of tuberculosis and the other
milk-borne infections, without in any way impairing the milk. Dr.
Rosenau fixes 20 minutes at 140 degrees Fahrenheit as the minimum
for efficient pasteurization.

In the light of these facts I feel that I am amply warranted in urg-
ing this association to take the important and necessary step forward
and to attack tuberculosis in its citadel — the dairy farm.

The progress hitherto made has been almost entirely in taking
better care of the tuberculous patient. Praiseworthy as this is, it is
not stamping out tuberculosis. The abolition of this unnecessary dis-
ease will begin when it is made a crime to sell milk unless it comes
from tuberculin tested cows, or has been properly pasteurized.

To Dr. Vincent Y. Bowditch, President.

143

REPORT MADE TO THE INTERNATIONAL CONFER-
ENCE AT STOCKHOLM ON THE INFECTION
OF CHILDREN BY MILK FROM
TUBERCULOUS COWS.

Stockholm, July 8, 1909.

HMERICAN investigations of the responsibility of bovine tuber-
culosis for the persistent spread of the disease among human
beings, particularly children, were officially reported to-day
to the eighth International Tuberculosis conference, in session here, by
Mr. Nathan Straus.

The paper by the New York philanthropist was presented by Dr.
Arthur Randolph Green, medical director of the Straus pasteurized milk
work, and one of the American delegates. It disclosed for the first time
the overwhelming evidence gathered by the American investigators to
show the responsibility of milk from tuberculous cows for the infection
of human beings with tuberculosis.

MR. STRAUS'S PAPER.

Mr. Straus's report was as follows:

The topic assigned for discussion, the protection of healthy children
from tuberculosis, suggests two important and imperative lines of action :

1. That their association, in families or otherwise, with tubercu-
lous patients be safeguarded by sanitary measures.

2. That their infection with bovine tuberculosis be prevented by
forbidding the sale or use of milk unless it comes from tuberculin-tested
cows, or unless it has been properly pasteurized.

Overwhelming proof of the necessity of stopping the use of tuber-
culous milk has been supplied, particularly within the past year, by the
definite tracing of a large number of cases of human tuberculosis to
its bovine origin.

The "Journal of the American Medical Association," in a leading
editorial on May 22, pointed out that in over 300 cases investigated
bacilli of the bovine type had been found in more than sixty cases, a
little more than 20 per cent., and this highest authority among the
medical publications of America declared: "Bovine tuberculosis is a
source of danger to man sufficiently great to demand rigorous precau-
tionary measures against it."

145

DR. PARK'S INVESTIGATIONS.

Quickly following this unanswerable summing up of the situation
came the disclosure in the same month of the investigations conducted
by Dr. William H. Park, director of the research laboratory of the
New York City Health department. Dr. Park reported to the Asso-
ciation of American Physicians that of seventeen fatal cases of general-
ized tuberculosis in infants, five were found to be due to bacilli of
bovine type. Two cases of abdominal tuberculosis were examined and
both were due to the bovine bacillus. In five cases of tuberculosis of
the bones and joints and four cases of pulmonary tuberculosis among
babies, the bacilli were of the human type. Of twenty-nine cases of
tuberculosis of the lymph glands of the neck nine disclosed bacilli of
the bovine type. Dr. Park observed: "Bovine infection is certainly a
considerable factor in the tuberculosis of children."

Dr. M. P. Ravenel, of the University of Wisconsin, as early as 1902
refuted the Koch error of 1901 by isolating the bacilli of bovine type
in the tissues of a child who died from tuberculosis. Dr. Theobald
Smith, of Harvard, found the bovine germ in four cases. Febiger and
Jensen, of Copenhagen, proved that seven of twelve children who died
from tuberculosis had been infected by milk, tracing the disease back to
tuberculous cows.

The German imperial commission, appointed to vindicate Koch, in-
vestigated eighty-four cases of tuberculosis in children and found twen-
ty-one, or 25 per cent., of bovine origin. The British Royal Commis-
sion established that fourteen out of sixty cases, or 23 per cent., were
due to the bovine bacillus.

PROOF OF BOVINE INFECTION.

Thus we have cumulative proof of the responsibility of milk and
milk products for the persistent spread of tuberculosis among human
beings, and the recent investigations of the American Department of
Agriculture have created a strong presumption that the infection has
been of bovine origin in many cases other than those in which post-
mortem examination discloses bacilli of undoubted bovine type. For
Dr. John R. Mohler has proved that the bacillus of bovine type changes
to the human type when transplanted into clots of human blood, indi-
cating that the form of the tubercle bacillus is due to the media in which
it lives. And Dr. Schroeder says : "If the two types really differ in an
important way it is only that the type commoner in cattle is of much
higher pathogenic virulence than that commoner in man."

Dr. Mohler's remarkable experiments open an absolutely new line
of investigation and suggest as highly probable the hypothesis that the
tubercle bacilli of the so-called human type are in many cases really of

146

bovine origin and differ in appearance from the bovine bacilli only
because of long residence in the human tissues. This hypothesis should
receive the studious attention of investigators.

EXTENT OF DISEASE IN DAIRY HERDS.

Besides the indisputable evidence that bovine tuberculosis is trans-
mitted to human beings, particularly to children, we have to recognize
the fact of the extent of tuberculosis among the dairy herds. Dr. A. D.
Melvin, chief of the American Bureau of Animal Industry, in his last
annual report showed that more than 10 per cent, of the dairy cattle
were tuberculous. "This disease is undoubtedly on the increase," he
said. Dr. Moore, of Cornell University, found tuberculosis in 302 out
of 421 herds examined in New York State, about one-third of the ani-
mals being diseased.

It is to be remembered in this connection that Dr. E. C. Schroeder
has proved that tuberculous cows, even though but slightly affected,
give off tubercle bacilli in their feces, and that the mere presence of a
tuberculous cow in a dairy herd may result in the infection of the entire
milk supply of that dairy. Dr. Schroeder's conclusions were amply
verified and confirmed by the British Royal Commission.

TUBERCLE BACILLI IN MILK.

Then we have evidence of the undoubted presence of tubercle bacilli
in milk offered for sale in our cities. Wherever examinations have been
made living, virulent germs of tuberculosis have been found in a con-
siderable number of the samples taken from the milk dealers.

The most important and thorough investigation of this sort was that
made by Dr. John F. Anderson, assistant director of the United States
Hygienic Laboratory. After years of work on the part of the agricul-
tural department had vastly improved the conditions as to health of the
dairy herds supplying the city of Washington, Dr. Anderson gathered
272 samples of milk from 104 dairies, the largest number ever examined
in one investigation. He obtained indisputable results from 223 of these
samples, finding 15, or 6.72 per cent., to contain virulent tubercle bacilli,
and that this tuberculous milk came from eleven different dairies.

And of the tubercle bacilli in milk, it must be remembered, as Dr.
Schroeder points out, that their lodgment in human bodies is not left to
chance, as in the case of germs in dust or sputum, but that they are in-
evitably consumed in large quantities and enter human bodies alive and
virulent. Wherefore, Dr. G. Sims Woodhead, of the British Royal Com-
mission, says: "Every tuberculous cow is either an actual or potential
center of infection."

147

MUST ELIMINATE GERMS FROM MILK.

Obviously, therefore, the efficient protection of human beings, and
particularly children, from tuberculosis requires that a summary stop be
put to the almost universal practice of using milk of doubtful origin in
the raw state. This was the position I took in 1895, almost at the begin-
ning of my work, and this was the conclusion reached in 1908 by the
United States Public Health service, after the most thorough investiga-
tion of the milk problem ever made.

By means of the tuberculin test the diseased cows can be weeded
out, but this will be a work of years. Through the activity of medical
milk commissions in America a supply of milk from tuberculin tested
cows has been secured, but this milk is costly and the total output is
only about 40,000 quarts a day, or one-tenth of one per cent, of the quan-
tity daily used in the United States.

For the other 99.9 per cent, we need measures that will eliminate
the tubercle bacilli and other germs and prevent the milk setting up in-
fections in the human body. The measures that are recommended by
the United States Bureau of Animal Industry are the tuberculin test
and pasteurization, the recommendation being that pasteurization be re-
quired in the case of all milk not produced from tuberculin tested herds.

GOVERNMENT FOR PASTEURIZATION.

Summing up the results of the milk investigation, Surgeon-General
Walter Wyman writes: "The important subject of pasteurization has
been C£<refully studied by Dr. Rosenau, who points out its advantages
and discusses its inconveniences. He recommends 60 degrees Centigrade
(140 degrees Fahrenheit) as the best temperature to use in pasteurizing
milk, as this degree of heat is sufficient to destroy the pathogenic micro-
organisms without devitalizing the milk itself. Pasteurization is forced
upon us by present conditions. It prevents much sickness and saves
many lives."

And Dr. Schroeder writes : "It is a simple matter to destroy tuber-
cle bacilli in milk and cream by pasteurization. It is necessary to edu-
cate men to a realization that tuberculosis is so common among dairy
cows that many years must pass before we can reasonably hope to eradi-
cate it, and that in the meantime pasteurization is absolutely necessary
for the protection of public health."

Dr. Rosenau, director of the United States Hygienic Laboratory,
after a thorough study of the amount of heat necessary to kill the tuber-
cle bacilli, decided that the milk should be heated to at least 60 degrees
Centigrade and kept at that temperature for twenty minutes.

148

VINDICATION OF THE METHOD.

The proof of the correctness of pasteurization of milk as a life-saving
measure has been rounded out by Dr. Joseph H. Kastle, chief of the
division of chemistry of the hygienic laboratory, who has shown that the
process, as recommended by the United States Public Health Service,
does not impair the ferments or enzymes contained in fresh milk, does
not alter the chemical composition of milk, does not lessen its food value,
either as to nutrition or digestibility, and does not alter its taste or phys-
ical qualities.

This method of destroying the tubercle bacilli in milk, so thoroughly
proved and justified by science, has been practically vindicated by my
eighteen years' experience in supplying pasteurized milk for the babies
in New York and other cities in America and abroad. The result has
been that wherever pasteurization has been introduced in cities having
excessive infantile death rates, the mortality among the babies has been
reduced one-half.

In view of all these facts that I have briefly summarized, the tuber-
culosis problem resolves itself largely into a milk problem, and the milk
problem is not what to do, but how to get it done.

The prevention of the infection of healthy children by tuberculous
patients is largely the work of the doctors, and they are quite able to
cope with this duty.

ACTIVE CO-OPERATION NEEDED.

The prevention of the infection of healthy children by tubercu-
lous milk requires the active and willing co-operation of the dairyman,
the milk dealer, the legislator, the health officer and the doctor. That
these men of diverse interests may work together to enforce the pasteur-
ization of milk that is not from tuberculin tested herds requires the
earnest endeavors of the organizations that have been formed to fight
tuberculosis and the assistance of the pulpit and the press to create such
well-informed public sentiment that it will be regarded as a crime to
feed a child upon milk of doubtful origin unless it has been properly
pasteurized.

The progress hitherto made in the fight against tuberculosis has been
chiefly in the treatment of the disease, the easing of the suff^erings of the
hopelessly tuberculous and the curing of incipient cases.

There are indications now that the anti-tuberculosis movement will
soon make headway against the plague along the lines of rational and
effective prevention. Within the past month the American Association
of Physicians and the National Association for the Study and Preven-
tion of Tuberculosis both issued warnings against infected milk as a
cause of tuberculosis, the former declaring the sale of such milk criminal,
the latter body earnestly commending all eff^orts to secure, especially
for the children, a pure milk supply.

149

PREVENTION OF INFECTIOUS DISEASES CAUSED

BY MILK.

SUBMITTED TO THE

INTERNATIONAL MEDICAL CONGRESS

AT BUDAPEST, AUGUST 31, 1909

BY NATHAN STRAUS OF NEW YORK.

^ ■ _^APPTI.Y the representative medical associations are on record
W ^ as frankly recognizing the perils of raw milk and officially
^ ii^ recommending the well-proved remedy, namely, the destruc-
tion by heat of the disease germs that may be in milk. And science has
made rapid progress in verifying the correctness of this wise advice and
in adding urgency to the warning that milk should be boiled or pas-
teurized.

Investigations in all the civilized countries have heaped up irrefut-
able evidence that infected milk is a frequent cause of infectious diseases,
and that pasteurization at not less than 140 degrees, for not less than
twenty minutes, thoroughly kills the pathogenic organisms, without in
the least impairing the physical qualities of the milk.

Health officers, having become keener in tracing epidemics to their
source, have proven that numerous outbreaks of infectious diseases
among children have been due to the use of infected milk in the raw
state.

Dr. John W. Trask, of the United States Public Health Service, has
tabulated the convincing records of 500 such epidemics that have been
definitely traced to the milk supply. This list includes 317 milk-caused
epidemics of typhoid fever, 125 of scarlet fever, 51 of diphtheria and 7
of epidemic sore throat.

Dr. M. J. Rosenau, director of the Hygienic Laboratory at Wash-
ington, who has just been designated the first Professor of Preventive
Medicine and Hygiene at Harvard University, made two thorough in-
vestigations, case by case, of typhoid fever in the American capital.
Rejecting all the instances in which the evidence fell short of actual
proof, out of 866 cases in 1906, he found that 85, or nearly 10 per cent.,
were due to infected milk; while out of 523 cases in 1907, 48, or more
than 9 per cent., were definitely traced to infected milk.

Marking all cases, irrespective of their proved origin, on a map of
Washington, and tracing thereon the routes of the milk dealers. Dr.

151

Rosenau obtained a remarkably illuminative result. In 1906 there were
only 3 cases, and in 1907 only 8 cases on the routes of one of the biggest
dealers in the city. Dr. Rosenau gives this explanation:

"This dealer is the only one in Washington who both sterilizes the
bottles and pasteurizes the milk. The low typhoid fever rate among his
customers is significant and perhaps is a fair index of the result which
would be accomplished by the pasteurization of the milk supply."

The pasteurization in this case is not the fraudulent half-minute
process called "commercial pasteurization," but consists in heating the
milk to 156 degrees Fahrenheit (69 degrees Centigrade) and holding it
at that temperature for half an hour.

While practical experience was furnishing this concrete demonstra-
tion of the efficacy of pasteurization, Dr. Joseph H. Kastle, the chief
chemist of the Hygienic Laboratory, made a most searching investiga-
tion of the effects of heat upon milk. He found that the heat necessary
to kill the germs of disease does not impair the ferments that assist di-
gestion, does not deteriorate the physical qualities of the milk, does not
lessen its food value, does not alter its chemical constituents.

Wherefore, Surgeon-General Walter Wyman, summing up these
and other inquiries, says: "Pasteurization prevents much sickness and
saves many lives."

In the face of these practical demonstrations, which coincide exactly
with my own experience of eighteen years in supplying pasteurized milk
for the babies of New York and other cities, it certainly seems that it
should be impossible for crude errors and prejudices to persist and to
protect the pathogenic organisms that so often are found in milk, and
thus enable them to spread disease and death broadcast.

But there is a reason for pasteurization that is more imperative than
the presence in milk of the germs of typhoid or scarlet fevers or diph-
theria.

The specific germ that causes tuberculosis is found in much of the
milk that is used for human food. In America, only one-tenth of one
per cent, of the milk daily sold is certified as free from tubercle bacilli.
Conditions are much the same in every country, for bovine tuberculosis
exists everywhere except on the Channel Islands, and the susceptibility
of cows to this plague increases with the development of their milk-
producing capacity.

Dr. John F. Anderson, of the Hygienic Laboratory, found virulent
tubercle bacilli in 6.72 per cent, of 223 samples of Washington milk,
after the Department of Agriculture had for years been diligently weed-

152

ing out the tuberculous cows from the dairies supplying the national
capital.

Dr. Alfred H. Hess found tubercle bacilli in 16 per cent, of 107
samples of New York milk.

The London County Council last month received a report of the
investigation of the milk supply of the British capital, which showed that

12.9 per cent, of 1,217 samples were undoubtedly tuberculous.

These facts would be alarming were they not illuminative. They
would inspire terror, did they not point the way to the means of saving
the human race from this widespread and ever present peril.

Among scientific men, save the few who in 1901 committed them-
selves to a hasty assumption, no one now in 1909 doubts the transmission
of bovine tuberculosis through the raw products of diseased animals to
human beings. Nor does any one, unless similarly committed to some
pet error, dispute the certain efficacy of pasteurization as killing the in-
fection, rendering the milk safe, while in no way impairing its food
qualities.

It is, in fact, proved, with mathematical certainty, that progress in
fighting the Great White Plague depends upon the adoption of methods
of evicting the tubercle bacilli from the milk supplies. The elimination
of the diseased animals from the herds, it is admitted, will be the work of
years, involving the expenditure of many millions. The destruction of
the tubercle bacilli in milk is the work of half an hour, the cost trifling.

I will yield to no one in enthusiastic appreciation of the services
that medical science is rendering to humanity in improving the treat-
ment of tuberculosis and in reducing the death rate from this disease.
In New York City the death rate from this cause fell from 2.42 per 1,000
of population in 1902 to 2.39 in 1907 and 2.29 in 1908, but the number
of deaths from tuberculosis in proportion to the total number from all
causes remained fairly constant. In 1902, 13.04 per cent, of all the deaths
were caused by tuberculosis; the percentage fell to 12.54 in 1904; rose to

13.10 and 13.37 in the next two years ; fell to 12.95 in 1907, and rose to
13.90 in 1908.

These figures reflect upon the medical profession greater credit than
appears upon the surface. This holding in check of the death rate from
tuberculosis has been in spite of a very great and alarming increase in
the number of new cases of the disease.

The population of New York has increased 26 per cent, since 1902,
while the number of new cases of tuberculosis reported in a year has
increased 100 per cent. Growth of the city has added 932,291 to the
population, while the spread of tuberculosis has added 144,172 to the

153

army of consumptives, until the vast resources of the great metropolis
are taxed to the utmost to care for these victims of the Great White
Plague.

Here are the figures of the new cases of tuberculosis, year by year :

New Cases.

Per 1,000 of Population

1902

12,914

3.55

1903

15,219

4.07

1904

18,723

4.88

1905

20,831

5.18

1906

20,085

4.83

1907

19,725

4.60

1908

23,325

5.27

1909 (half year)

13,350

5.85 (for year)

The cases reported up to July 1, 1909, indicate a total of 26,700 for
the year.

These are the official figures of the Health Department and they can-
not be successfully disputed. The explanation has been advanced that
the doctors have been remiss in past years in reporting cases, and have
suddenly begun to do their duty. This I reject as a mean and unmerited
attack upon the integrity of the physicians of New York City.

There is no way in which these figures can be shorn of their alarm-
ing significance, namely, that the number of new cases of tuberculosis
is increasing, in spite of better housing and working conditions. And
these figures are paralleled in every other city in which similar data is
available.

The logical and inevitable conclusion is that we must go back to the
proven source of much human tuberculosis if we are to check the ravages
of this plague. We must not stop at protecting the healthy from human
infection, but we must save the well from the infection that may lurk
unsuspected in raw milk.

If 16 per cent., or even 10 per cent., of the milk sold in New York is
tuberculous, can we wonder at 13,350 new cases in the first six months
of this year, and can we hope to stop this rapid infection of the popula-
tion while we are feeding the people upon live, virulent tubercle bacilli?
And are we not, as I said in 1894, guilty of criminal negligence in feeding
young children upon milk which has not been sterilized or pasteurized?

One of the foremost authorities in England, Sir James Crichton-
Browne, president of the Sanitary Inspectors' Association, has well said :

"The primary and paramount food question is the protection of the
milk supply. Suicide, as well as assassination, has to be prevented by the
strictest surveillance. The first and fundamental necessity in the protec-
tion of life is the application of efficient modern methods of purification
to the disease infested milk supply."

154

It stirs the heart to think of how much sickness and suffering could
be prevented by stripping the milk supplies of their power to cause dis-
ease and making this universal food of humanity a means of sustenance
and health instead of an instrument of disease and death.

If I feel deeply and speak warmly, it is because I have seen results
from my work. I have seen the infantile death rate in New York cut
down from 96.5 to 49.6 per 1,000 since 1891, coincidentally with the in-
creased use of pasteurized milk in the tenement districts. I have seen
the mortality in the infants' asylum at Randall's Island, New York, re-
duced from 44.36 to 19.80 per cent., with no other change in care or
diet than the substitution of pasteurized for raw milk. I have seen the
death rate of Sandhausen, Germany, cut to less than half of the average
for the preceding five years by no other means than by pasteurizing the
milk for the children. I have seen similar saving of life at Eberswalde,
near Berlin, with the remarkable record of not a single death of a child
fed on pasteurized milk from October, 1908, to July, 1909. Thus I might
multiply the evidence by citing the experience of twenty other cities.

This International Medical Congress meets at a time when the na-
tions are competing feverishly in building equipment for making war,
spending millions upon engines for the destruction of human life.

Your Congress, representing the men throughout the world who are
striving to save lives, has the right to urge upon the governments of the
world that the true way to make the nations great is to save the re-
sources given them in their children, by protecting them from tuberculo-
sis and the infectious diseases of childhood, by insisting that no milk
should be used unless pasteurized or produced from tuberculin-tested
herds under sanitary conditions.

Your labors against disease qualify you to insist that every expendi-
ture upon the means to destroy lives in war should be duplicated by the
setting apart of like sums for the saving of lives by the prevention of
disease.

The advocates of expensive armament justify their programmes by
saying that they seek to prevent war. No excuse is necessary for the
proposal that like millions at least be spent to prevent sickness and
death.

With national resources to support the higher warfare against death,
we would soon see real headway in the fight against the great white
plague in such a considerable reduction in the number of new cases that
humanity would take heart, and thousands would call the International
Medical Congress blessed for instituting such an enlightened policy of
practical life saving.

155

SAVING CHILDREN FROM MILK-BORNE DISEASES *

BY NATHAN STRAUS

r ^ ''he old city of New York (now the Borough of Manhattan),
fl ^\ has established a new record in the saving of the lives of
^^■^ babies. Notwithstanding unusually severe periods of in-
tensely hot weather the past summer, there have been fewer deaths of
children under five years than in any preceding summer, and for the first
time in the history of the city the summer mortality has fallen to a rate
less than fifty per thousand per annum.

When I first undertook to protect the babies of New York from
milk-borne diseases by supplying pasteurized modified milk in 1892, the
summer saw the dying of 6,612 children under five years, making the
rate per thousand per annum 136.1. With the steadily increasing use
of pasteurized milk there has been a steady decline in infant mortality,
until the summer just ended showed only 3,900 deaths in a population of
children larger by 125,000 than that of 1892.

In other words, in 1892, 964 children out of every 1,000 survived the
summer, while in 1910 there were 988 who escaped death out of each
thousand.

That the pasteurization of milk fed to children has been a consider-
able factor in this achievement none may deny, for the prevention of
sickness and death proceeds inevitably from the destruction of the germs
that cause illness and that slay the little ones.

These facts are too elementary to be recited before the American
Public Health Association. They are set forth fully in the thorough
exposition of the milk problem by the Federal Public Health Service in
the Bulletin, "Milk and Its Relation to Public Health," which Surgeon-
General Wyman summarized in the words, "Pasteurization prevents
much sickness and saves many lives."

This epitome of the results of the Federal Milk Investigation ought
to be the battle cry of the forces united in the warfare against prevent-
able diseases. Of all preventable diseases the most prevalent are tuber-
culosis, typhoid and scarlet fevers, diphtheria and the intestinal disorders
of infancy; the specific germs of each may be and often are transmitted
to the human system in raw milk, and these germs are rendered harm-
less by proper pasteurization.

*Read at 38th Annual Meeting of American Public Health Association, Milwaukee, September, 19 10,

157

We ought to recognize that the disease now attracting so much
attention — infantile paralysis — has all the appearance of a germ disease,
occurs among infants whose only food is milk, and is probably prevented
by pasteurization. I venture this presumption because of the fact that
this disease has never occurred among the babies fed upon the milk pas-
teurized at my laboratories. I submit this fact in the hope that this
practical experience may be used to the protection of child life while
scientists are engaged in the tedious effort to isolate the germ.

If resort to pasteurization precedes scientific justification in the case
of infantile paralysis, this method, as applied to the diseases known to
be milk-borne, follows and confirms the discoveries of science.

My recent experience at Sandhausen, Germany, may be cited. The
death rate among babies under two years of age had averaged 46 per
cent, for five years. I pasteurized the milk for most of the babies, and
the death rate fell to less than 20 per cent. I pasteurized the milk for
all the babies of the village, and last July there were no deaths at all.

Again at Karlsruhe, instead of 26 per cent, of the babies dying in a
year, the rate was reduced to 16 per cent, by pasteurization of the milk
fed to about one-fifth of the whole baby population. These children
were of the poorer classes, among whom the death rate had been higher
than the average for the city. After these babies had been fed upon
pasteurized milk the death rate among them fell to less than seven per
cent.

All of which confirms and emphasizes the warning uttered by the
eminent Prof. Jacobi at a meeting of child-saving agencies at the New
York Health Department last spring. He had listened to the broaching
of various ideas that had been put forth for approval of the conference.
The most important thing, said the greatest authority on the care of
infants, is this: "Use no raw milk."

There is no division of science upon this point. No competent au-
thority has ever disputed the fact that pasteurization kills the germs of
disease, while it in no way impairs the nutritive value or the digestibility
of the milk.

My practical experience in saving children from milk-borne diseases
warrants the assertion that the pasteurization of the milk supplies of our
big cities, under careful Health Department supervision, would infallibly
reduce the number of cases of infectious diseases and save lives of babies.

In no way could the American Public Health Association save so
many mothers from bitter grief and loss of their little ones as by hasten-
ing the time when efficient pasteurization will be the rule and when the
milk-borne diseases will be as rare as the plagues that medical science has
practically abolished.

158

REPORT BY

OFFICIAL DELEGATE ON THE PART OF THE

UNITED STATES

®I|p ProgrPBB Muhi \n Atttprtra
tn ®i|p Protprttmt of

SUBMITTED TO THE

THIRD INTERNATIONAL CONGRESS
FOR THE PROTECTION OF INFANTS

(GOUTTES DE LAIT)

BERLIN, SEPTEMBER 11-15. 1911

REPORT BY NATHAN STRAUS.

OFFICIAL DELEGATE ON THE
PART OP THE UNITED STATES ON THE

PROGRESS MADE IN AMERICA IN THE PROTECTION

OF CHILD LIFE.

PRESENTED TO THE

THIRD INTERNATIONAL CONGRESS
FOR THE PROTECTION OF INFANTS.

HELD AT
BERLIN, SEPTEMBER 11-15. 19".

Mr. President and Members of the Congress:

' 1 WTT the command of His Excellency, The President of the
^^^M United States, I am here to present to this International
^'^^^% Congress a report of the progress made in America in the
protection of the lives of infants and to commend to your attention and
approval the methods approved by our scientists and justified by our
practical experience.

We have been happy in America in having at the head of our na-
tional government and of the bureaus that deal with the public health
men who have been impressed with the social and economic importance
of the baby, and who have been diligent to exert the powers of govern-
ment for the protection of infants. Much has been accomplished; more
is to be done.

President Taft is determined that the Federal Government shall do
its utmost, both to show the local health officers and philanthropic
agencies the best ways of protecting the lives of babies, and to carry on
active work on their behalf in the protection of the milk supplies and in
the promotion of better standards of living.

TO SAVE 125,000 BABIES A YEAR.

The Government has examined with expert ability and care the work
in this field of individuals and philanthropic agencies, has made investi-
gations and conducted experiments, and has reached conclusions which
arc being applied in the confident expectation of saving 125,000 babies'
lives annually.

161

Of 1,324,660 deaths in the United States in 1909, 280,000 were of
babies under one year, and 113,000 of these deaths were from intestinal
disorders, due to improper feeding, and from infectious diseases, due
often to disease germs conveyed to the babies in the milk.

It has been completely demonstrated in the United States that such
deaths can be prevented, and that children, by proper nourishment, can
be made to withstand other sicknesses of infancy that are not directly
due to impure milk or improper feeding, and this is the basis of the
expectation that 125,000 babies can be saved annually.

At the opening of the present century 180 out of every 1,000 babies
born in the United States died in their first year ; such progress has been
made that the average for the decade has been 165 deaths out of every
1,000 births. We expect to reduce the rate to 100 or less.

SYSTEMATIC PROTECTION OF BABIES.

The systematic protection of babies' lives had its beginning in
America twenty years ago in the supplying of properly modified and
pasteurized milk for infant feeding. It was then that I opened my first
infant milk depot in New York City, with the advice and expert co-
operation of Dr. Rowland G. Freeman. In 1892 the death rate among
children under five years was 96.5 per 1,000; in 1910, in the same area,
the rate was 45.8 per 1,000.

This reduction in infantile mortality was coincident with the increase
in the number of stations and the output. This year I have eighteen
stations, and the municipality and other agencies have increased the
total number to eighty-seven. The statistics to date indicate a death
rate much lower than any ever recorded in New York.

The credit for the success of this pioneer work is due to the wise
guidance and unfailing helpfulness of that prince of savants. Prof. Dr.
Abraham Jacobi, whose authority as the greatest of experts on infant
feeding is recognized in Europe as well as in America, and who has just
been made president of the American Medical Association.

DEMONSTRATION ANSWERED OPPOSITION.

But even though my work had the approval of so eminent a special-
ist, it encountered bitter opposition at the very start. In an article
published in "The Forum" in November, 1894, I stated:

I hold in the near future it will be regarded as a piece of criminal neglect
to feed young children upon milk that has not been sterilized (pasteurized).
Milk is not always good in proportion to the price paid for it, nor free from
the germs of contagion because it has come from cattle of aristocratic lineage.
The latter quality, as recent experience has shown, carries with it special sus-
ceptibility to tuberculosis.

162

At first the editors refused to print this statement as being too
radical, but as a compromise put it in a footnote. Now this has become
the battle cry of this whole campaign.

It was necessary, therefore, to make a demonstration such as could
not be had by feeding babies in their homes. New York City at that
time cared for its waifs on Randall's Island. In the three years, 1895,
1896 and 1897, out of 3,609 children, 1,509, or 41.81 per cent. died. With-
out any other change in their diet or regimen, the children in this insti-
tution were supplied with pasteurized milk from the same cows instead
of the raw milk. The result was that in the next seven years out of
6,200 children only 1,349, or 21.75 per cent., died.

Thus the certainty of this method being efficacious was established.
I might recite with cumulative force other facts from my twenty years*
experience in this work, but I shall reserve this data for a brief paper
that I will submit at another session of this Congress.

WORK OF AMERICAN GOVERNMENT.

Up to 1907, when this Congress met at Brussels, progress had been
slow. But the foundation for effective work throughout the United
States had been laid by the Public Health Service and the Department
of Agriculture.

The former body, in 1907, under the direction of Dr. Walter Wyman,
Surgeon-General, made an exhaustive investigation of the milk problem
at the direction of President Roosevelt, proved that raw milk was often
the cause of tuberculosis, typhoid fever, diphtheria, scarlet fever and
intestinal disorders of babies; demonstrated that pasteurization does
not impair the nutritive or digestive qualities of milk, and summed up
the inquiry with the statement that "Pasteurization prevents much sick-
ness and saves many lives."

Officials of the Agricultural Department, under the leadership of
Dr. A. D. Melvin, chief of the Bureau of Animal Industry, formed the
Washington Milk Conference, in 1907, and declared that the only milk
reasonably safe in its raw state was that from tuberculin-tested cows,
produced under sanitary conditions and known as "certified milk," and
that all other milk should be pasteurized.

STAND TAKEN BY THIS CONGRESS.

At this juncture this Congress, in session at Brussels, issued the
warning :

Milk for children should be boiled, sterilized, or pasteurized — not used in
its raw state.

163

A year later (1908) the Sixth International Congress Against Tu-
berculosis was in session at Washington, and by reason of the weight of
the arguments advanced by the American authorities, Ravenel, Schroe-
der and Mohler, and by Woodhead, of England, declared:

That measures be continued against bovine tuberculosis, and that its trans-
mission to man be recognized.

At this time there were infant milk depots in 21 cities in the United
States; now there are such institutions in over 40 cities, and in some of
the cities the number of depots and the output of milk have been more
than doubled in the three years. The work of these institutions includes
instruction in the feeding and care of babies.

TWO GREAT CITIES REQUIRE PASTEURIZATION.

The City of Chicago, with Dr. W. A. Evans as Commissioner of
Health, set the example in adopting measures for dealing with the milk
supply as a whole by requiring in 1909 the pasteurization of all milk
not from tuberculin-tested herds. The death rate for the preceding ten
years had averaged 316 to the thousand ; in 1909 it fell to 287. As com-
pared with 1908 the lives of 521 babies under one year were saved.

On January 1, 1912, practically the* same regulations will be en-
forced by Health Commissioner Lederle in New York City. Thus the
two greatest cities in America will bar from use raw milk except such
as has been produced from healthy cattle under exceptionally good
conditions.

This stand has been taken by these two cities after years of diligent
effort to regulate the milk supplies by inspection alone have proved that
the most careful guarding of the sources of supply is not sufficient to
surely exclude the germs of disease from milk.

MUNICIPAL MILK DEPOTS.

Another step in advance has been made by the City of New York
in undertaking the establishment and maintenance of municipal milk
depots for supplying milk for infant feeding. Fifteen such depots have
been established in New York and are now in their first year. This clear
recognition of the responsibility of the municipality for the proper feed-
ing of babies is an important gain, and the example set by New York
is likely to be followed in many other cities.

Notwithstanding the thorough demonstration of the efficacy of pas-
teurization, it has been only after much controversy and keen argument

164

that the decision has been reached that safety for the babies can be had
only by the appHcation to the milk of sufficient heat to surely kill the
disease germs.

In 1904 the New York Milk Conference was formed with a strong
disposition among its influential members to fight to the end for that
elusive ideal, "clean raw milk." This Conference in 1910 decided officially
that two kinds of milk, and only two, were safe for human consumption,
namely :

(1) Milk in a raw state produced under sanitary conditions from tuberculin-
tested cattle.

(2) All other milk to be thoroughly pasteurized.

The former milk is known as "certified ;" it forms one-tenth of one
per cent, of the city's daily supply, and its cost is prohibitive except to
the wealthy.

DR. ROSENAU ON PASTEURIZATION.

The consensus of American opinion on this point is stated by one
of the country's highest authorities on hygiene. Dr. Rosenau, Professor
of Hygiene and Preventive Medicine at Harvard University, who as
director of the Hygienic Laboratory personally conducted the Federal
milk investigation. He says:

Pasteurization is rapidly gaining ground. Raw milk is apt to be dangerous
milk. The milk that is not certified or guaranteed as fresh, pure and clean should
be heated to at least 140 degrees Fahrenheit for twenty minutes. This in essence
constitutes pasteurization, and is the inevitable outcome of the future.

The dangers from raw milk are constantly brought to our notice through
epidemics of typhoid fever, scarlet fever, diphtheria and the summer complaints
of children. All these and many more infections are carried in milk.

The safeguard is to destroy the infection by the simple process of heating
the milk. Pasteurization does not injure the quality of the milk in any way, does
not diminish its nutritive value. It saves lives and prevents sickness.

Dr. Lederle, Health Commissioner of New York City, says:

No inspection can make milk entirely safe for infants. Compulsory pas-
teurization and the classification of all milk will enable us really to safeguard
the milk supply.

The Commission on Milk Standards, consisting of eighteen promi-
nent American experts, under the chairmanship of Dr. Evans, with Dr.
Charles E. North as secretary, on May 22, 1911, resolved :

That in the case of inspected milk, or milk produced under careful condi-
tions so far as cleanliness or infectious diseases is concerned, and from tuber-
culin-tested cattle, pasteurization is optional, otherwise compulsory.

That in the case of all milk not either certified or inspected, as required in
these standards, pasteurization is compulsory.

165

We have been letting babies tumble over the cliff quite long enough.
We have fed them with infected milk and have maintained great hos-
pitals to win them back from death's grasp. Now in America we are
putting the fence around the top of the cliff. We are beginning to shut
off the supplies of raw milk, with their possibilities of disease, and to
provide properly pasteurized milk that the babies may live, that their
childish prattle may gladden the hearts of mothers that would be bowed
with grief but for this precaution.

Prevention is the word that I bring to you from America, and
Prevention means Pasteurization. Upon this the health agencies of the
United States Government are agreed. I am here to commend to you
the results of patient scientific investigation and of years of practical
experience, and my message is confirmed by the dean of the American
medical profession, Dr. Jacobi, in the words, "Use no raw milk."

^y^^^£^ ^^^huu^

168

TWENTY YEARS'
PRACTICAL EXPERIENCE

Milk for infant J^fftring

FOUNDER OF INFANT MILK DEPOTS
PRESENTED AT THE

Third International Congress for the
Protection of Infants

ilGOUTTES DE LAIT)

BERLIN, SEPTEMBER 11-16, 1911

TWENTY YEARS* PRACTICAL EXPERIENCE

MODIFYING AND PASTEURIZING MILK FOR
INFANT FEEDING.

BY NATHAN STRAUS

FOUNDER OF INFANT MILK DEPOTS.

PRESENTED AT THE
THIRD INTERNATIONAL CONGRESS
FOR THE PROTECTION OF INFANTS

BERLIN, SEPTEMBER 11-15, 1911.

Mr. President and Members of the Congress :

IT has been my privilege as official delegate to this congress from
the Government of the United States to bring to your attention
the method that America has found successful in saving the lives
of babies. This method has been the modification and pasteurization
of milk for infant feeding, the maintenance of infant milk depots, and
the instruction of mothers in the feeding and care of their babies.

It was twenty years ago that the appalling waste of child life and
the recognition of the perils of raw milk for infant feeding led me to
start the first depots in New York City. In my official report to this
congress I gave the statistics showing the reduction of the death rate
among children from 96.5 per 1,000 in 1892 to 45.8 in 1910. This re-
duction was steady, the rate going down lower each year, as the number
of milk depots and their output increased.

WORK OF VAST POSSIBILITIES.

Almost at the start I recognized the vast possibilities of the work
and the fact that it was beyond the power and the means of any one man
to fill this field. I sought, therefore, to interest others in the protection
of the infants and to arouse the municipalities to their duty to the babies.

Plants that I installed in Philadelphia, St. Louis and Chicago formed
in each city the nucleus of work similar to mine in New York, with like
results. Beginnings were made in other cities, and finally, in the present
year, New York opened the era of municipal milk depots for the babies,
in response to popular demand that was incited by the results achieved
by my work in that city.

171

PROPER WORK FOR MUNICIPALITIES.

I need not weary you with the statistics of my American work.
The best proof of its success is the recognition, after twenty years, by
America's greatest municipality, of the fact that the maintenance of such
pasteurized milk depots is a proper and necessary municipal function.
Enlightened public policy has dictated that the babies should be saved
from needless sickness and death.

It has been recognized also in New York that this is a proper work
of humanity for a church to undertake, the Morningside Presbyterian
Church having set the example by establishing an infant milk depot
which takes care of 125 babies a day.

In 1908 the Countess of Aberdeen, wife of the Viceroy of Ireland,
accepted from me a pasteurization plant which has since been operated
by the Women's National Health Association in Dublin, with the result
that the death rate among the babies supplied with this milk has been
only 55 per thousand, while the mortality among the rest of the babies
of Dublin has been three times as great.

BABIES' LIVES SAVED IN BADEN.

The Women's Society for the Care of Infants, of the Grand Duchy
of Baden, accepted a similar plant, and it has been operated under the
patronage of her Royal Highness the Dowager Grand Duchess Luise.
The official report of this work for 1909 shows that the death rate among
the babies in the entire city of Karlsruhe was 17 per cent., while among
the babies supplied with pasteurized milk the mortality rate was only
6.3 per cent. The report says:

This very remarkable success of feeding with pasteurized milk is to be ap-
preciated more because these children were mostly sick or had become reduced
by long sickness before they were brought to us.

In Sandhausen (district of Heidelberg) the demonstration was com-
plete. I began supplying the babies with pasteurized milk in February,
1908. Immediately there was a reduction in the death rate. The aver-
age infant mortality for the preceding five years was 46 per cent. With
no other change except the substitution of pasteurized milk for raw milk,
the death rate fell to less than 20 per cent.

Extending the work so as to supply milk for all the babies in Sand-
hausen under two years, the record of two months last year, in which
there were no deaths at all among the babies, was highly gratifying.

WORK OF TWO NOBLE WOMEN.

Thus with the enthusiastic encouragement of two noble women, the
Dowager Grand Duchess of Baden and the Countess of Aberdeen, I have

172

been enabled to make conclusive demonstrations in Germany and in Ire-
land. The practical experience with pasteurization in the cases I have
just cited confirms the conclusions resulting from the work in America,
and warrants me in urging upon this congress the duty of encouraging
the establishment of pasteurized milk depots.

With the great increase in population and in industry in Germany
and other progressive countries conditions have changed so as to make
this necessity urgent. Instead of the cows having the benefits of life
in the open fields, they are more and more shut up in stables, which in-
creases their susceptibility to tuberculosis. No longer does any doubt
exist as to the dangers of raw milk from tuberculous cows; neither can
there be any reason to hesitate over adopting that means of safety that is
afforded by pasteurization. Moreover, there are the other diseases that
may be transmitted in milk — typhoid fever, diphtheria, scarlet fever and
intestinal disorders, and the last is more fatal than any other ailment in
babies, causing 37 per cent, of all deaths under one year.

DEMONSTRATION IN WASHINGTON.

My most recent demonstration of the value of pasteurization has
been in Washington, where I established a laboratory in 1910, with six
sub-stations. The medical director, Dr. Louise Taylor-Jones, kept care-
ful records of the work of the first six months. I quote these significant
figures :

Of the 506 babies that were supplied with the milk 57 per cent., or 289, were
ill when they were brought to the stations.

Out of the total 51, or 10 per cent., died.

Of the 318 babies that were fed upon the milk for a month or more, long
enough for a fair trial, only 20 died. This was 6.2 per cent.

Of the 192 still on the milk at the end of six months all were thriving.

None of the babies who were lost died from intestinal disorders or from
infectious diseases.

The period of these observations included the intensely hot summer months,
which are particularly severe in Washington.

INFANT DEATH RATES CUT IN HALF.

Summing up my twenty years' practical experience most conserva-
tively, I can state with certainty that excessive infantile mortality has
been immediately checked wherever I have supplied pasteurized modified
milk, and the rate has been cut down at least to half the average for the
preceding five years.

173

The prevention of sickness among babies is a public duty. This is
demanded by humanity and by public policy. Sickness and death are
among the chief burdens of the poor and the cause of much poverty.
The systematic prevention of the diseases that are caused by impure
raw milk will do more than anything else to lift these burdens.

Who can estimate the happiness that can be brought into the world
by these means? Who can realize what it will mean to mothers to pre-
vent milk being, as it is now, the means of spreading tuberculosis and
other infectious diseases? Blessed is the home in which the prattle of
babies is heard. Blessed will this congress be if it promotes measures
to prevent the stilling of the voices of the babies in death.

174

OFFICIAL REPORT

of the THIRD INTER-
NATIONAL CONGRESS
for the PROTECTION of
INFANTS held at BERLIN

SEPTEMBER ELEVENTH TO
FIFTEENTH, NINETEEN
HUNDRED AND ELEVEN

AS SUBMITTED TO
PRESIDENT TAFT

-<^^^fe^t^ c^^^^^u^^

PASTEURIZCD MILK LABORATORIES

rouNoco ia«i

34* tA«T THIMTV-SCCONO STRICT. NEW YORK CIT»

27 West 72d Street

Hew York, Dec. 20, 19X1

The Preoident,

T^aehlugtOD . D. c.

117 dear Mr. Taft:

Piireuant to your ISBtructlosB I attended the Third Interriatioual
CongreBb for the Protection of Infants, held^at Berlin September 11-16,1911,
at official delegate on the part of the United States. As the repreEentative
of Anerioa I was accorded marked consideration by Her Imperial Highness, the
Empress of O^rmany, under whose patronage the Congress was held. *ind she
expressed the keenest interest in the efforts that are bejng m&de in oui
country to protect the lives* of the infants, and in tht^ efficient work that
l8 being done by' yotii' administration to promote the public health.

I had the honor to present to. the Congress a report on "The Progress
made In Amerioa in the Protection of Child Life," and in my individual capacity
as a member of the Congress I submitted a brief paper on "Twenty Years' Practt-^
cal Experience In Modifying and Pasteurising Milk for Infant Feeding." A oopy
of each paper Is attached to this report.

Particular Interest was aroused by oy report of the activity of the
Anerican Government in investigating the causes of excessive infant mortality
and in finding practical methods of preventing unnecessary sickness and death
among the babies. The French delegates, coming from a nation that appreciates
more keenly than any other the value of an infant life, were particularly ready
to commend the able pioheer ^Ork^ of the United States Public Health Service and
of the Department of A^icu£tu2*e. Those of the members of the Congress who
were connected with pul>lio health agencies in their several countries were
familiar with muob of the work done by the American Public Health Service.

Some of them took pains to tell me that no reports on public health
questions rank higher among e7i)erts abroad than the volumes embodying the
results of the Milk and Typhoid Fever investigations by the Public Health
Service and the monographs by Drs. Sohroeder and Uohler on their investigations
Into the transmission of tuberculosis from cow to man. I found that these two
names, with those of Drs. iryman and Boaenau,..were regarded abroad as typical of
authority and progress, and as putting Ameridajln the very front rank among the
nations that are seriously grappling with the problems of the prevention of
disease.

So cordial were the expressions of appreciation that I feel warranted
in believing that the news of the death of the Sturgeon General of the Public
Health Service was received with genuine grief in the foreign health offices
and that the passing of J)r. TTymon from his sphere of beneficent activity was
regarded as 6 calamity to tne world at large.

177

I attended all the sesBious of the Congrees &nd folloved the papers
asd diecuoolocB with care. Id the hope that I vould he ahle to hrlcg haok eome
practical ideas on the prevention of aicknees aiaong infante » for incorporation
in the report that you desired me to submit.

But for the most part the paper's presented had little to do with the
prevention of slolcDesc. Methods of treating the diseases of children were
discussed at length, hut it pould be foreign to your purpose for me to attempt
to synopsige the array of cures brought before the Congress.

neither would it be to your purpose for me to recite the ideas on
institutional management put forth at the Congress, or to tell of the papers
that dealtjii vith such elementary principles of hygiene as personal cleanlinese.
or that discussed vhat nvursee ought and ought not do In the core of babies.

Upon one subject much stress vas laid, namely, upon the necessity for
accurate and uniform vital statistics. I gathered from the discussions that '
America is quite abreast of the other nations-in the registration of births,
deaths and epidemic diseases, and 'that no government issues better statistical
reports than those that are put/ forth by the U. S. Census Bureau. The exten-
sion of the registration area to cover t^e entire country is greatly to be
desired.

vThat which most impressed me at the Berlin Congress is the vital
ibportano^ of directing the attention of the r>orld at large and of the health
officers of cities and nations to the duty of preventing disease. It seemed
significant that delegates from two score nations, representing practically
'all the civilized world, could meet to discuss "the protection of infants" and
devote the bulk of their time to debating what kind of pills to give the babies.
The -treatment of sick babies can be trusted to the doctors. What is needed is'
the prevention of sickness.

Infantile death r'Atres the world over are needlessly high, not because
of lack of skill on the part of the physicians, but for the simple reason that
the babies are recklessly infected with diseases. Efforts to prevent these
sicknesses, beyond the elementary expedient of quarantine, are made in only a
few cities, and no nation except the United States has, as a nation, attacked
the sources of the sicknesses that slay the little ones.

The searching investigations by the Public Health Service and the
Agricultural Department have proven that typhoid and scarlet fevers, diphtheria,
tuberculosis, sore throat and summer complaint are often caused by raw milk, and
that the transmission of these diseases through this common food of babies may
be prevented by efficient pasteurization of the milk. I mention this because
it illustrates the advanced position of this Government In seeking to prevent
disease. The only parallel to these investigations is that conducted by the
British Covernmeut into the relation of bovine and human tuberculosis, an
Inquiry that was anticipated at every step by the Amerioan government in the

178

work of Dre. Sohroeder and Mohler, and by the independent investigator. Dr.
Ravenel, and their findings were verified in every particular by the Britieh
Boyal CoQDiesion on TuberouloBis.

In one other cospeot Aoerioa is' happily in advance of the times, in .
hax,lng at Earvard' University the only eoholaetio department in the world
devoted to the prevention of disease , the ohair being oooupied by Dr. Roeenuu,
trained in the Qovernmeut service and now the foremost exponent of scientific
measures to attack sickness at its sources

I mention these considerations as vindicating the propriety of
America taking the lead in the world-i;ide movement to strike at the roots of
disease. To launoh such a movement, I respectfully, suggest to you, as the
matured result of my observations at the Berlin Congress and at other similar
oonventiODS. that you call an International Congress for the Prevention of
Disease.

Such u gathering, held under your patronage, would call together the
men li^ all parts of the world who are fighting the causes of disease, as dis-
tinguished from the physicians who are engrossed vrith combatting the effeotjis
of disease.

That there is need for such a congress is illustrated by the faot that
there is no international body that gives more than passing attention to the
^prevention of disease, yet confessedly this is of far greater Importance than
the doctoring of the sick, for prevention means the delivery of great numbers
of people from the whole train of evils that follow the seizure the seizure of
one of a faaily with sickness.

It seeuB to me that by bringing together the great sanitarians, health
officers and others identified with the work of prevention, in a congress in
which the discussion of methods of treatment would be forbidden, you could bring
rich blessings upon the who\)^ world, emd could round out the first term of your
Presidency by setting in motion Infli^noes that would save hundreds of thousands
of lives In the years to come.

That there is necessity for conference on methods of preventing dis-
ease, has been recognized by the instructive annual conventions of the American
Public Health Association, by the periodic conferences of state health officers
Instituted by the late Dr. Wymon and by the establishment of a section of the
American Medical Association for the st4dy of prevention

This need of the age has been reoogniaed also in the incorporation of
the word "prevention" In the titles of associatione formed' to deal with tubercu-
losis and infant mortality, but it has been the unfortunate experience of these
praiseworthy movements that the vital necessity for prevention has been forced
into the background by the eagerness of medical delegates to discuss methods of
treatment and by the zeal of professional charity workers to expound their plans
of organization and of institutional work

179

In order that the euhjeot O? the prevention of dlBeaeo should have
the opportunity for diecusBion that its vaet importance demande, it is
neceesary that this matter he made the sole purpose of a gathering of eoien-
tistB and puhliciBts, at which no euhsidiary ieeue shall have hearing.

I. am sure that it will etir you profoundly to contemplate the good
that such a congreoe oould achieve — the potentiality of such a movement
for the benefit of the hiiman race, and I hope that your wise and far-seeing
Btatesmanship, which has made so mightily for the public weal, will dictate
the assemhling under your inspiring leadership of a congress that will mark
an epoch in the promotion of the puhlic health.

Very sincerely yours.

''^a^4^^>'^*^<2^^'^'^^

180

REPORT BY

OFFICIAL DELEGATE ON THE PART OF THE
UNITED STATES

BY APPOINTMENT OF THE PRESIDENT
ON

SUBMITTED TO THE

SEVENTH INTERNATIONAL CONGRESS
AGAINST TUBERCULOSIS

ROME. APRIL 15. 1912

REPORT BY NATHAN STRAUS.

OFFICIAL DELEGATE ON THE PART OF THE UNITED STATES
BY APPOINTMENT OF THE PRESIDENT.

PROGRESS MADE IN AMERICA IN THE
PREVENTION OF TUBERCULOSIS.

TO THE

SEVENTH INTERNATIONAL CONGRESS AGAINST TUBERCULOSIS

ROME, APRIL 15, 1912.

Mr. President and Members of the Congress :

^^^^ HE message with which I am charged by the government of

J ^ the United States is —

^^^ "Prevent tuberculosis. Stop it at its sources."

My government, as the result of twenty years' investigation, be-
lieves that the disease can be checked, controlled and finally practically
eradicated. Smallpox, yellow fever and the bubonic plague have been
stamped out in America, not by mere treatment of the victims, but by
scientific preventive measures that went to the origin of the
infections.

Our aim now is to end the ravages of the Great White Plague, and
it is my duty as delegate from the government of the United States to
report particularly the measures that we believe offer the means and the
hope of delivering humanity from this scourge. If any facts are neces-
sary to give urgency to this cause, it should be remembered that at the
present rate of infection, one out of every nine persons now living will
die from this most terrible of all the plagues that have ever afflicted
human kind. Tuberculosis causes 10.7 of all deaths in the United States.

$14,500,000 FOR ALLEVIATION.

The problems of the treatment of the disease have been admirably
handled by the physicians in co-operation with the philanthropic. In
the past year $14,500,000 has been spent in America in combating tuber-
culosis, two-thirds of this sum being money appropriated from public
funds, the rest the contributions of the people.

But the demands for funds to maintain institutions for the tubercu-
lous are breaking the back of philanthropy. Each year the necessities
of this work increase, and it becomes more and more difficult to secure
adequate means to alleviate the sufferings of the ever increasing army
of victims of this dreaded disease.

183

The growth of the work is illustrated in these figures, compiled by
the National Association for the Study and Prevention of Tuberculosis,
showing the principal lines of activity for each year since 1905:

Asso- Sanitoria and Dispen- Open Air Preven
ciations. hospitals. saries. schools. torium

Founded before 1905 18 111 18

during 1905 15 18 6

1906 18 16 14

1907 46 30 45 1

•" 1908 109 45 118 2

" " 1909 167 67 59 10

1910 117 68 62 16 1

" 1911 128 96 43 62

Totals 618 451 365 91 1

These figures show an increase in the number of associations and
institutions from 147 prior to 1905 to 1,526 by the end of 1911, a gain
of 1,048 in six years.

THE TUBERCULOUS PATIENT LESS A MENACE.

The vast work summarized in the above figures has been chiefly
one of alleviation, only incidentally tending to prevent tuberculosis.
But it is to be recognized that in caring properly for tuberculous victims
and in teaching the public the nature and dangers of the disease, much
important preventive work has been done, and the tuberculous patient
has been made less a menace to the community.

Chief among the measures tending to prevent the spread of the
plague from man to man have been these —

Segregation of patients in the more infectious stages.

Compulsory reporting of all cases to the health officers.

Sanitary disposition of sputum.

Checking of expectoration in public places.

Disinfection of tenements.

Letting sunlight into tenements.

Abolition of the common drinking cup.

Warfare upon the house fly. ^

Teaching the gospel of fresh air.

Rescuing children from tuberculosis environments.

Open air schools for children susceptible to tuberculosis.

Tuberculosis exhibitions.

INCREASE IN TUBERCULOSIS.

Though progress has been made, in varying degrees, along all these
lines of prevention, I was compelled, two years ago, to present to the
National Association for the Study and Prevention of Tuberculosis facts

184

that proved that tuberculosis was steadily increasing in New York City,
as shown by the number of new cases reported to the Health Depart-
ment, and to urge the necessity of resorting to the measures adopted
in the first work of prevention undertaken in the United States.

It was in 1892 that I inaugurated this work by supplying pasteur-
ized milk in New York City to protect the babies from infection through
the use of tuberculous milk, and in 1894, in **The Forum," I stated :

I hold in the near future it will be regarded as a piece of criminal neglect
to feed young children upon milk that has not been sterilized (pasteurized).
Milk is not always good in proportion to the price paid for it, nor free from the
germs of contagion because it has come from cattle of aristocratic lineage. The
latter quality, as recent experience has shown, carries with it special suscepti-
bility to tuberculosis.

INVESTIGATIONS BY THE GOVERNMENT.

It was at about the same time that the United States Government
undertook investigations that have resulted in the complete demonstra-
tion of the fact that the milk from tuberculous cows is a real and con-
siderable factor in the persistent increase of tuberculosis among
human beings.

It was in 1893 that Dr. Theobald Smith and Dr. E. C. Schroeder,
of the United States Department of Agriculture, proved the infection of
milk with tubercle bacilli, and in the following year they demonstrated
the value of the tuberculin test in the diagnosis of bovine tuberculosis.

When Dr. Koch, in 1901, presented his famous assumption of the
non-communicability of bovine tuberculosis to human beings. Dr.
Schroeder began the series of investigations that established, in 1902,
the probability, and in 1905-6, the certainty, that tuberculosis among
cattle was a factor in the causation of human tuberculosis. Besides
this, he proved a number of facts with regard to the tubercle bacilli, the
most important being that the bacilli may lie latent in animal tissues.

TUBERCLE BACILLI IN DAIRY PRODUCTS.

By subsequent investigations Dr. Schroeder demonstrated the mode
of infection with tubercle bacilli, the manner in which the bacilli from
tuberculous cattle pass into milk and dairy products, the persistence and
vitality of the bacilli in milk, butter and cheese.

Meanwhile, Dr. John R. Mohler, of the United States Department
of Agriculture, solved the mystery of the apparent difference between
tubercle bacilli in bovine and human tissues by showing that the varia-
tion was one of form only, and that each morphological type may

185

change to the other when transplanted. Thus he demolished the last
prop of those who argued that bovine and human tuberculosis were not
the same disease.

Dr. M. P. Ravenel, of the University of Wisconsin, and Dr. Theo-
bald Smith, of Harvard, made the demonstration of the bovine source
of much human tuberculosis complete by finding the germs of distinct
bovine type in the tissues of children who had been killed by tuber-
culosis.

AMERICAN INVESTIGATIONS CORROBORATED.

These American investigations were verified in every particular by
the independent work of the British Royal Commission on Tubercu-
losis, as set forth in their reports of 1904, 1907 and 1911.

And Prof, von Behring, the famous discoverer of the anti'ox'ns of
diphtheria and tetanus, in the Cassel lecture of 1903, declared:

The milk fed to infants is the chief cause of
consumption.

So well established was this fact when the Sixth International Con-
gress Against Tuberculosis met in Washington in 1908 that not even
the presence and the dominating personality of Dr. Koch, the discoverer
of the tubercle bacillus, could restrain the Congress from dismissing his
supposition of 1901 with the declaration that:

Measures are to be continued against bovine tuberculosis, and its transmis-
sion to man is to be recognized.

FACT UPON WHICH HOPE OF PREVENTION RESTS.

Thus has been vindicated the absolute truth of the fact upon which
rests the hope of preventing tuberculosis, the fact, as now confirmed by
Dr. Osier, the famous American whom we have loaned to the University
of Cambridge, namely —

That the two great causes of tuberculosis are:
The tuberculous patient, and
The tuberculous dairy cow.

Evidence of the prevalence of tuberculosis of bovine source among
human beings, particularly among the very young, has multiplied
rapidly.

Dr. W. H. Park, director of the Research Laboratories of the New
York City Health Department, has found the tubercle bacilli of bovine
type in nine out of fifty-four cases of tuberculosis in children over five
years and under sixteen. In children under five years he found the
bovine germ in twenty-two out of eighty-four cases examined.

186

On the basis of these studies, Dr. Park estimates that 10 per cent,
of all children dying from tuberculosis in infancy die from milk infection.

None may determine in how many of the cases of tuberculosis in
infants and adults the bovine source of the disease remains unproved
simply because the bacillus has changed its form from the bovine to the
human type through residence in human tissues, as Dr. Mohler has
proved possible.

DR. SCHROEDER'S WARNING.

The importance of this cause of tuberculosis — raw milk from tuber-
culous cows — has acquired greater urgency from each investigation.
The evidence has been cumulative and can no longer be ignored. The
reason for estimating this source of infection as of the greatest im-
portance is thus stated by Dr. Schroeder:

Milk is frequently infected with living, virulent tubercle bacilli. There is
nothing hypothetical, circumstantial or inferential about this. It is a fact, a
plain, experimentally demonstrated fact.

After showing how the inhalation theory of human infection has
been overestimated. Dr. Schroeder writes:

We must not forget the significant fact that tubercle bacilli in milk are not
on floors or on pavements or on places where they may or may not enter our
bodies; they are located in articles of food, to be eaten, in most instances, in a
raw state, and therefore are inevitably consumed in large quantities.

Dr. Sims Woodhead, of the British Royal Commission on Tuber-
culosis, writes:

Every tuberculous cow is either an actual or potential center of infection.
We cannot get rid of the Great White Plague until we take bacilli of bovine
origin into consideration.

PREVALENCE OF BOVINE TUBERCULOSIS.

The urgency of these facts is illustrated by the prevalence of tuber-
culosis among cows and the frequency with which the tubercle bacilli
are found in milk and other dairy products.

Dr. Alfred E. Hess, of the Tuberculosis Preventorium for Children,
near Lakewood, N. J., in an investigation of the New York City milk
supply, found tubercle bacilli in 16 per cent, of 107 samples of milk.

Dr. John F. Anderson, director of the Hygienic Laboratory at Wash-
ington, examining 223 samples from the Washington milk supply, after
the Agricultural Department had diligently weeded out tuberculous
cattle, found 6.72 per cent, contained tubercle bacilli.

Dr. A. D. Melvin, chief of the Bureau of Animal Industry, in guard-
ing the meat supply of the country in the past year, condemned more

187

than one million carcasses for tuberculosis, or one out of every fifty
animals slaughtered.

The persistence of the disease in dairy herds was strikingly proved
the past year by the application of the tuberculin test to 8,141 cattle in
the herds that supply Washington with milk. Where the animals had
not been previously tested, 16.06 per cent, were found tuberculous ; where
diseased animals had been previously removed from the herds after
earlier tests, it was found that an average of 3.95 per cent, of the dairy
cows were tuberculous.

This is a world-wide condition — bovine tuberculosis exists in all
countries to an alarming extent, except in the Channel Islands, where
the tuberculin test is systematically applied and a rigid quarantine is
maintained. This is illustrated by the fact that examination of the cattle
slaughtered in the Heidelberg district in Germany showed that 46 per
cent, were tuberculous.

PASTEURIZATION THE REMEDY.

It is this condition that has made necessary measures to prevent
the consumption of live tubercle bacilli by human beings. On this
point all the experts of the United States Government are agreed. Their
opinion is expressed by Dr. Schroeder in his report on "Milk as a Car-
rier of Tuberculosis Infection." He writes:

It is a simple matter to destroy tubercle bacilli in milk and cream by pas-
teurization.

For those who are opposed to pasteurization it may be well to call attention
to the fact that the United States Public Health Service has shown anew that
the benefits derived from it immeasurably outweigh the disadvantages attrib-
uted to it.

It is clearly desirable that milk and cream should either be pasteurized or
should be obtained from cows that are known to be free from tuberculosis and
are stabled, pastured and milked in a healthful environment.

An exhaustive investigation of the milk problem was made by the
Public Health Service in 1907, by a corps of twenty experts under the
direction of Dr. M. J. Rosenau, head of the Hygienic Laboratory, now
professor of Hygiene and Preventive Medicine at Harvard. This inquiry
by impartial scientific men, who had no other object than to ascertain
the truth, proved that raw milk was a considerable factor in spreading
tuberculosis and other infectious diseases, that pasteurization does ef-
fectually prevent milk and other dairy products carrying the infections
into the human system, that the process does not impair the taste, di-
gestibility or nutritive qualities of the milk. The report was summed up
by the late Dr. Walter Wyman, then surgeon general, in these words:

Pasteurization prevents much sickness and saves many lives.

188

STAND TAKEN BY THE MEDICAL PROFESSION.

Both in 1910 and in 1911 the National Association for the Study
and Prevention of Tuberculosis issued warnings against the use of
tuberculous milk. In the resolutions adopted last June, this body
declared:

That the bovine tubercle bacillus causes serious and fatal tuberculosis in
human beings.

That milk from tuberculous cattle appears to be the medium through which
transmission of bovine tuberculosis to human beings most commonly takes place.

That all cows furnishing milk for human consumption be subjected to the
tuberculin test, and that all animals which react be excluded from dairy herds.

That where these measures cannot be efficiently carried out, this association
recommends the efficient pasteurization of milk as a safeguard against the trans-
mission of bovine tuberculosis to mankind.

The same stand was taken by the highest medical authority in the
United States, the American Medical Association, at its annual meeting
at Denver, in June, 1911, when its Committee on Standard Measures
of Procedure for the Control of Bovine Tuberculosis in Relation to the
Milk Supply, decided:

That milk must come from cattle —

Tested once a year with the tuberculin test, or

Subjected to careful physical examination every three months —

Or it must be pasteurized.

In defining pasteurization the Committee on Regulations for the
Pasteurization of Milk held that —

The "flash" process is to be condemned.

The "holding" process shall be the only one recognized as efficient.

The milk must be held for twenty minutes at 145 degrees Fahrenheit (63
degrees centigrade), or for five minutes at 160 degrees Fahrenheit (71 degrees
centigrade).

In this connection Dr. W. C. Woodward, health officer of the Dis-
trict of Columbia, and secretary of the American Public Health Asso-
ciation, pointed out that it is not possible to rely absolutely on the
ratings given dairy farms in the score-card system, for conditions relat-
ing to cattle themselves count only 14 points out of 100, so that it would
be possible for a dairy to have a good rating with every cow tuberculous.

PASTEURIZATION IN CITIES.

Three cities have made beginnings in the practical application of
this method of preventing tuberculosis and other infectious diseases.

Chicago, under the leadership of the then Health Commissioner, Dr.
W. A. Evans, began in 1907 to require the pasteurization of all milk not

189

from tuberculin-tested herds. This measure led to the general cleaning
up of dairies and the removal of tuberculous cattle from many herds.
It has been fought, however, by politicians, who succeeded in invalidat-
ing the requirement of the tuberculin test, but the present health com-
missioner. Dr. G. B. Young, is framing new regulations that will compel
the pasteurization of milk from untested herds.

In New Jersey, however, the town of Montclair adopted a law re-
quiring the tuberculin test for cattle in herds supplying the town with
milk, and after a long battle in the courts, led by M, N. Baker, president
of the local health board, the right of a community to thus protect the
health of its people has been fully sustained by the highest court.

In Washington the influence of the health officer. Dr. Woodward,
has been potent in increasing pasteurization.

In New York City public demand has promoted pasteurization, and
now the Health Department has put into force new regulations that are
expected to have the effect of compelling the pasteurization of all milk
not conforming to high sanitary requirements.

TUBERCULOSIS IN NEW YORK CITY.

It is interesting in this connection to note the record of the number

of new cases of tuberculosis reported in New York City in each of the
last ten years:

Per 1,000 of

Year. New cases. population.

1902 12,914 3.55

1903... 15,219 4.07

1904 18,723 4.88

1905 20,831 5.18

1906 20,085 4.83

1907 19,725 4.60

1908 23,325 5.27

1909 25,667 5.62

1910 32,065 6.72

1911 24,747 4.96

It is significant that the first check in the increase in the number of
new cases of tuberculosis occurred in the years 1906 and 1907, following
such extensive agitation of the perils of raw milk that some of the
dealers began to supply properly pasteurized milk, while many house-
wives saw to the protection of their households by boiling the milk
used in their homes.

Then concerted attacks were made upon pasteurization, a raw milk
campaign was conducted by large milk interests, and the rate of increase
in tuberculosis went up each year till it reached the high mark of 1910.

190

The reaction came in the Fall of 1910, with an increase in efficient
pasteurization by some dealers, with the practical abolition of the "flash"
process, by which milk was heated for an instant and sold under the
label "pasteurized"; there was an increase in home pasteurization; the
city and charitable agencies duplicated my system of pasteurized milk
depots until there were 78 in operation in 1911, and there was for the
year a drop of over 40 per cent, in the number of new cases of tuber-
culosis.

PASTEURIZE AND THEREBY PREVENT.

Dr. Park has just made known the results of observations made in
co-operation with the Rockefeller Institute of Medical Research. The
cases of 500 babies were watched, and the results of feeding them with
different kinds of milk were observed. Dr. Park reports :

The observations proved that mother's milk is the best milk for a baby and
that pasteurized milk is the next best. One group of fifty babies had been given
pasteurized milk for three weeks, then half of them were changed to good milk
not pasteurized. Eleven of the twenty-five became ill, which proved conclusively
the good effect of pasteurization. We discovered that it wasn't the chemical
combination of milk that hurt, but the amount of bacteria.

There is little that America can add to the knowledge of methods of
preventing the infection of the well by tuberculous human beings, but
there is much that America can say to the nations out of its experience
and official investigations as to the importance of considering the other
great cause of tuberculosis — the use of milk and other raw dairy prod-
ucts from tuberculous cattle. And this is the message that I bring
from my government:

Pasteurize and thereby prevent tuberculosis.

THE ONLY GUARANTEE OF SAFETY.

Officially the American government and the American medical pro-
fession content themselves with recommending the pasteurization of
milk not from tuberculin-tested cattle. Personally I go farther.

Several years ago I contracted for a supply of milk from a model
dairy, where the most elaborate and costly system of cleanliness was
in vogue. The Health Department found the milk reeking with tubercle
bacilli. Fortunately, during the brief time that I used this milk it was
thoroughly pasteurized.

About the same time the milk produced under the certification of the
New York County Medical Society by one of the most famous dairy
farms in the State showed an increase in bacteria, tuberculosis was found
in the herd, and it developed that from the unknown date of the in-

191

vasion of tuberculosis into the herd to its discovery, customers who
were paying 20 cents a quart for this milk to be safe from tuberculosis
were in reality using tuberculous milk without suspecting their danger.
Pasteurization would have protected them.

Several weeks ago the certified milk supplied to my laboratory was
found to average 200,000 bacteria to the cubic centimeter before pas-
teurization. It was practically free from germ life as supplied to the
babies at my milk depots after pasteurization.

These personal experiences make me insist that none but certified
milk be bought for my infant milk depots, as this is confessedly the best
milk that can be obtained; but I know so well the fallibility of this
system that I require that every drop of this certified milk be thoroughly
pasteurized before being supplied to the babies.

It is from twenty-one years' practical experience that I speak when
I commend all efforts to produce clean milk from healthy cows, but
recognize that there is really no such thing as raw milk that can be
depended upon to be clean and pure and free from disease day after
day, even though it be produced with such elaborate precautions that it
costs three times as much as the ordinary market milk and is out of the
reach of all except the wealthy.

It is because of this condition that I urgently advise that every
quart of milk be thoroughly pasteurized, lest by any chance the germs
of tuberculosis or other diseases be carried to one of the little ones and
his food becomes his death.

This is prevention, practical, vindicated by impartial experts and
by twenty-one years' experience.

TUBERCULOSIS PREVENTORIUM FOR CHILDREN.

Besides urging this congress to promote the prevention of tubercu-
losis by recommending the pasteurization of milk and other dairy prod-
ucts, America offers another idea that has been found wonderfully suc-
cessful in rescuing from this plague children who are predisposed to
tuberculosis or who live in tuberculous environments.

With this object in view I initiated the Tuberculosis Preventorium
for Children at Lakewood, N. J., in 1909. Dr. H. M. Biggs, health officer
of the City of New York, estimated that there were at that time in the
tenements of the city 40,000 children who had been exposed to tubercu-
losis and who would in all probability fall victims to the plague. There
was no institution that offered to them means of escape from the disease.

With the advice of the famous Dr. Abraham Jacobi, the preven-
torium was planned to give such children life in the open, with pure food,
under wise supervision. The institution was moved to Farmingdale, N.

192

J., and permanently established, with the co-operation of philanthropic
people, on land given by Arthur Brisbane.

The last annual report shows that of 143 children admitted and
staying an average of 106 days, 29 were made entirely well and have
probably been permanently rescued from tuberculosis, while 64 were
so decidedly improved as to make their escape from the disease likely.

The work has proved that it is possible to snatch children from the
certain doom of tuberculosis, to make them well and strong, instead of
allowing them to become victims of the plague, and thus to make real
headway against tuberculosis, and to make useful, self-supporting citi-
zens of those who would otherwise be public charges. It is a work both
of mercy and of wise public economy.

The idea embodied in the preventorium has since been copied in
other institutions in America and in foreign countries, and it is reason-
able to believe that this movement will have important results in the
battle against tuberculosis.

PREVENTION THE WORD.

Both in this work of taking children from tuberculous surroundings
and in pasteurizing the milk supplies so as to stop the infection of the
babies with tuberculosis, we have in America methods of prevention
that we are earnestly endeavoring to commend to our own people and
to the other nations of the world, for we feel that in these measures we
have the means by which tuberculosis can be overcome.

What pasteurization has done wherever tried it will do in a larger
way when resorted to more generally, and the 40 per cent, drop in tuber-
culosis in New York City, when only part of the milk supply was pas-
teurized, will be paralleled and outdone, and we will make headway
against the Great White Plague, instead of allowing it to destroy our
civilization and our race.

The message that I bring to you is practically the same as that
which I carried to Berlin as the delegate from the United States Gov-
ernment to the Third International Congress for the Protection of
Infants, except that then I was dealing with all the diseases that are
carried in raw milk, and now my subject is the one dread malady that
holds all humanity in terror.

This is an age of vast expenditure for battleships and armies. All
Europe is staggering under the burden of maintaining huge engines of
destruction. With an hundredth part of this outlay the greatest war of
all the ages could be fought out; the greatest foe of humanity, tubercu-
losis, could be conquered. Instead of battlefields strewn with the dead
there would be cities, towns and villages made happy by the saving of

193

parents and children, of brothers and sisters, from the dreaded white
death.

Prevention is the word that I took to Berlin and that I now bring
to Rome, and prevention means pasteurization. Upon this the health
agencies of the United States Government are agreed. This stand is
indorsed by the National Association for the Study and Prevention of
Tuberculosis and by the American Medical Association, and my mes-
sage is confirmed by the dean of the American medical profession, Dr.
Jacobi, in the words, "Use no raw milk."

194

PAPER BY

FOUNDER OF INFANT MILK DEPOTS

DELEGATE FROM THE AMERICAN PUBLIC HEALTH
ASSOCIATION AND FROM THE STATE OF NEW YORK

in tljr QIampatgn for tl|^ Srtt^rm^tit of

Milk Proiurtton ani iiBtributtan

SUBMITTED TO THE

XVTH INTERNATIONAL CONGRESS ON
HYGIENE AND DEMOGRAPHY

WASHINGTON. D. C.
FRIDAY. SEPTEMBER 27. 1912

THE FUNCTION OF VOLUNTARY ORGANIZATIONS

IN THE CAMPAIGN FOR THE BETTERMENT OF

MILK PRODUCTION AND DISTRIBUTION.

BY NATHAN STRAUS

OF NEW YORK CITY

Founder of Infant Milk Depots.

BEFORE dealing with the subject assigned to me by the com-
mittee on program, I must express my deep satisfaction with
the action of the organizers of this congress in making the
ruling idea and purpose of this great international gathering the PRE-
VENTION OF DISEASE.

When I returned from my mission to Berlin, where I represented the
United Sta,tes Government at the International Congress for the Pro-
tection of Infants, I was impressed with the idea that great good could
be done humanity by a congress devoted, not to the treatment of ail-
ments, but to their prevention, and I embodied this idea in my report to
President Taft, with the suggestion that he call such an international
congress.

At that time the arrangements for the holding of this congress in
America were already under way, and I am happy to see from the pro-
gram that the active managers of the congress have acted generously
upon the President's suggestion that my idea of a great international
gathering devoted to the prevention of sickness be applied in the plan-
ning of the work of this congress.

I truly believe that many thousands of lives will be saved by the
work we are doing here, for, as I stated in the very first article that I
wrote upon public health questions a score of years ago,

**One ounce of prevention is worth a ton of cure.**

PUBLIC DUTY AS TO MILK SUPPLIES.

I do not for one moment admit that the betterment of milk pro-
duction and distribution is properly the work of voluntary organizations.
It is the duty of the public authorities to see that the milk supplies are
pure and wholesome. I have maintained this position from the very

197

beginning of my own work, a score of years ago, and within the last
five years it has come to be recognized that the municipality and the
State are primarily responsible for the milk supplies.

This was the position I took in my letter to the Mayors of the
American cities on June 8, 1895, and in the paper that I submitted at
the National Conference of Mayors and Councilmen at Columbus, Ohio,
on September 29, 1897, in which I said :

I appeal to you as if you were standing beside a great river in whose cur-
rent were constantly swept past hundreds of drowning infants. This stream is
a very real thing if people would but recognize its existence, and all its yearly
tribute of death is paid because of the public neglect of some of the simplest
precautions for the saving of children's lives.

You, gentlemen, have the means under your control by which these drown-
ing babies can be saved. I ask you, will you not apply them? Men are found
capable of acts of heroism in presence of danger less threatening and less
surely fatal.

All that I plead for is the extension of the activity of local Boards of Health
in a sphere which is legitimately theirs, but which they have, so far, lacked the
conviction and the courage to occupy. I shall not have spoken in vain if I have
succeeded in impressing you with the fact that the dictates of humanity and of
public duty combine in demanding that this backwardness should exist no longer.

i THE ONLY MEANS OF SAFETY.

Three years later, on November 15, 1900, having found by practical
experience, extended over nine years, that there was no safety save in
pasteurization, in a public appeal I said :

Milk is the one article of food in which disease and death may lurk without
giving any suspicion from its taste, smell or appearance.

If the pasteurizing of the entire milk supply were made the function of the
municipality, it would be an exceedingly clever business investment, for the
money expended would be returned a hundred fold. This is looking at it from
a practical, commercial standpoint, besides which, from a humanitarian point of
view, the amount of suffering and disease which would be prevented is incal-
culable.

When the news of a railroad wreck and accompanying loss of life is tele-
graphed across the continent it is followed by a shudder of horror, and if any
life-saving precautions have been lacking there is raised a cry of vengeance
against the "soulless" corporation, whose duty it is to provide every safeguard
for life.

But what of the thousands of infants whose lives pay the penalty of lack of
precaution? No shudder of horror passes over the land; no cry for reform is
raised, yet just as surely as the proper precaution would have prevented that
railroad catastrophe, just so surely would the lives of the thousands of these
helpless infants be saved did our municipal authorities adopt the preventive
measures shown to be effective.

It was because the municipal authorities were not alive to their
opportunity and their duty that there were place and work for voluntary
organizations. It was because individuals and associations took up this
work of protecting the babies and prosecuted it with increasing energy

196

and effectiveness year after year that there has at length come a great
awakening, and we now have Boards of Health in hundreds of cities
more or less effectively working for the betterment of the milk supplies.
And it is because this branch of municipal endeavor is yet new,
because the work is only partially done, that there is yet work for the
voluntary organizations, both in teaching the municipal authorities what
to do and how to do it, and in pushing them on to the full performance
of their duty to the babies.

TUBERCULOSIS IN RAW MILK.

When the peril of tuberculosis in raw milk came forcibly to my
attention, more than twenty years ago, there was practically no attention
paid to this serious menace to humanity. In fact, the very man who had
the distinction of isolating the tubercle bacillus scouted the idea that is
now proved a fact, and with unscientific recklessness denied, that con-
sumption could be contracted by drinking the milk from tuberculous
cows.

Therefore, we had not merely an uninformed public to instruct, but
a misinformed public to rescue from a foolish error. The peril of raw
milk was a new idea. I was regarded as an alarmist when I wrote in the
Forum in November, 1894:

I hold in the near future it will be regarded as a piece of criminal neglect
to feed young children upon milk that has not been sterilized (pasteurized).
Milk is not always good in proportion to the price paid for it, nor free from the
germs of contagion because it has come from cattle of aristocratic lineage. The
latter quality, as recent experience has shown, carries with it special suscepti-
bility to tuberculosis.

The time was not ripe, the way had not been paved for official action
by the public health authorities to protect the public from dangerous
raw milk. My warnings of the perils that lurked in milk were received
with incredulity, or with derision, or with open and bitter attacks. But
I persisted, with the result that to-day there is practical agreement, al-
most complete unanimity, on the part of medical men and sanitarians.

DECISION BY EXPERTS.

The years that bridge the space between the warnings that I sounded
in the early nineties and the recent report of the Commission on Milk
Standards have been for the most part weary, discouraging years ; but
all that is now a matter of the past, and we have at last the deliberate
decision of an able and impartial commission of experts that —

While public health authorities must necessarily sec that the source of
supply and the chemical composition should correspond with established defini-
tions of milk as a food, their most important duty is to prevent the transmission

199

of disease through milk. This means the control of infantile diarrhoea, typhoid
fever, tuberculosis, diphtheria, scarlet fever, septic throat infections and other
infectious diseases in so far as they are carried by milk.

Septic sore throat deserves special mention because of the frequency in
recent years with which outbreaks of this disease have been traced to milk
supplies.

The commission recognizes the magnitude of the milk industry, and that
the improvement of milk supplies is primarily an economic problem.

But while the basic problem is economic, and must eventually be solved by
commerce, public health authorities must show the way and must establish
standards and regulations in the interest of consumers, the value of which even
the consumers themselves often fail to appreciate.

While the process of pasteurization is a matter which has attracted a great
deal of attention in recent years, the commission has not entered into any dis-
cussion of its merits or demerits, but has given it recognition in its classification
as a process necessary for the treatment of milk which is not otherwise pro-
tected against infection.

The commission thinks that pasteurization is necessary for all milk at all
times excepting certified milk or its equivalent. The majority of the commis-
sioners voted in favor of the pasteurization of all milk, including certified. Since
this was not unanimous, the commission recommends that the pasteurization of
certified milk be optional.

WORK OF NOTABLE VOLUNTEERS.

This much have I quoted from the clear and definite recommenda-
tions of the Commission on Milk Standards. This report is the work
of a voluntary organization, inspired by a voluntary organization, and
summing up in its membership the vast deal of earnest study and prac-
tical experience that has been acquired in the great co-operative work
of many individuals and associations.

It comes to us with the authority of seventeen able, earnest and
eminent men, who have served humanity well, men whose names I recite
here as illustrating the great work that has been done by volunteers in
this fight that has been so vitally necessary to the protection of human-
ity and of its most helpless members — the babies:

Dr. W. A. Evans, professor preventive medicine. Northwestern University;
health editor Chicago Tribune, Chicago, 111., chairman.

Dr. B. L. Arms, director of bacteriological laboratory. Department of Health,
Boston, Mass.

Dr. John F. Anderson, director of Hygienic Laboratory, United States Pub-
lic Health Service, Washington, D. C.

Prof. H. W. Conn, director of bacteriological laboratory, Connecticut State
Board of Health; department of biology, Wesleyan University, Middletown,
Conn.

Dr. E. C. Levy, Health Officer, Richmond, Va.

Dr. A. D. Melvin, Chief of Bureau of Animal Industry, United States De-
partment of Agriculture, Washington, D. C.

200

Dr. William H. Park, Director of Laboratories, Department of Health of
New York City, foot of East Sixteenth street, New York City.

Mr. Raymond A. Pearson, Commissioner of Agriculture, Albany, N. Y.

Dr. M. P. Ravenel, director of Hygienic Laboratory, University of Wiscon-
sin, Madison, Wis.

Prof. M. J. Rosenau, Department of Hygiene and Preventive Medicine, Har-
vard Medical School, Boston, Mass.

Prof. Henry C. Sherman, Department of Chemistry, Columbia University,
New York City.

Dr. A. H. Stewart, antitoxin laboratories, Department of Health and Chari-
ties, Philadelphia.

Dr. William Royal Stokes, bacteriologist to State and City Health Depart-
ments, Baltimore.

Prof. William A. Stocking, Department of Dairy Industry, Cornell Uni-
versity, Ithaca, N. Y.

Mr. Chester H. Wells, Health Officer, Montclair, N. J.

Dr. L. L. Van Slyke, Department of Chemistry, New York Agricultural Ex-
periment Station, Geneva, N. Y.

Dr. Charles E. North, Consulting Sanitarian, member New York Milk Com-
mittee, New York City, secretary.

This Commission's platform of effective and efficient measures for
the betterment of milk production and distribution comes as the sequel
of a quarter of a century of voluntary labors on behalf of the babies — ■
it comes as the flower and fruit of efforts of which my own have been
only a part.

But my subject is not entirely retrospective. Voluntary effort and
voluntary organization has worked out a definite and comprehensive
plan of betterment that is fully and emphatically indorsed by the Public
Health Service and the Department of Agriculture — that is indeed but
a modification of the measures advocated by these Federal agencies as
a result of the thorough investigation of the milk problem by the Public
Health Service under President Roosevelt.

This program needs to be applied and enforced in every city of
the land.

This, I maintain, is the chief and imperative work and duty of volun-
tary organizations at this stage of the campaign for the betterment of
milk production.

All infant milk depots maintained by private philanthropy are but
examples to the municipalities of what ought to be done by the public
officials with public funds. All milk committees are first and chiefly

201

agencies charged with the responsibility of seeing to the adoption and
enforcement of this program that has grown out of a quarter of a cen-
tury of earnest work.

FUNCTION OF MILK DEPOTS.

In regard to the function of milk depots I feel obliged to emphasize
one lesson from my own long experience, namely:

That the fundamental and vital duty of the milk depot is to furnish
milk in nursing bottles, one feeding to the bottle, properly modified ac-
cording to formulae suited to the different ages of babies, and pasteurized
in the bottles. This assures the highest degree of safety.

The supplying of dipped milk — of milk drawn from cans and put
in containers brought by the mothers — ought to be rigorously prohibited.
It is bad enough to allow dipped milk to be sold for general use. It is
criminal to supply milk in this way for babies, however good the milk
may be in the first place, for the reason that the sensitive fluid is thus
exposed to contamination.

I must maintain, therefore, that the milk depot fails to fulfill its
primary object unless it supplies milk for infant feeding — milk modified
and then pasteurized in the nursing bottles.

As to the efficacy of this direct and simple method of preventing
sickness among the babies, I wish to cite the record of my own work
in New York City during the past Summer:

With an average of 2,200 babies supplied n>iih milk from my laboratories
there ivas just one death, and that was due to pneumonia.

In this connection I should say that in all the twenty-one years of
my work I have been guided in all things by the friendly advice of that
greatest of all specialists on infant feeding, the dean of the American
medical profession, Dr. Abraham Jacobi, whom the medical men of two
hemispheres delight to honor.

DISTRIBUTION OF MILK. •

Instruction of mothers is important. Medical attention is important.
I have always supplied both. But these things are secondary, and I
cannot but regard it as a grievous error to regard these things as funda-
mental, and to make secondary the dispensing of the food the babies
require — for it is the food, clean, safe, wholesome food, that the babies
need more than anything else in the world.

202

I speak of this frankly and plainly, because there is an unfortunate
disposition on the part of well-meaning people to exaggerate the "con-
sultation" to the detriment of the fundamental duty of the infant milk
depot. In some cases the resources of the organization are exhausted
upon nurses and doctors, and little is done in the way of feeding the
babies. The mothers are overwhelmed with instructions, while the
babies cry in vain for the food that is their essential need.

And so it has been in New York, where my seventeen depots are
the only ones out of a hundred that supply modified pasteurized milk
in nursing bottles ready for use upon warming.

Nothing could be further from my purpose than to discourage the
well-meaning people who have taken up this work, but I think I have a
right to speak out of my experience, which has extended over a longer
term of years and has reached more babies than any other work, and to
say to the people who have lately embarked upon this important work
in all kindliness and sincerity that they are in danger of minimizing the
real effectiveness of their efforts.

HOME PASTEURIZATION.

As to modification and pasteurization of milk in the home, it is
indeed very desirable that the mothers should be taught how to prepare
the milk for their babies, and I have tried to make it easy for them to
do so by devising a simple home pasteurizer. But even its use is feasible
only for the better situated classes. Where the mother goes out working,
returns in the evening tired, worn out by her labors, to find perhaps
her baby crying for its bottle, it is cruel to demand that she should
follow out the complicated and difficult process of modification and pas-
teurization. Besides, it must be remembered that conditions in tene-
ments do not ordinarily make it possible for mothers to do this work
properly and with the scrupulous cleanliness that is essential.

The object, therefore, should not be to substitute home-prepared
feedings for those supplied by the milk depot, but to encourage the use
of the depot milk where it can be had, and only to teach the mothers
how to prepare the feedings where they cannot get the better prepared
milk from properly conducted pasteurized milk depots.

And in case of home preparation, with all the increased probability
of contamination, it is even more than otherwise necessary to insist
strictly upon pasteurization.

203

In all that is said of infant milk depots, it is ever to be remembered
that these institutions are for babies that, for one reason or another,
are deprived of the better sustenance of breast feeding, and the very
first duty of all these institutions is to persuade and encourage mothers,
wherever it is physically possible, to nurse their babies as nature in-
tended.

PURPOSE TO BE KEPT IN VIEW.

To sum up briefly, all individual or organized voluntary efforts will
fail of their purpose unless they tend directly and powerfully and
unitedly to fix the responsibility where it belongs — on the municipal and
State health authorities ; unless they tend to compel such authorities to
take up energetically the work of regulating milk production and distri-
bution and the maintenance of pasteurized milk depots for the babies;
unless they see to it that the work of such public agencies is carried
out definitely and uncompromisingly along the lines set by the Commis-
sion on Milk Standards and the Public Health Service.

Many days will pass before these results are achieved, before the
milk supplies of our cities are really and efficiently safeguarded by the
officials charged with that duty. Meanwhile there is work to be done.

The babies cry for protection against disease ; their mothers lift their
hands in frantic supplication for their little ones. Disease and death
throw their shadow over the cradle and engulf the mothers of the land
in the inextinguishable sorrow that we can ward away from the home.

It is a call to battle — a call to united and energetic action. In this
emergency it is not enough to talk ; it is not enough to educate the public
and the health officers. We must do all this, but we must do more. We
must bend all our energies, strain all our resources to save the babies
that are now living and all those who will come into the world before
the tardy hand of official administration has been quickened and strength-
ened to grapple with this menace to the home and to the land.

GREAT POSSIBILITIES.

We need infant milk depots, we need doctors and nurses consecrated
to the work of assuring to the little ones the food that they need free
from the taint of disease. We need the co-operation of the poor and
the purses of the rich. As I have often said, it is a work beyond the
means of any one man or set of men — it is a work for all men and all
women.

204

It is a work too big and great with possibilities of human good to
afford room for jealousies or for disputes about non-essentials or about
methods. It is not a clinical work. The babies are human beings, not
subjects for study and exhibits for committees or doctors. They arc
human beings threatened with death, and it is our function to save
them — not to talk about them, not to experiment with them, not to cat-
alogue them, but to give them the chance to live that they can have
only in properly pasteurized milk properly modified, with such medical
attention as may be needed in particular cases.

This is a work to stir the good red blood in every man and woman
who has the fundamental instincts of humanity, a work that has greater
possibilities of good than any other that I have ever heard of, a work
that will pay dividends in the satisfaction that can come only in helping
the little ones, in making their hands chubby and their faces rosy and
giving them the fair start in life to which they are entitled.

^^^S^^^^ <3^faxi^

203

Department of State.
Washington, August 17, 1911.

Nathan Straus, New York :

Sir — Referring to this department's letter of
the 20th ultimo, inclosing the certificate of your
designation as a delegate on the part of the
United States to the Third International Con-
gress for the Protection of Infants, to be held
at Berlin, in September, I desire to inform
you that you were selected for this service
because of the facts that you were a pioneer
in the establishment of infants' milk depots in
this country, having used your time, means
and influence, without stint for the past twenty
years, both in the United States and abroad, to
promote the proper feeding of babies and to
protect them from tuberculosis and other in-
fectious diseases; and that the methods which
you have practiced and advocated have been
indorsed by the Public Health Service after a
thorough investigation by a corps of twenty
experts under Surgeon-General Wyman.

It is desired to have you communicate to the
congress the results reached by the experts of
the Public Health Service and of the Depart-
ment of Agriculture and apprise the delegates
of the other nations of the measures under-
taken in this country to protect life and to
commend these methods to their people.

It is further desired that you report to the
department the results of the congress, espe-
cially with a view to giving the country the
benefit of the assembled experience of the
delegates of the various countries.

I am, sir, your obedient servant,

P. C. KNOX, Secretary.

207

WORK ON TWO CONTINENTS.

While President of the New York City Board of Health in 1896
Mr. Straus was distressed over the excessive death rate among the city's
waifs, who were kept in institutions on Randall's Island. In 1898 he
erected a pasteurization plant on the Island. Without any other change
in the regimen or diet, except that the milk was pasteurized instead
of being used raw, the death rate dropped from an average of 41.81%
for the years 1895-7 to an average of 21.75% for the next seven years.

Prior to this, in 1896, Mr. Straus began distributing pasteurized
milk in Brooklyn, through the Diet Dispensary, with five stations. This
work has been taken over by the Brooklyn Children's Aid Society,
which maintains 16 stations.

In 1903 the work was begun in two other cities by the gift of Pas-
teurization Plants to the Milk Commission of the Chicago Children's
Hospital and to the Philadelphia Modified Milk Society.* Both plants
are still in operation and the work is carried on with great success. In
1904 Mr. Straus similarly equipped the St. Louis Provident Association.

In 1908 he gave a plant to Dublin, which has been maintained by
the Women's National Health Association, under the patronage of the
Countess of Aberdeen, wife of the Viceroy, with the result that the
death rate among the babies supplied with pasteurized milk has been
only 55 per thousand, while the mortality among the rest of the babies
of Dublin has been three times as great.

In the same year the Women's Society for the Care of Infants,
under the patronage of the Dowager Grand Duchess Luise of Baden,
accepted a pasteurization plant for Karlsruhe, which reduced the death
rate among the babies under the care of the society to 6.3%, while in
the entire city the death rate among the babies was 17%.

Remarkable results were obtained near Berlin, at Eberswalde, which
was also supplied with a Pasteurization Plant, presented to the Presi-
dent of the Vaterlaendische Frauen Verein. During the excessively hot

209

THE PHILADELPHIA PASTEURIZED MILK SOCIETY.
Filling the Bottles by Machinery.

THE PHILADELPHIA PASTEURIZED MILK SOCIETY.
Placing the Filled Bottles in the Pasteurizing Oven.

210

Summer of 1911 there were only two deaths in this town among the
babies supplied with pasteurized milk, while in Berlin proper the death
rate for the same months was double the average of previous Summers.

In 1907 Mr. Straus established a pasteurization plant at Heidelberg
and in 1908 at Sandhausen, District of Heidelberg, Germany, maintain-
ing each for a year at his own expense. In the latter village all the
children under two years were supplied with pasteurized milk, with
the result that the death rate, which for five years had averaged 46 per
cent., was cut down to less than 20 per cent.

In the spring of 1908 exhibitions were given with a model plant
at Frankfurt-on-Main, Berlin, Vienna and London.

EXHIBITION MADE WITH MODEL PLANT AT THE INTERNATIONAL

TUBERCULOSIS CONGRESS AT WASHINGTON,

IN OCTOBER, 1908.

This plant was also exhibited in operation at the International Tu-
berculosis Congress at Washington in October, 1908, and was awarded
honorable mention. It was also shown at the Tuberculosis Exhibition
in the American Museum of Natural History, New York City, in De-
cember, 1908, and at the Philadelphia Tuberculosis Exhibition in Feb-
ruary, 1909.

211

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STATION AT 1319 H ST. N. W., WASHINGTON, D. C.

212

In these years assistance was given in the erection of plants at
Toronto, Canada, and Wilkes-Barre, Pa.

In Washington Mr. Straus erected a plant in 1910 and maintained
it for two years. The death rate per annum among the babies fed on
this milk was 6.2 per cent, and none of these were lost from intestinal
disorders or infectious diseases. The Washington plant was afterwards
donated and shipped to the Gota de Leche (Gouttes de Lait) Society
in Manila, Philippine Islands, at the request of the War Department,
Bureau of Insular Affairs, Washington, D. C.

In connection with his work Mr. Straus has written numerous mag-
azine articles and has presented papers to a number of international
congresses.

In 1905 he attended the first Congress of the "Gouttes de Lait" at
Paris, urging that "It is milk — raw milk, diseased milk — which is re-
sponsible for the largest percentage of sickness in the world." He met
with little support. In 1907 he attended the Second International Con-
gress of this organization at Brussels, presenting a paper on "The
American Solution of the Milk Problem," (see page 89) and the con-
gress declared "That milk for children should be boiled, sterilized, or
pasteurized — never used in the raw state."

In 1911 this body assembled at Berlin under the title of the Third
International Congress for the Protection of Infants, and Mr. Straus, as
the sole official delegate from the United States Government, presented
a report on "The Progress Made in America in the Protection of Child
Life" (see page 159) and a paper on "Twenty Years' Practical Ex-
perience in Modifying and Pasteurizing Milk for Infant Feeding" (see
page 169).

His earliest magazine article was on "How the New York Death
Rate Was Reduced" and was printed in the "Forum" in November, 1894.
(See page 33.) On June 8, 1895, he wrote an open letter to the Mayors
of the American cities (see page 42) and on September 29, 1897, before
the National Conference of Mayors and Councilmen at Columbus, Ohio,
he submitted a paper on "The Influence of a Pure Milk Supply on the
Death Rate of Children" (see page 57). In July, 1905, he presented a
paper on "Infants' Milk Depots" (see page 73) before the British Med-
ical Association at Leicester, England.

213

On December 4, of the same year, he emphasized his stand that the
supplying of pure milk was a municipal duty and that it was a necessary
function of government to see to the pasteurization of milk as a means
of checking the Great White Plague. He submitted a statement entitled
"Pure Milk or Poison?" (see page 83) at the conference held at the
Academy of Medicine, New York City, on November 20, 1906, and sup-
ported the pasteurization ordinance that was introduced in the New
York City Board of Aldermen. This measure was first put in force in
Chicago by Dr. W. A. Evans, the Health Commissioner, in 1909, re-
quiring the pasteurization of all milk that was not from tuberculin-
tested cattle, and was adopted, with some modifications, by New York
City in 1911.

While in Heidelberg Mr. Straus on July 24, 1908, delivered a lecture
on "Milk Pasteurization an Economic and Social Duty" (see page 103)
before the students of political economy in the University of Heidelberg,
and under the title "America's Latest Contribution to the Milk Ques-
tion" (see page 119) he reviewed the report of the milk investigation
conducted by experts of the United States Government and published
under the title "Milk and Its Relation to Public Health."

While at Heidelberg Mr. Straus perfected a device for pasteuriza-
tion of milk in the home. To promote its use he refused to patent it
and gave permission to any tinsmith to make such pasteurizers from
plans which he freely supplied. This pasteurizer was awarded a gold
medal and diploma at the Concours General d'Hygiene at Paris in No-
vember, 1908.

In September, 1909, Mr. Straus helped to check the typhoid epi-
demic at Cassel, Germany. The disease was traced to a sanitary dairy
run under strict superficial supervision. This dairy was forbidden to con-
tinue the distribution of milk. Mr. Straus shipped 200 home pasteur-
izers to the town and by their use no new cases developed and the epi-
demic was gradually stopped.

On November 28, 1908, Mr. Straus issued a statement on "The
Difference Between Real Pasteurization and Commercial Pasteuriza-
tion," (see page 118) which has had the effect of practically abolishing
the fraudulent process by which milk was heated for a fraction of a
second and then passed off upon the public as "pasteurized."

214

In December, 1908, he protested to the authorities of New York
State that farmers were not protected against tuberculous cows and
that babies were not saved from diseased milk.

In 1909, in an open letter to the National Association for the Study
and Prevention of Tuberculosis, Washington, D. C. (see page 141), Mr.
Straus proved that the vigorous campaign against tuberculosis had
failed to check the Great White Plague, giving as the reason the neglect
of precautions against tuberculous milk; in 1910 the association warned
against such milk, and in 1911, under the presidency of Dr. Ravenel,
definitely "recommended the efficient pasteurization of milk as a safe-
guard against the transmission of bovine tuberculosis to mankind."

In May, 1909, Mr. Straus presented a paper on "The Necessity for
the Pasteurization of Milk and the Benefits Attained Thereby" to the
International Congress of Applied Chemistry at London (see page 135).
The following month, at Budapest, before the International Dairy Con-
gress, he presented a paper on "The White Peril; How It May Be
Avoided" (page 139). In July, 1909, at Stockholm, he submitted a
report to the Seventh International Congress on Tuberculosis on "The
Infection of Children by Milk from Tuberculous Cows" (see page 145)
and a paper on "Progress in America in the Fight Against Tubercu-
losis."

On August 31, 1909, Mr. Straus presented to the International
Medical Congress at Budapest a paper on "Prevention of Infectious
Diseases Caused by Milk" (see page 151), and at a later session of the
same Congress he submitted detailed figures to prove that tuberculosis,
instead of being conquered, was on the increase, owing, he charged, to
the neglect of prevention against tuberculous milk.

In September, 1910, Mr. Straus presented a paper on "Saving Chil-
dren from Milk-Borne Diseases" (see page 157) at the 38th Annual
Meeting of the American Public Health Association at Milwaukee, Wis.
In 1911 he served on the Committee of this Association on the Con-
servation of Child Life.

In 1911 the Commission on Milk Standards, after a year's investi-
gation and study, reported the standards desirable in milk production,
holding —

"That in case of all milk not either certified or inspected,
as required in these standards, pasteurization is compulsory."

215

A majority of the Commission favored the pasteurization of all
milk, but as there was not unanimity on this point, the pasteurization
of certified and inspected milks was left optional.

In April, 1912, as official delegate from America to the Seventh
International Congress Against Tuberculosis, at Rome, Mr. Straus sub-
mitted a report on "Progress Made in America in the Prevention of
Tuberculosis" (see page 181), and at the Fifteenth International Con-
gress on Hygiene and Demography at Washington in September, 1912,
he presented a paper on "The Function of Voluntary Organizations in
the Campaign for the Betterment of Milk Production and Distribution"
(see page 195).

216

OTHER PHILANTHROPIC WORK.

The establishment of the Infant Milk Depots in 1892 quickly led
Mr. Straus into other philanthropic work by bringing him into personal
touch with the tenement dwellers. He was among the first to see how
their necessities were made acute by the panic of 1893, when over 39,000
families were left without means of sustenance by the wage-earners
being without work.

The first step was the establishment of coal depots. The people
of the tenements bought their coal by the bucket, at from ten to fifteen
cents for 15 or 18 pounds. Mr. Straus established depots in November,
1893, at which he supplied 20 pounds of coal for five cents. Obtaining
10,000 tons from J. Pierpont Morgan at a reduced price, and securing
the free use of piers from the Dock Department for coal depots, the
price was reduced to 25 pounds for five cents. In this way over a mil-
lion and a half buckets of coal were supplied to the poor at a little less
than the car-load rate. No coal was given away directly, all being sup-
plied for cash or on tickets that Mr. Straus distributed to the really?
needy through the charity societies.

This work attracted the attention of Mr. Morgan, who asked Mr.
Straus to duplicate and extend the enterprise with $50,000 that he offered
for the purpose, upon the condition that his name should not be dis-
closed in connection with the gift. This was the only aid that Mr.
Straus ever accepted in his work. He agreed to manage the work, the
fund to be administered by a committee, and in January, 1894, he opened
a store in Grand Street where, for five cents, or upon presentation of
one of the tickets issued through the charity societies, 25 pounds of coal
was supplied, or a pound of bread, or 6 ounces of tea or coffee, or 1%
pounds of sugar, or 3% pounds of flour.

The city was thronged with homeless men who could get no work,
and for these Mr. Straus in January, 1894, opened four lodging houses
at which he supplied bed and breakfast for five cents or on presentation
of one of the tickets. This work was managed for him by the Rev.
Charles H. Yatman, the evangelist, with remarkable success.

The number of persons lodged and supplied with breakfast was
64,409. In addition 49,531 other meals were furnished.

217

At the coal depots and at the Grand Street store the following sup-
plies were distributed:

Pounds

Coal 37,551,200

Sugar 375,150

Bread 370,694

Flour 151,508

Coffee 69,812

Tea 48,563

The total number of tickets sold was 2,217,262.

When the distress was abated and the coming of warm weather ended
the need for the lodging houses the equipment was distributed among
the poor on the basis of a cot, three sheets, a pillow, two pillow cases,
a pair of blankets, a rubber sheet and a chair for one five-cent ticket.
This was so successful in promoting more sanitary living conditions
among the poor, and especially in providing separate beds for con-
sumptives, that many times the number of cots from the lodging houses
were thus distributed.

One of the stations for the distribution of coal and food supplies
was on the pier at East Third Street. Mr. Straus asked the Dock De-
partment to roof over this pier and make it a recreation place for
mothers and children from the tenements. This request was refused.
However, he persisted in advocating the idea, with the result that the
city adopted the policy of establishing Recreation Piers, which have be-
come a lasting benefit to the tenement house dwellers during the hot
summers. Of such Recreation Piers there are now ten adjacent to the
congested districts. On five of these Mr. Straus maintains Pasteurized
Milk stations in the summer months.

During the war with Spain in 1898 Rabbi Joseph Krauskopf, of
Philadelphia, was sent as a Special Commissioner by the National Re-
lief Commission to minister to the soldiers in Cuba. He reported to
Mr. Straus the serious need of pure water and ice for the American
troops in Santiago de Cuba. There was a balance of $15,000 left from
the Morgan fund of 1893-4, and with the consent of the committee, Mr.
Straus purchased an ice plant with a capacity of 13 tons a day and a
water distillation plant with a capacity of 20,000 gallons a day. This
he sent to Cuba, where he erected and operated the plant under the
supervision of Dr. Krauskopf, to the great relief of the soldiers and the
checking of sickness among them.

216

, At the Mass Meeting in Cooper Union on October 8, 1910, called
to persuade Mr. Straus to continue his milk stations, when unjust at-
tacks had disposed him to drop the work, Father J. J. Curran, of Wilkes-
Barre, revealed what had been known to very few. He recalled the
great anthracite coal strike, which began in May, 1902, and which was
estimated to have cost the country $142,000,000. Father Curran, who
has ever labored for the betterment of the condition of the miners, said
that in August, after the strike had gone on for three months, he came
to New York with another emissary of John Mitchell to engage Mr.
Straus' good offices on behalf of the strikers. He told Mr. Straus that
the operators were willing to take back the miners at an increase in
their wages, but that the proposition had been rejected by the miners
because the operators were not willing to bind themselves to take back
all the strikers.

Father Curran related that Mr. Straus at once said: "I will pay
the men who are not taken back and will support their families until
the men secure work elsewhere."

As the outcome of this interview the late lamented William N. Wil-
mer, with A. L. Kinkead and Sylvester Byrnes, Mr. Straus' secretaries,
went to Wilkes-Barre to confer with the miners. And at the New York
end Mr. Straus exerted every effort and all his influence, working actu-
ally day and night towards bringing the contending factions together.
Using Father Curran's words, "Although in the background, Mr. Straus
pushed the issue to ultimate success." Everything was so prepared
that when President Roosevelt stepped in the second time, using the
"Big Stick" on behalf of the miners, the strike was settled on Octo-
ber 17th.

Of all the strenuous times through which we have lived in the
numerous efforts to help humanity, the coal strike episode was by far
the severest.

Mr. Straus' first gift for the prevention of tuberculosis was the
erection of a small cottage in connection with Dr. Trudeau's work in the
Adirondacks. This was nearly thirty years ago. During the years that
followed he aided in many ways the establishment of sanitoria for the
victims of the Great White Plague. But always the idea was uppermost
in his mind that prevention was better than cure.

Finally in 1909 he put into operation a plan that had been forming
in his mind for years. On his property at Lakewood, N. J., in the pine
belt, he gathered children from the tenements who had been exposed to

219

tuberculous environment or who had shown predisposition to the plague,
and by life in the open air and good food he demonstrated that they
could be built up physically and equipped with power to resist the
tendency to the disease.

After six months of successful experiment he launched his plan for
a Tuberculosis PREVENTORIUM for Children, thus originating the
first idea of such an institution. He offered his interest in the Lakewood
property to the Society formed under the presidency of Marcus M.
Marks. But owing to objections by the residents of Lakewood the
institution was established at Farmingdale, N. J., on land given by
Arthur Brisbane, and Mr. Straus substituted the nucleus for a building
fund for the gift of the property.

Meanwhile, at the beginning of 1909, when the world was shocked
by the earthquake in Italy, Mr. Straus rushed quantities of food, clothing
and medical supplies to the stricken land at the first report of the disaster.
In charge of a physician and an assistant from his New York Milk
Laboratory he shipped on the steamship "Hamburg" on January 5th
and on the "Barbarossa" on the 6th, medical supplies and provisions
for thousands of families to Italy. The Hamburg American Steamship
Co. and the North German Lloyd Co. both took these supplies to their
destination free of charge.

Relief stations were set up at Naples and Messina, where the refu-
gees from the earthquake region found medical relief, and where the
distribution of the supplies was conducted in the most systematic and
helpful manner. (For supplies distributed see page 221.)

In 1912 Mr. Straus visited Palestine and was horrified at the distress
caused by poverty and by sickness. He established a Department of
Health for Palestine with headquarters in Jerusalem under the direction
of Dr. William Bruenn, a graduate of the Medical Department of the
University in Berlin. He also opened soup kitchens in Jerusalem for
the feeding of the starving people, and work rooms to give work to the
unemployed.

I have recorded here the works and deeds of Mr. Straus that have
come under my personal observation only. As I write this, in January,
1913, Mr. Straus has arranged to return to Palestine to enlarge the work
that he has undertaken there on a previous visit last Winter. This time
we are taking along three trained nurses to attach to the Health Depart-
ment and inaugurate district nursing in a scientific manner.

A 220

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221

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